Legislature(2017 - 2018)SENATE FINANCE 532
02/27/2018 09:00 AM FINANCE
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SENATE BILL NO. 105 "An Act relating to the licensure of marital and family therapists; relating to professional liability insurance for marital and family therapists; relating to medical assistance for marital and family therapy services; and providing for an effective date." 10:03:46 AM SENATOR DAVID WILSON, SPONSOR, read from the 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. He shared that approximately 20 percent of Alaska's adult population needed mental or behavioral health services; however, 19 percent of those in need received funding from Medicaid or the Behavioral Health Fund. He said that research had shown that Alaska was in need of additional psychiatrists to meet the state's mental health needs. He read from the Sponsor Statement: Currently, licensed marital and family therapists (MFTs) are only allowed to provide services in community health clinics of 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 • Designated 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. 10:09:44 AM GARY ZEPP, STAFF, SENATOR WILSON, discussed the Sectional Analysis (copy on file): Sections 1 & 2 of the bill impact AS 08.63 "Marital & Family Therapy" and the subsections 08.63.100 "Qualifications for license to practice" and 08.63.120 "Authorized Supervisors." Section 1: "Qualifications for license to practice" - AS 08.63.100 PAGE 2, LINES 17-25: adds a supervision requirement for martial & family therapists and clarifies that the required 1,500 hours of clinical contact must include 100 hours of individual supervision and 100 hours of group supervision and that may be conducted by one or more supervisors. The intent is to allow doctor A to supervise and if Doctor A becomes unavailable, doctor B can continue the supervision a Martial & Family Therapist associate. Section 1 continues on: PAGE 2, LINES 29-31: It requires not less than $30,000 in professional liability coverage for the applicant's regulatory investigation fees in the state. Section 2: impacts "Authorized Supervisors" PAGE 3, LINES 2-18: expands the group supervision to include professional counselors, marital & family therapists, physicians who are licensed as a psychiatrist, an advanced practice registered nurse who is authorized by the Board of Nursing to practice as an adult or family psychiatric mental health nurse practitioner, a psychologist, and a social worker. Sections 3, 4, & 5 impact AS 47.07 "Medical Assistance for Needy Persons" and the subsection AS 47.07.030 "Medical Services to be Provided." Section 3: impacts "Medical Services to be Provided" PAGE 3, LINE 31: adds marital and family therapy services to the list of optional services available through the Dept. of Health & Social Services under this subsection. Section 4: impacts "Medical Services to be Provided" PAGE 4, LINES 8-16: adds a new paragraph (g) to AS 47.70.030 to clarify that the term "direct supervision" may be performed by one or more psychiatrists, as long as that supervision takes place on the premises of the clinic 30 % of the time that the clinic is open. The so-called 30% Rule is found in regulation 7AAC 135.030 "Provider enrollment and organization." Section 5: impacts "Medical Services to be Provided" PAGE 4, LINES 17-31 & PAGE 5, LINE 1: adds a new subsection (h) to AS 47.70.030 that allows the department to reimburse a mental health physician clinic for services provided by a psychiatrist, or an individual who works under a psychiatrist and is licensed to practice as a professional counselor, a martial & family therapist, a physician assistant, an advanced practice registered nurse who is authorized by the Board of Nursing to practice as an adult or family psychiatric mental health nurse practitioner, a psychologist, a psychologist associate, and a clinical social worker. Section 6: PAGE 5, LINES 2-7: amends the uncodified law to authorize the Department of Health and Social Services and the Board of Marital and Family Therapy to adopt regulations to implement the changes of this act. Section 7: PAGE 5, LINE 8: contains the immediate effective date for Section 6 which refers to the regulation development. Section : PAGE 5, LINE 9: provides for a January 1, 2019 effective date for all sections other than Section 6. 10:13:29 AM Senator Stevens asked for the licensing timeframe to be licensed as a marital and family therapist, and whether temporary licenses could be issued. Senator Wilson deferred to the invited testimony. 10:14:26 AM Senator Stevens hoped that the marital and family therapists would not face the same problems as the medical practitioners of the previously discussed bill. Co-Chair MacKinnon OPENED public testimony. 10:15:08 AM Senator von Imhof assumed that the insurance required in Section 1 could be obtained after training was complete. Senator Wilson replied that the insurance language was intended to cover investigative regulatory issues after licensure. 10:16:08 AM RANDALL BURNS, DIRECTOR, DIVISION OF BEHAVIORAL HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, (DHSS) spoke in support of the bill. 10:16:34 AM Senator von Imhof read form the Sectional Analysis: Section 4: impacts "Medical Services to be Provided" PAGE 4, LINES 8-16: adds a new paragraph (g) to AS 47.70.030 to clarify that the term "direct supervision" may be performed by one or more psychiatrists, as long as that supervision takes place on the premises of the clinic 30 % of the time that the clinic is open. Senator von Imhof whether the population of psychiatrists in rural Alaska could support the requirement in this section. Mr. Burns replied that the language was in current regulation. He said that he was in support of changing the language at the direction of the committee. He stated that the division was currently crafting language that was less burdensome to rural clinics. 10:21:31 AM AT EASE 10:21:54 AM RECONVENED 10:21:58 AM Senator Stevens repeated his question about temporary licensing and licensing timelines. Mr. Burns replied that he could not speak to the question. 10:22:54 AM KAREN CUNNINGHAM, VICE PRESIDENT, MARRIAGE AND FAMILY THERAPY BOARD, ANCHORAGE (via teleconference), testified in support of the legislation. She stated that associate licensure was available; board approval was required before the license could be issued and there was a 2-year supervision period. She said that the bill would make the supervision period more accessible for applicants. 10:24:04 AM Senator Stevens directed his question to Ms. Cunningham. Ms. Cunningham replied that applications for associate licensure were submitted to, and approved by, the board. Before the application could be submitted the applicant needed to have a supervision plan laid out for the board to approve. She relayed that there were currently 18 approved supervisors in the state. 10:25:41 AM KEN MCCARTY, DIRECTOR, DISCOVERY COVE RECOVERY AND WELLNESS CENTER, EAGLE RIVER (via teleconference), testified in support of the legislation. He shared that the bill would serve a large need in the state. He expressed concern about the Section 4 language referenced by Senator von Imhof. He felt that the language could isolate telemedicine in rural areas. 10:32:08 AM ELIZABETH RIPLEY, CEO, MAT-SU HEALTH FOUNDATION, testified in support of the bill. She said that there were critical pieces missing for Alaska's continued care for mental health and substance use disorders; sadly, main paths to treatment are jails and emergency departments. She relayed that the Mat-Su Regional Emergency Department was the number one portal in Mat-Su for people experiencing a behavioral health crisis, in terms of both volume and cost, even though the department does not provide behavioral health services. She shared that in 2016, 3,443 patients with behavioral health diagnosis went to the Mat-Su Regional Emergency Department, which resulted in total charges of $43.8 million, not counting the additional costs for estimated law enforcement, 911 dispatch, and transportation. She believed that the state could improve the situation by providing care in lower cost settings. She relayed that the average annual growth rate for visits to the Mat-Su Regional Emergency Department by patients with a behavioral health diagnosis grew 20 percent between 2015 and 2017, due to the opioid epidemic and lack of treatment access. She offered further statistics to illustrate the statewide needs that the bill would address. 10:35:52 AM Senator Micciche expressed concern with the assumptions made in the fiscal note. He opined the Medicaid utilization rate in the state. He voiced concern that the state would be exposed to increased overutilization. Ms. Ripley replied spoke of a project called The Alaska Healthcare Blueprint, which hoped to take a bold look at the state's health objectives. She asserted that collaborative work was being done with state partners, providers, and local delegations to take a comprehensive view. She contended that significant research had been done to ensure that health care was being provided efficiently and effectively. She stressed the need for "whole person care." She admitted that there would be additional cost brought on by the bill but that the legislation would be more cost effective in the long-run. 10:38:47 AM AT EASE 10:39:10 AM RECONVENED Senator von Imhof understood that the cost would be shifted from expensive emergency room visits to more clinic visits, where the same population would be served, for the same ailments but in a different cost environment. Ms. Ripley agreed. 10:40:19 AM JON ZASADA, POLICY DIRECTOR, ALASKA PRIMARY CARE ASSOCIATION, testified in support of the legislation. He stated that health centers had made major investments in behavioral health integration and whole person care. He said that in the last two years there had been a 25 percent increase in the number of behavioral health providers, encounters, and patients; over 11,000 Alaskans received routine behavioral healthcare in Alaska's community health centers. He lamented that there was a shortage of billable providers in the state; a study completed in December 2017 revealed that Alaska community heath centers were short 12 to 18 FTE equivalents, which translated into service to 6,000 to 9,000 patients. He stressed that federally qualified health centers saved the state money by allowing same-day appointments at a single rate. He stated that if LMFTs were included in FQHC Medicaid billing a patient could see a medical provider and a mental health professional in the same day, for a single charge, instead of a referral to two sperate charges. He detailed the various ways in which the bill would serve more patients in comprehensive, whole-patient settings. 10:43:53 AM Senator Stevens asked which medical professionals could currently bill Medicaid. Mr. Zasada replied that licensed clinical social workers and psychologists could bill Medicaid. Co-Chair MacKinnon CLOSED public testimony. Co-Chair MacKinnon stated that a new fiscal note would be crafted for consideration during the next bill hearing. 10:45:15 AM Co-Chair MacKinnon solicited further discussion on the current fiscal note. Senator Wilson reiterated that the intent of the bill was not to create a new expanded care of treatment but to give patients access to care as primary prevention. Co-Chair MacKinnon announced that amendments were due the following day by 5pm. SB 105 was HEARD and HELD in committee for further consideration.