Legislature(1997 - 1998)
04/08/1997 01:43 PM L&C
* first hearing in first committee of referral
= bill was previously heard/scheduled
= 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 providers. 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 ordered. 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 visits. 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 statute. 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 town. 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.