BILL ANALYSIS Ó
SENATE COMMITTEE ON
BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
Senator Jerry Hill, Chair
2015 - 2016 Regular
Bill No: AB 250 Hearing Date: June 15,
2015
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|Author: |Obernolte |
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|Version: |May 11, 2015 |
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|Urgency: |No |Fiscal: |No |
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|Consultant|Sarah Huchel |
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Subject: Telehealth: marriage and family therapist interns and
trainees
SUMMARY: Authorizes marriage and family therapist (MFT) interns and
trainees working under licensed supervision to provide services
via telehealth, notwithstanding current law.
Existing law:
1)Authorizes the Board of Behavioral Sciences (Board) to license
and regulate the practice of marriage and family therapy and
licensed professional clinical counseling. (Business and
Professions Code (BPC) §§ 4980.34, 4999.14)
2)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 § 2290.5(a)(6))
3)Requires a licensed health care practitioner providing
services via telehealth to be subject to the requirements and
definitions set forth in existing law, as specified, to the
AB 250 (Obernolte) Page 2
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practice act relating to his or her licensed profession, and
to the regulations adopted by a board pursuant to that
practice act. (BPC § 686)
4)Defines "health care provider" for purposes of telehealth to
mean a person who is licensed under BPC. (BPC § 2290.5
(a)(3))
5)States that, unless otherwise expressly provided, "license"
means license, certificate, registration, or other means to
engage in a business or profession, as specified. (BPC §
23.7)
6)Defines a 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. (BPC §
4980.03(b)).
7)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 § 4980.03(c))
8)Requires a MFT applicant for licensure to complete no more
than 375 hours of experience providing personal psychotherapy,
crisis counseling, or other counseling services via
telehealth, as specified. (BPC § 4980.43 (a)(11))
9)Requires an applicant for a professional clinical counselor
license (LPCC) to complete a minimum of 3,000 postdegree hours
of supervised clinical mental health experience related to the
practice of professional clinical counseling, which may
include not more than 375 hours of experience providing
personal psychotherapy, crisis counseling, or other counseling
services via telehealth. (BPC § 4999.46)
This bill: Authorizes MFT interns and trainees working under
licensed supervision to provide services via telehealth within
the scope authorized by the Marriage and Family Therapist Act
(Act) and in accordance with any regulations governing the use
of telehealth promulgated by the Board, notwithstanding any
other law.
AB 250 (Obernolte) Page 3
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FISCAL
EFFECT: None. This bill has been keyed "nonfiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill is sponsored by the California Association
of Marriage and Family Therapists . According to the Author's
office, this bill is necessary to fix a contradiction within
the BPC pertaining to the licensure requirements of MFTs.
2.Background. Telehealth is the use of electronic information
and telecommunications technologies to support long-distance
clinical health care, patient and professional health-related
education, and public health. Technologies include
videoconferencing, the internet, store-and-forward imaging,
streaming media, and terrestrial and wireless communications.
Current law authorizes all licensed healthcare providers to
offer services via telehealth and sets forth for consumer
protections, such as proper notification and adherence to
privacy laws. However, unlicensed MFT interns and trainees
working towards licensure are authorized by the Act to obtain
experience towards their license via telehealth. This
presents a disconnect in code.
This bill specifically authorizes an MFT intern or trainee to
practice via telehealth in accordance with the Act, regardless
of the provisions in the general statute authorizing the
provision of telehealth.
3.Previous Legislation. AB 809 (Logue) , Chapter 404, Statutes
of 2014, revised the informed consent requirements relating to
the delivery of health care via telehealth by permitting
consent to be made verbally or in writing, and by deleting the
requirement that the health care provider who obtains the
consent be at the originating site where the patient is
physically located.
AB 1012 (Wyland) , Chapter, 435, Statutes of 2014, increased
from five to six the number of hours which a MFT trainee or
AB 250 (Obernolte) Page 4
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intern, and a professional clinical counselor intern, may
count towards their weekly supervision requirement.
AB 415 (Logue) , Chapter 547, Statutes of 2011, established 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.
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.
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.
4.Arguments in Support. The sponsors of this bill, the
California Association of Marriage and Family Therapists ,
writes, "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 without this proposed change."
5.Recommended Amendments. While general provisions of the BPC
state that a "license" also means a certificate, registration,
or other means to engage in a business or profession, it is
AB 250 (Obernolte) Page 5
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unclear as to whether this definition is meant to include
individuals who have not reached the culmination of their
education and training to practice independently within their
profession.
For example, the Board argues that because interns are
registered with the Board, they are covered under the existing
general telehealth statute which authorizes telehealth by a
licensed healthcare provider. While this may be a plain
reading of the statute, it makes other provisions of licensing
law unwieldy if it is read to mean that a pre-licensed
individual has the same rights and authority of a licensed
one. It is more likely that the inclusion of "certification"
or "registration" to be encompassed by the word "license" was
meant to include regulated professions under the BPC who are
not licensed, but rather registered, such as dispensing
opticians, or certificated, such as massage therapy.
Further, this bill does not require MFT interns and trainees
to adhere to the consumer protection provisions also included
in the general provisions of telehealth, such as patient
consent, confidentiality of health care information, and
safeguards that a patient may receive in-person for health
care delivery.
To clarify the ability of MFT interns and trainees (who are
neither registered nor certified by the Board) to practice
telehealth in accordance with the Act and the consumer
protection provisions in the master telehealth section, the
following amendments are suggested:
On page 2, line 1, amend Section 2290.5 as follows:
(a) For purposes of this division, the following definitions
shall apply:
(3) "Health care provider" means a person who is licensed
under this division either of the following:
(A) A person who is licensed under this division.
(B) A marriage and family therapist intern or trainee,
pursuant to Section 4980.43.
AB 250 (Obernolte) Page 6
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On page 6, line 32, strike "Notwithstanding" and insert "For
purposes of"
6.Policy Concern. This bill is specific only to MFT interns and
trainees. It is likely that other professions, namely LPCCs
who are currently authorized to practice telehealth within
their practice act, will have to face similar questions of
code conflict, and a generalized fix to section 2290.5 would
be preferable.
SUPPORT AND OPPOSITION:
Support:
California Association of Marriage and Family Therapists
(Sponsor)
American Association for Marriage and Family Therapy, California
Division
Association of California Healthcare Districts
Board of Behavioral Sciences
California Council of Community Mental Health Agencies
California Primary Care Association
Opposition:
None on file as of June 9, 2015.
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