BILL ANALYSIS Ó
AB 250
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Date of Hearing: April 7, 2015
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Susan Bonilla, Chair
AB 250
(Obernolte) - As Amended March 26, 2015
NOTE: This bill is double-referred, and if passed by this
Committee, it will be referred to the Assembly Committee on
Health.
SUBJECT: Telehealth: marriage and family therapist interns and
trainees.
SUMMARY: Clarifies that Marriage and Family Therapist (MFT)
interns and trainees may provide services via telehealth, under
specified supervision, to gain supervised hours required for
licensure as specified.
EXISTING LAW
1)Defines an MFT "intern" to mean "an unlicensed person who has
earned his or her master's or doctor's degree qualifying him
or her for licensure and is registered with BBS." Business
and Professions Code (BPC) Section 4980.03(b).
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2)Defines an MFT "trainee" to mean "an unlicensed person who is
currently enrolled in a master's or doctor's degree program,
as specified, that is designed to qualify him or her for
licensure, and who has completed no less than 12 semester
units or 18 quarter units of coursework in any qualifying
degree program." (BPC Section 4980.03(c))
3)Defines "experience" to mean "experience in interpersonal
relationships, psychotherapy, marriage and family therapy, and
professional enrichment activities that satisfies the
requirement for licensure, as specified." (BPC Section
4980.03(f))
4)Requires an MFT applicant for licensure to complete the
following: (BPC Section 4980.43 (a)(1-11))
a) A minimum of 3,000 hours completed during a period of at
least 104 weeks;
b) No more than 40 hours in any seven consecutive days;
c) No less than 1,700 hours of supervised experience
completed subsequent to the granting of the qualifying
master's or doctoral degree;
d) No more than 1,300 hours of supervised experience
obtained prior to completing a master's or doctoral degree,
and the applicant cannot be credited with more than 750
hours of counseling and direct supervision contact prior to
completing the master's or doctoral degree;
e) No hours of supervised experience may be grained prior
to completing either 12 semester units or 18 quarter units
or graduate instruction and becoming a trainee except for
personal psychotherapy;
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f) No hours of experience may be gained more than six years
prior to the date the application of examination
eligibility was filed, except that up to 500 hours of
clinical experience gained in the supervised practicum
required, as specified;
g) No more than a combined total of 1000 hours of
experience, as specified;
h) No more than 500 hours of experience providing group
therapy or counseling, as specified;
i) No less than 500 total hours of experience in diagnosing
and treating couples, families, and children, as specified;
and,
j) No more than 375 hours of experience providing personal
psychotherapy, crisis counseling, or other counseling
services via telehealth, as specified.
5)Defines telehealth to mean "the mode of delivering health care
services and public health via information and communication
technologies to facilitate the diagnosis, consultation,
treatment, education, care management and self-management of a
patient's health care service while the patient is at the
originating site and the health care provider is at a distant
site; telehealth facilitates patient self-management and
caregiver support for patients and includes synchronous
interactions and asynchronous store and forward transfers.
(BPC Section 2290.5(a)(6))
6)Requires the health care provider, prior to initiating the use
of telehealth, to inform the patient about the use of
telehealth and obtain verbal or written consent from the
patient for the use of telehealth, as specified; and requires
the consent to be documented. (BPC Section 2290.5(b))
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THIS BILL
1)Permits interns and trainees working under licensed
supervision, as specified, to provide services via telehealth
within the scope of MFTs and in accordance with any
regulations governing the use of telehealth promulgated by the
Board of Behavioral Sciences (BBS).
FISCAL EFFECT: None. This bill is keyed non-fiscal by the
Legislative Counsel.
COMMENTS
1)Purpose of the bill. According to the author, "Currently,
California statute [BPC] §4980.43 allows [MFT] Pre-Licensees
(interns and trainees) to obtain the necessary hours toward
their licensure by conducting therapy through telehealth
services. However, another section, 2290.5, of the [BPC]
fails to authorize the very same trainees to conduct
telehealth services. This lack of conformity has raised
concerns about interns, trainees, and their supervisors being
liable for performing telehealth services without this
proposed change. [This bill] will fix this contradiction
within the [BPC]. [This bill] does not propose new policy,
but rather aligns statute with a discipline that is already in
practice and contributes to the requirements for licensure for
these therapists in training."
This bill aims to clarify that MFT interns and trainees are
authorized to provide services via telehealth for the purpose
of gaining supervised experience as required for licensure.
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Current law specifies that interns and trainees may not count
more than 375 hours of supervised experience via telehealth;
however, the law is not clear that they are authorized to
provide telehealth services to gain experience. This bill
attempts to provide clarity by specifying that interns and
trainees are permitted to provide telehealth services, as
specified, under the appropriate supervision of a licensed
supervisor.
2)Background. Marriage and Family Therapists. 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 an area such as marriage, family, and child
counseling, marriage and family therapy, couple and family
therapy, psychology, clinical psychology, or counseling
psychology from an accredited school.
In addition, MFTs must complete supervised work experience of
at least 3,000 hours within a period of two years. In order
to accumulate supervised hours, a person must register with
BBS as an intern or function as a trainee. Trainees are
individuals who have been enrolled in MFT graduate programs
and who have completed at least 12 semester or 18 quarter
units of coursework. Interns have earned the appropriate
graduate degree and registered with BBS, but have not taken
the examination.
Trainees are not authorized to attain supervised experience
hours in private practice and can only gain hours in settings
such as a governmental entity, a school, college, university,
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or an institution that is both nonprofit and charitable. For
purpose of licensure, trainees can only count those hours of
supervised experience gained under the direct supervision of a
BBS-licensed individual who has been licensed for at least two
years, whose license is not under probation or suspension, and
has not provided therapeutic services to the trainee.
Current law allows MFT interns and trainees to gain up to 375
hours of supervised experience through telehealth services;
however, current law does not specifically include MFT interns
and trainees as individuals who are permitted to provide
telehealth services for purposes of gaining supervised
experience. This bill is not intended to expand or alter the
provisions of telehealth law or those persons who can provide
the services, but seeks to clarify that trainees and interns
are able to provide telehealth services, under the supervision
of a licensed MFT, for the purpose of gaining supervised
experience hours as required for licensure. According to
information from the sponsor, it is not uncommon for trainees
gaining supervised experience hours to utilize telehealth as a
method of providing services.
Telehealth Services. Telehealth is the delivery of
health-related services and information via telecommunications
technologies. Telecommunication technologies used in
telehealth provide support to long distance clinical health
care, patient education and public health and health
information. Current law requires a healthcare provider to
verbally inform the patient that telehealth may be used and
obtain verbal consent from the patient. In order to provide
telehealth services, an individual must be one of the licensed
healing arts professionals as defined under Division 2, in the
BPC, including LMFTs. This bill will more clearly specify
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that a MFT trainee or intern is authorized to provide
telehealth services under the supervision of a licensee, as
specified, in order to acquire supervised experience hours as
required for licensure. This bill does not alter the current
375 hour cap on supervised hours that can be counted towards
licensure.
3)Current Related Legislation. SB 620 (Block) of the current
legislative session revises the experience for MFTs and
Licensed Clinical Social Workers and provides that individuals
who submit applications for examination eligibility between
January 1, 2016, and December 31, 2017, may alternately
qualify under the current requirements and makes other
technical and clarifying changes. Status: (This bill is
pending in the Senate Business, Professions and Economic
Development Committee.)
4)Previous Legislation. AB 1012 (Wyland), Chapter, 435,
Statutes of 2014, increased from five to six the number of
hours which a MFT trainee or intern, and a professional
clinical counselor intern, may count towards their weekly
supervision requirement.
SB 632 (Emmerson), Chapter 50, Statutes of 2012, clarified
which MFT trainees are allowed to counsel clients outside of a
practicum course, and clarified a limited exemption for
trainees who are not allowed to counsel clients outside of a
practicum course.
SB 363 (Emmerson), Chapter 384, Statutes of 2011, authorized,
among other things, MFT trainees to counsel clients while not
enrolled in a practicum if the period of lapsed enrollment is
less than 90 calendar days and is immediately preceded and
immediately followed by enrollment in a practicum course.
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AB 956 (Roger Hernández), Chapter 166, Statutes of 2011,
required a marriage and family therapist intern and a marriage
and family therapist trainee, prior to performing professional
services, to provide each client or patient with the name of
his or her employer and indicate that he or she is under the
supervision of a licensed person, as specified, and required
any advertisement by or on behalf of an intern or trainee to
include specified information; required an intern's
registration number to be disclosed to clients and patients
and in advertisements.
SB 33 (Correa), Chapter 26, Statutes of 2009, updated and
revised the educational curriculum requirements for marriage
and family therapists to require persons who begin graduate
study after August 1, 2012 to meet increased total unit
requirements, increased practicum hours for face-to-face
counseling, integrates specified elements, including public
mental health practices, throughout the curriculum, repealed
current marriage and family therapist educational requirements
on January 1, 2019, revised requirements for applicants
licensed or educated outside of California, and made technical
and conforming changes.
ARGUMENTS IN SUPPORT
The California Association of Marriage and Family Therapists
write in support, "Telehealth affords both the patient and the
health care provider increased access, flexibility, and cost
efficiencies. [BPC] 2290.5 defines "telehealth," as well as,
states that telehealth can be administered by a "health care
provider" licensed under [BPC] 2290.5, which includes a [MFT].
Moreover, [BPC] 4980.43 allows [MFT] trainees to obtain the
necessary hours toward their licensure by conducting therapy
through telehealth services. However, [BPC] 2290.5 fails to
authorize the very same trainees to conduct telehealth services.
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This lack of conformity raises concerns about trainees, and
their supervisors, being liable for performing telehealth
services without this proposed change."
ARGUMENTS IN OPPOSITION
None on file.
REGISTERED SUPPORT / OPPOSITION:
Support
California Association of Marriage and Family Therapists,
(sponsor)
California Primary Care Association
Opposition
None on file.
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Analysis Prepared by:Elissa Silva / B. & P. / (916) 319-3301