BILL ANALYSIS Ó ----------------------------------------------------------------------- |Hearing Date:June 23, 2014 |Bill No:AB | | |2213 | ----------------------------------------------------------------------- SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT Senator Ted W. Lieu, Chair Bill No: AB 2213Author:Eggman As Amended:March 28, 2014Fiscal: Yes 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. 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) § 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 AB 2213 Page 2 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 accepted towards the licensure requirements for PCC 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) This bill: 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 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 AB 2213 Page 3 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 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 AB 2213 Page 4 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 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 AB 2213 Page 5 3,000 hours of experience required while registered as an intern. d) Twelve semester or 18 quarter units in the areas of 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, an institution approved by the BPPE, or from a continuing education provider that is acceptable to BBS, and does not include undergraduate coursework. 10)Requires an applicant to complete coursework, not already completed in his or her education, from an accredited school, college or university, as specified, an institution approved by the BPPE, or from a continuing education provider that is acceptable to BBS, and is not undergraduate coursework to include: AB 2213 Page 6 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 semester unit or 15 hours of instruction in psychopharmacology; b) Training in developmental issues from infancy to old age, AB 2213 Page 7 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 subjects 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. 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; AB 2213 Page 8 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; 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 AB 2213 Page 9 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; 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: AB 2213 Page 10 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. 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 AB 2213 Page 11 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 timeline, 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 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; AB 2213 Page 12 and b) Coursework must be from an 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 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. AB 2213 Page 13 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 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; AB 2213 Page 14 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 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 AB 2213 Page 15 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 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. FISCAL EFFECT: This measure has been keyed "fiscal" by Legislative Counsel. According to the Assembly Committee on Appropriations analysis dated April 30, 2014, the bill would have minor and absorbable costs to the BBS to update requirements. COMMENTS: 1.Purpose. The sponsor of the bill is the BBS . According to the Author, licensing requirements for out-of-state LMFT and LPCC applicants are set to change on January 1, 2016. After January 1, 2016, out-of-state applicants will be required to complete a long list of very specific education al requirements, including courses that deal with topics specific to California, which out-of-state applicants are highly unlikely to have completed. Moreover, the BBS would not be able to accept coursework completed through continuing education, but rather require all remediation coursework be completed at the graduate level. Additionally, all coursework would need to be remediated prior to registration with the board as an AB 2213 Page 16 intern. 2.Background. a) Licensing Requirements. Currently, requirements for licensure for MFTs are consistent for out-of-state applicants and in state applicants. Further, according to the BBS, approximately 3% of applicants for MFT intern and 1.5% of applicants for MFT exam eligibility are out-of-state applicants. However, 35% of applicants for clinical counselor intern are out-of-state applicants. The BBS was unable to provide statistics reflecting the exam eligibility for out-of-state PCC applicants because they have issued registrations for less than two years. Senate Bill 788 (Wyland, Chapter 619, Statutes of 2009) established the PCC Act which provided for the licensing and regulation of PCCs by the BBS. When the legislation took effect in 2010, many sections of California law that applied to other mental health professionals had not yet been 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. b) 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 regarding out-of-state applicants not being able to meet those revised requirements without significant challenges, the BBS sponsored AB 451 (Eggman, Chapter 551, Statutes of 2013). This bill 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 AB 2213 Page 17 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 prevent an individual licensed or educated outside of California from qualifying for licensure without providing a way to make up the required coursework. 3.Arguments in Support. The Association of California Healthcare Districts supports the bill and writes, "There is a growing demand to provide increased mental health services in California; in order to meet this growing demand, there must be a qualified workforce able to offer mental health services within our communities?AB 2213 would ease concerns with current law, making it possible for out-of-state licensees to consider employment in California. Additionally, this measure is vital to increasing the number of mental health professionals available in California." The California Council of Community Mental Health Agencies also supports the bill and writes, "Workforce capacity is an enormous challenge for our member agencies. This measure will make it easier to attract and retain workers from other states and will improve our workforce capacity." SUPPORT AND OPPOSITION: Support: Association of California Healthcare Districts California Council of Community Mental Health Agencies Opposition: None received and June 18, 2014. Consultant:Le Ondra Clark, Ph.D.