BILL ANALYSIS Ó
AB 250
Page 1
Date of Hearing: May 5, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 250
(Obernolte) - As Amended March 26, 2015
SUBJECT: Telehealth: marriage and family therapist interns and
trainees.
SUMMARY: Authorizes a marriage and family therapist (MFT)
intern or trainee, for the purposes of gaining experience to
apply toward licensure requirements, to provide services via
telehealth if the MFT intern or trainee is supervised, as
specified, and is acting within appropriate scope of practice
and in accordance with regulations promulgated by the Board of
Behavioral Sciences (BBS) governing the use of telehealth.
EXISTING LAW:
1)Defines an MFT intern as an unlicensed person who has earned
his or her master's or doctor's degree qualifying him or her
for licensure, and who is registered with the BBS.
2)Defines an MFT trainee as 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 a specified amount of
coursework in a qualifying degree program.
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3)Requires an applicant for licensure as an MFT to complete
3,000 hours of experience in a variety of areas including, no
more than 500 hours of experience providing group therapy or
counseling; no less than 500 hours diagnosing and treating
couples, families, and children; and, no more than 375 hours
of experience providing personal psychotherapy, crisis
counseling, or other counseling services via telehealth.
4)Defines telehealth as 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. Specifies that telehealth facilitates patient
self-management and caregiver support for patients and
includes synchronous interactions and asynchronous store and
forward transfers.
5)Defines a health care provider, for the purposes of
telehealth, as a person who is a licensed healing arts
practitioner.
FISCAL EFFECT: None
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, existing law
allows MFT interns and trainees to obtain hours of experience
necessary to obtain licensure by conducting therapy through
telehealth services. The author explains that another section
of existing law fails to authorize those very same interns and
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trainees to conduct telehealth services. The author states
that this conflict in the law raises concerns about whether
interns, trainees, and their supervisors are allowed under the
law to perform telehealth services. The author states that
this bill will fix this contradiction in the law. The author
concludes by stating that this bill does not create new
policy, but rather aligns existing statutes for a discipline
that is already in practice and contributes to the
requirements for licensure for MFTs-in-training.
2)BACKGROUND.
a) MFTs. MFTs are healing arts professionals licensed by
the BBS. MFTs are employed in clinics, counseling centers,
and private practice, and use counseling or
psychotherapeutic techniques to assist individuals,
couples, families, and groups with a focus on marriage and
family relationships. The minimum educational and
experience requirements for MFTs include a master's degree
in an area such as marriage, family, and child counseling;
marriage, couple, and family therapy; and, psychology. MFT
interns have earned a graduate degree and registered with
BBS, but have not taken the examination for licensure. MFT
trainees are individuals who have been enrolled in an MFT
graduate program and who have completed at least 12
semester or 18 quarter units of coursework.
To qualify for licensure as an MFT by the BBS, an
individual must apply for and successfully pass a licensure
examination. Prior to applying for licensure examination,
the applicant must complete at least 3,000 hours of
supervised work experience within a period of two years.
Current law allows MFT interns and trainees to gain up to
375 hours of supervised experience through telehealth
services. All MFT interns and trainees must provide
services under the supervision of a supervisor who is
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responsible for ensuring the counseling performed by the
intern or trainee is consistent with the training and
experience of the intern or trainee. The supervisor is
also responsible to the BBS for compliance with all laws,
rules, and regulations governing MFT practice.
b) Telehealth. Access to providers and health care
services is an ongoing concern among stakeholders and
policymakers throughout the state, particularly as
California continues with full implementation of the
Patient Protection and Affordable Care Act. In an effort
to ensure quality services are accessible to patients,
health reform policies have focused on innovative methods,
such as telehealth, to deliver care.
Telehealth uses telecommunication tools and technologies to
connect providers to patients who may otherwise have
limited access to care. In doing so, it provides a means
of delivering care and services, including diagnosis,
treatment, and patient education. The California
HealthCare Foundation reports that health plans, providers,
and information technology vendors are currently using
telehealth applications to increase quality of care, reduce
costs, and increase access for the underserved, and that
studies have demonstrated telehealth services have improved
outcomes and continuity of care for patients, particularly
in rural settings.
In order to provide telehealth services, an individual must
be a licensed healing arts practitioner, including MFTs.
Noncompliance with specified telehealth requirements,
including being a licensed provider, obtaining consent from
patients to use telehealth, and others, constitutes
unprofessional conduct.
AB 250
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3)SUPPORT. Supporters state that, while existing law authorizes
MFT interns or trainees to obtain experience providing
services via telehealth that can later be applied toward
licensure requirements, it also fails to authorize those same
interns and trainees to conduct telehealth services.
Supporters state that this lack of conformity raises concerns
about trainees and their supervisors, and could put them at
risk of disciplinary action by the BBS. Supporters state that
telehealth affords both the patient and the health care
provider increased access, flexibility, and cost-efficiencies,
and resolving this conflict in the law will allow MFT trainees
and interns to practice telehealth under supervision.
4)RELATED LEGISLATION.
a) AB 1485 (Patterson) prohibits the Department of Health
Care Services (DHCS) from using the location of a
radiologist as a condition of approving Medi-Cal provider
enrollment or reimbursement for radiology services provided
to Medi-Cal beneficiaries via telehealth, as specified. AB
1485 is pending in the Assembly Appropriations Committee.
b) SB 620 (Block) revises the experience for MFTs and
provides that individuals who submit applications for
licensure within specified dates may alternately qualify
under current requirements, and makes other technical and
clarifying changes. SB 620 is on Senate third reading.
5)PREVIOUS LEGISLATION.
a) AB 1310 (Bonta) of 2014 would have required a health
care provider located outside of California to meet
specified requirements as a condition for enrolling in the
Medi-Cal program for the purpose of providing telehealth
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services to Medi-Cal beneficiaries receiving care in
California. AB 1310 was held in the Assembly Health
Committee.
b) AB 415 (Logue), Chapter 547, Statutes of 2011,
establishes the Telehealth Advancement Act of 2011 to
revise and update existing law to facilitate the
advancement of telehealth as a service delivery mode in
managed care and the Medi-Cal program.
c) AB 175 (Galgiani), Chapter 419, Statutes of 2010, for
the purposes of Medi-Cal reimbursement, expanded, until
January 1, 2013, the definition of "teleophthalmology and
teledermatology by store and forward" to include services
of an optometrist who is trained to diagnose and treat eye
diseases.
d) AB 1733 (Logue), Chapter 782, Statutes of 2012, updates
several code sections to replace the term "telemedicine"
with "telehealth" and expands the potential for the use of
telehealth in additional health care programs administered
by DHCS, such as the Program of All-Inclusive Care for the
Elderly.
e) AB 1012 (Wyland), Chapter 435, Statutes of 2014,
increases from five to six the number of hours which an MFT
trainee or intern may count towards their weekly
supervision requirement.
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f) SB 33 (Correa), Chapter 26, Statutes of 2009, updates
and revises the educational curriculum requirements for
MFTs, and increased the number of hours of experience
authorized for the provision of service via telehealth from
125 to 375.
6)SUGGESTED AMENDMENT. The author may wish to consider the
following technical amendment (in bold, italic) to language
cross-referencing Business and Professions Code section
2290.5, (which sets forth requirements for providers
delivering care and services via telehealth to be licensed):
Business and Professions Code Section 4980.493(i):
"? For purposes of Notwithstanding section 2290.5, interns
and trainees working under licensed supervision, consistent
with subdivision (b), may provide services via telehealth
within the scope authorized by this chapter and in accordance
with any regulations governing the use of telehealth
promulgated by the board?"
REGISTERED SUPPORT / OPPOSITION:
Support
California Association of Marriage and Family Therapists
(sponsor)
Association of California Health Care Districts
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California Council of Community Mental Health Agencies
California Primary Care Association
Opposition
None on file.
Analysis Prepared by:Kelly Green / HEALTH / (916) 319-2097