legislative alerts

Dear Colleagues:

On Monday, the 22nd, a Congressional Conference Committee met to decide whether ALL Mental Health Counselors will be able to see TRICARE beneficiaries, irrespective of whether they went to a CACREP School. The American Counseling Association advocated for a special provision in the National Defense Authorization Act that would grandfather ALL Mental Health Counselors as independent providers who possess 5 years of clinical experience. This grandfathering period would last 10 years.

This is a VERY IMPORTANT precedent and I am asking every member to take a moment to send an email to a specially created listserve below that emails every legislative director involved in the conference committee. I need you to write a brief statement telling Congress why CACREP should not be used as the sole criterion to select providers for TRICARE. I fear if we do not stand strong now, the use of CACREP as a selection criterion for insurance reimbursement will seep into MEDICARE and other insurers.

It is a heavy burden to serve as President of our state association while knowing that many of us could face employment and insurance discrimination in the future if we do not act concertedly now to address this threat. I want to do everything possible on my watch to stand up for our profession in Maryland, but I need your help. Thank you for taking a moment to email these legislative staffers. You could make a difference in securing the profession we love into the future.

tricarecounseling@concernedcounselors.org

Larry Epp, President

Dear Fellow Maryland Counselors:

The Virginia Board of Counseling wants to restrict the practice of counseling in the Commonwealth within a ten year time frame to only counselors who graduated from a CACREP accredited graduate program. While in fairness to their proposal, they offer grandfathering to licensed counselors in other jurisdictions. We, however, are concerned about three possible ramifications of this regulatory change:

It creates the impression that graduates of non-CACREP and Counseling Psychology programs are in some way inferior; and we are concerned about how insurance companies may capitalize upon this distinction, as has already occurred with TRICARE reimbursement and Veteran's Administration employment.

Master Degree Recipients in Counseling Psychology, Clinical Psychology, School Psychology or various Expressive Therapies will not likely be licensable in Virginia as counselors, even if they are licensable in Maryland. They would first need to be licensed in Maryland, even if they graduated from a Virginia university unaffiliated with CACREP.

The proposal engenders hard feelings between the states as Virginia is instituting a standard that the graduates of many Maryland non-CACREP schools will never be able to achieve (Most Maryland schools are currently non-CACREP), thus they will be denied employment opportunities in Virginia. Whereas Virginia CACREP graduates will be able to freely seek employment in Maryland and Virginia (Most Virginia schools are CACREP). In a regional economy, where the ability to compete for better employment is important, Virginia CACREP programs are giving themselves an unfair advantage in the counselor employment market.

If the Virginia Board of Counseling adopts a CACREP only standard, it is preempting a needed national dialogue on how to creatively include all quality training programs in a national accreditation standard, whether CACREP's or the emerging MCAC's (a newer counseling accrediting body). CACREP has not established that its graduates yield superior clinical outcomes. In fact, the Institute of Medicine Study on Mental Health Counseling in TRICARE could not discern a difference in clinical outcomes between mental health professionals trained at the masters and doctoral levels. What CACREP offered was a consistency of standards across states for TRICARE credentialing, which we agree is necessary, but CACREP need not be the only organization that can insure this consistency in the future.

The Licensed Clinical Professional Counselors of Maryland (LCPCM) is disappointed that Virginia CACREP Counselor Educators cannot supportall counselors and all quality counselor preparation programs. The heart of the counseling profession is empathy, tolerance, and the creative development of solutions. There is a place in our profession for all counselors, CACREP and non-CACREP, Counseling and Counseling Psychology; and the mission of the Virginia licensure board should be to find that inclusive place.

Please tell the Virginia Board of Counseling and Virginia's governor that a CACREP standard for licensure is not an appropriate standard at this time.

Respectfully,

Larry Epp, EdD, LCPC

President, Licensed Clinical Professional Counselors of Maryland

Susan Roistacher, LCPC - Legislative Chair

Several bills were proposed this year in the Maryland General Assembly of interest and importance to LCPCs. They affected the powers and requirements of the Board of Professional Counselors and Therapists and LCPC practice. Although many other bills of interest to LCPCs were proposed concerning such issues as mental health, health insurance, child abuse, sexual assault and domestic violence, this summary is limited to an overview of bills specific to the LCPC profession. Particular attention was paid to bills that included or excluded LCPCs.

HOUSE BILL 33 – PROFESSIONAL COUNSELORS –CONDUCT

(ALSO KNOWN AS LYNETTE’S LAW) - DEFEATED

House Bill 33 required strong action by LCPCM and its members. We are very pleased to inform you that we were successful stopping this bill in the Senate.

House Bill 33 discriminated against LCPCs and the other professions licensed by our Board of Professional Counselors and Therapists. Its objective was to stop “therapist sexual abuse” by making it a crime, but focused only on Professional Counselors. The genesis of this bill began last year, when a client of an LCPC was dissatisfied by the Board’s disciplinary action against her therapist. The Board allowed the therapist to voluntarily surrender his license after admitting in writing to engaging in a sexual relationship with the client. The client wanted more severe punishment for her therapist and approached Delegate Smiegle to submit a bill last year and again this year to make this behavior a crime, rather that a civil disciplinary matter.

Last year, and again this year, we offered to support the bill in the House, if it applied to all licensed mental health practitioners and not just Professional Counselors. Last year our amendments to include psychiatrists, psychologists, social workers, and psychiatric nurses were included and passed in the House only to be killed in the Senate Judicial Proceedings Committee. This year, our amendments failed, and the bill still passed in the House of Delegates. We strongly opposed the bill without our amendments and it fortunately died for a second time in the Senate Judicial Proceedings Committee.

The other mental health professions lobbied that their ethics and civil disciplinary measures are sufficient to deter this behavior. They strongly opposed making sexual acts with a client/patient a criminal offense. We argued that it was unconstitutional and discrimination to make a sexual act with a client a crime for just one group of professionals and not for all professionals who diagnose and treat mental and emotional disorders.

SB 607 Child Abuse and Neglect-Failure to Report and training – Defeated

LCPCM submitted written testimony opposing this bill which would have required all new and renewing health care licensure applicants to take a child abuse training every two years. In addition, it made it mandatory for the licensing boards to remove a healthcare provider’s license for failure to report child abuse. LCPCs are healthcare providers and therefore were affected by this bill. Although we supported the intent, we objected to the solutions.

We told the Senators that HB 607 requires the investigative agency to file a complaint to the Boards for “failure to report suspected abuse or neglect”. “Suspected abuse or neglect” is not defined. The child abuse reporting laws allow the clinician to violate the patient’s confidentiality when the clinician suspects that child abuse or neglect is occurring. The ‘suspicion” is in the mind of the clinician. The decision to breach the confidence of a patient based on a suspicion belongs to the clinician. Not every clinician will come to the same decision given the same circumstances.

HB1193 Task Force to Study Implementation of Strategies for Preventing Sexual Exploitation of Clients by Health Professionals (Smigiel) - Defeated

LCPCM supported this bill for two reasons. One was that we were specifically included on the Task Force. The other was because we know the discriminatory issues of HB33 (Lynette’s Law) will come up again next year.

HB841 State Board of Professional Counselors and Therapists and State Board of Social Work Examiners – defeated

LCPCM was neutral on this bill which specified language changes in our law regarding the denial of licenses to applicants who were sex offenders, guilty of crimes of moral turpitude, or guilty of a felony. We believe our law already states this in broader language and that the bill was unnecessary.

HB150-Maryland Behavior Analyst Act - Passed

Behavior Analysts are master’s level professionals who develop behavioral plans mostly for children and adults suffering with autism and dementia. They are not clinicians and do not treat individuals with mental and emotional disorders. This group and their clients sought licensure in order to be insurance reimbursable. BOPCT supported it and worked on the amendments. The Behavior Analyst will now have a license and will be regulated by a Committee under the administration of the Board of Professional Counselors and Therapists. They will not have a seat on our Board.

HB112 and SB448 - State Board of Professional Counselors and Therapists-Cease and Desist Orders and Penalties for Misrepresentation and Practicing without a license - Passed

LCPCM wrote testimony in support of this bill which puts some real clout in the Board’s ability to take action against people who misrepresent themselves as professional counselors and/or practice without a license. They have complained for years that they had little recourse in these situations. The Board will now be able to impose a fine up to $50,000.

SB 784 – Education-Loan Assistance – Professional Counselors and Alcohol and drug Counselors - passed

LCPCs, LCMFTs, and LCADC are now among the listing of professionals who are eligible to receive assistance from the Janet L. Hoffman Loan Repayment Program for graduate program tuition if their practice is in a high need geographic area of the State.

SB 803/ hb641 Courts and Judicial Proceedings – Communications Between Patient or Client and Health Care Professional-Exceptions to PRIVILEGE - passed

LCPCM wrote of letter of support for this bill which included LCPCs along with other mental health practitioners. This bill waives the client privilege if the clinical information is needed to support the provider in pursuing legal actions if the client presents a danger to the provider.

SB 882 Assertive Community Treatment (ACT) – Targeted Outreach, Engagement and Services (PUGH) –passed with significant amendments

LCPCM submitted written testimony in support of this bill with amendments to include LCPCs on the ACT team. The bill that passed established a committee to make recommendations to the General Assembly next year. The effort and focus is to provide crisis intervention and on-going services to the chronically mentally ill and potentially dangerous populations.

The legislative session this year resulted in a big change in the composition of the Maryland Board of Professional Counselors and Therapists. With the strong support and leadership of former Senator Paula Hollinger, the art therapists passed licensure legislation and won a new seat on the Board. Unfortunately, our efforts to prevent the removal of two LCPC seats from the Board, succeeded in only saving one. The Board’s composition now consists of 4 LCPC members, 3 LMFT members, 3 LCADC members, 1 Art Therapist member, and 2 consumer members.

LCPCM and the Board of Professional Counselors and Therapists were successful in amending the original art therapist licensure bill to include the specific clinical education and training standards that are consistent with the other licensed professionals regulated by the Board.

We have concerns regarding these changes. Board members each have one vote on issues directly effecting our profession. Representation of the professions on the Board is vastly disproportional to the numbers of licensees. Secondly, the workload of our members is much greater due to our greater numbers. For example, members of each profession review applications for licensure and most recently supervisor approval. The reduction of our seats on the Board is likely to delay the processing of applications and possibly the adjudication of grievances.

There are over 3000 LCPCs and LGPCs in Maryland. The numbers of the other licensed groups are in the low hundreds, although the addictions profession certifies approximately 2000 other individuals working under supervision at various levels.

LCPCM has nominated two of our most experienced members on the Board of Professional Counselors and Therapists, Lisa Jackson-Cherry and Alan Twigg, to serve second 4 year terms. Only one will be able to continue their invaluable service. We owe a debt of gratitude to both for their service to the LCPC profession. If you get a chance, please let each know how much we appreciate their efforts.

Susan Roistacher, LCPC

Legislative Chairaryland

LCPCM believes there are several issues that may be getting lost in reference to the Institute of Medicine’s (IOM) recommendation that all mental health counseling programs be accredited by CACREP.

Fifty to seventy percent of counseling programs are not CACREP accredited; and CACREP is not a mandatory accrediting agency. Whatever the merits of the recommendations, they overreached in asking universities and state boards to collectively abandon their current standards and adopt the IOM recommendations, if they wish their state’s counselors to be recognized by TRICARE. A profession cannot change this quickly; and current members and students are getting caught in the controversy.

The CACREP Accreditation issue has regrettably been divisive to our profession. CACREP must create accrediting standards that are achievable and affordable by our universities. And they have to stop arguing that CACREP graduates are superior when this has no basis in fact. LCPCM also recommends achievable grandfathering standards in TRICARE, the Veterans Administration and potentially MEDICARE that excludes CACREP Accreditation as a criterion.

LCPCM is worried that the IOM model, with its mandatory CACREP Accreditation, will become the standard for MEDICARE providers; and if it does, this will be a great blow to Maryland LCPCs, most of whom did not graduate from CACREP Programs. It is like telling our nation's lawyers who have passed their bar and have been practicing successfully for many years, that they are not qualified since their law school was not accredited by a voluntary accrediting body (that may not have even existed at the time they were in school) and they must take a new exam, despite their many years of effective practice.

It is ironic that Maryland LCPCs can treat Members of Congress and the Executive Branch, since we are recognized by Federal Blue Cross and Blue Shield, but we are felt unqualified to serve veterans and military families who need our services desperately.