BILL ANALYSIS Ó AB 2213 Page 1 Date of Hearing: April 8, 2014 ASSEMBLY COMMITTEE ON BUSINESS, PROFESSIONS AND CONSUMER PROTECTION Susan A. Bonilla, Chair AB 2213 (Eggman) - As Amended: March 28, 2014 SUBJECT : Behavioral health care licensees. SUMMARY : Revises the current education and curriculum requirements for licensure as a Marriage and Family Therapist (MFT) and Professional Clinical Counselor (PCC) for out-of-state applicants who are applying for licensure on or after January 1, 2016. Specifically, this bill affects the following license categories, as specified : For persons licensed outside of California and apply for licensure as a MFT on or after January 1, 2016: 1)Permits the Board of Behavioral Sciences (BBS) to accept time actively licensed as a MFT towards licensure at a rate of 100 hours per month, up to a maximum of 1,200 hours if the if the applicant has less than 3,000 hours of qualifying supervised experience and the applicant's degree meets specified practicum requirements without exemption and remediation. For persons who do not hold a license outside of California and apply for licensure or registration as a MFT on or after January 1, 2016: 2)Revises the current number of units required for an applicant educated outside of California as follows: a) For an applicant who obtained his or her degree within a specified timeline, the degree must contain no less than 60 semester units or 90 quarter units of instruction, and up to 12 semester or 18 quarter units of instruction may be remediated if missing from the degree and may occur while the applicant is registered as an intern; b) For an applicant who obtained his or her degree within a specified timeframe, the degree must contain no less than 48 semester units or 72 quarter units of instruction; and, c) An additional 75 hours of either face-to-face counseling AB 2213 Page 2 or client-centered advocacy, or a combination thereof. 3)Revises the coursework requirements for California law and ethics as follows: a) An applicant who completed a course in law and professional ethics for MFTs, as specified, that did not contain instruction in California law and ethics must complete an 18-hour course, as specified, prior to registering as an intern; and, b) An applicant, who has not completed a course in law and professional ethics for MFTs, as specified, must complete coursework which contains content specific to California law and ethics and completes the coursework prior to registration as an intern. 4)Clarifies for an applicant who completes specified educational requirements, which were not completed during his or her education, that the coursework must be from an accredited school, college or university, as specified, an educational institution approved by the Bureau of Private Postsecondary Education (BPPE) or from a continuing education provider that is acceptable to BBS, as specified, which cannot be undergraduate coursework. 5)Requires an applicant to complete the following coursework, which cannot be undergraduate coursework, not already completed in his or her education from a specified educational institution: a) At least three semester units or 45 hours of instruction regarding the principles of mental health recovery-oriented care and methods of service delivery in recovery-oriented practice environments, including structured meetings with various consumers and family members of consumers of mental health services to enhance understanding of their experience of mental illness, treatment, and recovery; and, b) At least one semester unit, or 15 hours, of instruction that includes an understanding of various California cultures and the social and psychological implications of socioeconomic position. 6)Clarifies that an applicant may complete any specified units AB 2213 Page 3 and course content requirements not already completed in his or her education while registered as an intern, unless otherwise specified. For persons licensed outside of California and apply for licensure or registration as a MFT on or after January 1, 2016: 7)States that education will be considered substantially equivalent if all of the following requirements are met: a) The degree is obtained from a school, college or university accredited by an accrediting agency recognized by the United States Department of Education and consists of: i) For an applicant who obtained his or her degree within a specified timeframe, the degree must contain no less than 60 semester or 90 quarter units of instruction and up to 12 semester or 18 quarter units of instruction may be remediated while registered as an intern. b) For an applicant who obtained his or her degree within a specified timeline, the degree must contain no less than 48 semester or 72 quarter units of instruction; c) Six semester or nine quarter units of practicum, including but not limited to, a minimum of 150 hours of face-to-face counseling, and an additional 75 hours of either face-to-face counseling or client-centered advocacy, or a combination thereof; i) An out-of-state applicant, who has been licensed for at least two years in clinical practice, as verified by the BBS, is exempt from the requirement above; and, ii) An applicant who has been licensed for less than two years in clinical practice, as verified by the BBS, who does not meet the practicum requirement, is required to remediate it by obtaining 150 hours of face-to-face counseling and an additional 75 hours of either face-to-face counseling or client-centered advocacy, as specified, in addition to the 3,000 hours of experience required while registered as an intern. d) Twelve semester or 18 quarter units in the areas of AB 2213 Page 4 marriage, family, and child counseling and marital and family systems, and approaches to treatment, as specified. 8)Specifies that an applicant must complete coursework in law and ethics as follows: a) An applicant who has completed a course in law and professional ethics for MFTs, as specified, that did not include instruction in California law and professional ethics must complete an 18 hour course in California law and professional ethics prior to registering as an intern, and the content of the course must at least include, advertising, scope of practice, scope of competence, treatment of minors, confidentiality, dangerous patients, psychotherapist-patient privilege, recordkeeping, patient access to records, state and federal laws relating to confidentiality of patient health information, dual relationships, child abuse, elder and dependent adult abuse, online therapy, insurance reimbursement, civil liability, disciplinary actions and unprofessional conduct, ethic complaints and ethical standards, termination of therapy, standards of care, relevant family law, therapist disclosure to patients, differences in legal and ethical standards in different types of work settings, and licensing law and licensing process prior to registering as an intern; and b) An applicant, who has not completed a course in law and professional ethics for MFTs, as specified, shall complete the coursework which includes content specific to California law and ethics, prior to registering as an intern. 9)Permits coursework not already completed during an applicant's education to be from an accredited school, college or university, as specified, from the BPPE, or from a continuing education provider that is acceptable to BBS, and cannot be undergraduate. 10)Requires an applicant to complete coursework, not already completed in his or her education, from an accredited school, college or university, as specified, from the BPPE, or from a continuing education provider that is acceptable to BBS, and is not undergraduate to include: AB 2213 Page 5 a) At least three semester units or 45 hours of instruction regarding the principles of mental health recovery-oriented care and methods of service delivery in recovery-oriented practice environments, including structured meetings with various consumer and family members of consumers of mental health services to enhance understanding of their experience of mental illness, treatment, and recovery; and b) At least one semester unit or 15 hours of instruction that includes an understanding of the various California cultures and the social and psychological implications of socioeconomic position. 11)Clarifies that an applicant's degree title does not need to be identical to other specified degree titles. 12)Specifies that an applicant may complete specified units and course content requirements not already completed in his or her education, while registered as an intern unless otherwise specified. For persons who apply for licensure as a MFT between January 1, 2010, and December 31, 2015, and hold a valid license issued by a board or corresponding authority outside of California: 13)Permits BBS to accept time actively licensed to be accepted toward licensure at a rate of 100 hours per month, up to a maximum of 1,200 hours if the applicant has less than 3,000 hours of qualifying supervised experience. For persons who do not hold a license outside of California and apply for licensure or registration as a MFT on or after January 1, 2016: 14)Requires an applicant to meet the following educational requirements: a) A minimum of two semester units of instruction in the diagnosis, assessment, prognosis, and treatment of mental disorders, including severe mental disorders, evidence-based practices, psychological testing, psychopharmacology, and promising mental health practices that are evaluated in peer review literature; this must include at least one semester unit or 15 hours of instruction in psychological testing and at least one AB 2213 Page 6 semester unit or 15 hours of instruction in psychopharmacology; b) Training in developmental issues from infancy to old age, including demonstration of at least one semester unit or 15 hours of instruction that includes the following subjects: i) The effects of developmental issues on individuals, couples, and family relationships; ii) The psychological, psychotherapeutic, and health implications of developmental issues and their effects; and, iii) The understanding of the impact that personal and social insecurity, social stress, low education levels, inadequate housing, and malnutrition have on human development and specifies that an applicant who is deficient in any of the subject above may remediate the coursework by completing three hours of instruction in each deficient subject. c) Training in the broad range of matters and life events that may arise within marriage and family relationships and within a variety of California cultures, including instruction in the following: i) A minimum of seven contact hours of training or coursework in child abuse assessment and reporting, as specified, and any regulations promulgated; ii) A minimum of ten contact hours of coursework that includes: (1) The assessment and reporting of, as well as treatment related to, elder and dependent adult abuse and neglect; (2) Aging and its biological, social, cognitive, and psychological aspects; (3) Long-term care; and (4) End-of-life grief. AB 2213 Page 7 iii) A minimum of 15 contact hours of coursework in spousal or partner abuse assessment, detection, intervention strategies, and same-gender abuse dynamics; iv) Cultural factors relevant to abuse of partners and family members; v) Childbirth, child rearing, parenting, and step-parenting; vi) Marriage, divorce, and blended families; vii) Poverty and deprivation; viii) Financial and social stress; ix) Effects of trauma; and, x) The psychological, psychotherapeutic, community and health implications of the matters and life events, as specified. d) At least one semester unit, or 15 hours, of instruction in multicultural development and cross-cultural interaction, including experiences of race, ethnicity, class spirituality, sexual orientation, gender, and disability, and their incorporation into the psychotherapeutic process; e) A minimum of 10 contact hours of training or coursework in human sexuality, as specified, including the study of physiological, psychological, and social cultural variables associated with sexual behavior and gender identity, and the assessment and treatment of psychosexual dysfunction; f) A minimum of 15 contact hours of coursework in substance use disorders, co-occurring disorders and addiction and the coursework must include: i) The definition of substance use disorders, co-occurring disorders and addiction and defines "co-occurring" to mean a mental illness and substance abuse diagnosis occurring simultaneously in an individual; AB 2213 Page 8 ii) Medical aspects of substance use disorders and co-occurring disorders; iii) The effects of psychoactive drug use; iv) Current theories of the etiology of substance abuse and addiction; v) The role of persons and systems that support or compound substance abuse and addiction; vi) Major approaches to identification, evaluation, and treatment of substance use disorders, co-occurring disorders, and addiction, including best practices; vii) Legal aspects of substance abuse; viii) Populations at risk with regard to substance use disorders and co-occurring disorders; ix) Community resources offering screening, assessment, treatment, and follow-up for the affected person and family; x) Recognition of substance use disorders, co-occurring disorders, and addiction and appropriate referral; and, xi) The prevention of substance use disorders and addiction. g) A minimum of a two semester or three quarter unit course in law and professional ethics for MFTs, including instruction in the following: i) Contemporary professional ethics and statutory, regulatory, and decisional laws that delineate the scope of practice of marriage and family therapy; ii) The therapeutic, clinical and practical considerations involved in the legal and ethical practice of marriage and family therapy, including family law; iii) The current legal patterns and trends in the mental health professions; AB 2213 Page 9 iv) The psychotherapist-patient privilege, confidentiality, the patient dangerous to self or others and the treatment of minors with and without parental consent; v) A recognition and exploration of the relationship between a practitioner's sense of self and human values and his or her professional behavior and ethics; vi) Differences in legal and ethical standards for different types of work settings; and, vii) Licensing law and licensing process. For persons who apply for licensure as an MFT between January 1, 2010, and December 31, 2015, who have gained experience out-of-state: 15)Permits BBS to accept time actively licensed as a MFT to be accepted towards licensure at a rate of 100 hours per month, up to a maximum of 1,200 hours if the applicant has less than 3,000 hours of qualifying supervised experience. For persons who apply for examination eligibility or registration, as a PCC, between January 1, 2011, and December 31, 2015, and who are not licensed out-of state: 16)Exempts an applicant from taking an 18-hour ethics course, as specified, if the applicant completed a course that included instruction in California law and ethics. For persons who apply for examination eligibility between January 1, 2011 and December 31, 2015, and who have held a PCC license, out-of-state, for at least two-years: 17)Permits BBS to accept time actively licensed as a PCC to be accepted towards licensure at a rate of 100 hours per month, up to a maximum of 1,200 hours if the applicant has less than 3,000 hours of qualifying supervised experience. 18)Exempts an applicant from taking an 18-hour ethics course, as specified, if the applicant completed a course that included instruction in California law and ethics. AB 2213 Page 10 For persons who apply for examination eligibility between January 1, 2011 and December 31, 2015, and who have held a PCC license, out-of-state, for less than two-years: 19)Permits BBS to accept time actively licensed as a PCC to be accepted towards licensure at a rate of 100 hours per month, up to a maximum of 1,200 hours if the applicant has less than 3,000 hours of qualifying supervised experience. 20)Exempts an applicant from taking an 18-hour ethics course, as specified, if the applicant completed a course that included instruction in California law and ethics. For persons who apply for examination eligibility for licensure as a PCC who are licensed outside of California and apply on or after January 1, 2016: 21)Permits BBS to accept time actively licensed as a PCC to be accepted towards licensure at a rate of 100 hours per month, up to a maximum of 1,200 hours if the if the applicant has less than 3,000 hours of qualifying supervised experience and the applicant's degree meets specified practicum requirements without exemptions or remediation. For persons who apply for examination eligibility or registration as a PCC on or after January 1, 2016, who do not hold a license outside of California: 22)Clarifies that education is considered substantially equivalent if: a) For an applicant who obtained his or her degree within a specified timelime, the degree must contain no less than 60 graduate semester or 90 graduate quarter units, and up to 12 semester or 18 quarter units of instruction may be remediated while registered as an intern; and, b) For an applicant who obtained his or her degree within a specified timeline, the degree must contain no less than 48 graduate semester or 72 graduate quarter units of instruction, as specified. 23)Clarifies that an applicant whose degree is deficient, as specified, may satisfy those deficiencies by successfully completing graduate level coursework at an accredited or AB 2213 Page 11 approved institution and the coursework taken must be the equivalent of three semester units or four and one-half quarter units of study. 24)Provides that an applicant who completed a course in professional orientation, ethics, and law in counseling that did not contain instruction in California law and professional ethics must complete an 18-hour course, as specified, prior to registering as an intern. 25)Provides that an applicant, who has not completed a course in law and professional ethics for MFTs, as specified, shall complete the coursework which includes content specific to California law and ethics, prior to registering as an intern. 26)Requires an applicant who completes any units, as specified, not already in his or her education to comply with the following: a) At least 15 semester units or 22.5 quarter units of advanced coursework to develop knowledge of specific treatment issues or special populations in addition to currently required coursework; and b) Coursework must be from and accredited or approved school, college of university as specified. 27)Requires an applicant to complete the following graduate level coursework not already completed in his or her education to comply with the following: a) A minimum of 10 contact hours of training in human sexuality, as specified, including the study of the physiological, psychological, and social cultural variables associated with sexual behavior, gender identity, and the assessment and treatment of psychosexual dysfunction; b) A minimum of 15 contact hours of instruction in spousal or partner abuse assessment, detection, intervention strategies, and same-gender abuse dynamics; c) A minimum of seven contact hours of instruction in child abuse assessment, and reporting, as specified; and, d) A minimum of 10 contact hours of instruction in aging AB 2213 Page 12 and long-term care, including biological, social, cognitive, and psychological aspects of aging, and include instruction on the assessment and reporting of, and treatment related to elder and dependent adult abuse and neglect. 28)Requires an applicant who completes coursework not already completed in his or her education to be at a graduate level and include: a) At least three semester units or 45 hours of instruction regarding the principles of mental health recovery-oriented care and methods of service delivery in recovery-oriented practice environments, including structured meetings with various consumers and family members of consumers of mental health services to enhance understanding of their experiences of mental illness, treatment and recovery; and b) At least one semester unit or 15 hours of instruction that includes and understanding of various California cultures and the social and psychological implications of socioeconomic position. 29)Clarifies that an applicant may complete units and course content requirements not already completed in his or her education while registered with the BBS as an intern. For persons who apply for examination eligibility or registration as a PCC on or after January 1, 2016, and hold a license outside of California: 30)Specifies that education is deemed substantially equivalent if: a) The degree was obtained at an accredited or approved institution, as specified, and consists of the following: i) For an applicant who obtained his or her degree within a specified timeframe, the degree must be no less than 60 graduate semester or 90 quarter units and up to 12 semester or 18 quarter units of instruction may be remediated if missing from the degree while registered as an intern. b) For an applicant who obtained his or degree within a AB 2213 Page 13 specified timeframe, the degree shall contain no less than 48 graduate semester or 72 graduate units of instruction; c) Six semester or nine quarter units of practicum, including but not limited to, a minimum of 280 hours of face-to-face counseling: i) An applicant who has been licensed for at least two years in clinical practice, as verified, is exempt; and, ii) An out-of-state applicant who has been licensed for less than two years in clinical practice, as verified by BBS, and does not meet the practicum requirement, shall remediate the requirement by demonstrating completion of a total of 280 hours of face-to-face counseling, as specified, in addition to the 3,000 hours of experience required and must be gained while registered as an intern. d) Specified areas of study: i) An applicant whose degree is deficient in no more than six of the required areas of study, as specified, may satisfy those deficiencies by successfully completing graduate level coursework which must be the equivalent of three semester units or four and one-half units of study; ii) An applicant who completed a course in professional orientation, ethics, and law in counseling that did not contain instruction in California law and ethics must complete an 18 hour course in California law and professional ethics, as specified; and, iii) An applicant who has not completed a course in professional orientation ethics and law in counseling, as specified must complete this coursework prior to registration as an intern. 31)Requires an applicant to complete any required units, as specified, not already completed in his or her education as follows: a) At least 15 semester units or 22.5 quarter units of advanced coursework to develop knowledge of specific treatment issues or special populations, in addition to AB 2213 Page 14 specified requirements; and, b) Coursework shall be from an accredited or approved school, college, or university, as specified. 32)Requires an applicant to complete the following coursework not already completed in his or her education: a) A minimum of 10 contact hours of training in human sexuality, as specified, and any regulations promulgated thereunder including the study of physiological, psychological and social cultural variables associated with sexual behavior, gender identity, and the assessment and treatment of psychosexual dysfunction; b) A minimum of 15 contact hours of instruction in spousal or partner abuse, assessment, detection, intervention strategies, and same-gender abuse dynamics; c) A minimum of seven contact hours of training or coursework in child abuse assessment and reporting, as specified; d) A minimum of 10 contact hours of instruction in aging and long-term care including biological, social, cognitive, and psychological aspects of aging and this coursework must include instruction on the assessment and reporting of, as well as treatment related to elder and dependent abuse and neglect; and, e) This coursework may be from an accredited or approved school, college or university, as specified, and undergraduate coursework will not satisfy this requirement. 33)Requires an applicant to complete the following coursework not already completed in his or her education from an accredited or approved school, college, or university, as specified, or from a continuing education provider that is acceptable to the BBS and undergraduate coursework will not satisfy this requirement: a) A least three semester units or 45 hours of instruction regarding the principles of mental health recovery-oriented care and methods of service delivery in recovery-oriented practice environments, including structured meetings with AB 2213 Page 15 various consumers and family members of consumers of metal health services to enhance understanding of their experience of mental illness, treatment, and recovery; and, b) At least one semester unit or 15 hours of instruction that includes an understanding of various California cultures and the social and psychological implications of socioeconomic position. 34)Provides that an applicant may complete any units and course content requirements, as specified, not already completed in his or her education while registered with the BBS as an intern, unless otherwise specified. 35)Makes other technical and clarifying changes. EXISTING LAW : 1)Establishes licensing requirements for MFT applicants who are licensed outside of California and apply for licensure on or after January 1, 2016. (Business and Professions Code (BPC) Section 4980.72) 2)Establishes registration, education and experience requirements for MFT applicants who currently do not hold a license outside of California, on or after January 1, 2016. (BPC 4980.74) 3)Establishes the equivalent education guidelines for MFT applicants licensed outside of California who apply for licensure on or after January 1, 2016, and obtained education outside of California, as specified. (BPC 4980.78) 4)Establishes the licensure requirements for MFT applicants who hold an out-of-state license and apply for licensure between January 1, 2010, and December 31, 2015, and repeals these requirements effective January 1, 2016. (BPC 4980.80) 5)Authorizes experience gained outside of California to be accepted towards the licensure requirements for MFT applicants who apply for licensure between January 1, 2010, and December 31, 2015, if specified criteria are met, and repeals that authority effective January 1, 2016. (BPC 4980.90) 6)Authorizes experience gained outside of California to be AB 2213 Page 16 accepted towards the licensure requirements for PCCs applicants who apply for examination or eligibility requirements between January 1, 2011, and December 31, 2015, if specified criteria are met, and repeals that authority effective January 1, 2014. (BPC 4999.57) 7)Establishes the examination eligibility requirements for PCC applicants who apply for licensure between January 1, 2011, and December 31, 2015, who hold a valid license outside of California for more than two years and meet specified criteria, and repeals these requirements effective January 1, 2016. (BPC 4999.58) 8)Establishes the examination eligibility or registration requirements for PCC applicants who apply for licensure between January 1, 2011, and December 31, 2015, and hold a valid license outside of California for less than two years and meet specified criteria, and repeals that authority effective January 1, 2016. (BPC 4999.59) FISCAL EFFECT : Unknown COMMENTS : 1)Purpose of this bill . This bill revises and updates the new educational requirements for licensure as a MFT and PCC for out-of-state applicants which are scheduled to become effective January 1, 2016, to allow more flexibility for applicants who reside outside of California and may have met all other licensing requirements except certain coursework relevant to California. This bill will address the issue that current education and experience requirements for out-of-state MFT and PCC applicants may be overly restrictive and present barriers to obtaining licensure in California. This bill is sponsored by the Board of Behavioral Sciences (BBS). 2)Author's statement . According to the author, "The BBS is concerned that new requirements that are set to take effect in January of 2016, for licensure of MFTs and PCCs from out-of-state create unnecessary barriers to licensure for these professionals, thus restricting portability of these licenses to California. These changes would come as a result of SB 33(Correa), Chapter 26, Statutes of 2009, which modified requirements for MFT licensure, yet inadvertently created barriers for out of state applicants. AB 2213 Page 17 "Beginning January 1, 2016, out-of-state applicants will be required to complete a long list of educational requirements, including courses that deal with topics specific to California, which out-of-state applicants are highly unlikely to have completed. Under existing law, this coursework would need to be completed at the graduate level and would thus require out-of-state applicants to enroll in a graduate program in order to remediate this coursework. Additionally, all coursework and practicum requirements would need to be remediated prior to registering with [BBS] as an intern. "This bill address[es] these concerns by allowing out-of-state applicants to remediate coursework through continuing education and to do so while registered as an intern. Furthermore, it will allow applicants who are licensed in another state to remediate practicum requirements while registered as an intern with the BBS [and] exempt out-of-state applicants who have been licensed for more than two years from this requirement. This bill will allow [BBS] to accept supervised hours at a rate of 100hrs/months for up to 1,200 hours for applicants licensed in another state. Finally, this bill adds clarity to existing coursework requirements by specifying the number of course hours or units required." 3)LMFT licensure requirements . MFTs are employed in clinics, counseling centers and private practice. They use counseling or psychotherapeutic techniques to assist individuals, couples, families, and groups with a focus on marriage and family relationship issues. The minimum educational and experience requirements for MFTs include a master's degree in areas such as marriage, family, and child counseling, marriage and family therapy, couple and family therapy, psychology, clinical psychology, and counseling psychology, from an accredited school. In addition, MFTs must complete supervised work experience of at least 3000 hours within a period of two-years. Requirements for licensure are consistent for out-of-state applicants and instate applicants; however, the way in which out-of-state applicants are able to take additional coursework that meet California-specific standards may be overly burdensome without the clarification and revisions addressed in this bill to ensure that those with the proper education and experience are able to become licensed without unreasonable or unattainable AB 2213 Page 18 constraints. According to the BBS, approximately3% of applicants for MFT intern and 1.5% of applicants for MFT exam eligibility are out-of-state applicants, and 35% of applicants for clinical counselor intern are out-of-state applicants. According to BBS, they currently do not have statistics on the exam eligibility for out-of-state Licensed PCC applicants because they have only been issuing registrations for less than two years. The licensure requirements for MFTs and PCCs vary based on the date an applicant applies for licensure, the time in which the applicant obtained his or her degree, and whether or not the applicant holds an active license from out-side of California. This bill addresses each licensure category to revise and update the current educational requirements including specifying the number of units obtained and the specific law and ethics coursework to allow more flexibility for out-of-state applicants to meet California-specific educational requirements. 4)PCC licensing . SB 788 (Wyland) (Chapter 619, Statutes of 2009) established the PCC Act which provided for the licensing and regulation of PCCs by BBS. When the legislation was set to take effect in 2010, many sections of California law that applied to other mental health professionals had yet to be revised to incorporate PCCs. Because PCCs are largely comparable to MFTs, SB 146 (Wyland) (Chapter 381, Statutes of 2011) was passed to amend various code sections relating to MFTs so that the same substantive provisions and requirements would apply to PCCs as well. Because the out-of-state applicant requirements for PCCs were patterned after MFT law, with similar education, exam and experience requirements, PCC applicants are faced with similar licensure access and portability issues as MFTs. This bill revises the out-of-state educational and experience requirements consistent with the changes for MFT requirements. 5)Out-of-state MFT and PCC applicants . Certain educational and experience requirements were scheduled to take effect as result of SB 33 (Correa) (Chapter 26, Statutes of 2009) beginning January 1, 2014. SB 33 revised the requirements for MFTs seeking licensure or registration in California who were educated or licensed outside of California. Based on concerns raised by the BBS, that out-of-state applicants were AB 2213 Page 19 not going to be able to meet those revised requirements without significant challenges, the BBS sponsored AB 451 (Eggman) Chapter 551, Statutes of 2013, which extended the effective date for the new education, examination and eligibility requirements for out-of-state applicants for MFTs and PCCs by two years from January 1, 2014, to January 1, 2016. The two-year delay allowed the BBS time to revise changes contained in SB 33 for licensure requirements for out-of-state applicants. Under the provisions of SB 33, new applicants are required take a broad range of coursework, from understanding marriage and family principles to cultural competency and sensitivity, including a familiarity with the racial, cultural, linguistic, and ethnic backgrounds of persons living in California. These courses could be difficult to obtain in out-of-state programs as they relate specifically to California and may not be offered at out-of-state educational institutions which could potentially block an individual licensed or educated outside of California from qualifying for licensure in California without providing an appropriate way to make up the required coursework. In addition, because current law requires that specified coursework must be taken in a graduate course, without the clarifications provided by this bill, it may be difficult for applicants to re-apply to a graduate program to take one or two courses. This could be both time consuming and cost-prohibitive for out-of-state applicants who have already completed masters' or doctoral degree programs outside of California. Because it could cost applicants several thousands of dollars and potentially months of additional delay to satisfy educational requirements, it could discourage otherwise qualified mental health providers from applying for licensure in California. To avoid those problems, this bill modifies the current requirements to allow a specified amount of coursework remediation to be completed during intern registration, clarifies the California law and ethics course content and length, clarifies the required number of units depending on graduation and application dates, and allows some supervised experience gained out-of-state to be accepted in California. AB 2213 Page 20 6)This bill the result of extensive BBS working group meetings . As a result of the current challenges predicted for out-of-state applicants seeking licensure or intern registration resulting from the education and curriculum changes made by SB 33, BBS formed the Out-of-State Education Review Committee (Committee) which was established to consider the potential barriers to licensure for out-of-state applicants after January 1, 2014. The challenge that out-of-state applicants would encounter as they applied to California for LMFT licensure under the new curriculum requirements was discussed during the Committee process. The Committee held its first meeting on April 26, 2013 and through a series of meetings the Committee and stakeholders discussed and considered the following topics: current educational requirements; educational requirements after January 1, 2014; current options to remediate educational deficiencies and potential cost; and options to remediate educational deficiencies and potential cost. The Committee held its fourth and last meeting in November 2013. The Committee's work resulted in the recommended changes this bill proposes with respect to continuing education, coursework remediation, practicum experience, and course content requirements. 7)Arguments in support . According to BBS, "Licensing requirements for out-of-state applicants were set to change on January 1, 2014. However, BBS had concerns that these new out-of-state requirements may be too stringent, restricting portability of these license types to California. The resulting proposal makes changes to the practicum requirements for out-of-state applicants as well as allows them to remediate certain coursework through continuing education, instead of requiring all coursework to be from a graduate program. It also allows certain coursework to be remediated while registered as an intern." 8)Previous legislation . AB 451 (Eggman) (Chapter, 551, Statutes of 2013) extended the current effective date for new education, examination and eligibility requirements for out-of-state applicants for MFT and PCC licenses from January 1, 2014, to January 1, 2016, and extended the operation and repeal date for current examination, eligibility and curriculum requirements for out-of-state applicants from AB 2213 Page 21 January 1, 2014, to January 1, 2016. SB 146 (Wyland) (Chapter 381, Statutes of 2011) extended existing law that applies to MFTs to apply to PCCs as well. SB 33 (Correa) (Chapter 26, Statutes of 2009) updated the educational curriculum requirements for MFTs to require persons who begin graduate study after August 1, 2012 to meet increased total unit requirements and practicum hours for face-to-face counseling. Additionally, it added new elements to the curriculum, including public mental health practices, revised the requirements for applicants licensed or educated outside of California; and repeals the current MFT educational requirements on January 1, 2019. SB 788 (Wyland) (Chapter 619, Statutes of 2009) established the PCC Act which provides for the licensing and regulation of PCCs by BBS. SB 1218 (Correa) of 2008 attempted to update and recast the educational curriculum requirements for MFTs. SB 1218 was vetoed by the Governor, stating that due to the 2008-2009 State Budget delay, only bills of the highest priority for California would be signed. AB 234 (Eng) (Chapter 586, Statutes of 2007) revised to the LMFT licensing law pertaining to the number of hours of experience required for licensure. REGISTERED SUPPORT / OPPOSITION : Support Board of Behavioral Sciences (sponsor) American Association for Marriage and Family Therapy Association of California Healthcare Districts California Council of Community Mental Health Agencies Opposition None on file. Analysis Prepared by : Elissa Silva / B.,P. & C.P. / (916) 319-3301 AB 2213 Page 22