Legislature(1995 - 1996)

04/04/1996 03:04 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
          HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                          
                       STANDING COMMITTEE                                      
                         April 4, 1996                                         
                           3:04 p.m.                                           
 MEMBERS PRESENT                                                               
 Representative Cynthia Toohey, Co-Chair                                       
 Representative Con Bunde, Co-Chair                                            
 Representative Norman Rokeberg                                                
 Representative Caren Robinson                                                 
 Representative Tom Brice                                                      
 Representative Al Vezey                                                       
 MEMBERS ABSENT                                                                
 Representative Gary Davis                                                     
 COMMITTEE CALENDAR                                                            
 CS FOR SENATE BILL NO. 165(L&C)                                               
 "An Act relating to psychologists and psychological associates."              
       - HEARD AND HELD                                                        
 * HOUSE JOINT RESOLUTION NO. 50                                               
 Proposing an amendment to the Constitution of the State of Alaska             
 relating to freedom of conscience.                                            
      - SCHEDULED BUT NOT HEARD                                                
 (* First public hearing)                                                      
 PREVIOUS ACTION                                                               
 BILL:  SB 165                                                               
 JRN-DATE     JRN-PG               ACTION                                      
 04/25/95      1230    (S)   READ THE FIRST TIME - REFERRAL(S)                 
 04/25/95      1230    (S)   HES, L&C                                          
 01/17/96              (S)   HES AT 9:00 AM BUTROVICH ROOM 205                 
 01/17/96              (S)   MINUTE(HES)                                       
 01/18/96      2166    (S)   HES RPT  CS  4DP       SAME TITLE                 
 01/18/96      2166    (S)   ZERO FISCAL NOTE TO SB & CS (DCED)                
 01/30/96              (S)   L&C AT  1:30 PM FAHRENKAMP RM 203                 
 01/30/96              (S)   MINUTE(L&C)                                       
 01/31/96      2262    (S)   L&C RPT  CS  2DP 2NR   SAME TITLE                 
 01/31/96      2262    (S)   PREVIOUS ZERO FISCAL NOTE (DCED)                  
 02/02/96              (S)   RLS AT 10:15 AM FAHRENKAMP RM 203                 
 02/02/96              (S)   MINUTE(RLS)                                       
 02/07/96      2324    (S)   RULES TO CALENDAR 2/9/96                          
 02/09/96      2359    (S)   READ THE SECOND TIME                              
 02/09/96      2359    (S)   L&C  CS ADOPTED UNAN CONSENT                      
 02/09/96      2359    (S)   ADVANCED TO THIRD READING UNAN                    
 02/09/96      2359    (S)   READ THE THIRD TIME  CSSB 165(L&C)                
 02/09/96      2360    (S)   PASSED Y19 N0 E1                                  
 02/09/96      2363    (S)   TRANSMITTED TO (H)                                
 02/12/96      2718    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 02/12/96      2718    (H)   HEALTH,EDUCATION AND SOCIAL SERVICES              
 04/02/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 04/02/96              (H)   MINUTE(HES)                                       
 04/04/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 WITNESS REGISTER                                                              
 MIKE TIBBLES, Legislative Assistant                                           
   to Senator Lyda Green                                                       
 Alaska State Legislature                                                      
 Capitol Building, Room 423                                                    
 Juneau, Alaska  99801-1182                                                    
 Telephone:  (907) 465-3762                                                    
 POSITION STATEMENT:  Gave sponsor statement for CSSB 165(L&C)                 
 JERRY REINWAND, Lobbyist                                                      
 Blue Cross                                                                    
 2 Marine Way, Number 219                                                      
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 586-8966                                                    
 POSITION STATEMENT:  Testified on CSSB 165(L&C)                               
 DR. ROBB STOKES, Vice-Chair                                                   
 Alaska Psychology Board                                                       
 P.O. Box 20949                                                                
 Juneau, Alaska  99802                                                         
 Telephone:  Not Available                                                     
 POSITION STATEMENT:  Testified in opposition to CSSB 165(L&C)                 
 ALLEN MOMA                                                                    
 P.O. Box 231453                                                               
 Anchorage, Alaska  99523                                                      
 Telephone:  (907) 562-1846                                                    
 POSITION STATEMENT:  Testified on CSSB 165(L&C)                               
 KATHRYN CARSSOW                                                               
 1335 O Street                                                                 
 Anchorage, Alaska  99501                                                      
 Telephone:  (907) 274-7909                                                    
 POSITION STATEMENT:  Testified on CSSB 165(L&C)                               
 KAREN GIBSON                                                                  
 P.O. Box 110623                                                               
 Anchorage, Alaska  99511                                                      
 Telephone:  (907) 346-3738                                                    
 POSITION STATEMENT:  Testified in support of CSSB 165(L&C)                    
 JENNIFER HALL-JONES                                                           
 2453 West 27th Street                                                         
 Anchorage, Alaska  99517                                                      
 Telephone:  Not Available                                                     
 POSITION STATEMENT:  Testified on CSSB 165(L&C)                               
 ACTION NARRATIVE                                                              
 TAPE 96-36, SIDE A                                                            
 Number 001                                                                    
 The House Health, Education and Social Services Standing Committee            
 was called to order by Co-Chair Con Bunde at 3:04 p.m.  Members               
 present at the call to order were Representatives Bunde, Toohey,              
 Brice and Vezey.  Members absent were Representatives Davis,                  
 Robinson and Rokeberg.                                                        
 CO-CHAIR BUNDE announced the calendar for the meeting was CSSB
 165(L&C), an act relating to psychologists and psychological                  
 associates and HJR 50, proposing an amendment to the Constitution             
 of the State of Alaska relating to freedom of conscience.  He asked           
 Mike Tibbles, Senate HESS Committee Aide to present SB 165.                   
 Number 082                                                                    
 MIKE TIBBLES, Legislative Assistant to Senator Lyda Green, read to            
 following sponsor statement:  "Currently under Alaska law,                    
 psychological associates are held to a more stringent standard in             
 the licensure process than other masters-level mental health                  
 practitioners.  For example, psychological associates are now the             
 only mental health practitioners required to have three years of              
 supervision by a Ph.D. psychologist prior to examination, followed            
 by five years of supervision before they are eligible for                     
 independent practice.  These provisions are too restrictive and               
 often dissuade or prohibit individuals from entering into this                
 particular profession.                                                        
 "The goal of this legislation is to bring the psychological                   
 associates into conformity with other masters-level programs; i.e.,           
 social workers, marriage and family therapists.  It also insures              
 the quality of these professionals by maintaining the examination,            
 education, and ethical standards prior to licensure.                          
 "This bill has a zero fiscal note from the Department of Commerce             
 and Economic Development."                                                    
 REPRESENTATIVE CAREN ROBINSON arrived at 3:05 p.m.                            
 CO-CHAIR BUNDE asked if the intent of the legislation was to allow            
 people who have master's degrees full licensure, as opposed to                
 other states where a person must have a Ph.D. to achieve full                 
 MR. TIBBLES explained there are two different levels of                       
 individuals; psychologists and psychological associates.  The                 
 psychological associates are the masters-level and this legislation           
 changes the existing practice of a three year supervision period              
 and an additional five years before an individual can practice on             
 their own to a two-year period of supervision and considering the             
 fact they meet all the requirements under regulation with their               
 academics, they would be subject to licensure.                                
 Number 237                                                                    
 CO-CHAIR BUNDE referred to the psychological associates as opposed            
 to psychologists who have a Ph.D. and asked what procedure they               
 would follow for licensure.                                                   
 MR. TIBBLES said a psychologist would be required to have one year            
 of post doctoral supervised experience approved by the board.                 
 CO-CHAIR TOOHEY said a psychologist is a doctorate and a                      
 psychological assistant can never become a psychologist without two           
 additional years of education.                                                
 CO-CHAIR BUNDE said he understood that, but he wanted the record to           
 reflect what the procedure was for licensure.                                 
 MR. TIBBLES added that after the one year of post doctoral                    
 supervised experience, the individual would be required to pass an            
 examination for licensure.                                                    
 CO-CHAIR BUNDE said inasmuch as there were three people on                    
 teleconference wishing to testify as well as people in Juneau, he             
 would rotate between Juneau and Anchorage.  He asked Jerry Reinwand           
 to come forward.                                                              
 Number 338                                                                    
 JERRY REINWAND, Lobbyist for Blue Cross of Washington & Alaska,               
 said he had just been alerted to a potential problem in that                  
 Section 10 seems to change the scope of services of a psychological           
 associate, making it broader in scope.  He said it may not be a big           
 issue, but he wanted committee members to be aware that it could              
 add to the cost of health care.  He provided the committee with a             
 copy of the unfair discrimination statute, AS 21.36.090(d) and said           
 the Division of Insurance is reexamining to determine what all that           
 statute does because there has always been some question about it.            
 His interpretation, as a lay person, is that if a provider is on              
 this list, the insurance company has to reimburse for services.               
 There has been a progression of people wanting to get licensed by             
 the state, and once they are licensed the next move is to get on              
 the list.  He pointed out that in the last hours of the 1993                  
 legislature, psychologist, psychological associate and licensed               
 clinical social workers were added to a bill that was a NAIC model            
 and basically, Mr. Reinwand thinks the net effect of that is to               
 potentially add to the cost of health insurance.  Based on Section            
 10, does it mean that virtually anything a psychological associate            
 does under this definition is reimbursable under an insurance                 
 policy and is it an expansion of the scope of services? If so, is             
 it an additional cost?  He apologized for not talking with the                
 sponsor about this, but it had just been brought to his attention.            
 CO-CHAIR TOOHEY said this was the exact problem she had with the              
 licensure of physician assistants who are very much needed, but               
 they should not be paid the same amount of money as a physician.              
 Psychological associates are not psychologists and should be paid             
 at a lower level than a psychologist.                                         
 Number 564                                                                    
 CO-CHAIR BUNDE asked Mr. Tibbles to comment on the rationale for              
 deleting "in association with a licensed psychologist" in Section             
 10, line 16 and added he would give Mr. Tibbles time to ponder the            
 question while the committee received testimony from Anchorage.               
 Number 619                                                                    
 REPRESENTATIVE AL VEZEY said he appreciated the debate on Section             
 10, but didn't understand the connection between it and the handout           
 on AS 21.36.090.                                                              
 REPRESENTATIVE NORM ROKEBERG arrived at 3:13 p.m.                             
 MR. REINWAND said his question is:  Does the definition of                    
 psychological associate contained in Section 10 expand the scope of           
 service that a psychological associate provides?  If that's the               
 case, does it mean that anything a psychological associate bills to           
 an insurance company therefore is payable, which could be an                  
 expansion of cost.  He commented said that history has shown that             
 people get the state to license them and jump on this section of              
 the law, because then the insurance companies have to pay.                    
 REPRESENTATIVE VEZEY asked if this would be the appropriate time              
 for the legislature to consider removing the changes made in 1993?            
 MR. REINWAND commented he had an amendment that would accomplish              
 REPRESENTATIVE VEZEY asked if Mr. Reinwand believed that the change           
 in definition in Section 10 would expand the number of people that            
 insurance companies are obligated to reimburse and would also                 
 require they be reimbursed at the same rate as a more highly                  
 trained professional?                                                         
 MR. REINWAND said he was raising the question, but to him that's              
 exactly what it appears to do; however, he could be wrong.                    
 CO-CHAIR BUNDE asked with the psychological associate being on the            
 list now, isn't it a foregone conclusion that they are now on the             
 approved list and insurance companies will have to pay for their              
 MR. REINWAND replied that's right, unless they are removed from the           
 CO-CHAIR TOOHEY said she was not suggesting they be removed from              
 the list; however, she was suggesting that a criteria be                      
 established for their payment of services and not lumped in with              
 services for a psychologist.                                                  
 MR. TIBBLES said he believed that in Section 10, the change stems             
 from the fact that psychological associates who wished to go into             
 rural communities where there was no psychologist would be unable             
 to do that.  He said, "We have set up a two year requirement that             
 they serve under a psychologist after they meet those requirements            
 and the licensing requirements, they would be able to go into rural           
 communities.  But the way the current law is set up, it is                    
 dissuading psychological associates from going into those areas."             
 CO-CHAIR BUNDE asked if the services for a psychological associate            
 working under a psychologist during the two year period are billed            
 at the same rate as a psychologist or at a reduced rate.                      
 MR. TIBBLES said the bill didn't specifically address that question           
 and he didn't know the answer.                                                
 Number 862                                                                    
 ALLEN MOMA testified via teleconference from Anchorage.  He                   
 addressed to the issue of expansion of services under Section 10              
 and said the regulations as currently written are cumbersome.  The            
 reason for the rewrite of the section was to bring it in line with            
 specific training and educational background.  He referred to                 
 Section 5, AS 08.86.164(a) and said this addresses psychological              
 associates practicing within the scope of their training and                  
 education; thus, the services are not being expanded, but rather              
 they were attempting to address language that was awkward                     
 CO-CHAIR BUNDE asked Mr. Moma if he would be comfortable addressing           
 Co-Chair Toohey's concern about how the services of a psychological           
 associate are billed as opposed to a psychologist.                            
 Number 922                                                                    
 MR. MOMA said currently, psychologists are typically reimbursed at            
 a rate of between $110 and $130 per hour and psychological                    
 associates are reimbursed at between $70 and $90 per hour.  He did            
 not envision psychological associates raising their rate up to the            
 higher rate.  As a professional, he recognized the difference                 
 between the training of a psychological associate and the training            
 of a Ph.D.  He is aware of psychological associates who have                  
 practicing for 10 years and their rates are still below that of a             
 CO-CHAIR BUNDE asked if the committee could assume that based on              
 his testimony Mr. Moma was a psychologist associate and currently             
 employed in that field?                                                       
 MR. MOMA responded that he is the co-chair of the organization that           
 introduced this legislation - the Alaska Psychological Association,           
 which is a professional organization within the state that                    
 represents psychologists and psychological associates.  He added              
 that he is actually in the training phase; he doesn't have a                  
 psychological associate license, but is working through the                   
 training phase with the goal of acquiring his license in the near             
 Number 1005                                                                   
 CO-CHAIR TOOHEY referred to a situation where psychological                   
 associates are working for a psychologist and asked if the                    
 psychologist bills the insurance company for his/her work or for              
 the psychological associates' work.                                           
 MR. MOMA said ethically, as he understands it, the psychologist has           
 to bill for the psychological associates' work which would be at              
 the reduced rate.                                                             
 CO-CHAIR TOOHEY asked if a qualified psychological associate                  
 working on his/her own in a rural community has a specific code               
 used to bill the insurance company that would automatically trigger           
 a lesser fee than that of a psychologist.                                     
 MR. MOMA said Co-Chair Toohey would need to check with the                    
 insurance companies, but he thought it was market economics at some           
 point.  He added there are standards, but no guidelines that                  
 specifically state how much money can be charged and in a smaller             
 community, the psychological associate would probably charge                  
 whatever the market would bear.                                               
 CO-CHAIR TOOHEY asked if it was correct that a psychological                  
 associate would not be lumped under a fee for service when it was             
 covered by a psychologist.                                                    
 MR. MOMA said that was his understanding of how the American                  
 Psychological Association ethic guidelines would address that                 
 CO-CHAIR BUNDE said there were additional people to testify in                
 Juneau and asked Dr. Robb Stokes to come forward.                             
 Number 1122                                                                   
 DR. ROBB STOKES, Vice-Chair, Alaska Psychology Board, said the                
 opinions he was going to express were the unanimous opinions of the           
 Alaska Psychology Board.  The Alaska Psychology Board opposes the             
 legislation, but not the spirit of the bill.  He said he is a                 
 psychological associate, has done the eight years and earned a                
 Ph.D.  He pointed out the flaw in this legislation is there is an             
 assumption that the scope of practice by a marriage and family                
 therapist, by a social worker, and a psychological associate are              
 all the same.  According to Alaska Statute that is not true.  He              
 pointed out the mission of the Psychology Board is protection of              
 the public and it is their feeling this particular bill will not              
 protect the public.                                                           
 Number 1183                                                                   
 DR. STOKES referred to AS 08.63.900 and said that marriage and                
 family therapists and licensed clinical social workers' scope of              
 practice is limited considerably more than that of a psychological            
 associate.  A psychological associate has a much broader scope of             
 practice that requires considerably more training and ethical                 
 responsibility and, the board feels, supervision before that person           
 should be independent.  It is the board's position, however that              
 five years is too long, but two years is too short.                           
 CO-CHAIR BUNDE asked if Dr. Stokes was saying that even though                
 marital and family counselors are on the list, they serve a                   
 narrower function than a psychological associate and the board's              
 problem with the bill is they want something less than five years             
 but more than two years of supervision.                                       
 DR. STOKES stated that marriage and family therapists and clinical            
 social workers are licensed to provide counseling and                         
 psychotherapy, that's all.  However, the scope of practice of a               
 psychological associate or what is called the practice of                     
 psychology, which includes both psychological associates and                  
 psychologists is as follows:  "To practice psychology means to                
 render or offer to render for a fee to individuals, groups,                   
 organizations, or the public for the diagnosis, prevention,                   
 treatment, or amelioration of psychological problems and emotional            
 mental disorders of individuals or groups or for conducting                   
 research on human behavior, a psychological service involving the             
 application of psychological principles, methods, and procedures of           
 understanding, predicting, and influencing behavior, including..."            
 Dr. Stokes said the prior portion would be similar to the marriage            
 and family and social work, but this is where the differences come            
 in.  He continued "...(A) the principles pertaining to learning,              
 perception, motivation, emotions, and interpersonal relationships;            
 (B) the methods and procedures of interviewing, counseling,                   
 psychotherapy, biofeedback, behavior modification, and hypnosis."             
 He added that only psychological associates and psychologists are             
 licensed in the state to provide biofeedback, to provide behavior             
 modification and to provide hypnosis.  He went on to cite                     
 subsection (C) "constructing, administering and interpreting tests            
 of mental abilities, aptitudes, interests, attitudes, personality             
 characteristics, emotions, and motivations."  That is psychological           
 testing which is a very broad part of the profession of psychology            
 and requires considerable preparation.   Psychological testing                
 requires an educational background in statistics, test                        
 construction, research design methodology and a training in the               
 administration, scoring and interpretation in the scoring in each             
 of these psychological tests, and there are many.  The Board's                
 concern is that a psychological associate needs additional                    
 supervision in order to provide a quality service to the public and           
 to protect the public by providing psychological testing, hypnosis,           
 biofeedback and behavior modifications.                                       
 Number 1400                                                                   
 CO-CHAIR BUNDE commented less than eight years, but more than two;            
 what does that leave?                                                         
 DR. STOKES said the board hasn't discussed it.  He commented that             
 as the senior member of the board, this board is very flexible,               
 very pro psychological associate and it has been very accommodating           
 in facilitating people getting licensure as psychological                     
 associates.  He added that he is the representative of the                    
 psychological associates on this board.  The board is held to the             
 statutes that were in place before they came on board.                        
 CO-CHAIR TOOHEY said if she were a psychological associate she                
 would be very upset with Dr. Stokes in that the legislation was               
 introduced at the request of psychological associates and he was              
 speaking against the bill.                                                    
 DR. STOKES said that was correct.                                             
 CO-CHAIR TOOHEY asked if he was a doctorate?                                  
 DR. STOKES responded yes, but he was licensed as a psychological              
 CO-CHAIR TOOHEY stated he was not billing as a psychological                  
 associate, he was billing as a doctorate, as a psychologist.  She             
 asked if this was a turf battle?                                              
 DR. STOKES replied no.  He explained that with respect to scope of            
 practice the only difference between an independent psychological             
 associate and a psychologist is titular.                                      
 CO-CHAIR TOOHEY asked Dr. Stokes to explain titular.                          
 DR. STOKES explained that it's title.  He went on to say an                   
 independent psychological associate is able to do everything that             
 a psychologist can do according to state statute.                             
 CO-CHAIR BUNDE verified that Dr. Stokes' role on the Alaska                   
 Psychology Board was as the representative of psychological                   
 associates, and his work was that of a psychological associate in             
 DR. STOKES said he is licensed as an independent clinical                     
 psychological associate.                                                      
 CO-CHAIR TOOHEY asked if he was a psychologist?                               
 DR. STOKES replied no, he earned his Ph.D., but did not go back and           
 get licensed as a psychologist, he stayed licensed as a                       
 psychological associate.                                                      
 CO-CHAIR BUNDE asked if Dr. Stokes was implying that the work he              
 does would not change with a title change, but possibly the billing           
 would change.                                                                 
 DR. STOKES said he didn't know and added the board does not address           
 billing issues.                                                               
 CO-CHAIR BUNDE stated the committee needs to know what the board              
 would recommend with respect to less than eight years, but more               
 than two years.                                                               
 Number 1556                                                                   
 REPRESENTATIVE ROKEBERG asked Dr. Stokes if he could provide a                
 breakdown of the rates billed for a pre-psychologist associate, a             
 psychologist associate and a psychologist.                                    
 DR. STOKES thought the rates that Mr. Moma gave were quite                    
 accurate; a psychologist would bill at $100 - $120 per hour and a             
 psychologist associate would bill at $75 - $90 per hour.                      
 REPRESENTATIVE ROKEBERG inquired about the title and the rate                 
 billed of the person who is in the training period and works under            
 DR. STOKES replied the same as the psychological associate.  He               
 explained that after the individual passes the examination, they              
 are licensed as a psychologist associate, but are required to be              
 under the supervision of a psychologist for three years.  If that             
 person desires to work independently, it requires an additional               
 five years, for a total of eight years.  He reiterated the board              
 feels the eight years is too much, but two years which is                     
 equivalent to the marriage and family, and social workers, is not             
 enough because psychological associates have much greater                     
 responsibility and are licensed to do additional things.                      
 CO-CHAIR BUNDE asked if some people view the eight years as an                
 attempt to keep them off the job market?                                      
 DR. STOKES replied yes, and that was his view also.  He said when             
 he was pursuing licensure, he wrote letters to the Governor and was           
 very militant in what he felt was discrimination.  He felt there              
 was an attempt by the previous board of which he was a member, to             
 get rid of psychological associates.  The current board is very               
 supportive of psychological associates.                                       
 REPRESENTATIVE ROKEBERG asked what the typical length of time for             
 a master's degree to qualify under the licensure requirements for             
 a psychological associate.                                                    
 DR. STOKES responded two to three years.  He added the board gets             
 applications from all over the country.                                       
 REPRESENTATIVE ROKEBERG asked if it depended on the institution and           
 the type of specialty.                                                        
 DR. STOKES responded yes.                                                     
 REPRESENTATIVE ROKEBERG asked if the next step after the two to               
 three years was for an individual to become a supervised                      
 psychological associate by licensure and examination?                         
 DR. STOKES explained that if the board approves an individual's               
 application, he/she can then sit for the national and state                   
 examinations.  If the individual passes those exams, then he/she              
 must be supervised by a psychologist for five years.  He further              
 explained that three years of post master's supervision is required           
 in order to be eligible to take the exam; under the current                   
 statutes, if the exams are passed, then the individual is required            
 to be supervised for five years before he/she can be independent.             
 REPRESENTATIVE ROKEBERG noted there was three years academic                  
 training at the university level, followed by three years of                  
 supervised activity under a psychologist.                                     
 DR. STOKES interjected the supervision could be under a                       
 psychologist or a person with a Ph.D. in psychology.                          
 REPRESENTATIVE ROKEBERG inquired if at the point, assuming the                
 individual passed the examinations, the person would then be a                
 fully accredited psychological associate.                                     
 DR. STOKES added under the supervision of a psychologist.                     
 REPRESENTATIVE ROKEBERG inquired if there would be an additional              
 five years under supervision, following the three years, in order             
 to "put out your own shingle."                                                
 DR. STOKES said no, an individual could "put out their own shingle"           
 but the psychological associate would have to meet with a                     
 psychologist, he believed once a month.                                       
 REPRESENTATIVE ROKEBERG verified that a person could be                       
 independently employed after the three year level.                            
 DR. STOKES responded affirmatively.                                           
 Number 1767                                                                   
 REPRESENTATIVE ROBINSON asked Dr. Stokes if the reason for his                
 opposition to the bill was the two year period and if he believed             
 that somewhere between eight years and two years would be a more              
 appropriate length of time.                                                   
 DR. STOKES replied yes.  He added the board agrees with the spirit            
 of the bill.                                                                  
 REPRESENTATIVE ROBINSON asked how quickly the board could make a              
 recommendation as to an appropriate length of time.                           
 DR. STOKES said it would depend on how many board members were                
 available, but he thought it could be done pretty quickly.                    
 CO-CHAIR BUNDE advised Dr. Stokes the committee would need to know            
 next week.                                                                    
 CO-CHAIR TOOHEY commented that Dr. Stokes had spoken of a national            
 and a state exam and asked Dr. Stokes to explain the difference               
 between the two tests.                                                        
 DR. STOKES said the national test is called the "E Triple P;" the             
 examination for the professional practice of psychology and is                
 given in all 50 states.  The state test is composed by the board              
 and is on ethics only.                                                        
 CO-CHAIR TOOHEY asked if she could see a copy of the state exam?              
 DR. STOKES suggested she talk to the Division of Occupational                 
 Licensing regarding that request.                                             
 REPRESENTATIVE VEZEY submitted that making copies of a test could             
 compromise the integrity of the exam.                                         
 Number 1863                                                                   
 REPRESENTATIVE ROKEBERG referred to Section 4, subsection (b), and            
 asked Dr. Stokes if he understood what that meant.                            
 DR. STOKES explained that a number of years ago, the only degrees             
 that were accepted were those degrees approved by the American                
 Psychological Association.  That was contested and the Attorney               
 General's Office found that it could not be held, so the                      
 professional organization referenced in Section 4, subsection (b)             
 is referring to the American Psychological Association.                       
 REPRESENTATIVE ROKEBERG maintained there could be universities with           
 curriculum that is not accredited by that particular group.                   
 DR. STOKES said that was correct, but they could be fully                     
 accredited by regional accreditation.                                         
 CO-CHAIR TOOHEY asked if a state board is considered a regional               
 DR. STOKES interjected no.  He believed there were six large                  
 regional accrediting bodies and added it's the highest level of               
 true, formal accreditation in the United States.                              
 Number 1924                                                                   
 KATHRYN CARSSOW testified via teleconference that she is a resident           
 of downtown Anchorage and a 20-year resident of Alaska.  She said             
 just last spring she earned her master's degree in clinical                   
 psychology from the University of Alaska and is looking forward to            
 licensure.  She noted the university has an impressive clinical               
 psychology program and through that training she spent over 1 1/2             
 years in supervision doing clinical work with children, couples,              
 families and the elderly.  As a master's level person, she does not           
 feel the master's level point of view is represented at all on the            
 board of examiners.  She thought Co-Chair Toohey hit the nail on              
 the head when she pointed out that the person who is representing             
 the psychological associates has a Ph.D. and is practicing as a               
 person with a Ph.D. regardless of what his license says.  She said            
 prior to going back to school to get her master's in clinical                 
 psychological, she had been a practicing community and resources              
 planner for the state.  She is very much aware of the need for                
 mental health providers in the rural communities and cost                     
 effectiveness is an important consideration.  The current                     
 requirement for eight years of supervision for master's level                 
 people is an expensive acquisition; that supervision isn't free               
 unless the person is working for an agency.  If a master's level              
 person is working in private practice, they are paying for that               
 supervision and that cost is passed on to the consumer.  She felt             
 that was keeping the cost of mental health services higher than               
 necessary, especially in consideration of the investment that                 
 citizens of Alaska have put into providing a master's level                   
 clinical psychology program in Alaska.  She believed in order to              
 get the maximum return on that investment, the length of time it              
 takes to get master's level people out in the field and practicing            
 without the expense of supervision needed to be restructured.  She            
 noted there are indeed specialties such as behavior modification,             
 biofeedback and hypnosis which are provided by people in the                  
 psychology profession, but by law those can't be provided unless              
 the person has specific training in those specialty areas.                    
 CO-CHAIR BUNDE said the previous testifier felt that eight years              
 was too long, but two years was too short and asked if Ms. Carssow            
 had an opinion about the length of time of supervision.                       
 MS. CARSSOW responded that she helped draft this legislation, so of           
 course she felt two years was appropriate, which puts the                     
 psychological associates in parity with the other professions that            
 are practicing at a master's level.  She pointed out that each                
 board member was approached individually last fall with this                  
 legislation and they never mentioned any problem with the change in           
 years.  She was upset about the manner in which this was handled              
 and felt it was very consistent with the way this board has                   
 approached the master's level practitioner.                                   
 CO-CHAIR TOOHEY asked if the eight year requirement falls in line             
 with the requirement of other states.                                         
 MS. CARSSOW responded that eight years is far beyond what other               
 states require.  She added that in drafting this legislation, they            
 reviewed the requirements of other states and found a range between           
 one year and five years, at the very most.                                    
 CO-CHAIR TOOHEY said she wanted to find out when the eight year               
 requirement came into effect.  She reiterated this sounded like a             
 turf battle to her and the psychologists don't want the                       
 psychological associates practicing in the field.  She asked if               
 person is trained for a specific field such as marital therapist or           
 child psychologist, is that specified on their license?                       
 MS. CARSSOW said it doesn't show up, but the American Psychological           
 Association has a very strict code of ethics they have to abide by            
 or have the threat of losing their license and practice.  It is               
 very specific that a person doesn't practice outside their field of           
 training.  Also, Alaska Statutes require that a person provide                
 support for any specialty areas being practiced.                              
 CO-CHAIR TOOHEY asked if Ms. Carssow felt that was covered                    
 MS. CARSSOW replied yes, she did.  She also wanted to point out in            
 terms of the supervised experience in other states that about eight           
 states require two years.  The Alaska Psychological Association has           
 endorsed the two year requirement and fully supports this                     
 CO-CHAIR BUNDE noted that Representative Brice had just made the              
 observation that if teacher tenure takes three years, a                       
 psychological associate should take at least that long.                       
 REPRESENTATIVE BRICE remarked it was actually Representative                  
 Robinson who had made the observation.                                        
 Number 2262                                                                   
 KAREN GIBSON testified that she is in the master's program of                 
 clinical psychology at the University of Alaska, Anchorage.  She              
 noted that much of her testimony had already been addressed by                
 previous speakers, but she does support SB 165 and observed that it           
 had received two hearings in the Senate where there was no                    
 objection made to the content of the bill.  This bill does more               
 than revise the amount of time it takes a psychological associate             
 to achieve independent practice; it allows for a temporary license            
 of a psychological associate.  She said that Representative                   
 Rokeberg had referred to it as the pre-psychological associate                
 period - that three year period before a person can sit for                   
 licensure.  She noted those people are not under the purview of the           
 licensing board because they aren't eligible for a license.  This             
 bill corrects that so as soon as the board approves the education             
 and the years of supervision, the person can sit for the exam.  If            
 the person passes the exam, a temporary license can be granted                
 while meeting the time frame to gain the eligibility to become a              
 fully licensed psychological associate.  The legislation also                 
 tightens up the language for temporary licenses of psychologists              
 for their one year post doctoral supervision.  Also, SB 165                   
 clarifies sexual misconduct and makes the definition tighter and              
 easier for the board to implement sanctions.                                  
 CO-CHAIR BUNDE asked if that would apply to both psychologists and            
 psychological associates?                                                     
 MS. GIBSON replied yes it does.                                               
 REPRESENTATIVE BRICE said that Ms. Gibson had mentioned sexual                
 misconduct and asked if that two year time period after therapy or            
 counseling with the patient...                                                
 TAPE 96-36, SIDE B                                                            
 Number 001                                                                    
 REPRESENTATIVE BRICE continued... had been terminated was based on            
 anything specific?                                                            
 MS. GIBSON said she didn't know, but based on APA ethics, there               
 should never be sexual contact with a patient or a former patient;            
 this legislation provides a minimum of two years.                             
 Number 026                                                                    
 JENNIFER HALL-JONES testified that she is in the process of getting           
 her degree from the University of Alaska Anchorage.  She is also              
 the co-chair of the licensing equity committee for the Alaska                 
 Psychological Association and helped draft SB 165.  She pointed out           
 the state has a wonderful institution, yet it is virtually                    
 impossible to get licensed in Alaska.  As of this date, there are             
 37 licensed psychological associates in the state, 144 Ph.D.                  
 licensed people in the state and there has been about 400 graduates           
 of the combined master's level program in both psychology or the              
 various kinds of psychology in the last four or five years and yet            
 these people are not going for licensure.  She pointed out the                
 reason for that is the current statutes are (indisc.-coughing).               
 Another point that has been raised several times has to do with the           
 kinds of people served by the Ph.D. level versus the master's level           
 individuals; they are indeed different by statute.  For instance,             
 a Ph.D. is the only one who is able to work within the court system           
 which is often the criminal population and the master's level                 
 individuals don't even have access to that population.  In reality,           
 the practices can be quite different.  She concluded that the                 
 University of Alaska Anchorage, Life Quest Comprehensive Mental               
 Health Services in the Mat-Su Valley, Anchorage Center for Families           
 and the Alaska Pacific University are all supportive of SB 165.               
 Number 122                                                                    
 CO-CHAIR TOOHEY recalled the 400 graduates mentioned by Ms. Hall-             
 Jones who are not going for their license and asked if that was               
 because they didn't have the proper training or was it because of             
 the time restraints?                                                          
 MS. HALL-JONES responded that a lot of people end up getting out of           
 the profession because it is too difficult to earn a living.  She             
 noted that Co-Chair Toohey had talked about it being a turf battle            
 and she felt there were Ph.D. folks in the state who do view it               
 that way.  She reiterated that eight years is too prohibitive.                
 CO-CHAIR TOOHEY asked if the time frame was pared down to two                 
 years, were the educational requirements sufficient in the state              
 between UAA and APU to graduate, certify and license graduates?               
 MS. CARSSOW replied she believed so.                                          
 CO-CHAIR BUNDE asked Ms. Hall-Jones if she was a member of the                
 Psychological Association?                                                    
 MS. HALL-JONES said that was correct.                                         
 CO-CHAIR BUNDE asked if the membership consisted of master's degree           
 level individuals, Ph.D. level individuals or both.                           
 MS. HALL-JONES said it was predominately Ph.D., there are very few            
 master's level people within that organization.                               
 CO-CHAIR BUNDE addressed the people who were not going for                    
 licensure.  He asked Ms. Hall-Jones, "Do you mean that they were              
 not putting in the eight years to become independently licensed or            
 are they -- you know currently work three years under supervision             
 and then you have a license to work in association with a                     
 psychologist.  At what point are people....                                   
 MS. HALL-JONES interjected the reason she quoted the 37 is because            
 that is the number of people who have gone through the three years;           
 she does not have the figures for beyond that.  She added there are           
 only 37 people licensed at the master's level in the state.                   
 CO-CHAIR BUNDE confirmed those would be the individuals working               
 under the supervision of a psychologist.                                      
 MS. HALL-JONES said that was correct.  She added the reality of the           
 market place is such that insurance companies will not reimburse              
 unless a Ph.D. level individual has signed off on the services                
 Number 280                                                                    
 CO-CHAIR TOOHEY inquired if it was Ms. Carssow's or Ms. Hall-Jones'           
 understanding that when they bill an insurance company through a              
 clinic it would be at a lesser fee than that of a psychologist.               
 MS. HALL-JONES said that was correct.  She added there are many               
 agencies who will not hire an individual unless he/she is licensed            
 or is in the process of becoming licensed.                                    
 CO-CHAIR TOOHEY asked Ms. Hall-Jones if adding M.A. at the end of             
 name for billing purposes automatically triggers a different pay              
 MS. HALL-JONES said that was her understanding of how it works;               
 however, she's not in that position yet so she really can't speak             
 with authority on that.                                                       
 CO-CHAIR BUNDE said he would like Mr. Reinwand to get together with           
 the sponsor of SB 165 regarding the insurance questions.  Also, he            
 asked Dr. Stokes to have a recommendation from the board regarding            
 a length of time of supervised experience.  He announced that SB
 165 would be heard again on Tuesday, April 9.                                 
 REPRESENTATIVE ROKEBERG referenced AS 08.18.062 relating to the               
 three years of supervised experience as a qualification for the               
 associate's examination and said he didn't see that specific                  
 section mentioned in the bill for revision.                                   
 CO-CHAIR BUNDE said that question could be addressed at the next              
 hearing on CSSB 165(L&C).                                                     
 CO-CHAIR BUNDE called an at-ease at 4:01 p.m.                                 
 CO-CHAIR BUNDE called the HESS Committee back to order at 4:02 p.m.         
 and announced the sponsor of HJR 50 was not available.  There being           
 no further business to come before the committee, Co-Chair Bunde              
 adjourned the meeting of the House HESS Committee at 4:04 p.m.                

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