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Written on April 11, 2017
Catherine Atkins, JD
Deputy Executive Director
The first year of this two-year California legislative session is well underway. Hundreds of bills have been introduced and have been reviewed and analyzed by CAMFT staff and CAMFT’s Legislative Committee in order to determine the impact on CAMFT members and the profession. This article provides a brief overview on the main pieces of legislation and regulation that CAMFT has made a priority for 2017. Additional bills are still being analyzed and will be reported on in the next Legislative update.
CAMFT encourages all members to visit CAMFT’s Legislative Action Page to learn about all of the bills CAMFT is following, including in depth descriptions, legislative analysis, and up-to-date status. You can also subscribe to CAMFT’s Action E-lerts for CAMFT emails on key pieces of legislation.
CAMFT Legislation for 2017
AB 191 (Wood)—Psychiatric Holds: This bill would add LMFTs and LPCCs to the list of eligible providers who can act as a second signatory to extend involuntary commitments. Currently, extensions on involuntary mental health holds need to be signed first by a psychiatrist or psychologist and then either a second psychiatrist/psychologist or social worker or registered nurse (RN). Although LMFTs and LPCCs routinely work as part of the treatment team within treatment centers where assessments are made, they are unable to act as secondary signers.
When treatment teams need to find a secondary signer, there are often delays because the pool of signers is limited and, thus the patient could end up being held longer than the 72 hours, breaching the patient’s rights. The addition of LMFTs and LPCCs allows facilities the flexibility to efficiently utilize their provider care teams while maintaining patient safety and patient’s rights. This bill passed out of the Assembly with a 75-0 vote, and is now in the Senate.
SB 374 (Newman)--Mental Health Parity: CAMFT is a co-sponsor of this legislation, that would mandate health care plans regulated by the Department of Insurance (DOI) to cover mental health and substance use disorder benefits in compliance with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). This would be a follow-up bill to SB 857 (2014--Committee on Budget and Fiscal Review) that mandated the same for plans covered by the Department of Managed Health Care. The purpose of the bill is to reinforce and clarify that the DOI has the authority to enforce the MHPAEA. The California Psychiatric Association is a co-sponsor, and it is likely that other co-sponsors will join as the legislative season moves forward. This bill is currently in the Senate Appropriations Committee.
Other 2017 State Legislation
AB 93 (Medina)—Supervision Requirements: This bill, sponsored by the Board of Behavioral Sciences (BBS), would revise and recast some LMFT supervised experience requirements. To address changing and evolving supervised experience and supervisor relationships, the BBS formed a special committee in 2014, to examine supervision requirements. Through that Committee, and relying on fruitful stakeholder participation, came SB 620 (2015), the proposed legislation discussed below, as well as regulations that will be introduced in the next year or two. Some of the more notable changes in AB 93 include:
One hour of face to face supervision will now include “triadic supervision” which means one hour of face-to-face between one supervisor and two supervisees.
CAMFT participated in all stakeholder meetings and has taken a position of support on this legislation.
AB 154 (Levine)—Prisoners and Mental Health: This bill allows the court to order a defendant to serve all, or part, of their state prison or county jail sentence in a residential mental health facility, when a defendant establishes that they meet specified criteria regarding mental illness. Defendants with a current conviction for a violent felony would not qualify. This bill also mandates that the California Department of Corrections and Rehabilitation (CDCR) or the county jail prepare a post-release mental health treatment plan six months prior to the defendant’s release. CAMFT is currently reviewing this bill and its fiscal impacts on the state to help determine CAMFT’s position.
AB 387 (Thurmond)—Minimum Wage and Allied Health Professionals: This bill expands the definition of employer under provisions related to minimum wage, to include any person or persons engaged in a period of supervised work experience to satisfy requirements for licensure, registration, or certification as an allied health professional (as defined under federal law). This bill has met with fierce opposition from numerous health care provider and hospital advocacy groups with concerns about fiscal implications. This bill has not yet been given a price tag, but it most certainly will be quite high given the impact on counties and state agencies. This bill remains unclear as to its definition of what professions actually fall under “allied health professional.” Although this bill is being heavily lobbied by labor advocacy groups, it is not likely to move forward, as currently written given the opposition by state, county, private employers and provider groups.
CAMFT is aware of the controversial nature of this issue, not only within the California work arena, but within the CAMFT membership. The CAMFT Board of Directors has long prioritized ensuring that pre-licensees are not exploited, and that the therapy field is open to a financially diverse population. CAMFT is also aware of the financial struggles of low or no-pay client service agencies. Until further fiscal analysis is put forward, CAMFT has taken a neutral position on this bill. The CAMFT Board of Directors will be reviewing this bill at its upcoming Board meeting in June.
AB 834 (O’Donnell)—School Based Health Programs: This bill would establish an Office of School-Based Health Programs (OSBH) that would support and advise school districts on issues related to the delivery of school-based health services. Due to a recent federal change, schools will soon have access to far greater resources to pay for these services. This change means that many more students will be eligible to receive health services at school, including school nurse services for chronic conditions, mental health and counseling services, occupational therapy, speech pathology, audiology, and targeted case management. The OSBH program would develop infrastructure within the various state departments to increase access to services and remove barriers to reimbursement. CAMFT has selected increasing mental health services within the K-12 system as a priority and has taken a position of support on this legislation.
AB 1074 (Maienschein)—Coverage of ABA Services: Current law requires managed care plans to cover behavioral health treatment for pervasive developmental disorder (PDD) or autism by qualified autism service providers and qualified autism service professionals working under supervision. This bill would amend the supervision requirements for qualified autism service professionals and qualified autism service paraprofessionals. This bill would also expand the scope of qualified autism service professionals to include clinical case management and case supervision. Although CAMFT is supportive of the use and coverage of behavioral health treatment for PDD and autism, it is essential to protect this vulnerable patient population by ensuring that the providers of this care are properly educated and experienced, as well as supervised. CAMFT has concerns that this bill could lower the supervision requirements for non-licensed providers creating a potential for patient harm. CAMFT is working with the sponsors of this legislation, and have an opposed unless amended position at this time.
AB 1188 (Nazarian)—Loan Repayment: Current law allows MFTs, and other BBS and Board of Psychology licensees, who work at publicly funded mental health facilities or nonprofit mental health facilities, and provide direct patient care, to apply for grants under the Licensed Mental Health Service Provider Education Program to reimburse for educational loans. This bill would increase each licensee’s annual renewal fee by $10 to be applied towards the existing Education fund for his/her license. The CAMFT Board of Directors has made it a priority to advocate that pre-licensees and newly licensed MFTs have increased opportunities for paid employment—CAMFT believes this bill will assist in that goal. This bill is co-sponsored by NASW and CALPCC, and supported by the California Psychological Association. CAMFT is in support of this legislation.
SB 191 (Beall)—Pupil Health: This bill will create the County and Local Educational Agency Partnership Fund to promote partnerships between counties and school districts in an effort to better address student mental health and substance use disorders. This bill will reduce barriers to access for children and families, such as stigma, affordability, and problems recognizing symptoms, and provide maximal coverage for universal prevention and early intervention programs. As noted above, CAMFT has prioritized increasing mental health services in the K-12 system, and believe this legislation will assist in that effort. CAMFT is in support of this legislation.
SB 399 (Portantino)—Coverage of PDD and Autism: Among other issues, this bill expands the requirements to become a qualified autism service professional and authorizes the substitution of specified education, work experience, and training qualifications to meet the criteria of a qualified autism service paraprofessional. As discussed above, CAMFT has concerns about legislation that could result in patient harm; this includes reducing education and experience requirements for providers working with patients with PDD or autism. CAMFT has taken an opposed unless amended position at this time while we work with the sponsor to ensure patient safety.
SB 562 (Lara)--The Health California Act: The primary intent of this bill is to replace private medical insurance with a government health care system providing comprehensive universal single-payer health care coverage and a health care cost control system for the benefit of all 38 million residents of the state. Proponents of a single-payer system have gained a lot of traction over the last few years, especially with the recent threat of an ACA repeal. With that said, historically single-payer bills have been given a hefty price-tag – often an amount that exceeds the entire California state budget. This legislation will be heavily opposed by health care plans, and likely see varying responses from provider groups across the state. The bill, as currently written, does not address the specifics of financing and no financial assessment has been released by the state or legislature to date. Until further analysis is put forward, including financial assessment, CAMFT has taken a neutral position on this bill. The CAMFT Board of Directors will also be reviewing this bill at its upcoming Board meeting in June given its controversial nature within the membership.
Non-Legislative Advocacy
LMFTs within FQHCs/RHCs: CAMFT-sponsored Assembly Bill 1863 (2016-Wood) added LMFTs as providers within Federally Qualified Health Centers (“FQHCs”) and Rural Health Clinics (“RHCs”). The bill was intended to increase the pool of licensed professionals who could be hired in these entities so that adequate mental health services could be provided to the patients. The bill was signed by Governor Brown in 2016 and was set to go into effect on January 1, 2017. Unfortunately, in response to concerns about a possible ACA repeal, Governor Brown (through his draft state budget) delayed implementation of AB 1863 until at least July 2018. CAMFT has been lobbying the California Legislature, through the budget process, to remove the delaying language or at least change the language to “implement by July 2018”. We are hopeful that the Legislature will back CAMFT’s efforts to challenge the Governor’s existing draft budget on this budget item.
DMV Gender Identity: In March 2013, CAMFT submitted a proposal requesting an amendment to Section 20.05 of Adm. Code, Title 13, adding Licensed Marriage and Family Therapists (LMFTs) to the list of those who can certify that gender identification is transitional and will require a change. This certification appears on DMV Form DL 329: Medical Certification and Authorization. CAMFT continues to put pressure on the Department of Motor Vehicles (“DMV”) to put this proposal out for public comment.
Affordable Care Act: In early 2017, the American Health Care Act (AHCA) was introduced to repeal and replace the Affordable Care Act (ACA). During this time, CAMFT utilized internal lobbying methods, and grassroots efforts, to advocate that if the ACA was indeed replaced, mental and behavioral health essential benefits needed to be protected for all Californian consumers. Due to opposition from various advocacy groups, as well as non-consensus within the majority party, the AHCA was pulled from the House floor in late March. Although the ACA remains intact for the time being, it is likely it will be reassessed in the coming months or years and/or pieces of it dismantled. CAMFT will continue to advocate that all Californians must have access to and coverage of life-saving mental and behavioral health benefits.
Medicare: CAMFT’s priority on the federal landscape is to pass legislation that will allow LMFTs to reimburse as Medicare providers. Because we have a new Congress in 2017, CAMFT will need to reintroduce legislation similar to bi-partisan HR 2759/ S 1830 (2015). CAMFT is working with Rep. Thompson to identify a new Republican sponsor in the House of Representatives as Rep. Gibson, the sponsor for the last two Congresses has retired. It is expected that Senator Barrasso (R-WY) and Senator Stabenow (D-MI) will re-introduce our bill in the Senate by the beginning of May. During the recent legislative recess, CAMFT lobbied for support of our Medicare bill in Washington D.C. when it is introduced.
Veterans Affairs: CAMFT continues to meet with the Department of Veteran Affairs (VA) to discuss implementation of the Military Construction, Veterans Affairs, and Related Agencies Appropriation Bill. This bill, signed into law in 2016 removed the requirement that LMFTs must be graduates of COAMFTE-accredited programs in order to work at the VA. A committee consisting of five LMFTs employed through the VA, and a psychologist, have begun drafting the new employment standards for LMFT hiring with a target date of completion of early Fall. It then goes through a multi-tiered internal department review CAMFT will continue to lobby a swift review and implementation.
Oregon to Recognize CA LMFTs: The Oregon Board of Licensed Professional Counselors and Therapists is proposing a rule amendment that would make it easier for California licensed MFTs to obtain licensure in Oregon. The rule amendment would add California’s BBS MFT Written Clinical Exam as an approved competency exam for licensure as a Licensed Marriage and Family Therapist in Oregon. Note: The Oregon Board previously adopted a temporary administrative rule amendment to accept the California exam, effective December 12, 2016 through June 9, 2017. This current permanent rulemaking proposal will allow for continued acceptance of the exam. CAMFT has provided written comment in support of this proposed rule amendment.
Nuclear Regulatory Commission (NRC): In 2010, CAMFT petitioned the NRC to include LMFTs as “Substance Abuse Experts.” Over the last six years, numerous delays at the NRC have impeded CAMFT’s petition to be put out to public comment. Although CAMFT was assured that this process would begin by late 2016, the NRC expects additional delays given President Trump’s recent cautions about new regulatory packages. This is disappointing news, given our work to date, but we remain vigilant to push this package forward. In coming months, CAMFT will be asking members to write the NRC directly, advocating to advance this package.
CAMFT is excited to announce its increased focus on member-based grassroots advocacy efforts. Although CAMFT has always engaged members to reach out to elected officials on highly-charged relevant state and federal legislation, CAMFT’s new Grassroots Advocacy Team aspires to have CAMFT members trained in every state and federal district to complement CAMFT’s longstanding internal lobbying and advocacy program. The Grassroots Advocacy Team participated in successful lobby days in March in Sacramento, and in April in Washington, DC.
Catherine L. Atkins, JD, is a staff attorney and the Deputy Executive Director at CAMFT. Cathy is available to answer members’ questions regarding legal, ethical, and licensure issues