BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  SB 570
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          Date of Hearing:   June 24, 2014

                            ASSEMBLY COMMITTEE ON HEALTH
                                 Richard Pan, Chair
                   SB 570 (DeSaulnier) - As Amended: June 17, 2014

           SENATE VOTE  :  Not relevant.
           
          SUBJECT  :  Advanced Alcohol and Drug Licensing Act.

           SUMMARY  :  Establishes a licensing and certification system for  
          alcohol and drug abuse counselors to be administered by the  
          Department of Health Care Services (DHCS).  Specifically,  this  
          bill  :   

          1)Establishes the Advanced Alcohol and Drug Counselor Licensing  
            Board (Board) within DHCS.  Provides that the Board consist of  
            11 members with nine members appointed by the Governor and one  
            each by the Senate Rules Committee and the Speaker of the  
            Assembly.  

          2)Prescribes various requirements for the composition and terms  
            of the Board's membership.

          3)Defines an advanced alcohol and drug counselor intern (AADCI)  
            as an unlicensed person who has fulfilled the testing and  
            education requirements to become licensed, but has yet to meet  
            the supervised experience requirements, as specified, and is  
            registered with the Board.

          4)Defines a licensed advanced alcohol and drug counselor (LAADC)  
            as a person licensed to practice alcohol and drug counseling,  
            pursuant to specified provisions.  Allows LAADCs to provide  
            clinical supervision to AADCIs.

          5)Assigns numerous duties to the Board including:

             a)   Adopt rules and regulations, in accordance with the  
               Administrative Procedure Act , as necessary to administer  
               and enforce the Board;

             b)   Issue licenses and certificates to persons who meet the  
               qualifications of this bill and subsequent regulations  
               beginning on January 1, 2017, as specified;









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             c)   Take disciplinary action against LAADCs or AADCIs,  
               including reprimand or probation, suspension, or revocation  
               of the license or registration, issuance of administrative  
               citations, or impositions of administrative fines not to  
               exceed $5,000;

             d)   Maintain a public database of registrants and certified  
               LAADCs, including their status, any public record of  
               discipline, and other information as the Board requires;

             e)   Establish an advisory committee, that sunsets two years  
               after the issuance of licenses, that must meet at least two  
               times per year and make recommendations to the Board  
               concerning curriculum, criminal background checks,  
               unprofessional conduct, and other matters referred to the  
               committee by the Board; and,

             f)   Other duties as specified.
          6)Requires the Board, commencing January 1, 2017, to register  
            AADCI applicants who meet the following requirements:

             a)   Possesses an earned Master of Arts, Master of Science,  
               or Doctorate degree in alcohol and drug counseling,  
               psychology, social work, counseling, marriage and family  
               therapy, counseling psychology, clinical psychology, or  
               other clinically focused major or an equivalent degree  
               recognized by the Board, as specified.  Allows the Board to  
               accept any or all of the hours of education as part of the  
               education leading to an applicant's earned Master of Arts,  
               Master of Science, or Doctorate degree;

             b)   Completes 315 clock hours of alcohol and drug-specific  
               education approved by the Board, as specified;

             c)   Completes a supervised practicum of no less than 315  
               performance (experience) hours, including a 45-hour  
               practicum, as well as 255 hours of practical experience  
               performed at an agency approved by the practicum  
               instructor;

             d)   Receives a passing score on the exam for licensure  
               designated by the Board;

             e)   Submits to a state and federal level criminal offender  
               record information search and passes both background  








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               checks, as specified;

             f)   Pays the required fees as set by the Board; and,

             g)   Completes the application for registration.

          7)Requires the Board, beginning January 1, 2017, and ceasing  
            with the disposition of all completed applications actually  
            received by the Board by June 30, 2018, to issue an LAADC  
            license to each applicant the Board determines meets all of  
            the requirements in 6) above and meets either of the  
            requirements in a) or b) below:

             a)   A certified alcohol and drug counselor who meets all of  
               the following requirements on or before January 1, 2017:

               i)     Holds a current, valid, advanced alcohol and drug  
                 counseling certification or clinical supervision  
                 certification issued by a certifying organization  
                 recognized by DHCS, and completes, at a minimum, all of  
                 the following:

                  (1)       Completes 315 hours of specified formal  
                    instruction, as specified;

                  (2)       Completes 6,000 hours of work experience;

                  (3)       Receives a passing score on a test to qualify  
                    for certification, and completion of specified  
                    education has been completed;

                  (4)       Submits to a state and federal level criminal  
                    offender record information search and passes both  
                    background checks, as specified; and,

                  (5)       Provides documentation of a total of 10,000  
                    hours of experience in alcohol and drug abuse  
                    counseling:  allows documentation of:  an associate  
                    arts degree to count for 2,000 experience hours; a  
                    bachelor's degree to count for 4,000 experience hours;  
                    a master's degree to count for 6,000 hours of  
                    experience; and, requires any degree used in lieu of  
                    experience hours to be substantially related to  
                    alcohol and drug counseling.









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               ii)    Pays the required fees as set by the Board; and,

               iii)   Completes the application for a license; or,

             b)   A person licensed in the State of California who  
               practices alcohol and drug counseling who meets all of the  
               following requirements on or before January 1, 2017:

               i)     Provides documentation to the Board that he or she  
                 currently holds a valid license in the state to practice  
                 marriage family therapy, psychology, social work,  
                 professional counseling, or medicine;

               ii)    Provides documentation to the Board of 6,000 hours  
                 of experience in providing alcohol and drug counseling  
                 services directly to patients;

               iii)   Pays the required fees as set by the Board; and,

               iv)    Completes the application for a license.

          8)Permits education and work experience gained outside of  
            California to be accepted towards LAADC license requirements  
            if it is substantially equivalent to the requirements of this  
            bill.

          9)Establishes and defines the scope of practice for AADCIs and  
            LAADCs and, commencing January 1, 2017, makes it unlawful to  
            engage in the practice of alcohol and drug counseling without  
            holding a valid certificate or license. 

          10)Specifies that nothing in this bill should be construed to  
            construct, limit, or withdraw other healing arts professional  
            scopes of practice, as specified.

          11)Specifies that the provisions of this bill do not apply to  
            employees of the California Department of Corrections and  
            Rehabilitation, an employee or volunteer of the State of  
            California, an employee or volunteer of an agency of the  
            government of the United States, volunteers of peer or  
            self-help groups, or clerics or other religious leaders.

          12)Establishes title protections for AADCIs and LAADCs, as  
            specified.









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          13)Provides that licenses or registration expire within two  
            years after the issue date and specifies renewal procedures.

          14)Requires an LAADC to display his or her license or  
            registration in a prominent place.

          15)Allows a license to be placed on inactive status.

          16)Requires an AADCI or LAADC to provide written notice to the  
            Board within 30 days of a name change or a change of address.

          17)Authorizes the Board to deny, revoke, suspend, or impose  
            conditions upon a license or registration for unprofessional  
            conduct, as defined, and provides a process for AADCIs and  
            LAADCs to appeal adverse decisions of the Board.

          18)Establishes the Advanced Alcohol and Drug Counselors License  
            Fund (Fund) in the State Treasury.

          19)Requires all fees collected under this bill to be deposited  
            in the Fund and be available for appropriation by the  
            Legislature. 

          20)Directs the Board to establish fees to be paid by persons  
            seeking licensing as an LAADC or registration as an AADCI, and  
            requires that the total fees collected not to exceed the  
            reasonable cost to the Board for administering and  
            implementing this bill.

           EXISTING LAW  

          1)Establishes the Medi-Cal program, administered by DHCS, under  
            which qualified low-income individuals receive health care  
            services.

          2)Establishes the Drug Medi-Cal (DMC) program, which provides  
            substance use disorder services to Medi-Cal recipients.

          3)Allows DHCS to enter into contracts with counties for the  
            provision of DMC services.  If a county declines to contract  
            with DHCS, existing law requires DHCS to contract for services  
            in the county to ensure beneficiary access.

          4)Requires each county to fund the nonfederal share for DMC  
            services through realignment funds, as specified.








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          5)Requires providers of DMC services to obtain certification  
            from DHCS to provide those services.

           FISCAL EFFECT  :  This bill, as amended, has not been analyzed by  
          a fiscal committee.

           COMMENTS  :

           1)PURPOSE OF THIS BILL  .  According to the author, California's  
            system of overseeing those who provide drug and alcohol  
            treatment is delegated to seven private certifying  
            organizations, accredited by a national organization.  
            Currently, Alcohol and Other Drug (AOD) Counselors  must  
            either register with or become certified by one of these  
            organizations. However, each organization has differing  
            requirements for certification and existing law does not  
            require a criminal background check as part of their minimum  
            standards. There is currently no statutory authority for DHCS  
            to impose quality or consumer protection measures for AOD  
            counselors working outside of licensed and certified  
            facilities, putting consumers at risk.  This bill establishes  
            state certification and licensure for AOD counselor's  
            administered by the DHCS.  The author further states that This  
            bill provides a comprehensive certification requirements for  
            counselors, including education, supervised work requirements,  
            specific and comprehensive counselor testing criteria to meet  
            federal "best-evidence" standards, "grandparenting" the  
            existing workforce, and a "career ladder" (including a  
            licensed counselor level) that will help counselors and AOD  
            treatment programs.  This bill includes criminal background  
            checks necessary to evaluate criminal histories to make sure  
            that we protect all vulnerable individuals who seek services  
            from AOD counselors.

           2)BACKGROUND  .  AOD dependency is a treatable condition, but no  
            one treatment modality is successful with all persons who  
            exhibit chemical dependency problems.  Due to the fact that  
            individual problems, needs, and resources vary greatly, a  
            variety of treatment strategies must be available.  Treatments  
            for chemical dependency vary because there are multiple  
            perspectives about the condition, itself.

          Most treatments focus on helping people discontinue their AOD  
            intake, followed by life training and/or social support in  








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            order to help them resist a return to substance use.  Since  
            chemical dependency involves multiple factors which encourage  
            a person to continue using, they must all be addressed in  
            order to successfully prevent a relapse.  An example of this  
            kind of treatment is detoxification, followed by a combination  
            of supportive therapy, attendance at self-help groups, and  
            ongoing development of coping mechanisms.

          About 36,000 registered or certified counselors work in 2,534  
            private and publicly funded drug and alcohol programs, ranging  
            from luxury residential rehabs to DUI and outpatient programs.  
            This workforce is key to the successful treatment of AOD  
            addicts.  Demand for their services will grow as people newly  
            insured under the federal Patient Protection and Affordable  
            Care Act seek help for substance dependence.

          Currently DHCS authorizes 10 different certifying organizations  
            to certify counselors.  Each program develops its own  
            classroom curriculum, training, supervisor and work experience  
            requirements.  Background checks are not performed and there  
            is no central repository of counselor information, including  
            disciplinary action taken to suspend or revoke certification  
            for misconduct.  DHCS can direct a certifying organization to  
            take action against a counselor for misconduct, but there is  
            nothing to prevent a counselor who has had certification  
            suspended or revoked from obtaining certification from another  
            organization.  This bill authorizes DHCS to register, certify,  
            and license AOD counselors in California and to charge fees to  
            do so.  This bill creates a tiered system for counselor  
            certification and licensure with specific education,  
            supervision, training, and experience criteria for each tier.   
            This bill also requires DHCS to impose sanctions for counselor  
            misconduct.

             a)   Potential Cost Savings.  Besides being effective,  
               treatment is widely considered to save money by combating  
               the problems associated with substance abuse.  A benefit  
               cost analysis done in conjunction with the evaluation of  
               Proposition 36: Substance Abuse and Crime Prevention Act of  
               2000, found that for every $1 invested in substance abuse  
               treatment, state and local governments have saved $2.50  
               from reduced health care costs and crime.  Other studies  
               have found that the per capita cost of treatment is  
               significantly less than the cost of incarceration.   
               According to the Institute of Medicine, the cost of  








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               incarceration is about $40,000 per year compared to $12,500  
               and $3,100 for residential and outpatient treatments,  
               respectively.  Despite the cost effectiveness of substance  
               abuse treatment programs, a substantial gap exists between  
               the number of people who need treatment and the number who  
               receive treatment.

             The number of people seeking treatment who have co-occurring  
               mental health disorders has steadily increased in recent  
               years, although it is not clear if the reason is improved  
               diagnosis of mental disorders or a change in the  
               population.  It is estimated that individuals with  
               co-occurring disorders now comprise 20% to 50% of those  
               with addiction problems.  DHCS has noted that, if  
               counselors were better qualified, they would be better  
               prepared to accurately identify these co-occurring  
               disorders earlier, treat the addiction and make appropriate  
               referrals to treat the co-occurring mental health disorder.

             b)   CSOOO Report.  A 2013 report by the California Senate  
               Office of Oversight and Outcomes (CSOOO) extensively  
               examined the current process to become an AOD counselor,  
               and noted some of the systemic flaws.  California is one of  
               only two states among the nation's 15 largest that makes no  
               attempt to review counselors' criminal backgrounds.  Even  
               within California, AOD counselors are the only  
               health-related profession not required to undergo these  
               checks.  Among those who submit to screening are  
               acupuncturists, dental hygienists, optometrists, and  
               veterinarians.

             The ability to easily evade regulators represents a gaping  
               loophole in California's system.  While the state's seven  
               certifying organizations are required to check with their  
               counterparts to see if a counselor has ever been revoked,  
               the regulation states that this must be done only upon  
               certification.  Counselors can work for five years before  
               they must become certified.

             In 2004, Governor Gray Davis directed the California  
               Department of Alcohol and Drug Programs (DADP) to come up  
               with regulations for certifying counselors.  As the  
               regulations were being considered, treatment programs and  
               organizations that certify counselors warned against strict  
               standards that would prevent too many people from becoming  








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               counselors, a problem they said had been encountered by  
               other states that set the bar too high. The regulations  
               went into effect on April 1, 2005. 

             The CSOOO cross-checked lists of counselor names against  
               individuals who have been excluded from receiving Medicare  
               and Medi-Cal payments because of misconduct including fraud  
               or other criminal activity.  CSOOO found several counselors  
               who were able to keep working despite having their  
               registrations or certifications revoked; they simply signed  
               up with a different certifying organization.  The  
               organizations are supposed to check with their counterparts  
               to make sure that an applicant has not been ordered revoked  
               by DHCS.  However, the regulation states that the check  
               must be done only when the organization certifies  
               counselors, not when they register, providing for a  
               regulatory loophole.  Regulations allow counselors to work  
               for five years without being certified, meaning that a  
               revoked counselor could go that long without being  
               detected.  After five years, that same counselor might be  
               able to register with another of the certifying  
               organizations and keep working.  A current regulation  
               requires the seven certifying organizations to check with  
               one another to see if applicants' registrations or  
               certifications were ever revoked - but only when they seek  
               certification, not when they register.

             DADP regulations approved in 2005 imposed the five-year  
               limit.  Individuals can work as counselors with no  
               education or training by registering with one of the  
               certifying organizations. But the state wanted to assure  
               that inexperienced counselors were working towards the  
               standards required for certification.  Five years was seen  
               as a reasonable interval for registrants to meet the  
               requirements.  Counselors who failed to achieve  
               certification within five years would be revoked, unless  
               the certifying organization granted a two-year hardship  
               extension.  The regulation also required that 30% of a  
               program's counseling staff be certified.

             c)   CSOOO Recommendations. The CSOOO Report concluded with  
               recommendations to improve California's system for  
               credentialing counselors including the following:

                 i)       Because many shortcomings of the current system  








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                   stem from the complications of seven private  
                   organizations sharing oversight with the State, the  
                   Legislature should once again consider putting the  
                   state firmly in charge of licensing and/or certifying  
                   counselors.  This change could be phased in over  
                   several years to allow certifying organizations to  
                   shift to an emphasis on education and training;

                 ii)      Alternatively, the state agency that oversees  
                   counselors should promulgate a regulation authorizing  
                   and requiring certifying organizations to perform  
                   criminal background checks.  In this case, the state  
                   could still establish guidelines for assessing criminal  
                   histories, and could set up an advisory panel of  
                   experts from within the treatment industry to evaluate  
                   and make recommendations on individual cases;

                 iii)     If the state does not institute  
                   fingerprint-based criminal background checks with  
                   subsequent arrest notifications, it should promulgate a  
                   regulation requiring registered and certified  
                   counselors to notify their certifying organizations  
                   within a certain time frame if they have been arrested.  
                    The regulation should also specify sanctions for  
                   counselors who failed to comply;

                 iv)      The state department that oversees counselors  
                   should amend current regulations to require certifying  
                   organizations to check with their counterparts, upon  
                   registration rather than certification, to see if a  
                   counselor has ever been revoked;

                 v)       If the state does not take over counselor  
                   credentialing, it should develop a regulation  
                   specifying the methods certifying organizations should  
                   use to cross-check applicants.  The regulation should  
                   require certifying organizations to share identifiers  
                   other than names, such as driver's license numbers,  
                   dates of birth, or Social Security numbers.  The  
                   regulation should clarify that certifying organizations  
                   are required to check with each other to see if a  
                             registrant has already reached the five-year limit for  
                   working without certification with another  
                   organization;









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                 vi)      The state department that oversees counselors  
                   should clarify through regulation its authority to  
                   sanction certifying organizations for failing to  
                   adequately vet those they register and certify.

                 vii)     The Senate may want to consider legislation to  
                   extend the jurisdiction of the department that oversees  
                   counselors to those who are not working in programs  
                   licensed or certified by the department.
                 viii)    The department that oversees counselors should  
                   consider a change in regulations to make exceptions to  
                   the requirement to become certified in five years for  
                   those who have left the field for a time.

             d)   Current Regulations.  California Code of Regulations,  
               Title 9, Division 4, Chapter 8, governs the current  
               certification of AOD counselors. They delegate the  
               certification of counselors to 10 private organizations,  
               which must be accredited by a national organization. (The  
               number of certifying organizations has since decreased to  
               seven.) 

            ------------------------------------------------------------ 
           |Organizations that register and certify counselors must be  |
           |accredited by a national organization.  Currently, there    |
           |are seven.                                                  |
            ------------------------------------------------------------ 
           |------------------------------------------------+-----------|
           |                      Name                      | Location  |
           |------------------------------------------------+-----------|
           |Addiction Counselor Certification Board of      | Lakewood  |
           |California                                      |           |
           |------------------------------------------------+-----------|
           |American Academy of Health Care Providers in    |  Solano   |
           |the Addictive Disorders                         |   Beach   |
           |------------------------------------------------+-----------|
           |Board of Certification of Addiction Specialists |Sacramento |
           |(affiliated with California Association of      |           |
           |Addiction Recovery Resources)                   |           |
           |------------------------------------------------+-----------|
           |Breining Institute                              |Sacramento |
           |------------------------------------------------+-----------|
           |California Association of Drinking Driver       |Sacramento |
           |Treatment Programs                              |           |
           |------------------------------------------------+-----------|








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           |California Certification Board of Alcohol and   |Sacramento |
           |Drug Counselors                                 |           |
           |------------------------------------------------+-----------|
           |Indian Alcoholism Commission of California,     |Redding    |
           |Inc.                                            |           |
            ------------------------------------------------------------ 

            Regulations require all counselors either to register with or  
            become certified by one of the organizations. Those who  
            register must get certified within five years. They set  
            minimum standards for certification, including a score of at  
            least 70% on a test, work experience, and formal classroom  
            education on drug and alcohol counseling.  One provision  
            requires that five years after the regulations went into  
            effect - 2010 - treatment programs would have to assure that  
            30% of their treatment staffs were certified. 

            The regulations include a code of conduct that makes DHCS  
            responsible for investigating complaints against counselors.   
            Within 90 days of receiving a complaint, DHCS is required to  
            send a written order to a counselor's certifying organization  
            specifying what corrective action, if any, must be taken.   
            Before certifying a counselor, the private organizations are  
            required to check with their counterparts to determine if a  
            counselor has ever been revoked. 

           3)SUPPORT  .  The California Association of Alcoholism and Drug  
            Abuse Counselors (CAADAC) states that creating a license  
            category for this profession raises the level of care provided  
            to addicts seeking treatment in both the public and the  
            private sectors.  Creating a licensed category allows  
            California to take advantage of federal health care reform  
            provisions, thus encouraging private sector treatment where  
            the progression of the disease may be treated before costly,  
            in-patent, publicly financed treatment becomes necessary.  
            CAADAC writes that alcohol and drug treatment providers have a  
            narrowly defined scope of practice.  They are single-diagnoses  
            treatment providers that treat a disease, not a behavior, and  
            should not be considered behavioral health practitioners.   
            CAADAC believes that it would be most beneficial to place the  
            regulation of the profession in a system that is separate from  
            that of licensed behaviorists, and therefore DHCS is an  
            appropriate place for these licensing provisions.  CAADAC  
            writes that this bill will put an end to professionals who are  
            banned from working in state licensed facilities for harming  








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            clients or who may have had a license revoked by one of  
            California's licensing boards for sexually abusing patients  
            who turn to work under the guise of AOD counseling.  Consumers  
            have no mechanism for distinguishing legitimate counselors  
            from those who have previously abused clients and have no  
            recourse should they become victims of unscrupulous providers  
            of addiction treatment services.

            The California State Sheriff's Association states that the  
            creation of a professional licensing board which is dedicated  
            to insuring quality counseling services through professional  
            certification and education can be a proven tool in combating  
            substance abuse induced criminal behavior.  Using proven  
            clinical skills within the framework of professional and  
            ethical responsibility, and much needed client advocacy, is  
            valuable in addiction and prevention treatment. 

            The California Association of Addiction Recovery Resources  
            believes that this bill helps establish part of a career  
            ladder in the addiction treatment field just as the subject is  
            being explored nationally. 

           4)OPPOSITION  .  The California Psychological Association,  
            California Association of Marriage and Family Therapists  
            (CAMFT), National Association of Social Workers, California  
            Mental Health Directors Association, and the County Alcohol  
            and Drug Program Administrators Association of California, all  
            have concerns that DHCS is not the appropriate department to  
            administer a licensing program, since it is does not currently  
            license any other healthcare professions.  All organizations  
            recommend the Department of Consumer Affairs (DCA) or a  
            certifying board within DCA as a more appropriate place for a  
            licensing program. The opposition notes that individuals  
            seeking treatment should have the benefit of a public board  
            that is tasked with protecting consumers. The Board of  
            Behavioral Sciences licenses four different practitioner  
            groups within the Master Mental Health and related field, and  
            could be a good fit.

            The California Psychological Association (CPA) has concerns  
            regarding the referral process for individuals.  Over half of  
            the potential clients will have a co-occurring mental illness,  
            so the curriculum listed as a model for programs should  
            include training case management, referral and integrated  
            treatment for co-occurring disorders.  The CPA is also  








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            concerned that creating a new license will, intentionally or  
            unintentionally, limit what a psychologist can do with their  
            current, broader scope of practice.  Requiring a trained  
            psychologist go back and get an additional Master's degree to  
            practice alcohol and drug counseling which is already included  
            in their scope, would be costly and time-consuming to the  
            professional, as well as limiting consumer choice.  Clearer  
            language needs to be included to ensure that current licensed  
            professionals could continue to practice in the same manner,  
            with or without this new license.

            The California Psychiatric Association writes that a  
            foundation of specific education and training is necessary to  
            create the ability to recognize issues needing referral.  Ten  
            hours of classroom instruction in recognition of co-occurring  
            mental health or health disorders would be insufficient given  
            that those ten hours must cover referral processes,  
            determinations of appropriate levels of care, determining  
            eligibility for admission to particular treatment programs,  
            and familiarity in the use of nationally recognized guidelines  
            and placement tools. The California Psychiatric Association  
            believes that this is bad policy that will lead to incoherent  
            regulation of the health professions and puts consumers in  
            harm's way.  The California Psychiatric Association recommends  
            amendments that would address the following: education to  
            provide familiarity with and sue of the Diagnostic and  
            Statistical Manual of Mental Disorders; coursework in the  
            biological basis of mental illness and substance abuse issues;  
            pharmacological treatments and related medical issues; and,  
            training in either inpatient facilities and/or in county  
            mental health or substance use clinics. 

            CAMFT expresses concerns regarding how applicants prove the  
            required hours of experience.  CAMFT states that while current  
            language suggests that an applicant can receive a letter  
            affirming hours of experience from a certifying organization,  
            many applicants will have received hours from agencies and  
            organizations no longer in existence.  To assure consumer  
            protection, it would be safer to administer the high caliber  
            licensing process and testing from the beginning rather than  
            push through a workforce of under-qualified individuals. 

            The California Association of Alcohol and Drug Educators  
            believe that this bill would allow for the licensing of  
            individuals with high school diploma or GED to the same  








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            educational level of an individual with a master's degree, and  
            place California far below the national standards.

           5)POLICY CONCERNS  . 

             a)   Where to place.  Currently, DHCS has no licensing  
               responsibilities.  DHCS currently manages 58 programs and  
               services, including Medi-Cal expansion and the  
               implementation of the Patient Protection and Affordable  
               Care Act implementation. There are significant concerns  
               about DHCS's ability and capacity to implement any  
               licensing operation, particularly within the time frame  
               prescribed in this bill. In addition to capacity concerns,  
               there are concerns about DHCS's ability to provide  
               appropriate oversight. AB 106 (Committee on Budget),  
               Chapter 32, Statutes of 2012, transferred DMC functions  
               from DADP to DHCS in 2012.  DHCS is now the payee for all  
               drug and alcohol treatment programs, and this bill would  
               also make DHCS the licensing authority for providers of  
               these programs, establishing a self-regulating system with  
               no third party oversight.

             The Committee may wish to place the provisions of this bill  
               within DCA.  Currently, DCA issues licenses in more than  
               100 business and 200 professional categories, including  
               doctors, dentists, contractors, cosmetologists and  
               automotive repair facilities.  DCA includes 41 regulatory  
               entities (25 boards, nine bureaus, four committees, two  
               programs, and one commission).  These entities establish  
               minimum qualifications and levels of competency for  
               licensure.  Given DCA's current authority and  
               responsibilities, a licensing and certification program  
               such as the one established in this bill is more  
               appropriate in DCA.

             b)   Duplicative licenses.  The Committee may wish to add  
               language that ensures that certain that duplicative  
               licenses will not be required of currently licensed  
               professions including doctors, nurses, psychologists,  
               marriage and family therapists, clinical social workers,  
               and professional clinical counselors.

           6)RECOMMENDED AMENDMENTS  . 

             a)   An amendment to remove the provisions of this bill from  








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               DHCS and place them in DCA.

             b)   On page 21, line 2, add "Nothing in this section shall  
               be construed to mean that persons exempted from this Act  
               under Section 11975.57 shall be required to be dually  
               licensed in order to provide alcohol drug counseling  
               services."   


           7)RELATED LEGISLATION  . 
             
              a)   AB 1644 (Medina) would have required DMC providers to be  
               designated as a 'high' categorical risk and be subject to  
               criminal background checks as a condition of DMC  
               certification.  AB 1644 was held under submission in the  
               Assembly Appropriations Committee.

             b)   SB 1339 (Cannella) requires a county or DHCS, before  
               contracting with a DMC provider, to obtain criminal  
               background checks for the owner and key staff.  SB 1339 is  
               in this Committee.

             c)   AB 1967 (Pan) requires DHCS, when it commences or  
               concludes an investigation of a DMC provider, to notify  
               counties that contract with the provider.  AB 1967 is in  
               the Senate Health Committee.

             d)   SB 1045 (Beall) decreases, from four to two, the minimum  
               number of participants in a group counseling session  
               provided by certain DMC providers and eliminates the  
               maximum of 10 participants.  SB 1045 is pending on the  
               Assembly Floor.

           8)PREVIOUS LEGISLATION  .  

             a)   AB 2007 (Williams) of 2012 would have established a  
               licensing and certification system for AOD counselors to be  
               administered by the Department of Public Health.  This bill  
               was held in Assembly Health Committee

             b)   SB 1203 (DeSaulnier) of 2010 would have instituted a  
               licensing and certification structure for AOD counselors by  
               DADP.  SB 1203 was held in the Assembly Rules Committee.

             c)   SB 707 (DeSaulnier) of 2009, which was substantially  








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               similar to SB 1203, died on the Assembly Appropriations  
               Committee Suspense File.

             d)   AB 239 (DeSaulnier) of 2008 would have established two  
               categories of licensed alcoholism and drug abuse counselors  
               for persons licensed to practice alcoholism and drug abuse  
               counseling under clinical supervision, and persons licensed  
               to conduct an independent practice of alcoholism and drug  
               abuse counseling, and to provide supervision to other  
               counselors, both to be overseen by the DCA Board of  
               Behavioral Sciences (BBS).  AB 239 was vetoed by Governor  
               Arnold Schwarzenegger who stated, in his veto message, that  
               he was directing DADP to work to craft a uniform standard  
               for all alcohol and drug counselors whether in private  
               practice or in facilities.

             e)   AB 1367 (DeSaulnier) of 2007 would have provided for the  
               licensing, registration and regulation of Alcoholism and  
               Drug Abuse Counselors, as defined, by BBS.  AB 1367 died on  
               Assembly Appropriations Committee Suspense File.

             f)   AB 2571 (Longville) of 2004 would have created the Board  
               of Alcohol and Other Drugs of Abuse Professionals in DCA  
               and established requirements for licensure of AOD abuse  
               counselors.  AB 2571 failed passage in the Assembly Health  
               Committee.

             g)   AB 1100 (Longville) of 2003 would have enacted the  
               Alcohol and Drug Abuse Counselors Licensing Law, to be  
               administered by BBS.  AB 1100 was held in the Assembly  
               Business and Professions Committee.

             h)   SB 1716 (Vasconcellos) of 2002 would have required BBS  
               to license and regulate alcohol and drug abuse counselors.   
               SB 1716 was held in the Assembly Business and Professions  
               Committee.

             i)   SB 537 (Vasconcellos) of 2001 would have required DCA to  
               initiate a comprehensive review of the need for licensing  
               substance abuse counselors.  SB 537 was vetoed by Governor  
               Gray Davis due to cost concerns.  In his veto message, the  
               Governor directed DADP to require counselors in drug and  
               alcohol treatment facilities to be certified for quality  
               assurance purposes.
           








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          REGISTERED SUPPORT / OPPOSITION  :

           Support 
           
          California Association of Addiction Recovery Resources
          California Association of Alcoholism and Drug Abuse Counselors
          California State Sheriffs' Association
           
            Opposition 
           
          Breining Institute
          California Association for Alcohol/Drug Educators
          California Association of DUI Treatment Programs
          California Association of Marriage and Family Therapists
          California Psychiatric Association
           
          Oppose Unless Amended
           
          California Psychological Association
          National Association of Social Workers


           Analysis Prepared by  :    Paula Villescaz / HEALTH / (916)  
          319-2097