Written on December 9, 2016

Catherine Atkins, JD
Deputy Executive Director

2016 was the end of a two-year legislative cycle in California, as well as in Washington D.C. The CAMFT Legislative Committee worked with staff and the CAMFT lobbyist and reviewed hundreds of bills introduced for consideration in 2016 to determine the impact on CAMFT members and the profession. This article provides a brief overview on CAMFT-sponsored legislation, some of the bills on which CAMFT actively advocated, and general advocacy updates. For more complete descriptions, as well as the full list of bills CAMFT followed in 2016, visit the CAMFT Legislative Action Center on the CAMFT website.

STATE ADVOCACY

CAMFT Legislation for 2016

AB 1808 (Wood): Trainee Treatment of Minors over 12 years of age: Currently, under Health and Safety Code section 124260 and Family Code section 6924, a therapist can provide services to a minor, twelve years or older, without parental consent, in certain circumstances. While LMFTs and registered interns are listed as appropriate providers, “trainees” have been left off the list of eligible providers. This impacts the number of providers available to the consumer, as well as limits the job opportunities for trainees. We have seen this impact services in schools, where many trainees gain their hours; the trainee providers send a consent form to the parents who are unwilling or unable to consent, and thus the student gets no services. This legislation added LMFT trainees to the H&S Code so that trainees, like LMFTs and Interns, can see clients 12 years of age and older without parent consent. The language also assures that trainees seek appropriate supervision consultation after seeing a minor without parental consent, if necessary. LPCC, LCSW and psychologists in training were also amended into AB 1808. This bill was signed by the Governor and goes into effect January 1, 2017.

AB 1863 (Wood): LMFTs Within Medi-Cal: Federally Qualified Health Centers: AB 1863 is a reintroduction of AB 858 (Wood- 2015) and AB 1785 (Lowenthal-2012). Current law provides that federally qualified health center services and rural health clinic services, as defined, are covered benefits under the Medi-Cal program to be reimbursed, to the extent that federal financial participation is obtained, to providers on a per-visit basis. “Visit” is defined as a face-to-face encounter between a patient of a federally qualified health center or a rural health clinic and specified health care professionals. This bill includes a marriage and family therapist within those health care professionals covered under that definition.

This bill was signed by the Governor and goes into effect January 1, 2017. CAMFT is currently working with stakeholders to best determine how this law will be implemented in the various clinics throughout California.

Other 2016 State Legislation

AB 1644 (Bonta): Early Mental Health Intervention: This bill, among other things, established a 4-year pilot program, the School- Based Early Mental Health Intervention and Prevention Services Support Program, to provide outreach and free regional training for local educational agencies (LEAs) in providing mental health services at school sites. The bill required the State Department of Public Health to submit specified reports after two and four years. Given the lack of mental health providers accessible to the K-12 school system, and the lack of information flowing from LEAs to the state, CAMFT believes this legislation increases quality services at the schools, as well as increases job opportunities for members. CAMFT was in support of this legislation. This bill did not make it out of Senate Appropriations, and we are hopeful it will be reintroduced in the coming years.

AB 1715 (Holden): Licensure of Behavioral Analysts: This bill established the Behavior Analyst Act, which provides for the licensure, registration, and regulation of behavior analysts and assistant behavior analysts, and requires the California Board of Psychology to administer and enforce the Act. While CAMFT is in support of the better regulation of applied behavioral analysts, especially given the vulnerability of the population served, there were numerous sections of this bill that caused concern. Some of these concerns included: those working towards licensure could only do so under a psychologist or licensed Behavior Analyst (not a LMFT, LPCC, or LCSW); to gain licensure the M.A. degree must be in psychology or behavioral analysis (excluding most of our practitioners—many who currently work in applied behavioral analysis); there were no real qualifications or standards for the ABA technicians, who will be doing much of the work with this population; interns were not listed as those that could work in ABA; they were not deemed mandated reporters; and we had concerns that this bill would create a “Gold Standard” for what health care plans would require for reimbursement. This bill, that CAMFT opposed, died for the 2016 legislative year.

AB 1884 (Harper): Mental Health Awareness License Plates: This bill required the Department of Health Care Services (DHCS) to apply to the DMV to create a specialized license plate program to promote mental health awareness. According to the author, “Awareness is an important part of treating mental health issues in California. This bill will let Californians spread the word about this critical issue every time they get in their cars.” CAMFT was in support of this piece of legislation, however it did not make it out of the Assembly Appropriations Committee.

AB 1917 (Obernolte): Educational Requirements for LMFTs and LPCCs: This bill proposed modifications to the education required to become an LPCC or an LMFT as follows: 1) It amended the coursework and practicum required of LPCC applicants in order to ensure that the degree was designed to qualify the applicant to practice professional clinical counseling; and, 2) It amended the law to define education gained out -of-state based on the location of the school, instead of based on the residence of the applicant. This concept had previously been discussed and approved by stakeholders, including CAMFT. CAMFT was in support of this legislation, and it has been signed by the Governor. It goes into effect January 1, 2017.

AB 2262 (Levine): Prisoners-Mental Health Treatment: This bill allowed 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 mandated 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 to parole or post-release community supervision which specifies the manner in which the defendant will receive mental health treatment services following that release. CAMFT was in support of this legislation, but it died in the Assembly Appropriations Committee.

AB 2507 (Gordon): Telehealth Access: This bill required health care service plans and health insurers to reimburse telehealth services to the same extent as services provided through in person. A few of the sections included: 1) Requirement that a health plan or health insurer include in its plan contract coverage and reimbursement for services provided to a patient through telehealth to the same extent as though provided in person or by some other means; 2) Requirement that a health plan or health insurer reimburse a health care provider for the diagnosis, consultation, or treatment of the enrollee when the service is delivered through telehealth at a rate that is at least as favorable to the health care provider as those established for the equivalent services when provided in person or by some other means; and, 3) Revision of the definition of telehealth to include video communications, telephone communications, email communications, and synchronous text or chat conferencing. Although CAMFT was in support of this legislation, it did not make it out of the Assembly Appropriations Committee. We are very hopeful that it will be reintroduced next year.

AB 2606 (Grove): Mandated Reporting of Licensees: This bill required a law enforcement agency to report to a state licensing agency (like the BBS) if the law enforcement agency receives or makes a report that one of the licensing agency’s licensees has allegedly committed certain crimes, including failure to file a mandated report. While CAMFT believes it is important to uphold the integrity of the profession, as well as protect our most vulnerable populations (children, elders, dependent adults, persons with disabilities), we are concerned that the language as currently written could lead to frivolous complaints/ reports against providers. This bill died in the Assembly Appropriations Committee.

AB 2607 (Ting): Gun Restraining Order: This bill expanded current law to include mental health providers as those who are eligible to apply for a gun violence restraining order (GVRO) for their patients. While we concur with the author that “…mental or emotional crises combined with access to firearms can be a deadly combination,” including mental health providers as petitioners for a GVRO is not the solution. Mental health providers have in place the ability (and often the duty) to breach confidentiality if they believe that their patient is a harm to themselves or others—AB 2607 muddied the waters on a mental health provider’s duty and obligation. Moreover, the language was very vague, as written—including no clear guidance on when a provider could/should apply for a GVRO. The lack of clarity leads to misunderstandings, unnecessary breaches of confidentiality and frivolous (but damaging) lawsuits against providers. Lastly, the language provided for no protection to the provider who did choose to breach confidentiality— there is still the ability for the patient to sue for that breach. This bill, which was opposed by CAMFT, was vetoed by the Governor.

SB 614 (Leno): Peer Specialist: This bill required the State Department of Health Care Services (DHCS) to develop a peer and family support specialist certification program. While we are concerned about the current lack of regulation of peer counselors, this bill does not provide a clear definition of a peer and family support specialist, as well as does not adequately address therapy services currently performed by existing therapists—these tasks appear to be delegated to DHCS. AAMFT-CA, the LPCCs, and psychologists have all conveyed similar concerns on this bill. CAMFT was opposed to this bill and it ultimately died late in the 2016 legislation season.

SB 1101 (Wieckowski): Licensed Alcohol and Drug Counselors: This bill established the Alcohol and Drug Counseling Professional Bureau within the Department of Consumer Affairs (DCA) to license and regulate licensed alcohol and drug counselors. CAMFT is generally in favor of better regulation of those providing alcohol and drug counseling to consumers in California, especially those working in private practices. However, the language of the bill as written was problematic. CAMFT requested certain amendments be introduced, including: scope of practice definition; clarity that this licensure does not interfere with current work being done by LMFTs; greater clarification of grand-parenting of non-Masters level providers; and less left to regulation. This bill did not make it out of the Senate Appropriations Committee and died.

SB 1113 (Beall): Pupil Mental Health: This bill authorized local educational agencies (LEAs) to enter into partnerships, as specified, with county mental health plans for the provision of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mental health services and to expand the allowable uses of specified mental health funds, and required the California Department of Education (CDE) to expand its reporting system for mental health services to include academic performance and other measures. Similar to AB 1644, CAMFT believes this bill would have increased the quality and quantity of mental health services within the K-12 schools, as well as increased jobs for mental health providers, like LMFTs. CAMFT was in support of this bill. Unfortunately, this bill was vetoed by the Governor.

SB 1155 (Morrell): Licensing Veterans: This bill required every board under the Department of Consumer Affairs, including the BBS, to grant a waiver for the application and initial licensing fee to an honorably discharged veteran. It is worth noting that the BBS already provides for an expedited review process for military applicants. CAMFT was in support of this legislation. This bill did not make it out of Assembly Appropriations.

SB 1478 (Committee on Business, Professions and Economic Development): Among other things, this non-controversial technical bill changed the title for those obtaining hours towards licensure as a Marriage and Family Therapist from “Intern” to “Associate.” The bill also reinforced that interns, trainees, and associates may not be employed as independent contractors, and that they may not gain any experience hours for work performed as an independent contractor. CAMFT was in support of this bill. This bill has been signed by the Governor and goes into effect in January 2018. More information on the implementation of this law will be coming up in the next few months.

FEDERAL LEGISLATION & REGULATION

Affordable Care Act (ACA): Since the November election, CAMFT has received many inquires as to the effects of a potential repeal of the ACA both federally and statewide. It is too early to conjecture, given President-Elect Trump has not yet taken office at the time of this writing, stakeholders are just beginning to provide briefings and analysis, the intricate and complicated reliance various sections of the ACA have upon one another, and California’s heavy expansion of the ACA. Instead of an immediate repeal of the entire ACA, it is likely we will see the ACA slowly dismantled, section by section, while a replacement is created and put forward. Whether the replacement is better or worse for those with mental health care costs and/or providers has yet to be determined. Approximately 1/3 of Californians rely on the ACA for their coverage, 16 of California’s 19 billion in health care funds is from the federal government, and while California does have state funding to cover some of the costs created by the ACA, it cannot cover all the Californians covered by the ACA. As developments occur, we will keep our members updated on this important issue.

Medicare: At the very close of the 114th Congress, Congress passed a health reform bill (“21st Century Cures.”) The consensus in Washington by the mental health advocacy groups is that the mental health bill part of the “21st Century Cures” legislation is a good, small first step to address some of the varied, complex problems that exist in delivering mental health services in America to patients. Despite CAMFT’s and the Medicare Access Coalition’s best efforts, this bill did not include provisions that would allow LMFTs to become Medicare providers. However, the advocacy and grassroots efforts put forward in 2015/2016 will serve as a basis for our efforts to have a Medicare bill introduced and attached to 2017 legislation on mental health.

Veterans Affairs: As a follow up to the passage of the legislation that removes the COAMFTE requirement for employment in the VA for LMFTs, CAMFT representatives are meeting with the staff of the VA to address implementation of this new law. One of the structural problems in this effort is to get the central office of the VA to quickly alter the hiring regulations that are followed by the human resource staff f at the local level. Concurrent with this effort, we are meeting with the VA to work on opening up more employment opportunities for MFTs in the VA, particularly in their internship program.

Nuclear Regulatory Commission (NRC): In 2010, CAMFT petitioned the NRC to include LMFTs as Substance Abuse Experts (SAEs). CAMFT has been in regular communication with the NRC regarding the lengthy and frustrating delays. Although the NRC staff stated that they are currently developing a rulemaking plan, they also indicated that the new administration generally opposes the creation of new regulations—this will likely create even additional delays. CAMFT will continue to advocate in 2017 in the hopes that the NRC will prioritize this issue. Once the final rule is approved, it will open the door to new jobs for LMFT professionals as SAEs within the NRC.

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.