Public Health, Welfare and Labor Committee- House

I don't think she's a talk turn on the she's prepared yet to run her re referred bill house bill one one five five yet so we'll pass over that represent Hawker you in the room. you prepared run house bill eleven eighty one great you come to the table in the tradition of. Good morning members represented Delia hop District seventeen and western Benton county. Wanted to present a bill that was brought to me last fall from a counselor's in my area seeking to help more Arkansans find the help they need. this bill establishes a counseling compact or Arkansas to become a member of the counseling compact as an interstate contract between the member states allowing licensed professional counselors LPC is a privilege to practice in the member states within this compact. The compact maintains Arkansas's ethical and legal requirements providing standards for public safety so the main thing. That I want this committee to understand is Arkansas maintains the ethical and legal requirements provided by the licensing board here in Arkansas. The first compact meeting was held in October last year twenty twenty two by ten states so the compact came into existence in may of twenty twenty two with these ten states in alphabetical order. Alabama Florida Georgia Kentucky Maine Maryland Mississippi Nebraska Utah and West Virginia and currently legislation is pending and eleven more states. An Arkansas is not on that current list of pending legislation even though we are considering that before it's here today. an interim study was performed on this bill last fall through representative Ladyman is public health committee the mental health commission that was established last summer is in favor of this Arkansas joining the compact the American mental health counselors association endorses the counseling compact. Each home state sets their requirements I just want to repeat that each home state. Sets their requirements the Arkansas board of examiners and counseling is the compact administrator for the state of Arkansas. A licensed practical skews me a licensed professional counselor The compact or member states. A privilege to practice in a member state so in the compact language member states are all the members as a part of the compact the home state is where the licensed professional counselor resides a remote state which is part of the members of the compact is where a a licensed professional counselor can apply to use their license in a member state which then becomes a remote state and which that LPC has the privilege to practice and likewise it would be those people could practice with our Kansans here. Also the counselors at this time can go to another state and and apply and fulfill any requirements of that home state one of the counselors in support of this is of the director of the graduate counseling program at John Brown University and my district he came from Colorado to become the director of this counseling program and had to take two more courses here in Arkansas in order to practice his degree for which she was qualified to teach the classes he was required to retake that's what councillors face when they try to have a privilege to practice in other states so we are trying to. As we are this session and many of our licensed practices trying to reduce barriers that are unnecessary and keep the the requirements hi for that kind of quality care we want to provide for our Kansans. A licensed professional counselor must follow the the requirements are state laws and member states so that gives us the authority over any licensed professional counselor practicing in Arkansas that is from another state house to follow our state laws. If I home state license is encumbered. and or adverse action is taken the privilege to practice in a member state is deactivated until resolved in the home state's. Of the compact commission is made up of one delegate per state selected by the state board and that most states have their state board of examiners chairman as the member that represents their states the commission is made up of the compact member states and it takes a majority of votes to oversee that and. We've had this go through the department of health I know Mr Gilmore's here the Department of Health had no language changes suggested they had concerns as with any compact or any reciprocity agreement with other states that Arkansas would maintain sovereignty over our own licensing as well as those that are practicing in our state and that is our main concern that we have to make sure all of those standards remain at the levels that we require of all Arkansas licensed professional counselors and With that I will take any questions. If the person you're recognized for a question. Yes I have a question about my concern with all these compact's is typically you're right the ethical and legal concerns is not really a concern my concern is the credentialing and clinical requirements up for instance if if I'm in the compact and I'm in a border state then if I have a less restrictive credentialing requirement in Tennessee I could get license there in practice in Arkansas and that's a concern for me because we've said a very specific clinical educational requirements that that what I would do if I'm in any of these professions I would just go to the least restrictive state get license and then I could get a license in Arkansas that that's my concern not not especially that counseling but especially about compact's in general so am I reading this right that they can get go to the state that has the least restrictive credentialing requirement and Senate actual test so all states that issue a LPC have that requirement for a national certification and standards so my at my understanding is those are things that while each program might have some difference in their courses are requirements I think you see a sixty course requirement listed here plus practice hours and those kind of things but all of that is standard to a national licensing or certification. I mean it's it's not standard in other professions is all I'm saying if you look at. A note but the A. B. R. E. N. particularly their compact And senator Johnson's agreed bill for clinical hours so I I I mean it may be the same national exam but I I would like to know if they make that exact clinical and yes ma'am continuing ed requirements yes ma'am. President Wardlaw you're recognized for a question thank you Mr when I went over this bill. What really concerns me and also concerns me what representative first is bring up but when you get to page twelve. You're you're creating this compact if I understand your explanation this compact consist of all the states that are members of this year creating the membership for an Arkansas person to set on this compact and my understand that correct Mr chairman it's gonna take me a few questions to get to the point yes okay so if you follow me down the twenty line twenty seven on page twelve. You're given on the authority in Arkansas to establish bylaws maintain its financial records meet and take such actions which given also promulgate rules authority but it doesn't say in here these rules I follow the state's role thought rulemaking of procedures that we have today so they're not gonna come rules are not going to go to council we're not gonna have any oversight over those rules that I can find in the bill you going to page thirteen look at line one bring and prosecute legal proceedings I mean that's a lot of power we're given a committee does not even made up but of one voting member from Arkansas so explain to me why we would give all of this power away our rulemaking are prosecuting power why would we do that. Well that's a really good question of concern that's probably why we haven't there hasn't been a compact like this nation wide I think the reason to your point that we would want to. Not give away any sovereignty of the state of Arkansas our purpose is to provide access to mental health care for our Kansans it's to provide that's not what you're this is your bill okay so you're bringing this bill so you're asking us to vote to give away rulemaking authority and to give away prosecuting authority in this field so that's what you're doing is not what we're doing we have voted yet but that's what's in this bill so I mean are you are you saying you pull that down to take those things out or because I got all the concerns to throughout the building this is main there's a lot of power we're giving away right here hi I understand and that's what the interim study was designed to do and have that be looked at by the inspector general's office all of those concerns have been outlined I think we're always going to be looking at are we going to be able to have that representation from the State of Arkansas to maintain the adequacy and professionalism that we require here so you're willing to give up this power to get that is that what you're saying I am willing for Arkansas to participate in the compact that could provide access to mental health care for more Arkansans yes Sir so to get to that goal we would give up rulemaking authority and we give up prosecuting power with our courts to give it to this compact to get there we don't give up any power to have over our licensees in the cot in our home state if a counselor chooses to and that's the thing our counselors don't automatically become or have the privilege to practice and all these other states unless they apply and say they will voluntarily adhere to the laws in those other states those to use their their license so other states. That they would be practicing in would have particular law so if there's an adverse action taken by another state to your question. That counselor has already voluntarily said. For my privilege to practice in your state I will abide by your state's rules and and requirements. So I'm not giving up any power of Arkansas over our licensed professional counselors here in Arkansas if an LPC desires to practice in another state and have the privilege to practice part of joining that is there. So I'm reading to booze going to oversee this rule making authority that you're given on here so each member states would be if you're practicing your a licensed professional counselor and you want to practice in hold on I'm not asking you about practices I said who's going to oversee the promulgation of the rules of this compact in Arkansas it's like any other compact that Arkansas joints when we join a compact and I've never saying those former compact where we give them the ability to promulgate rules represent Wardlaw I think represent Ladyman has a question to I don't mean to interrupt the dialogue but I do think I'll set up House up brick come back to you for the question shortly. Representative Paul thank you Mr chairman I just wondered during this process whether individual counselors that had concerns about this and if so what were they the individual counselors that I heard from we're very much in favor of this because when they come to Arkansas we we currently have a lot of barriers to them if they're already licensed in another state they want to common practice in Arkansas we have and they moved here we have a lot of hurdles for them to John in order to be able to practice here in Arkansas so that was the part of the reasoning for wanting if we're going to provide more mental health care access for our Kansans we want to provide a more access to counselors that's what this is all about this morning and joint budget we heard a request for two and a half million dollars for for veterans mental health care access where I was that counseling access going to come from where will that money go so yes I understand there are many many questions and concerns that I would have as well to ensure the public safety for all our Kansans receiving care from a licensed practicing a professional counselor. But I think the concerns we have will always be there I don't think we'll resolve that we will always want to practice oversight to make sure that this is always done appropriately. But I think that this solves the problem that we currently have in providing adequate access for mental health in Arkansas. Represent region recognized for a question. Thank you Mr I represent pop thinks for bringing this I I really like the idea of the reciprocity I do have a couple questions from from a clarity perspective around oversight of that reciprocity I know you kind of touched on it a little bit but let's my question would be let's assume someone in another state that's joined the compact Fails to meet certain requirements within the state associated with rules or laws already in our state what is the action that's taken by our state the sovereignty of our state to be able to take action against that individual so uh from a legal perspective so I'm not quite sure I understand your question you're asking if we have a home state LPC practicing in another state okay call has it so you have to join the compact with a an individual into the seller remote state practicing in Arkansas and they're not fulfilling or green or they're not abiding by our they're not abiding by our laws are a requirement so they are ready for something yes yes so that's where the an adverse action would be taken their license to practice in Arkansas would be de activated to practice in our state but there voluntarily agreeing to the requirements that we have to practice in Arkansas they would abide by all requirements here I'd appreciate that follow up Mr. So given that that they required they would be kicked out of the current contact until that issue is resolved what action if there is an action that's available from the individual the person who. They broke the law with what action does that individual have to take or what it the wordy of action do they go through our rules to and to seek legal compensation or legal so we have those ramifications right now we have all of those guardrails in place right now to ensure public safety for both counselors and their patients so if whatever wherever they action takes place whether it's in a home state or remote state is where the action would be taken against a particular licensed so Arkansas would be were we would be found the law the lawsuit or legal action here and then prosecuting under our laws correct thank you. Representative voted you're recognized for a question thank you Mr president of vodka and I'm all for reciprocity I'm all for providing mental health services to all our Kansans there's definitely a shortage there of I see the benefit in the need for that I have concerns about this bill we spoke we spoke prior to the committee about a few of those concerns but I also wanted to follow up with the comments or the dialogue between university of Richardson if we already have those practices in place to oversee these out of state actors as they come in they provide services then that takes me back to the point representative Wardlaw was making what is the point of the commission because it the commission does not supersede or provide any additional authority that seems to be a little bit of a belt suspenders approach other may not be a need for that duplication so I have concern there also have concern when you start to. Add curriculum for programs into the wall because when I went there program eleven years ago as you and I discussed that curriculum changes obviously involves as practices involved as different you know modalities and things like that develop curriculum is going to involve this does not allow for that evolution in my opinion thank you and that sixty hours of course credit that you referred to I believe is the national standards currently so to your point it might be beneficial to have something that says or meets the national standards of you know a certification or certified program follow up Mr you're recognized and yes ma'am I agree with that but this is not an hour requirement that I'm referring to this specifically outlines coursework in understand that in the law so I am all for making sure that the process is protected we don't want to delete the process and take a chance on providing an adequate care to our Kansans because there's a shortage but when you specifically outlined course curriculum and work that's my issue not the amount of our yes I understand thank you represent gross you're recognized for a question. So thank you Mr absent this compact why can't out of state mental health professionals practice telehealth medicine in Arkansas. My understanding is the telehealth and maybe our health department can answer questions and they would like to my understanding is if they're not a member of the compact it can't practice telehealth and any of the other medical fields as well. So without this. There's there's no ability for out of state mental health professionals to provide what the compact is suggesting it can provide. And the length of that I would say that is no and that's the reason why we need this kind of opportunity for other counselors to meet needs we have here in Arkansas. per the questions have been asked in conversation are you the position that any concern on the table at this moment is outweighed by the benefits of the additional mental health care provided our Kansans after this past absolutely MMA my mind and again. I have a degree in education I'm not a licensed practical a professional counselor but this was brought to me by those who want to be able to practice here in Arkansas and for us to reduce barriers for those that are qualifying nationally certified licensed professional counselors to be able to. Provide that a service to our Kansans that's what this bill is about in terms of finding of some of the questions in terms of the oversight. Rules of the compact are that each state. Every licensed practical sorry I think I'm getting make the LPN an LPC licensed professional counselor would have to follow any laws in each member state they are voluntarily agreeing to do that so we aren't saying when they come in practice here in Arkansas they don't have to follow our laws we're saying their degree recognized by a member state allows them of privilege to practice and our state licensing board is the oversight of our contact they can they could not have a person give the privilege to practice in Arkansas so they have a fingerprint they have a background check there's a lot of things that they have to go through to be approved by our board of licensing so to representative ward's lots question in my mind we're not giving power to any other entity because anyone that has to come here to practice with their certification has to go through and be approved by our board. Of licensing for counseling which is just like any other LPC that has to be approved by our board here in Arkansas to the question of funding I know our state travels to other state conferences we send our our agency people we send our state representatives from the house and Senate to other comp other states to look at what best practices and things like that are being practice so that we can bring those here to Arkansas that's what would continue under this compact the amount of funding that would be required is to send a. Certificate the our board of counseling to an annual meeting of the member states of which they would be a voting member. President Alan you're recognized for a question. Thank you Mr chairman of represent how I really appreciate what you're trying to do but there are some major concerns with some of the memos on this committee and I think what you're doing is good one of the things that I've learned from my experience up here is when there is some major concerns and people start asking a lot of questions I'll pull my bill back so the questions can be answered are you willing to. Well you'll be a back so some of these questions on this committee can be answered and and some of the concerns could probably make your bill a great deal. Absolutely and I think that I think because we did an I. S. P. on this because we have the health department go through this bill because we took it to the board of of counseling examiners who are not opposed to this bill but sought as yes we have a concern which will always be there to oversee what's happening in Arkansas but it solves a problem that we have so to to this committee right here I value your input you are. It responsible to make sure good bills come through this committee we want that happy to do that if that is the will of the committee. At the it would be up to you with the pool building or not I certainly would acticin representative balance comments it does seem like this a lot more questions an interest in this building maybe were anticipated coming into the meeting so I think you did pull it down it would give you time to work with some members of the committee individually answer some of the questions more at length and if there is a need to amend it that's a fair approach I recognize the work that went into this with the ISP in the other things but just the truth is is that is there your new members here who maybe weren't a part of that process out of the gate and I think it's fair to give them time to ask questions absolutely. I thank you that thank you for starting that conversation for sure president Gonzalez yet a commenter questions of questions yes thank Mr This may be a question for the health former you might of the answer to that one when we do these compacts like this do they have to be written identical in every state that adopts the compact or or can can they be somewhat different. Many of the questions represent hawking answers anyone there in that would have a comment from the health department on that. Thank you Mr Gilmore you're recognized. Per Matt Gilmore department health. I have not had discussions with this compact commission typically though and represent hawking correct me I think that the compact as it's written and presented in the bill I think they have to be that uniformity across all states I think it's my understanding that could be wrong and I would defer to represent hawk on the on this one. So I think the distinction here would be the actual joining the commission the commission has just. Formed an agreement of what the commission's authority or position would be each member state still holds sovereignty over their own states licensing programs so again anyone that would be coming to Arkansas to practice in Arkansas would agree voluntarily to practice under our requirements here in Arkansas they would have to be approved by our board of licensing of counseling just like any other licensed practical a professional counselor in Arkansas so I think again there's only so much that we can do to alleviate any concerns that will always be there in terms of how Arkansas wants to oversee our programs here and be able to have the benefits of being having reciprocity with other states so with that I'm happy to withdraw the bill today and would love to meet with the members and have any other counselors come and share their experiences with the members so you have a better understanding of what they are experiencing okay thank you so much for your time represent auction are there any other comments from the Committee represent Ferguson you're recognized for comment thank you Mr chairman yeah and not at at represent hawk I'm I'm not opposed compact's I mean I think they serve as a valuable service but typically this goes way beyond what we we approve the nursing compact we prove psychology this goes way beyond but most compact's day the real value of the diverse reciprocity in a compact is in the credentialing process because when you apply for a license you have to submit all your education your criminal background check all of those things so the real value of compact is expediting the licensing process in when you go beyond that which I think this bill does is representive Wardlaw point out. Not only in the rulemaking process but M. waving some of the credentialing aspects I think it goes beyond what we receive what we perceive and value in reciprocity so maybe if you'd like to go back and look at some of the other compacts and take some of their rulemaking credentialing out I could completely before because I I want to expedite people getting licensed here thank you. Thank you again represent park yes Review Kavanagh's out here revision will bridge you prepared to run her bill or is that something you want to wait on Mr chairman her bill we believe it's been fixed the federal level she's asked for it to be skipped over today and shall follow up with you in future for these three run okay we'll pass over a house bill twelve eighteen representative Cavenaugh bill I talked to representative five house bill twelve thirty four we're gonna pass over that as well today which leaves us with nothing on the agenda of members I do plan to have one of these informational meetings on Tuesday afternoon normally we have committee meetings upon adjournment there's some interest I think in the Senate joining us for a joint committee for hearing some of this information I think DHS is gonna be planning to come to present some information that they've gathered on a Q. behavioral services in our state and some of the places a different ways we're looking at that so we'll plan that meeting right now my tentative plans have that late afternoon depending on the rooms is available and we want to appear bills that time we'll just have to get just kind of gives a presentation listen some of things I've gathered and on the way of information on behalf of health services in our state and be a good opportunity to learn ask questions receive Allen you're recognized. The question was asked how we schedule Dave the photographer the come and take pictures. That's a good question and you'll see me turn to the right is really on me so I from a standpoint of scheduling so we meet will be I I anticipate this meeting in next Tuesday at ten it would you want to try to have a picture before the meeting or that's probably better because after the meetings nebulous so what. So would check with the Secretary say stay tuned we'll text everyone the time and we'll try to have pictures bill for next Tuesday's meeting. Any other comments or questions from the committee. All right thank you so much for