Today the Oregon House unanimously passed HB 2217, which adds LPCs and LMFTs to the long list of licensed health professionals in Oregon who are exempt from punitive damages in lawsuits. The bill came to the House floor after passing out of the House Judiciary Committee unanimously.
We are halfway there.
It is now onto the Senate.
We will keep you informed.
Larry Conner MA LPC
There was one more issue with HB 3028 that was significant for us. You may remember the Oregon Society of Clinical Social Workers, the small group of LCSWs who were instrumental in killing our attempted vendorship bill in 2007. They have a very effective lobbyist who also is a dominant member of the business lobby. One of his co-lobbyists contacted me to tell me that they were proposing an amendment to HB 3028 that would statutorily define what reimbursement rates would be paid to each mental health profession. He asked me what percentage of reimbursement we would agree to. I told him we would only accept being reimbursed exactly what LCSWs receive. He told me that he had been told by his membership that LCSWs have a higher degree of training than LPCs or LMFTs and so they should have a higher level of reimbursement. Please understand this did not come from NASW-Oregon, which represents the vast majority of LCSWs in Oregon. Rather it comes from a small, but admittedly very influential group of LCSWs, mostly in private practice, primarily in Portland.
I wrote a number of emails to legislators, the OPA, and to the Oregon Society of Clinical Social Workers explaining there is no significant difference in training between LPCs/LMFTs and LCSWs. I pointed out that PSU’s Social Work program requires 78 semester credits for graduation including 10 or more credits that are not directly focused on mental health treatment or psychotherapy. Currently the licensure requirement for LPCs and LMFTs is 72 semester credits. Fortunately, the amendment was tabled because the Oregon Psychological Association was not happy with the language for other reasons.
What this episode tells us is that LPCs and LMFTs will have to continue to fight for the recognition we deserve. Sadly, there will still be turf wars that we have to be ready to respond to. With health care reform, there will be more demand for mental health services all while there will be downward pressure on reimbursement rates. In this kind of environment, we can expect other professions to compete with us to get a larger slice of the available reimbursement dollar.
Which brings me to my current mantra: we need more money in COPACT so that we can hire a lobbyist to protect us. The only reason I knew anything about HB 3028 was that someone mentioned it to me in passing. The only reason I knew about the proposed amendment was the one of the lobbyists called me after the fact. We need a lobbyist who will have an ear on this kind of thing in order to protect us. We were lucky this time. We can’t rely on luck.
You may think legislation like HB 3028 has an impact on private practitioners only. LPCs and LMFTs working in agencies could have been hurt if a hierarchy of reimbursement rates passed into law. If such a hierarchy is set in place, it will be harder for an LPC or LMFT to get employed in an agency. LPCs and LMFTs are already facing the challenge of not having Medicare rights. If we add to that, a potential lower level of Oregon Health Plan or private insurance reimbursement, many LPCs and LMFTs employed in agencies could find themselves out of work.
With such a hierarchy of reimbursement, those of us in private practice would have to require our clients to pay more out-of- pocket or see our incomes drop. We passed the practice act in 2009 by convincing legislators of both parties that LPCs and LMFTs had unjustly ended up being the most expensive option for consumers because we cost the most out-of-pocket. We need to be vigilant to avoid becoming the most expensive option again.
LMFTs and LPCs need to financially support COPACT, so that we will have adequate representation in Salem. Please donate directly to COPACT on this website and make sure you are a member of OMHCA, OAMFT, and/or ORCA because our professional organizations all funnel funds into COPACT. Pass the word onto all your LPC and LMFT associates.
Larry Conner MA LPC
We have been keeping an eye on HB 3028. It is sponsored by the Oregon Nurses Association. It would have required insurance companies to reimburse Psychiatric Nurse Practitioners the same as it does Psychiatrists per CPT code. It was an attempt to undo the huge reimbursement cuts that Regence Blue Cross enacted in 2009, just as our practice act was passing.
HB 3028 was helpful to LPCs and LMFTs as well. It had a section that said:
“An insurer may not discriminate in the rate of reimbursement paid for any coverage required by this section, whether the treatment is provided by a physician or by any other provider who performs the service within the provider’s lawful scope of practice, including but not limited to a clinical social worker, nurse practitioner, psychologist, professional counselor or marriage and family therapist.”
We are grateful that the Oregon Nurses Association was attempting to ensure that all mental health provider groups were included in their legislation and that there would be parity for all licensed providers. That was a generous thing for them to do. Please thank any Nurse Practitioners you know.
The first hearing in the House Health Care Committee on HB 3028 was hopeful because members of both parties expressed support for the plight of Nurse Practitioners and LCSWs who have been forced to close their practices due to the severe reimbursement cuts. They were especially concerned that current reimbursement rates are at levels that existed in the mid-90s, and that psychiatrists have not experienced any such cuts. They were concerned about losing providers in rural areas where there is already a shortage.
There were so many persons testifying at the hearing that the committee had to adjourn just before the lobbyist from Blue Cross was set to testify. The Republican co-chair promised there would be a follow-up hearing and that we would all get to hear from Blue Cross.
Unfortunately, that never happened as HB 3028 was tabled today. There was no follow-up hearing. The Republican co-chair explained that the rationale for the tabling of HB 3028 was that the issue of parity is very complicated and that it is best that it be dealt with outside of the legislative process.
We have no idea what actually happened, but Blue Cross never had to publicly defend its policies and now has another year to continue its current reimbursement policies while other insurance companies follow their lead and cut reimbursement rates significantly. We will inform you if we learn anything more about the demise of HB 3028.
Larry Conner MA LPC
3/18/11 HB 2217 doing well. HB 2065 in trouble.
Hello COPACT supporters
A lot has been happening politically and I want to bring you up to speed. Our current bill, HB 2217, which adds LPCs and LMFTs to the list of licensed health professionals who are exempt from punitive damages, has moved out of the House Human Services Committee and onto the House Judiciary Committee. From there it goes to the House floor and then onto the Senate.
HB 2065, which is the board’s bill to modify some of the language of the practice act of 2009, has hit some big problems. The hearing in the House Human Services Committee was on Feb 16. You can listen to it if you wish. I will give you directions how to do that at the end of this update.
The hearing was very concerning. Typically testimony lasts for 3-5 minutes and then is followed by a few questions. I was answering questions for 40 minutes. I was aware right off that some of the committee members were openly hostile to us. There were some questions and comments that revealed that some committee members knew little or nothing about us. All but the Democratic co-chair were new to the committee this year. Two of the members said they believe professional counselors means counselors who get paid. There was a claim that the practice act harms christian counselors. There was an accusation that we are engaging in a turf war with unlicensed providers. There was concern about whether we know how to differentiate serious mental illness from milder conditions and about whether we know how to refer for psychiatric care. I tried to explain the professions of professional counseling and marriage and family therapy and our scopes of practice in as clear language as possible. I think I got through to a number of them, but amazingly, two Democrats remained hostile and confused. I have since learned that their confusion resulted from a number of unlicensed providers contacting them before the hearing and telling them that the board’s bill will put a thousand unlicensed providers out of work.
Following the hearing, I found out that one of the Republican members, Rep Weidner, wants to repeal the practice act. At that point I became acutely aware of the danger we faced because the House is split 50/50 between Republicans and Democrats and on this committee there were two Democrats who were likely to not support us. Through difficult experiences, we have learned that we cannot trust our Republican supporters to remain loyal because of the strong influence the insurance industry and the business lobby has over them. I was also aware that unlicensed providers were up in arms about this bill even though they have nothing to fear from it. I expected they would show up in force in the Senate. That would open us up there to a potentially hostile amendment to the practice act. There was then a chance that it could pass in the House on a revote. I was recalling the debacle of 2007 when we lost all our Republican supporters in a half an hour. This time we could have lost everything we have achieved. The main concern is that the insurance industry or the business lobby could find a way to amend the practice act in a way that either limits our scopes of practice or takes away our insurance billing rights.
I consulted with the other COPACT directors from OAMFT and ORCA who were at the hearing. We all decided that COPACT had to “kill” the board’s bill. We contacted our supporters in the House and the bill was permanently tabled. It will not come to a vote in the committee and thus cannot go to the floor of the House or onto the Senate.
Becky Eklund, the Director of the Board and members of the Board were also concerned and had begun their own discussion about whether to kill HB 2065. We informed them that we went ahead and did so because it was too dangerous to have it out in the open.
The COPACT directors expressed our support for what Becky and the Board are attempting to do with HB 2065. We explained it is just not the right time and circumstances need to be different before it is safe to open the practice act up again. For one thing, we defined that we need a lobbyist for it to be safe to proceed.
We learned a lot from this process. We know we have the skills to pass a bill into law. We now are learning how to defend a law. It is a different skill set. We have to be fully aware of what is going on in the legislature and what bills are being proposed that could have an impact on us, and then we need to be ready to defend ourselves. In order to do that, we need to have influential supporters in both parties in the legislature.
Having a lobbyist will allow us to know what is going on and to build ongoing relationships with legislators. With a lobbyist, we will have an early warning system. Without a lobbyist we are flying blind. We must raise the money to hire a lobbyist. Please donate to COPACT and become members of one or more of our professional associations, OMHCA, OAMFT, and ORCA. Then please remind all of your LPC and LMFT friends to do the same.
It was a close call. LPCs and LMFTs are safe for now. But I for one will not rest easy until we have a lobbyist in Salem to watch our backs.
Here are the directions for listening to the hearing:
The link is www.leg.state.or.us/listn and then click on 2011 Session under Audio Archives. Then click on Archives of Committee Meetings from the 2011 Session. Then click on Human Services under House Committees. Then click on 2/16/2011. My testimony for HB 2065 and HB 2217 starts at 9:40 and goes through 50:18. Becky’s testimony is 1:06:55-1:36:47. Toward the end of her testimony, I was called back to testify some more. Becky was followed by an unlicensed provider with a doctorate in Psychology speaking against us.
Larry Conner MA LPC
COPACT’s current political agenda
COPACT has a new bill in the Oregon Legislature to exempt LPCs and LMFTs from punitive damages in malpractice lawsuits. Currently all licensed health professionals including psychologists, social workers, nurse practitioners, and physicians as well as others, are exempt. This bill is an attempt to make the rules we work under the same as that for other mental health professions.
The bill is HB 2217. Our chief sponsor is Representative Buckley. It is co-sponsored by Representatives Tomei and Gelser and Senator Bates. If any of these is your legislator, please express your thanks directly to him/her. We rely on our strong supporters in the legislature. They love to hear from constituents who care about what the legislature is doing. They work hard and want to have good relationships with their constituents.
We wanted to have two other amendments in the bill: one creating the same rules for access to teens without parental consent that social workers and psychologists have, and the other tying our level of reimbursement to that of social workers so that we will continue to be reimbursed the same as they are. Representative Buckley and we decided together that those amendments could raise enough opposition that we would need a lobbyist to be successful.
As you can see from this website, we still have to raise money in order to hire a lobbyist. There is no way we can pass a piece of legislation that has any kind of opposition without a lobbyist. So, we will come back to those amendments as soon as we have enough money to hire a lobbyist.
In the meantime return to this site often to get updates as the legislative session progresses in 2011.
Please support our effort to hire a lobbyist by visiting our donate page.
In 2011/2012, COPACT will be focusing on the following goals on behalf of LMFTs and LPCs:
- Give LPCs and LMFTs the same malpractice protections as other licensed health professionals in Oregon. Unlike all other licensed health professionals in Oregon, LPCs and LMFTs are not exempt from punitive damages in malpractice lawsuits. We are concerned that malpracice attorneys may jump at the chance to sue an LPC or LMFT because of the potentially large damage award. We are working on a piece of legislation that will add LPCs and LMFTs to the list of health professionals in Oregon who are exempt from punitive damages.
- Make the laws defining access to adolescent clients the same for LPCs and LMFTs as it is for LCSWs and Licensed Psychologists. LPCs and LMFTs do not work under the same rules for access to teen clients as other mental health professionals. Currently Licensed Psychologists and LCSWs may work with adolescents age 14 and up without initial parental consent. LPCs and LMFTs do not legally have the same professional right. We seek to change the statutes so that the playing field is the same for all mental health professions, making it less of a challenge for LPCs and LMFTs to be hired by agencies or to work successfully in private practice.
- Ensure that all masters level mental health providers are reimbursed the same by insurance companies. Current law requires that social workers are to be reimbursed at at rate that is a portion of that reimbursed to psychologists. LPCs and LMFTs do not have any such reimbursement protections. We seek to amend insurance statute so that insurance companies must reimburse all master’s level providers at the same rate.
- Work with other mental health professions to restrict insurance companies from unfairly cutting reimbursement rates for psychotherapy. As we did in 2010, we plan to work together with other mental health provider groups to pass legislation to require insurance companies to honor parity legislation and treat mental health clients and providers just as they treat patients seeking help with their health issues and their doctors. This includes access to care and the calculation of reimbursement rates paid to providers.
- Open closed insurance provider panels to LPCs and LMFTs. We seek to have provider panels opened up to LPCs and LMFTs as soon as possible. It is our position that closed provider panels are an attempt to limit access to mental health care, which violates parity law.
- Get LMFTs and LPCs access to clients from self-insured entites. We seek to have LPCs and LMFTs receive access to clients who work for self-insured entities like local governments and unions. Self-insured entities are exempt from state laws governing insurance procedures. We seek to negotiate directly with self-insured entities to have them open up their panels to LPCs and LMFTs.
We need to hire a Lobbyist
With the funds raised by COPACT, we will hire a lobbyist to work on behalf of LPCs and LMFTs in Oregon. Without a lobbyist, we cannot pass legislation to benefit our professions, and we won’t have an early warning system to alert us if there is a piece of legislation pending that could have a detrimental effect on our practices. We also will rely on the lobbyist to represent us, when we are not available, at many meetings of commissions and committees that set mental health and health insurance policy throughout the year.
What you can do
To be successful on your behalf, COPACT will need your help. COPACT must hire a full-time lobbyist. There are two ways you can support this effort and your profession:
- Please return to this website often to find out what political and health care changes are developing.
- Make sure you and your colleagues are members of OMHCA, ORCA, and/or OAMFT. A portion of all membership dues will be used to pay for a lobbyist. There are memberships available for interns and students. Membership in ORCA is tax-deductible as a charitable donation. Membership in OMHCA and OAMFT is tax-deductible as a business expense.
- Donate to COPACT directly at the PO Box below or online here. All donations to COPACT are tax-deductible as a business expense.
PO Box 230334
Tigard, OR. 97281