Legislature(2017 - 2018)BARNES 124

03/05/2018 03:15 PM LABOR & COMMERCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Heard & Held
-- Public Testimony --
Moved HB 277 Out of Committee
-- Public Testimony --
Heard & Held
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
         HB 353-MARITAL & FAMILY THERAPY LIC. & SERVICES                                                                    
3:20:52 PM                                                                                                                    
CHAIR KITO  announced that the  first order of business  would be                                                               
HOUSE BILL NO. 353, "An Act  relating to the licensure of marital                                                               
and  family  therapists;  relating   to  medical  assistance  for                                                               
marital  and family  therapists' services;  and providing  for an                                                               
effective date."                                                                                                                
3:21:29 PM                                                                                                                    
BERNICE  NISBETT,  Staff,  Representative Ivy  Spohnholz,  Alaska                                                               
State Legislature,  presented HB 353 on  behalf of Representative                                                               
Spohnholz, prime  sponsor.  She presented  the PowerPoint "HB353:                                                               
Marital  & Family  Therapist Licensure  & Services"  [included in                                                               
committee packet].                                                                                                              
MS. NISBETT addressed slide 2:                                                                                                  
     What is marital & family therapy (MFT) and why is this                                                                     
     ? MFTs treat serious clinical issues including                                                                             
     depression,  marital   obstacles,  anxiety,  individual                                                                    
     psychological problems, and child-parent difficulties.                                                                     
     ? MFTS are mental health professionals trained in                                                                          
     psychotherapy and family systems, and are licensed to                                                                      
     diagnose and treat mental and emotional disorders                                                                          
     within the context of marriage, couples, and family                                                                        
     ? Source: American Association for Marriage & Family                                                                       
     Therapy, 2018.                                                                                                             
MS. NISBETT spoke to "What does this bill do?" in slides 3-6:                                                                   
     1. It  requires 1,500 hours of  supervision for marital                                                                    
     and family  therapists (MFTs). 100 hours  of individual                                                                    
     supervision, and 100 hours of  group supervision may be                                                                    
     conducted by one or more supervisors.                                                                                      
3:23:25 PM                                                                                                                    
MS. NISBETT addressed slide 4:                                                                                                  
     2.  It  specifies  that   a  qualified  supervisor  for                                                                    
     supervision must have 5 years of experience in                                                                             
     marital and family therapy and a license to practice.                                                                      
     Or, that a qualified group supervisor can be licensed                                                                      
     as another professional mental health clinician (LPC,                                                                      
     LMFT, LCSW, Psy.D, M.D., or ANP).                                                                                          
MS. NISBETT addressed slide 5:                                                                                                  
     3. It defines:                                                                                                             
     ? Direct  supervision   one  or more  psychiatrists on-                                                                    
     site  a mental  health physician  clinic 30  percent of                                                                    
     the time the clinic is open.                                                                                               
     ? Mental health  physician clinic   operated  by one or                                                                    
     more  psychiatrists   and  primarily   provides  mental                                                                    
     health services.                                                                                                           
     ? Psychiatrist    a  person licensed  to practice  as a                                                                    
     physician under AS  08.64 and is licensed  by the State                                                                    
     Medical Board as a psychiatrist.                                                                                           
MS. NISBETT addressed slide 6:                                                                                                  
     4. Lastly, it allows the Department of Health & Social                                                                     
     Services (DHSS) to reimburse a mental health clinic                                                                        
     for services performed by mental health clinicians                                                                         
     who   are   under   the   direct   supervision   of   a                                                                    
3:25:18 PM                                                                                                                    
MS. NISBETT paraphrased from the Sectional Analysis [included in                                                                
committee packet] which reads as follows [original punctuation                                                                  
     Section 1.  AS 08.63.100(a) is amended  to clarify that                                                                    
     before an individual can receive  a license to practice                                                                    
     marital and  family therapy,  they must  complete 1,500                                                                    
     of  supervised clinical  hours. Of  those 1,500  hours,                                                                    
     100 hours must be  individual supervision and 100 hours                                                                    
     must be for  group supervision. These 200  hours may be                                                                    
     attended by one or more supervisors.                                                                                       
     Section 2. AS  08.63.120(b) is amended to  state that a                                                                    
     supervisor  who  oversees   a  license  for  individual                                                                    
     supervision  must  have  practiced marital  and  family                                                                    
     therapy  for   five  years,  be  licensed   under  this                                                                    
     chapter, and meet the  minimum standards established by                                                                    
     the board  for approved  supervisors. A  supervisor who                                                                    
     oversees  a  licensee  for group  supervision  must  be                                                                    
     licensed  to practice  as a  professional counselor,  a                                                                    
     marital  and family  therapist,  a physician,  advanced                                                                    
     nurse  practitioner, psychologist,  or clinical  social                                                                    
     Section 3.  AS 47.07.030(b)  is amended to  add marital                                                                    
     and  family   therapists'  services  to  the   list  of                                                                    
     optional  services  that  the Department  of  Health  &                                                                    
     Social Services (DHSS) may offer.                                                                                          
     Section    4.   AS    47.07.030(g)   defines    "direct                                                                    
     supervision," "mental health physician clinic," and                                                                        
     Section 5.  AS 47.07.030  is amending  by adding  a new                                                                    
     section  (h) that  allows DHSS  to  reimburse a  mental                                                                    
     health  physician clinic  for  services  provided by  a                                                                    
     psychiatrist or  an individual  who works  under direct                                                                    
     supervisor   and  is   licensed   to   practice  as   a                                                                    
     professional   counselor,   a    marital   and   family                                                                    
     therapist,   physician    assistant,   advanced   nurse                                                                    
     practitioner,  psychologist,  psychological  associate,                                                                    
     or clinical social worker.                                                                                                 
     Section  6. Authorizes  DHSS and  the Board  of Marital                                                                    
     and Family  Therapy to  adopt regulations  necessary to                                                                    
     implement this Act.                                                                                                        
     Section  7. States  that Sec.6  of this  Act will  take                                                                    
     effect immediately under AS 01.10.070(c).                                                                                  
     Section  8.  Not  including  Sec.7  of  this  Act,  the                                                                    
     effective date of this bill will be January 1, 2018.                                                                       
3:27:52 PM                                                                                                                    
MS. NISBETT presented slide 16, "Suggestions from Stakeholders":                                                                
     ? Defining "direct supervision" as:                                                                                        
     ? One or more psychiatrists on-site at a mental health                                                                     
     clinic 30 % of the time, OR                                                                                                
     ? Available by a communication device to provide                                                                           
     general oversight.                                                                                                         
     ? Allowing  advanced nurse practitioners  authorized by                                                                    
     the  Board  of Nursing  to  practice  as a  psychiatric                                                                    
     mental  health  nurse  practitioner to  provide  direct                                                                    
     ? Changing "mental health physician clinic" to simply,                                                                     
     "mental health clinic."                                                                                                    
3:30:06 PM                                                                                                                    
REPRESENTATIVE JOSEPHSON asked what prompted the proposed bill.                                                                 
MS.  NISBETT  asked  whether he  was  referring  specifically  to                                                               
Licensed Marriage and Family Therapists (LMFTs).                                                                                
REPRESENTATIVE JOSEPHSON answered in the affirmative.                                                                           
MS. NISBETT deferred the question to a member of the board.                                                                     
REPRESENTATIVE   JOSEPHSON   asked   why  marriage   and   family                                                               
therapists are the feature of this bill.                                                                                        
3:32:29 PM                                                                                                                    
DOROTHEA  GODDARD-AGUERO, Public  Member,  Board  of Marital  and                                                               
Family Therapy, Office  of the Governor, testified  in support of                                                               
HB  353.   She  explained  the proposed  bill  would clarify  the                                                               
requirements to  define who can be  a supervisor.  She  added the                                                               
board has very few members.   She said she doesn't have the whole                                                               
history of the proposed bill.                                                                                                   
3:33:53 PM                                                                                                                    
JON  ZASADA, Policy  Integration  Director,  Alaska Primary  Care                                                               
Association, testified  in support of  HB 353. He  identified the                                                               
association  of  qualified  health  centers  and  said  they  are                                                               
operating  at 160  sites within  the  state.   He underlined  the                                                               
importance of  expanding the billable mental  health labor force.                                                               
He said  over 11,000 Alaskans  receive primary  behavioral health                                                               
care  in community  health centers.   He  underlined the  problem                                                               
that there is a shortage of  billable providers.  It was recently                                                               
discovered that  Alaska health centers  have a shortage of  up to                                                               
18  behavioral health  providers.   He  added  at a  conservative                                                               
estimate, 9,000 additional Alaskans could  be served if the labor                                                               
force were full.                                                                                                                
MR.  ZASADA said  that  currently health  centers  can only  bill                                                               
under  a bundled  rate  for  services from  an  MD,  a PhD  level                                                               
psychiatrist, or  an LCSW.   He added  centers also  employ LMFTs                                                               
and  licensed  professional  counselors,  but  they  cannot  bill                                                               
Medicaid.     He  added  health   centers  continue   to  attract                                                               
additional investment  in behavioral  health and  substance abuse                                                               
treatment   with   the  goal   of   serving   more  patients   in                                                               
comprehensive care  settings. The  majority of these  funds would                                                               
be spent on  hiring additional providers, but at  this time those                                                               
funds aren't  sustainable because  additional provider  types are                                                               
not  billable  under Medicaid.    With  new federal  funding  for                                                               
addressing the  opioid epidemic, community health  centers expect                                                               
additional  direction and  funding to  continue to  provide these                                                               
services.  He  stated  LMFTs  are a  good  match  for  integrated                                                               
primary  care  settings,  caring   for  patients  through  timely                                                               
intervention,  short-term therapy,  and  collaborating with  care                                                               
coordinators and nurse practitioner prescribers.                                                                                
MR. ZASADA  referenced Section  2 of the  proposed bill  and said                                                               
the aim is  to broaden the definition of a  supervisor to include                                                               
physicians  and  primary  care  MDs.    He  said  these  are  the                                                               
predominant   supervising  types   in  Alaska   community  health                                                               
MR. ZASADA spoke  to language in Section 4 of  the proposed bill.                                                               
He  said  additional  clarification  was being  sought  that  the                                                               
mental  health clinic  allows  primary  care federally  qualified                                                               
health centers to benefit from the provider expansion.                                                                          
3:38:35 PM                                                                                                                    
REPRESENTATIVE   SULLIVAN-LEONARD  said   she  would   like  more                                                               
information on Section 2.                                                                                                       
MR. ZASADA  said broader supervision  of psychiatrists  was being                                                               
sought.    He  added  that   having  a  psychiatrist  creates  an                                                               
additional bottleneck to  care and could cost  well over $100,000                                                               
a year.                                                                                                                         
3:40:24 PM                                                                                                                    
REPRESENTATIVE  KNOPP asked  whether there  was any  concern over                                                               
asking psychiatrists  who have extensive specialized  training to                                                               
be supervised by less specialized professionals.                                                                                
MR. ZASADA answered he is  not an expert in supervision practices                                                               
but said  family practice physicians  have a level  of behavioral                                                               
health supervision  in their training  and it is a  best practice                                                               
in other states.                                                                                                                
REPRESENTATIVE   KNOPP   reiterated   his   concern   about   the                                                               
discrepancies in education in the groups.                                                                                       
MS. NISBETT answered LMFTs must have  a master's degree or PhD to                                                               
practice and  have to have 1,500  hours or two years  before they                                                               
can get licensed.   She added LMFTs must pass  an examination and                                                               
maintain a clean record.                                                                                                        
3:43:03 PM                                                                                                                    
REPRESENTATIVE WOOL asked  about the types of  therapy covered in                                                               
the proposed bill.                                                                                                              
MR. ZASADA answered  that in a community health  center the trend                                                               
has been  to integrate  care in  one site, so  a care  team would                                                               
likely  have  an  MD,  a   physician's  assistant,  and  a  nurse                                                               
practitioner, a  prescribing nurse  practitioner, and  a licensed                                                               
clinical social worker.  He said  with the proposed bill, an LMFT                                                               
would  be added.   He  stated addressing  behavioral health  with                                                               
medical assistance  in one visit  helps control the cost  of care                                                               
3:46:09 PM                                                                                                                    
CHAIR KITO opened public testimony on HB 353.                                                                                   
3:46:19 PM                                                                                                                    
ALBERT WALL, Chief Executive  Officer, Peninsula Community Health                                                               
Services  of Alaska,  testified in  the hearing  on HB  353.   He                                                               
clarified the services that LMFTs provide and how LMFTs bill.                                                                   
He  said there  is  currently a  way for  LMFTs  to bill  through                                                               
Medicaid.  He said  they can  bill at  a community  mental health                                                               
center  that   is  a  grantee  of   the  state.    He   said  the                                                               
reimbursement rate  on the rehabilitation  side is very  poor, so                                                               
many of  them do  not.   He explained it  is the  bottleneck that                                                               
needs to be addressed.    He added right now oversight is limited                                                               
to  psychiatrists  and there  are  not  enough  in the  state  to                                                               
provide oversight for clinicians.                                                                                               
MR.   WALL  said   he  strongly   supports   an  advanced   nurse                                                               
practitioner being  given the ability  to supervise as  they have                                                               
specialized training  and it  would take some  of the  burden off                                                               
the smaller providers  in the state.  He said  most small clinics                                                               
don't  have  the  money  to hire  a  full-time  psychiatrist  and                                                               
allowing advanced  nurse practitioners  to sign off  would reduce                                                               
the administrative and financial burden  on the clinic, so it can                                                               
provide more services for less money.                                                                                           
3:50:20 PM                                                                                                                    
CHAIR  KITO spoke  to  the  supervision aspect  and  said he  was                                                               
confused  about a  psychiatric nurse  practitioner supervising  a                                                               
licensed psychiatrist as they would  not have the same experience                                                               
or  be qualified  to sign  off  on mental  health experience  for                                                               
MR. WALL  gave the example  of his  organization.  He  stated the                                                               
Chief Medical  Officer (CMO) there  is a psychiatrist.   He added                                                               
the center is under two separate  sets of regulations as they are                                                               
a federally qualified center and  a Division of Behavioral Health                                                               
grantee. He said there are  also two advanced nurse practitioners                                                               
with psychiatric  experience.   He added  he is  more comfortable                                                               
with advanced  nurse practitioners  having oversight of  LMFTs as                                                               
they  have  direct  contact   with  evidence-based  practice  and                                                               
clinical work.                                                                                                                  
CHAIR  KITO asked  whether advanced  nurse practitioners  provide                                                               
therapy services.                                                                                                               
MR. WALL answered they can  provide therapy services, but most do                                                               
not because they tend to bill at the top end of their licensure.                                                                
CHAIR KITO reiterated his concern.   He said he did not think the                                                               
state would  accept that  a LMFT  could sign  off on  the therapy                                                               
hours of a licensed psychologist.                                                                                               
MR. WALL said  he did not think the proposed  bill was asking for                                                               
LMFTs to sign off on hours.                                                                                                     
CHAIR KITO stated  he was trying to understand  the knowledge and                                                               
experience of the  people who would be given the  ability to sign                                                               
3:55:24 PM                                                                                                                    
REPRESENTATIVE JOSEPHSON  surmised the  aim of the  proposed bill                                                               
would  be to  expand the  number of  mental health  practitioners                                                               
that are  able to bill for  Medicaid.  He asked  whether that was                                                               
the case.                                                                                                                       
MR.  WALL clarified  that the  bill is  not about  supervision of                                                               
client  hours.    He  said  there  are  two  different  types  of                                                               
supervision.   He explained  that when a  therapist is  going for                                                               
licensure, they receive  15 hours of oversight  in which trainers                                                               
observe therapy and educate on  improvements.  He stated that was                                                               
not in  the proposed bill.   The supervisors are  supervising the                                                               
actual  clinical work  only  for the  submission  of the  billing                                                               
process. Currently,  psychiatrists are  the only people  that can                                                               
do  that and  LMFTs can't  do  the work  they are  trained to  do                                                               
because there are not enough people to provide oversight.                                                                       
3:59:07 PM                                                                                                                    
CHAIR KITO announced  he would leave public testimony  open on HB
CHAIR KITO held over HB 353.                                                                                                    

Document Name Date/Time Subjects
HB353 Letters of Support 2.21.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 353
HB353 Supporting Document - Arctic Mental Health Working Group - Alaska's Mental Health Needs.pdf HL&C 3/5/2018 3:15:00 PM
HB 353
HB353 Sectional Analysis 2.21.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 353
HB353 Sponsor Statement 2.21.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 353
HB353 version A 2.21.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 353
HB353 Fiscal Note DCCED CBPL 3.2.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 353
HB353 Fiscal Note DHSS BHMS 3.2.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 353
HB353 HLAC PowerPoint 3.3.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 353
HB277 Opposition Documents 2.13.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 277
HB277 Supporting Document-Fast Facts for Conservatives on Net Neutrality 2.12.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 277
HB277 Letters of Support 2.28.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 277
HB309 CS Presentation.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 CS Support Letter SK to HLAC.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 CS Exhibit D1 Ver J.PDF HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 Sponsor Statement 2.2.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 Supporting Document- Bruce Botehlo Letter to SOCC 2.2.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 Ver A 2.2.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 CS A Exhibits.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 CS B Exhibits.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 CS C Exhibits.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB309 Fiscal Note LEG 3.5.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 309
HB277 Opposition Letters 3.5.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 277
HB309 Legal Memo 3.16.18.pdf HL&C 3/5/2018 3:15:00 PM
HB 309