SB 105-MARITAL & FAMILY THERAPY LIC. & SERVICES  1:33:38 PM CHAIR COSTELLO announced the consideration of SB 105. She noted the proposed amendment and stated her intention to take public testimony and move the bill from committee. SENATOR DAVID WILSON, Alaska State Legislature Juneau, Alaska sponsor of SB 105, introduced the legislation paraphrasing the following sponsor statement: If enacted, Senate Bill 105 would add licensed marital and family therapists to the list of independent licensed practitioners, in order to address the shortage of Medicaid-eligible behavioral health providers in the state, afford more options for beneficiaries, and increase access to care. Currently, licensed marital and family therapists (MFTs) are only allowed to provide services in community health clinics or physician mental health clinics, which limits the number of willing providers in the mental health care arena. SB 105 expands medical assistance reimbursement services to cover those services provided by MFTs. Specifically, SB 105 • Designates LMFTs as providers eligible to render and bill for Medicaid-funded services as independent practitioners under Alaska Statute 47.07.030(b) • Clarifies supervisory requirements for marital family therapist licensees • Requires marital family therapist licensees to carry liability insurance for regulatory investigation fees of at least $30,000. In 2016, the Alaska Board of Marital and Family Therapy unanimously recommended the statute changes contained in SB 105. SENATOR WILSON said his understanding is that the foregoing recommendations were discussed during the hearings for Senate Bill 74 but weren't included in the final bill. The board has requested these changes and the regulations have been written but won't be promulgated until SB 105 is enacted. 1:36:43 PM GARY ZEPP, Staff, Senator Wilson, Alaska State Legislature, Juneau, Alaska, reviewed the two fiscal notes attached to SB 105. The fiscal note from the Department of Commerce, Community and Economic Development (DCCED) appropriation is for Corporations, Business and Professional Licensing. The total is $1,300 for the services line in FY 2019 and with no expenditures in outlying years. The revenue collection is receipt supported and totals $1,300 for FY 2019 with no revenues reflected in the outlying years. The summary states that the funding is needed for regulation review, advertising, printing, and postage. The fiscal note from the Department of Health and Social Services (DHSS) appropriation is for Medicaid services. The total is $50 thousand for the services line in FY 2019 and $1.8 million in the grants & benefits line for FY 2020 and beyond. The revenue supporting the fiscal note is a blend of 66 percent federal receipts and general fund match of 34 percent. The FY 2019 revenue shows $25 thousand of federal receipts and $25 thousand of general fund match totaling $50 thousand. Annual revenue thereafter shows $660.5 thousand in federal receipts and $340.3 thousand in general fund match totaling $1.8 million. The summary states that in FY 2019 the $50 thousand general fund match is for the development of business rules in the Medicaid Management Information System detailing the parameters for services and reimbursement. FY 2020 and annually thereafter reflect $1.8 million. It's the average annual per recipient cost times the estimated number of recipients. DHSS estimates $1,581 annually per recipient times 6,330 recipients for a total of $1,000,773. 1:39:28 PM MR. ZEPP provided the following sectional analysis for SB 105. Section 1: Amends AS 08.63.100(a). Provides that 1,500 hours of clinical contact with couples, individuals, and families required for licensure of marital and family therapy must be supervised. Clarifies that 1,500 hours of clinical contact must include at least 100 hours of individual supervision and 100 hours of group supervision. Provides that the required hours of individual and group supervision may be conducted by one or more supervisors. Requires that an applicant for a license to practice marital and family therapy must have professional liability insurance including coverage of at least $30,000 for the applicant's regulatory investigation fees. Section 2: Provides the qualification for a person to perform individual supervision of a licensee under AS 08.63 and the qualifications for a person to perform group supervision of a licensee under AS 08.63. Section 3: Adds marital and family therapy services to the optional services that the Department of Health and Social Services may provide medical assistance for under AS 40.07.030(b). Section 4: Adds a new subsection (g) that defines "direct supervision," "mental health [physician clinic]," and "psychiatrist" for AS 47.07.030.   Section 5 Adds a new subsection (h) that provides that the department may reimburse a mental health physician clinic for certain services if the services are provided by a psychiatrist or an individual who works under the direct supervision of a psychiatrist and is licensed to practice as a professional counselor, a marital and family therapist, a physician assistant, an adult or family psychiatric mental health nurse practitioner, psychologist, psychological associate, or clinical social worker. Section 6: Authorizes the department and the Board of Marital and Family Therapy to adopt regulations necessary to implement this act.   Section 7: Provides an immediate effective date for Section 6 of this act. Section 8: Provides a January 1, 2018 effective date for Sections 1-5 of this act. 1:43:12 PM CHAIR COSTELLO informed members of a friendly amendment to change the effective date to January 1, 2019. SENATOR MEYER moved Amendment 1. AMENDMENT 1  OFFERED IN THE SENATE Page 5, line 9: Delete "2018" Insert "2019" CHAIR COSTELLO asked if there was objection to Amendment 1. SENATOR GARDNER asked if the amendment addresses the DHSS fiscal note that twice references a July 1, 2018 effective date in the analysis. CHAIR COSTELLO asked if the sponsor or staff could answer 1:45:14 PM At ease 1:45:41 PM CHAIR COSTELLO reconvened the meeting and clarified that the fiscal note was updated to reflect the legislation. SENATOR GARDNER withdrew her objection. CHAIR COSTELLO found no further objection and Amendment 1 was adopted. She noted who was available to answer questions. SENATOR GARDNER asked if the bill would allow LMFTs to bill Medicaid directly as an independent provider if they choose to do so. SENATOR WILSON clarified that the bill would allow LMFTs to bill Medicaid both under supervision and as a private entity. SENATOR GARDNER questioned the statement on the bottom of page 2 of the DHSS fiscal note that says: Therefore, we are unsure of the number of LMFTs who will be interested in beginning to independently bill Medicaid, subjecting their practices to the documentation and audit requirements that follow on enrollment in Medicaid as an independent provider. She said she was trying to anticipate the beneficial impact of being able to bill independently when there are just under 100 LMFTs in the state with an active license. SENATOR WILSON said that's their decision; this is intended more for the nonprofit agencies or grantees that didn't benefit as intended from the Medicaid expansion. The bill also seeks to increase capacity to meet the demand for behavioral health services. CHAIR COSTELLO asked if marital and family therapist services could be delivered through telemedicine. SENATOR WILSON deferred to Ms. McCarthy. CHAIR COSTELLO asked if there was any opposition to the bill. SENATOR WILSON said no. 1:51:01 PM CHAIR COSTELLO determined no one wished to comment and close public testimony on SB 105. 1:51:31 PM SENATOR MEYER moved to report SB 105, as amended, from committee with individual recommendations and attached fiscal note(s). 1:51:49 PM CHAIR COSTELLO announced that without objection, CSSB 105(L&C) moves from the Senate Labor and Commerce Standing Committee.