Legislature(1997 - 1998)

04/08/1997 01:43 PM L&C

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
        SB 122 INS.COVERAGE:MARRIAGE & FAMILY THERAPIST                       
 CHAIRMAN LEMAN announced  SB 122  to be up for consideration.                 
  MS. RACHAEL MORELAND , Aide to Senator Leman, said that SB 122 was           
 requested by the Alaska Association for Marriage and Family                   
 Therapy.  It adds marital and family therapists to the list of                
 providers against whom insurers may not discriminate.  It does not            
 mandate insurers to add coverage of marital and family therapists             
 where the coverage currently is not provided.  It merely requires             
 that insurers treat marital and family therapists on equal footing            
 with other licensed mental health providers and extend the same               
 opportunities for coverage that the insurer offers these licensed             
 Currently health insurers offering mental health services may not             
 discriminate against licensed psychologists, psychological                    
 associates, or clinical social workers.  SB 122 would allow those             
 insured with mental health coverage to choose treatment from a                
 licensed marital and family therapist.                                        
 MS. MORELAND said she wanted to correct a phrase on sponsor                   
 statement at the end of paragraph two.  It is incorrect where it              
 says the insurance company offers the same as in other states.  It            
 should read, "It merely requires that insurers treat marital and              
 family therapists on equal footing with other licensed providers in           
 their field.                                                                  
 She said marital and family therapists are licensed or certified in           
 37 states and are recognized by the U.S. Department of Health and             
 Human Services as one of the five core mental health disciplines in           
 the U.S.                                                                      
 CHAIRMAN LEMAN asked if it was correct that if an insurance policy            
 provides for mental health services, then the insurer cannot                  
 discriminate against marriage and family therapists because they              
 practice in that area.  MS. MORELAND said that was correct for                
 certain services.                                                             
 Since there was a quorum present,  SENATOR MACKIE  moved and asked            
 unanimous consent that the individuals they listened to for                   
 confirmation for the various boards be submitted to the joint                 
 session for confirmation.  There were no objections and it was so             
  MS. BEVERLY LINDELL , President, Alaska Association for Marriage and         
 Family Therapy, supported SB 122 saying it's very simple.  They are           
 just being asked to be added to the list of providers that cannot             
 be discriminated against by insurers.  It's not a mandate for                 
 coverage; it's not any willing provider language.                             
 MS. LINDELL thought this bill is important because it provides                
 fairness as marriage and family therapists are one of the five core           
 mental health professions as identified by the National Institute             
 of Mental Health.  The others are already in this legislation.                
 They are not asking for special treatment.                                    
 She said the second issue is cost, the argument being that it will            
 increase insurance costs.  An opinion from the Division of                    
 Insurance on this question a few years ago came back stating they             
 could find no evidence of that happening and there is some                    
 suggestion that it could actually decrease costs.                             
 MS. LINDELL stated that there is considerable evidence that the               
 treatment of mental and emotional disorders is not unproductive.              
 She said a report prepared by the Mental Health Liaison Group out             
 of Washington D. C. estimated on a national basis over $1 billion             
 could be saved with appropriate mental health treatment.  Another             
 study by the Harvard Community Health Plan involved patients whose            
 symptoms may have still included psycho-social problems and when              
 group therapy was added, there was a reduction by 50% of doctor               
 She said there is now considerable evidence that licensed marriage            
 and family therapists can complete treatment in fewer sessions than           
 individual treatment which translates into reduced costs for                  
 consumers and insurers.                                                       
 The third issue has to do with the rights of consumers, and                   
 allowing freedom of choice of qualified providers is fair.  In a              
 1993 survey of consumers, the American Psychologists found that               
 marriage and family therapists were the type of therapist most                
 often recommended by consumers to family and friends.                         
 Finally, she said they have heard a lot about how the American                
 family is in a lot of trouble.  They are the profession that has              
 special expertise in the treatment and care of families and they              
 would like the opportunity to do that.                                        
 CHAIRMAN LEMAN asked if she supported Senator Mackie's proposed               
 amendment that would insert a new section on page 2, line 11                  
 saying, "(2) "unfair discrimination" does not include requirements            
 imposed by an insurer for purposes of utilization review, cost                
 containment, or standards of clinically appropriate health care               
 services".  MS. LINDELL deferred to the Division of Insurance.                
 Number 500                                                                    
 CHAIRMAN LEMAN asked what the core mental health groups were.  MS.            
 LINDELL replied the other groups are psychiatrists, psychologist or           
 psych-associates, social workers and professional nurses.  CHAIRMAN           
 LEMAN noted that they are not in this legislation, but are in the             
 CHAIRMAN LEMAN said in a letter of support from Dr. Pollick that              
 insurers do not compensate licensed marriage and family therapists            
 equally.  He asked if the intent was to mean that they did not have           
 equal access to insurance coverage.  MS. LINDELL said that is                 
 correct and agreed that they do not intend to make compensation               
 equal to that of a medical doctor.                                            
  MS. MARCI WOLFF , licensed marriage and family therapist, supported          
 SB 122.  She has specific training for family therapy rather than             
 a focus on other areas of psychology such as research or social               
 policy making.  She recited an extensive list of credentials and              
 said she is currently in private practice and regularly receives              
 referral from doctors, psychologists, social workers, and other               
 family therapists, attorneys, military sources, and community                 
 agencies.  She receives these referrals because she's effective in            
 providing quality therapy in a brief cost effective manner.  She              
 said marriage and family therapists need to be recognized and                 
 supported legislatively in providing the services for which they              
 are uniquely qualified to provide.                                            
 CHAIRMAN LEMAN asked if any of her services are currently being               
 paid by insurance.  She replied that many are.                                
 Number 540                                                                    
  MS. TIMA PRIESS  said she is a licensed marriage and family                  
 therapist.  She said she has been accepted as a provider by several           
 insurance companies including the Veterans Administration.  She has           
 had the experience of being turned down by insurance companies,               
 including a company that had certified her under their managed care           
 program, but would not certify her independently for clients who              
 use their insurance without the managed care which doesn't make               
 much sense to her.                                                            
 MS. PRIESS pointed out under section 47.17.020, the Alaska Child              
 Protection Statute, professionals who are required to report child            
 abuse include practitioners of the healing arts.  These                       
 professionals are defined in section 47.17.290 (13) as including              
 marital and family therapists.  In addition 47.24.010, the statute            
 that defines who is required to report abuse of elders and disabled           
 adults also includes marital and family therapists.                           
 Number 561                                                                    
  MS. MARIANNE BURKE,  Director, Division of Insurance, said this              
 particular section of the code has somehow mutated over time.  The            
 original intent, according to her reading of the enacting                     
 legislation, was the practice of unfair discrimination was to mean            
 unfairly discriminating against similar professions.  For example,            
 if you were an M.D. licensed to perform an appendectomy, an                   
 insurance company could pay one doctor and not another.                       
 MS. BURKE said regarding cost, that the services provided under an            
 insurance contract is a matter of a contractual arrangement.  You             
 contract to have particular services covered at a particular rate             
 or up to a particular cap.  As long as there's no expansion of                
 those services by adding another profession, it would not increase            
 the cost.  Her only concern is if a profession expanded the scope             
 of services that was provided under the contractual arrangement;              
 for example, expanding marital and family therapists to include               
 priests, rabbis, or ministers - all of whom provide counseling.               
 But this is a licensed group and she does not know their scope.               
 She understand that this is a credible group and has standards of             
 practice and conduct to which they adhere.                                    
 TAPE 97-16, SIDE B                                                            
 SENATOR MACKIE asked her if she had problems with his proposed                
 amendment.  MS. BURKE replied the first portion, "unfair                      
 discrimination does not include requirements imposed by an insurer            
 for purposes of utilization review" is perfectly appropriate.  She            
 said cost containment is not inappropriate as long as it is not               
 used to dictate that you go to the cheapest available service in              
  MR. JERRY REINWAND,  Blue Cross, said SB 122 raises an issue bigger          
 than just the issue of family and marital therapists.  The proposed           
 bill really talks about unfair discrimination and there is no                 
 statutory definition of what is unfair discrimination, nor is there           
 in regulation.  While the Division has been a tough, but fair                 
 regulator, the legislature is still leaving it up to them to apply            
 their own idea of what constitutes unfair discrimination.  They               
 support Senator Mackie's amendment, because it puts, by contract,             
 what terms and conditions would not constitute unfair                         
 discrimination which brings clarity to the issue.                             
 CHAIRMAN LEMAN asked if he thought the legislature should define              
 unfair discrimination.  MR. REINWAND replied that discrimination is           
 an important issue and there have been cases in the past where                
 insurance companies have not always done the right thing regarding            
 discrimination.  He thought it would be in everyone's interest and            
 good public policy if you're going to say you can't do it, to                 
 define what it is.                                                            
  MS. LINDELL  clarified that any licensed group has within its                
 statutes that regulate the profession the scope of practice.  Under           
 marriage and family therapists it lists first of all the                      
 requirements in terms of formal education, specific courses that              
 are required, time of supervision, practicum experience, etc.  In             
 terms of what the practice means, that is also in the statute and             
 includes the diagnosis and treatment of mental and emotional                  
 disorders that are referenced in a standard diagnostic nomenclature           
 for marriage and family therapy, whether a cognitive affected                 
 behavior within the context of human relationships, particularly              
 marital and family systems.  They must also apply the understanding           
 of the dynamics.                                                              
 CHAIRMAN LEMAN noted that some ministers may qualify, but probably            
 very few.  MS. LINDELL agreed.                                                
 SENATOR MACKIE moved to adopt amendment #1.  There were no                    
 objections and it was so ordered.                                             
 SENATOR MACKIE moved to pass CSSB 122(L&C) from committee with                
 individual recommendations and $0 fiscal note.  There were no                 
 objections and it was so ordered.                                             

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