Written on February 8, 2016

Catherine Atkins, JD
Deputy Executive Director

The 2016 California legislative session is well underway, as we enter the second year of a two-year legislative cycle. Hundreds of bills have recently been introduced, which CAMFT has reviewed to determine the impact on CAMFT members and the profession; some bills are still under review as we learn more about their intent and effect. This article provides a brief overview on CAMFT bills and some of the bills CAMFT influenced this year. For more complete descriptions, as well as the full list of bills CAMFT followed this year, you can subscribe to CAMFT’s Action E-lerts for CAMFT emails on key pieces of legislation.

STATE ADVOCACY

CAMFT Legislation for 2016 As of this writing, two of CAMFT’s legislative priorities have been introduced as legislation. This is a significant accomplishment given the limited amount of bills each legislator can author and a testament to CAMFT’s sphere of influence in Sacramento.

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. If a registered intern was in the same position and the parents did not consent, the student (twelve years or older) could consent on his/her own behalf. This legislation would add LMFT trainees to the H&S Code and Family Code so that trainees, like LMFTs and Interns, can see clients 12 and older w/o parent consent.

AB 1863 (Wood): LMFTs Within Medi-Cal: Federally Qualified Health Centers: AB 1863 is a reintroduction of AB 858 (Wood2015) 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 would include a marriage and family therapist within those health care professionals covered under that definition.

AB 858 received immense support from the legislature and stakeholders in 2015. And although Governor Brown did not object to the merits of the bill, the veto message stated that it “…unnecessarily… required the expansion or development of new benefits and procedures in the Medi-Cal program…[it]would require new spending at a time when there is considerable uncertainty in the funding of this program. Until the fiscal outlook for Medi-Cal is stabilized, I cannot support any of these measures.” We are hopeful that with the advocacy to fund mental health in California underway in 2016, the Governor will be more open to passage of this bill.

LMFT Interns with the CDCR: In 2009, AB 1113 (Lowenthal/ Anderson) was signed by the Governor, that amended Penal Code, Section 5068.5(c) to allow persons aspiring to MFT licensure to work within the Department of Corrections and Rehabilitation (CDCR), as was the case with persons pursuing psychology and social work licenses. Unfortunately, in 2010, through a Budget Trailer bill, this section was removed—it is unclear if the removal was intentional or accidental. Accordingly, CAMFT would like to see this amendment reinserted into PC 5068, to allow those pursuing MFT licensure, to have a vehicle to obtain a job in the CDCR. The timing of this advocacy is still being discussed as the CDCR is not currently experiencing significant vacancy rates for mental health providers, as it was in 2009, making for a more difficult legislative process.

Other 2016 State Legislation AB 41 (Chau): Health Care Coverage Discrimination: Existing federal law, beginning January 1, 2014, prohibits a group health plan and a health insurance issuer offering group or individual health insurance coverage from discriminating with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law. This bill would prohibit a health care service plan or health insurer from discriminating against any health care provider who is acting within the scope of that provider’s license. CAMFT was in support of this bill. This bill did not make it out of the Assembly Appropriations Committee, and is a two-year bill.

AB 796 (Nazarian): Health Care Coverage of ABA Services: This bill modifies the definition of “qualified autism service professional” to allow insurance coverage for types of behavioral health treatment other than applied behavior analysis, specifically LCSWs and Psychologists in training. While we agree with the general intent of AB 796, we are very concerned about the exclusion of Marriage and Family Therapist Registered Interns, who are qualified to do this work, as well as already working in the field. This could lead to the loss of jobs, as well as a lack of desire to hire additional MFT Interns. CAMFT took an Oppose Unless Amended position to this bill. AB 796 met with great opposition by other stakeholders and is now a two year bill.

SB 614 (Leno): Peer Specialist: This bill requires the State Department of Health Care Services to develop a peer and family support specialist certification program. While we agree with the intent given the lack of current 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. The BBS, has taken an Oppose Unless Amended position to this bill for the above concerns, and while CAMFT has not taken an official oppose position, we have conveyed those concerns to the Author, as has AAMFT-CA, the LPCCs, and psychologists. This bill did not make it out of the Assembly Appropriations Committee and is now a two-year bill.

Non-Legislative Advocacy Reimbursement for Telehealth Services: California law mandates that managed health care service plans and insurers cover telehealth services (Health and Safety Code, §1374.13, Welfare and Institutions Code §14132.72, and Insurance Code §§10123.13 and 10123.85). Over the course of the last few years, however, some insurance companies are maintaining the law does not require telehealth to be covered, or have created additional barriers to reimbursement. CAMFT recently met with the California Association of Health Plans (CAHP) to discuss this situation, which confirmed a different interpretation of the controlling law on telehealth. CAMFT and other stakeholders will be reviewing and planning next steps in the coming months, including meeting with legislators.

BBS Regulations on Telehealth: The BBS has created regulations which would guide how psychotherapists practice telehealth in California. For instance, providers licensed in California that wish to provide services to out of state clients would need to adhere to the patient’s state’s laws surrounding how a provider can practice within the state in question. Also, providers that wish to provide therapy to patients that live in California, must be licensed/registered in California. To review the entire regulation package, see: http://bbs. ca.gov/bd_activity/reg_pending.shtml. These regulations are expected to be final this summer.

LMFTs within the Schools: CAMFT is seeking to find ways to increase the presence of LMFTs in the K-12 school system in California. Currently there are unnecessary barriers for ensuring that students receive necessary and competent mental health care services in the K-12 school system in California. Unmet mental health needs rank among the most pressing concerns for California educators, directly affecting student attendance, behavior and readiness to learn. Depending on the district, LMFTs and other licensed psychotherapists are unable to obtain jobs within the school based on credentialing requirements—creating schools that have no mental health services or services rendered by individuals either underqualified or overloaded with other school duties. This not only limits jobs for qualified psychotherapists, but harms children needing services. Accordingly, CAMFT is advocating on ways to open the doors to greater mental health providers within the schools, including LMFTs. We are hopeful to meet with the Department of Education/Commission on Teacher Credentialing in the coming year to advocate on this important issue.

DMV Gender Identity: In March 2013, CAMFT submitted an informal proposal to the Department of Motor Vehicles (“DMV”) to request an amendment to Section 20.05 of Adm. Code, Title 13, to add 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. The DMV has assured CAMFT that this proposal will be out to the public by summer 2016.

FEDERAL LEGISLATION & REGULATION

Medicare Bi-partisan HR 2759 was introduced in 2015, which would amend title XVIII of the Social Security Act to provide for the coverage of marriage and family therapist services and mental health counselor services under part B of the Medicare program. To date, HR 2759 has 38 co-sponsors; CAMFT has sent a member-wide grassroots request for members to pressure their congressperson to co-sponsor HR 2759—this resulted in 16 co-sponsors from our California districts. The companion bill, S. 1830, was introduced by Senator Barrasso (WY).

Tragically, with the numerous mass shootings of late, there is increased interest in passing a wide reaching mental health bill in both the House and the Senate. The Republican majority has centered its efforts on a pharmacy bill sponsored by Rep. Tim Murphy (R-PA), a child psychologist. Along with our coalition partners, we have been actively seeking support among members of the Energy and Commerce Committee, such as Representatives Anna Eshoo (D-18) and Doris Matsui (D-6), to urge Rep. Murphy to add our Medicare bill to his legislation. Similar efforts in the Senate with a similar mental health bill being sponsored by Senators Cassidy (R-LA) and Murphy (D-CT) are underway, although that bill is not as far along in the legislative process. Finally, there is a Medicare bill related to hospital costs being developed in the Ways and Means Committee; although related to hospitals, there is recognition by the staff that our bill will cut down on hospital admissions, thus saving money. If HR 2759 is included into one of these larger bill packages, grassroots efforts will be engaged.

In addition, conversations in early February with staff of the two Committees in the House of Representatives that have jurisdiction over Medicare revealed that there may be a possibility that a package of relatively non-controversial bills, such as ours, will be cobbled together into one package and brought to the floor for a vote.

Veterans Affairs CAMFT awaits feedback from the VA on a proposal that CAMFT has put forward to solve the COAMFTE problem without legislation. Absent that agreement, we are exploring with Congressional staff the insertion of language in the Committee Report that accompanies the Veteran Department’s funding bill addressing this problem. Additionally, we are actively advocating for passage of HR 2639, the bill introduced by Rep. Scott Peters (D-52) that would remove the COAMFTE bar by statute. Currently, it has 10 co-sponsors, with 4 from California districts including Representatives Brownley (D-26), Takano (D-41), Huffman (D-2), and Napolitano (D-32).

In addition, we are engaged with the VA and the Office of Personal Management (OPM) in an effort to create a specific classification in the Federal Government’s employment grades for LMFTs.

Nuclear Regulatory Commission (NRC) In 2010, CAMFT petitioned the NRC to include LMFTs as “Substance Abuse Experts.” At this point, the petition is in final rulemaking phase for approximately one more year- late 2016. CAMFT has been in continued communication with the NRC inquiring as to the lengthy and frustrating delays—and have been assured that there should not be any more delays. 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.