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Written on February 8, 2017
Catherine Atkins, JD Deputy Executive Director
The California legislative session for 2017 is well underway as we enter the first year of a two-year legislative cycle. Hundreds of bills are currently being introduced that CAMFT will review to determine the impact on CAMFT members and the profession. This article provides a brief overview on CAMFT bills and bills of interest reviewed to-date. For more complete descriptions, as well as the full list of bills CAMFT will be following this year, you can 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 Licensed Marriage and Family Therapists (LMFTs) and Licensed Professional Clinical Counselors (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 may end up being held longer than 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.
SB 374 (Newman)—Mental Health Parity: CAMFT is a co-sponsor of this legislation, that would mandate health care policies 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, as well as continue MHPAEA enforcement authority even if there is an Affordable Care Act (ACA) repeal. The California Psychiatric Association is a co-sponsor, and it is likely that other co-sponsors will join as the legislative season moves forward.
Other 2017 State Legislation
AB 93 (Medina): This bill, sponsored by the Board of Behavioral Sciences (BBS), would revise and recast BBS licensee supervised experience requirements. To address changing and evolving supervised experience and supervisor relationships, in 2014, the BBS formed a special committee for two years that examined 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:
Supervisors to monitor for and address clinical dynamics, including countertransference, intrapsychic-, interpersonal-, or trauma-related issues that may affect the supervisory or practitioner-patient relationship;
Supervisors to directly observe or review recordings of supervisee’s counseling, as deemed appropriate;
Supervisors to review supervisee’s progress notes, process notes, and other patient treatment records, as deemed appropriate;
The BBS will obtain the right to audit the records of supervisors to verify completion of supervisor qualifications; and,
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 supports the majority of the changes as proposed.
NOTE: Since the deadline for bill introduction will take place after this article has been drafted, CAMFT will have a full assessment of all relevant bills in the next issue of The Therapist.
LMFTs within FQHCs/RHCs: CAMFT sponsored Assembly Bill 1863 (2016-Wood) adding 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 can be hired in these entities so that adequate services can be provided to the patients of these facilities. 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 the effect an ACA repeal, and/or insufficient replacement funds, might have on Medi-Cal funding, Governor Brown has delayed implementation of AB 1863 until at least July 2018. Although CAMFT will be advocating for the removal of the delay to AB 1863, it is unlikely the Governor will change his mind given the concerns over increases in the state’s share of Medi-Cal expansion costs and the uncertainty of ACA federal funding. CAMFT will urge the legislature/Governor to set a “no later than” date for the implementation within the bill.
LMFTs within K-12 Schools: CAMFT continually seeks 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, and unmet mental health needs rank among the most pressing concerns for California educators, directly affecting student attendance, behavior and readiness to learn. CAMFT has begun discussions with the Steinberg Institute as they begin their review of the mental health needs of children in the K-12 school system.
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.
Managed Care Advocacy: CAMFT continues to advocate on a variety of issues, including but not limited to: pushing the Department of Health Care Services (DHCS) to enforce counties and plans recognition of MFT Registered Interns as Medi-Cal providers; working with the DMHC to survey health plans on their approaches to tele-health; formulating communications with plans to educate on members’ concerns regarding provider reimbursement rates; and meeting with various plans on continued administrative burden issues, including audits, late reimbursements and authorizations.
Affordable Care Act: CAMFT continues to advocate in Washington DC, urging the California Congressional delegation as well as House and Senate leader not to repeal the ACA without concurrently replacing it with a legislative vehicle safeguarding Californians’ access to comprehensive mental and behavioral health, as well as substance abuse services. Specifically, CAMFT is advocating to keep mental health and addiction treatment an “essential benefit,” mandated coverage of patients with pre-existing conditions, and protection of the Medi-Cal expansion which covers 5 million Californians. CAMFT will continue to lobby, and mobilize our members to act as grassroots advocates for the protection of this vulnerable population.
Medicare: CAMFT’s priority on the federal landscape is to pass legislation that will allow LMFTs to reimburse as Medicare providers alongside psychologists and LCSWs. 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 seeking out replacement sponsors 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 April.
Due to the focus on ACA repeal and replacement, it appears that any significant revision of Medicare will need to wait for the ACA overhaul to begin (which will likely last until late Spring 2017, at its earliest).
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 (the 2016 bill signed into law removing the requirement that LMFTs must be graduates of COAMFTE-accredited programs in order to work at the VA.) It has been reported to CAMFT that a committee consisting of five LMFTs employed through the VA, as well as a psychologist, have begun drafting the new employment standards for LMFT hiring with a target date of completion of late Spring. It then goes through a multi-tiered internal department review. CAMFT will continue to lobby a swift review and implementation.
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.
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.