Page 1 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). 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;
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. AB 250 Page 2 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)) 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."
Page 3 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. 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, 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 BBSlicensed 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 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
Page 4 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. 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. This lack of conformity raises concerns about trainees, and their supervisors, being liable for performing telehealth services
Page 5 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. Analysis Prepared by: Elissa Silva / B. & P. / (916) 319-3301