OCA Discusses Paths to Licensure

OCA was recently asked by a State Legislator to comment on a possible change to the law to allow additional practitioners the ability to be licensed in Ohio as counselors. This request for comment came about after a constituent contacted the legislator. This individual had recently moved to Ohio from Illinois and was not able to be licensed as a counselor. She had studied Forensic Psychology and was licensed as a clinical counselor in Illinois.

The legislator had suggested amending counselor law as follows: Amend O.R.C. 4757.22 and 4757.23 to allow professional clinical counselors to hold graduate degrees in immediately related fields such as psychology, social work, or family therapy under the condition that their coursework reflects a clear focus on the counseling profession. This will apply only to applicants attempting to transfer their license from another state to Ohio. The Counselor, Social Worker, and Marriage and Family Therapist Board bill have the authority to decide what constitutes appropriate coursework. This change will provide the Board with additional flexibility in reviewing license applications.

OCA representatives Sean Gorby and Amanda Sines met with the legislator to discuss concerns with this path. Mr. Gorby was able to have several follow-up conversations about this issue. Separately, we have heard from other groups about the restrictiveness of the CACREP qualifiers for licensure. Specifically, counselor law specifies the CACREP degree be from a “clinical mental health counseling program, a clinical rehabilitation counseling program, or an addiction counseling program”

We expect this conversation to continue into 2018 and we would like to get additional feedback from the OCA Board.

CSWMFT Rule Package Moves Forward

The CSWMFT board has officially filed a package of rule revisions.  All rules can be found using links here: http://www.registerofohio.state.oh.us/jsps/publicdisplayrules/processPublicDisplayRules.jsp?agencyNumberString=4757&actionType=all&doWhat=GETBYFILINGAGENCY&Submit=Search

The public hearing will be held on January 4th at 9am.   The OCA will be submitting comments voicing support for the rule package, except for 4757-9-04, which will allow all counselor CE to be obtained online.

The proposed changes are as follows:

4757-1-04 Application of first licensure - The rule is being amended to remove references to the notarization of applications; modifies language regarding transcript submission to enable the Board to create policies regarding transcript submission. 4757-1-08 Military provisions related to licensure for counselors, social workers, and/or marriage and family therapists – no substitutive changes. 4757-1-09 Conditional permission to render services (New Rule – approved by the Board in July 2017) 4757-3-01 Definitions – No concerning changes. 4757-5-02 Standards of ethical practice and professional conduct: clients/consumers of services – Adds the following provision regarding informed consent: (5) Counselors, social workers, and MFTs as part of the on-going informed consent process shall obtain any relevant court documents pertaining to custody, visitation, shared parenting, guardianship, or other matters, before proceeding with treatment. 4757-5-11 Standards of ethical practice and professional conduct: change of name and/or address – Requires all licensees to have and maintain a working e-mail address for purposes of the e-licensing system.

 4757-5-13 Standards of practice and professional conduct: electronic service delivery (internet, email, teleconference, etc.) – Adds provision to allow patients to waive encryption forms of communication like e-mail. 4757-7-03 Inactive status of license; restoration. – Makes updates to accommodate elicensing. 4757-9-04 Clock hours for continuing professional education - Removed restriction on the number of online CE hours counselors and MFTs can earn. All 30 hours may be earned online.  OCA submitted comments objecting to this change. 4757-9-05 Approval of continuing professional education programs required for renewal of licenses and certificates of registration issued by the board (Approved in July 2017) - Clarifies sources of CE; increases access to CE for licensees by creating more opportunities to approve CE programs and providers. Increases provider accountability through an application process. 4757-9-06 Sources of continuing professional education – Adds that CE can be earned by providing volunteer counseling services.  This was added in accordance with Ohio law. 4757-9-07 Documentation of continuing professional education required for renewal of a license or certificate of registration – no substantive changes 4757-13-01 Education requirements for admission to the examination for licensed professional counselor - Eliminates duplicative paperwork requirement by requiring the internship evaluation form only from graduates of non-accredited programs. 4757-13-02 Requirements for licensure as a professional counselor - Adds seven year exam re-take standard for persons not actively licensed in Ohio or another jurisdiction. 4757-13-03 Requirements for licensure as a licensed professional clinical counselor - Adds seven year exam re-take standard for persons not actively licensed in Ohio or another jurisdiction. 4757-13-08 Approval of applications for professional counselor licenses – No substantive changes 4757-15-02 Scope of practice for a licensed professional clinical counselor - No substantive changes

Mental Health Hold Legislation – HB 111 – OCA Testifies

Representative Rick Carfagna (R – Genoa Township) has introduced House Bill 111 to allow certain advance practice registered nurses to place a mental health hold on patients. Nurses must be certified as a psychiatric-mental health nurse by the American Nursing Credentialing Center to be granted this authority.

The Ohio Counseling Association has had legislation introduced in several legislative sessions to grant licensed professional clinical counselors this important authority. OCA has formally requested that HB 111 be amended to allow LPCCs the pink slip authority. OCA submitted written remarks to the House Health Committee formally requesting consideration. The statement submitted highlighted the extensive education and training of counselors and also spoke to the delay of care the current law can create. The bill sponsor has asked OCA to work with other interested parties to see who may oppose the inclusion of LPCCs. OCA representatives have spoken with NAMI Ohio, who stated they would not oppose the inclusion. OCA has also reached out to Disability Rights Ohio. Unfortunately, Disability Rights is not supportive of an amendment.

The legislation was reported out of the House Health and Aging Committee without an amendment to include LPCCs. It went on to pass the House of Representatives 94-0. The bill will now be considered by the Senate Health Human Services and Aging Committee. There have been two hearings on the bill to date. At the proponent hearing on October 3, 2017, Candy Rinehart, President of the Ohio Association of Advanced Practice Nurses, testified in support. Chairman Dave Burke, who raised concerns about patient rights, asked how often psychiatric APRNs would likely need to order psychiatric evaluations. The witness said in her experience, she only comes across such a case about once a year.

On November 14, 2017, Sean Gorby testified before the Senate Committee. Mr. Gorby was asked by Senator Charleta Tavares how many other states allow LPCCs this authority. OCA has reached out to ACA for an answer to that question. Chairman Dave Burke (R – Marysville) commented that he appreciated Mr. Gorby’s testimony, but stated he wanted to evaluate the effect allowing APRNs the authority before expanding it further.

ODE Rule Regarding Autism Services

The Ohio Department of Education has circulated a draft rule for input regarding instructional assistant permits issued upon the request and recommendation of a registered private provider under the autism scholarship program.

The draft rule states:

Pursuant to section 3310.43(C) of the Revised Code, registered private providers shall demonstrate the necessary training and supervision of these individuals to the department of education by ensuring that:

(1) Direct supervision is provided by a qualified, credentialed individual who meets one of the requirements. The supervising person must be one of the following:

(a) A licensed intervention specialist in Ohio;(b) A certified Ohio behavior analyst by the Ohio State Board of Psychology;(c) A psychologist licensed to practice in Ohio under Chapter 4732 of the Revised Code;(d) A school psychologist licensed by the State Board of Education under section 3319.22 of the Revised Code; or(e) The holder of a doctoral degree in psychology or special education from a program approved by the Chancellor of the Ohio Department of Higher Education or the equivalent if completed outside the state of Ohio.

However, the Ohio Revised Code states in section 3310.41 (E):

(E) The state board shall adopt rules under Chapter 119. of the Revised Code prescribing procedures necessary to implement this section, including, but not limited to, procedures and deadlines for parents to apply for scholarships, standards for registered private providers, and procedures for approval of entities as registered private providers.

The rules also shall specify that intervention services under the autism scholarship program may be provided by a qualified, credentialed provider, including, but not limited to, all of the following:

(1) A behavior analyst certified by a nationally recognized organization that certifies behavior analysts;(2) A psychologist licensed to practice in this state under Chapter 4732. of the Revised Code;(3) A school psychologist licensed by the state board under section 3319.22 of the Revised Code;(4) Any person employed by a licensed psychologist or licensed school psychologist, while carrying out specific tasks, under the licensee's supervision, as an extension of the licensee's legal and ethical authority as specified under Chapter 4732. of the Revised Code who is ascribed as "psychology trainee," "psychology assistant," "psychology intern," or other appropriate term that clearly implies their supervised or training status;(5) Unlicensed persons holding a doctoral degree in psychology or special education from a program approved by the state board;(6) Any other qualified individual as determined by the state board.

The OCA and OSCA are being asked if counselors should be included in the rule to provide direct supervision.

“Ohio Right to Shop Act” Introduced

Representatives Mike Henne (R – Clayton) and Jim Butler (R - Oakwood) have introduced comprehensive legislation regarding insurance and healthcare. The legislation would do all of the following:

Price transparency/Cost estimates

Exempts a provider from giving a good-faith estimate if the health insurer has done so. Requires the good-faith estimate include the facility fee along with the professional’s fee (along with applicable

CPT codes).

The cost estimate required by this section shall be based on information provided at the time an appointment is made or, in the absence of an appointment, at the time the patient initially presents for the health care product, service, or procedure. In addition, the estimate need not take into account any information that subsequently arises, such as unknown, unanticipated, or subsequently needed health care products, services, or procedures provided for any reason after the initial check-in or appointment. Only one estimate is required per visit.

The cost estimate required by this section shall be provided within 24 hours of the date the appointment for the health care product, service, or procedure is made or the time the patient initially presents for the product, service, or procedure, whichever is sooner.

If the insurer does not provide the healthcare professional the required information, the professional shall notify the patient that the insurer failed to comply.

A patient is responsible for payment for an administered health care product, service, or procedure even if the patient does not receive a cost estimate under this section before the product, service, or procedure is received.

If the service, product, or procedure is delivered in the hospital, the hospital is responsible for providing the estimate.

Requires licensure boards to create a document explaining the requirements in the bill. This document must be sent to all licensees annually.

Insurers would be required to create a website for providers to submit necessary information to get the cost estimate. The site must also allow enrollees to generate estimates. Those websites must be submitted to ODI by October 18, 2018.

The bill provides fining authority for violations against both the insurer and the provider though ODI, ODH, and the licensure boards.

Prior Authorization

Requires the Office of Health Transformation (OHT) to develop a standardized prior authorization form by January 1, 2019.

Specifies that prior authorization is not required for drugs that cost less than $100 for a 30-day supply, or for medical equipment/tests/procedures that cost less than $100.

Specifies that prior authorization is not required for the top 25% of prescribers that have prior authorizations approved.

Additional provisions

Requires OHT, in consultation with the Ohio Department of Insurance and the Ohio Department of Medicaid, to study the administrative burdens placed on healthcare providers.

Puts limits and prohibitions on Step therapy protocols. Requires coverage to continue even when a drug is removed from a formulary or the insurer puts new restrictions

on a product or procedure. Creates a “Shared Saving Incentive Program” which is a program established by a health plan issuer under which

the health plan issuer provides to an individual covered under a health benefit plan offered by the issuer a shared savings incentive payment for utilizing a shoppable health care service.

Shoppable health care services shall include health care services in the following categories:o Physical and occupational therapy services;o Obstetrical and gynecological services;o Radiology and imaging services;o Laboratory services;o Infusion therapy;o Inpatient and outpatient surgical procedures;o Outpatient nonsurgical diagnostic tests or procedures;o Any other category determined by the superintendent of insurance.

The patient shall receive at least 50% of the savings.

HB 416 – Price Transparency

Separately from proposal introduced by Representatives Henne and Butler, Representative and practicing physician Steve Huffman (R – Tipp City), have introduced House Bill 416 to address healthcare price transparency. HB 416 provides that

beginning June 1, 2018 a healthcare provider must, on the request of a patient or the patient's representative, provide to that individual a reasonable, good faith estimate of the cost for each scheduled service. Under the bill "scheduled service" means a health care service or procedure that a patient or the patient's representative has scheduled at least seven days before the service or procedure is to occur.

The estimate may be given in writing, electronically, or verbally and must include the following:

If the patient is insured, the estimate shall specify the amount the healthcare provider expects to receive as payment from the patient's health plan issuer for each scheduled service.

The estimate shall specify the amount that the patient or party responsible for the patient's care will be required to pay to the healthcare provider for each scheduled service.

The estimate shall include a disclaimer that the information provided is only an estimate based on facts available at the time the estimate was prepared and that other required health care items, services, or procedures could change the estimate.

If applicable and known to the healthcare provider at the time the estimate is given, the estimate shall include a notification that the provider is out-of-network for the patient.

The estimate required must be based on information available at the time the estimate is provided and need not take into account any information that subsequently arises, such as unexpected additional services or procedures.

These requirements would not apply in either of the following circumstances:1. The patient is insured and the health plan issuer fails to supply the necessary information to the health care

provider within 48 hours of the provider's request to the issuer for that information. In that case, the health care provider may notify the patient or the patient's representative of the health plan issuer's failure.

2. The scheduled service the patient is to receive requires preauthorization from the patient's health plan issuer. In that case, section 3726.03 of the Revised Code applies.

The legislation also provides that the patient is responsible for payment of the healthcare service or procedure even if they do not receive a cost estimate.

School Resource Officer

House Bill 318 has been introduced by Representatives John Patterson (D- Jefferson) and Sarah LaTourette (R- Chagrin Falls). The bill would define the qualifications and duties of a school resource officer. A "school resource officer" means an officer who provides services to a school district or school as described in the Revised Code. Among the training, skills and duties outlined in the bill is a provision that states:

Any association with a certified training program that includes instruction regarding skills, tactics, and strategies necessary to address the specific nature of all of the following:

School campuses; School building security needs and characteristics; The nuances of law enforcement functions conducted inside a school environment, including understanding the

psychological and physiological characteristics consistent with the ages of the students in the assigned building or buildings, deescalation techniques, and behavior management strategies;

The mechanics of being a positive role model for youth, including informal counseling techniques; Providing assistance on topics such as classroom management tools to provide law-related education to students

and methods for managing the behaviors sometimes associated with educating children with special needs; The mechanics of the laws regarding compulsory attendance, as set forth in Chapter 3321. of the Revised Code; Identifying the trends in drug use, eliminating the instance of drug use, and encouraging a drug-free environment

in schools.

The bill has been assigned to the House Education and Career Readiness Committee. There have been two hearings to date.

OSCA and OCA representatives have been working with the bill sponsors to craft alternative language to the provision requiring training in “informal counseling techniques”. We expect an amendment to change the language to “the mechanics of being a positive role model for youth, including appropriate communication techniques which enhance interactions between the school resource officer and students.”

OCA representative Amanda Sines attended an interested party meeting on the legislation on November 15, 2017. There were no objections to the amendment sought by OCA and OSCA. We expect a substitute version of the bill to be accepted in 2018.

Bill Introduced to Address Text Book Cost

Representative Mike Duffey (R – Worthington) introduced legislation to exempt college text books from sales tax. HB 337 defines "college textbook" as a new or used book or workbook that is required or recommended by an institution of higher education for a course offered by the institution, including a digital copy thereof. The student would have a responsibility to provide information proving their enrollment and requirement to purchase the book.

This legislation will be considered by the House Ways and Means Committee. There have been two hearings to date. At the proponent hearing on December 12, 2017, one witness stated that currently textbooks are exempt from sales taxes in the following states: Arizona, Connecticut, Florida, Hawaii, Iowa, Kentucky, Massachusetts, Minnesota, Mississippi, Missouri, New Jersey, New Mexico, New York, North Dakota, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Vermont, Virginia, and West Virginia.

School Suspension Legislation

Senators Peggy Lehner (R – Kettering) and Gayle Manning (R – North Ridgeville) have introduced Senate Bill 246, legislation intended to eliminate school suspensions for young students.

The bill generally prohibits a school district from issuing out-of-school suspensions or expulsions for students in grades pre-K through 3. The legislation does provide for some exemptions if the suspension/expulsion is necessary to protect the immediate health and safety of the student, the student's fellow classmates, or the classroom staff and teachers. It also allows for expulsions if the students brings a firearm to school, brings a knife capable for causing physical injury, etc…

The legislation also specifies that: “whenever possible, the principal shall consult with a mental health professional under contract with the district or school prior to suspending or expelling a student in any of grades pre-k through 3. If the events leading up to suspension or expulsion indicate a need for additional mental health services, the student's principal or the district's mental health professional shall, in any manner that does not result in a financial burden to the school district or school, assist the student's parent or guardian with locating providers or obtaining those services, including referral to an independent mental health professional.”

The legislation contains a provision requiring all teacher training programs to include a semester course that covers the following topics:

Positive behavior intervention and supports and social-emotional development; Classroom systems for establishing the foundation for positive behavior, such as supervision, acknowledgment,

prompts, and precorrection; Classroom systems for responding to unwanted behavior, including error correction and other strategies; Classroom data collection systems; Effective instructional strategies and how to implement them with fidelity; Matching curriculum to student needs and data.

Teachers who have graduated before the above course is implemented would have three years to get the training through CE.

SB 246 would require school districts to implement a positive behavior intervention and supports framework on a system-wide basis. Under this bill "positive behavior intervention and supports framework" or "positive behavior intervention

and supports" means a multi-tiered, school-wide, behavioral framework developed and implemented for the purpose of improving academic and social outcomes and increasing learning for all students.

The bill allows for time for districts to come into compliance with the law should it be enacted. Additionally, the legislation includes reporting requirements for districts so the state may measure progress and effectiveness.

Mental Health Instruction in School

Representative Martin Sweeney (D – Cleveland) has introduced House Bill 443. The legislation would require school district boards of education to incorporate mental health instruction into their health education curricula. The instruction would include general information about identifying, treating, and, when possible, preventing mental illness.

Legislators Resign

Two members of the Ohio General Assembly have resigned due to inappropriate behavior. Senator Cliff Hite (R – Findley) and Representative Wes Goodman (R – Cardington) gave up their seats when information about their unacceptable behavior came to light.

The Ohio Senate has selected Representative Rob McColley (R – Napoleon) to replace Hite. McColley has already be sworn in to his new position. A process to replace Goodman and McColley is expected to be completed after the first of the year. Additionally, as Representative McColley was a member of the House Republican leadership team, his spot in leadership was filled by Representative Bill Reineke (R – Tiffin).

Copies of legislation – Go to www.legislature.state.oh.us

How to Contact Your Lobbyists

Amanda Sines and Mikayla PollittGovernment Advantage17 South High Street, Suite 750Columbus, Ohio 43215614-221-7157

amanda@gov-advantage.com mikayla@gov-advantage.com

Follow us on Twitter! h ttps://twitter.com/Gov_Advantage