Existing law provides for the registration, certification, and licensure of various healing arts professionals. Existing law provides for various programs to eliminate alcohol and drug abuse, and states the finding of the Legislature that state government has an affirmative role in alleviating problems related to the inappropriate use of alcoholic beverages and other drug use.

This bill, among other things, would establish the Alcohol and Drug Counseling Professional Bureau within the Department of Consumer Affairs, specify the bureaus powers and duties, and authorize the bureau to adopt necessary rules and regulations. The bill would prohibit any a person from using the title licensed alcohol and drug counselor unless the person had applied for and obtained a license from the State Department of Health Care Services bureau and would specify the minimum qualifications for a license, including, but not limited to, educational qualifications, being currently credentialed as an advanced alcohol and drug counselor, and having submitted to a criminal background check. The bill would provide that a license for an alcohol and drug counselor would be valid for 2 years unless at any time during that period it is revoked or suspended, that the license would be authorized to be renewed prior to the expiration of the 2-year period, and that a licensee fulfill continuing education requirements prior to renewal. The bill would also require that the license fee the bureau to establish the fees for an original initial alcohol and drug counselor license and the license a renewal fee be license in an amount reasonably related to the departments bureaus actual costs in performing its duties under this part, duties, but to not exceed $200.

This bill would require the department bureau to ensure that review the state and federal level criminal history of the applicant is reviewed before issuing a license, and the department bureau would be required, with exceptions, to deny, suspend, delay, or set aside a persons license if, at the time of the departments bureaus determination, the person has a criminal conviction or pending criminal charge relating to an offense, the circumstances of which substantially relate to actions as a licensed alcohol and drug counselor. The bill would also require the department to oversee the disciplinary actions of certifying organizations it approves, as provided.

Existing law provides for the registration, certification, and licensure of various healing arts professionals. Existing law provides for various programs to eliminate alcohol and drug abuse, and states the finding of the Legislature that state government has an affirmative role in alleviating problems related to the inappropriate use of alcoholic beverages and other drug use.

This bill, among other things, would prohibit any person from using the title licensed alcohol and drug counselor unless the person had applied for and obtained a license from the State Department of Public Health, Health Care Services and would specify the minimum qualifications for a license, including, but not limited to, educational qualifications, being currently credentialed as an advanced alcohol and drug counselor, and having submitted to a criminal background check. The bill would provide that a license for an alcohol and drug counselor would be valid for 2 years unless at any time during that period it is revoked or suspended, that the license would be authorized to be renewed prior to the expiration of the 2-year period, and that a licensee fulfill continuing education requirements prior to renewal. The bill would also require that the license fee for an original alcohol and drug counselor license and the license renewal fee be reasonably related to the departments actual costs in performing its duties under this part, but to not exceed $200. The

This bill would require the department to ensure that the state and federal level criminal history of the applicant is reviewed before issuing a license, and the department would be required, with exceptions, to deny, suspend, delay, or set aside a persons license if, at the time of the departments determination, the person has a criminal conviction or pending criminal charge relating to an offense, the circumstances of which substantially relate to actions as a licensed alcohol and drug counselor. The bill would also require the department to oversee the disciplinary actions of certifying organizations it approves, as provided.

Existing law provides for the registration, certification, and licensure of various healing arts professionals. Existing law provides for various programs to eliminate alcohol and drug abuse, and states the finding of the Legislature that state government has an affirmative role in alleviating problems related to the inappropriate use of alcoholic beverages and other drug use.

This bill, among other things, would prohibit any person from using the title licensed alcohol and drug counselor unless the person had applied for and obtained a license from the State Department of Public Health, and would specify the minimum qualifications for a license, including, but not limited to, educational qualifications, being currently credentialed as an advanced alcohol and drug counselor, and having submitted to a criminal background check. The bill would provide that a license for an alcohol and drug counselor would be valid for 2 years unless at any time during that period it is revoked or suspended, that the license would be authorized to be renewed prior to the expiration of the 2-year period, and that a licensee fulfill continuing education requirements prior to renewal. The bill would also require that the license fee for an original alcohol and drug counselor license and the license renewal fee be reasonably related to the departments actual costs in performing its duties under this part, but to not exceed $200. The bill would require the department to ensure that the state and federal level criminal history of the applicant is reviewed before issuing a license, and the department would be required, with exceptions, to deny, suspend, delay, or set aside a persons license if, at the time of the departments determination, the person has a criminal conviction or pending criminal charge relating to an offense, the circumstances of which substantially relate to actions as a licensed alcohol and drug counselor.

This bill, effective July 1, 2017, would transfer the administrative and programmatic functions of the State Department of Health Care Services pertaining to alcohol and drug counselor certification and the approval and regulation of certifying organizations to the department. The bill would also require the State Department of Public Health to oversee the disciplinary actions of certifying organizations it approves, as provided.

SENATE COMMITTEE ON

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

SB 1101 (Wieckowski) - Alcohol and drug counselors: regulation

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

SB 1101 would establish a new licensing bureau within the Department of Consumer Affairs to license alcohol and drug counsellors.

Fiscal Impact:

• One-time costs of about $750,000 for information technology upgrades to the BreEze system to accommodate a new license type (special fund). Because those costs would be incurred before any license revenue is collected, it is assumed that the Department of Consumer Affairs would need to loan funds from an existing special fund source to cover those initial costs.
• Ongoing costs of $1.1 million per year for the new bureau to perform licensing activities such as processing applications and renewals, processing background checks, and reviewing continuing education information (special fund).
• Potential additional licensing and enforcement costs up to $1 million per year (special fund). The bill authorizes the new bureau to license applicants with criminal convictions under specified circumstances. The Department of Consumer Affairs indicates that the criteria for waiving criminal convictions under the bill are different and more lenient than those in existing law that apply generally to the issuance of licenses by Department boards and bureaus. Therefore, the Department indicates that there are likely to be additional licensing and enforcement costs due to those potential conflicts.

Background:

Under current law, alcohol and drug counsellors are not licensed in the state. The Department of Health Care Services requires alcohol and drug counsellors working at certain inpatient programs to be certified by one of three third-party certification bodies.

Proposed Law:

SB 1101 would establish a new licensing bureau within the Department of Consumer Affairs to license alcohol and drug counsellors.

Specific provisions of the bill would:

• Establish a new Alcohol and Drug Counseling Professional Bureau within the Department of Consumer Affairs;
• Prohibit a person from using the title “licensed alcohol and drug counsellor” unless the person is licensed by the new Bureau;
• Establish minimum qualifications for licensure – including having a masters or doctoral degree in one of several specified fields, passage of a master’s level exam offered by a certifying organization, having a credential with a certifying organization, and have completed specified educational coursework;
• For one year, exempt individuals who have 12,000 hours of experience from the educational requirements for licensure and but require those applicants to pass a master’s level exam before the first license renewal;
• Impose continuing education requirements on licensees;
• Authorize the Bureau to revoke a license under specified circumstances;
• Authorize the Bureau to assess licensing fees not to exceed $200;
• Require a criminal background check for license applicants:
• Generally prohibit a license from being issued to an individual with a criminal conviction substantially relating to counselling actions;
• Authorize the Bureau to waive a criminal convictions in certain circumstances.

Related Legislation:

In recent years, there have been several bills proposed to license drug and alcohol counsellors, including SB 570 (DeSaulnier, 2013), AB 2007 (Williams, 2012), SB 1203 (DeSaulnier, 2010), SB 707 (DeSaulnier, 2009) and others. None of those bills were enacted.

Staff Comments:

Under current law, state licensing boards and bureaus enforce both “practice acts” and “title acts” in the licensing of professions. Practice acts require licensed professionals to obtain a professional license (generally by meeting certain educational requirements and/or passage of examinations). In addition, practice acts impose requirements on the practice of the profession by licensees. For example, practice acts may impose professional responsibilities, requirements for protection of the public, continuing education responsibilities, and other requirements. On the other hand, title acts simply permit professionals who meet certain requirements to use a title and prohibit those who have not met those standards from using the specified title. Title acts generally do not impose professional requirements on licensed professionals. This bill establishes title protection for Licensed Alcohol and Drug Counsellors but does not impose full practice act requirements on the practice of such counsellors.

-- END --

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Jerry Hill, Chair

2015 - 2016 Regular

Bill No: SB 1101 Hearing Date: April 18, 2016

Subject: Alcohol and drug counselors: regulation

SUMMARY:

Establishes the Alcohol and Drug Counseling Professional Bureau
(Bureau) within the Department of Consumer Affairs (DCA) to license and regulate the title protection of licensed alcohol and drug counselors.

Existing law:

1. Establishes the DCA within the Business, Consumer Services, and Housing Agency. (Business and Professions Code (BPC) Section 100)
2. States that the boards, bureaus, and commissions in DCA are established for the purpose of ensuring that those private businesses and professions deemed to engage in activities which have potential impact upon the public health, safety, and welfare are adequately regulated in order to protect the people of California.

To this end, they establish minimum qualifications and levels of competency and license persons desiring to engage in the occupations they regulate upon determining that such persons possess the requisite skills and qualifications necessary to provide safe and effective services to the public, or register or otherwise certify persons in order to identify practitioners and ensure performance according to set and accepted professional standards. (BPC § 101.6)

1. Establishes the Medi-Cal program, administered by Department of Health Care Services (DHCS), under which qualified low-income individuals receive health care services. (Health and Safety Code (HSC) Section 11750)
   
2. Establishes the Drug Medi-Cal (DMC) program, which provides substance use disorder services to Medi-Cal recipients. (HSC § 11750)
   
3. Allows DHCS to enter into contracts with counties for the provision of DMC services. If a county declines to contract with DHCS, existing law requires DHCS to contract for services in the county to ensure beneficiary access. (HSC §11758.20)
   
4. Requires each county to fund the nonfederal share for DMC services through realignment funds, as specified. (HSC §11758.10)
   
5. Requires providers of DMC services to obtain certification from DHCS to provide those services. (HSC § 11755)

This bill:

1. Establishes the Bureau within the DCA to regulate the practice of alcohol and drug counselors.
2. States that protection of the public shall be the highest priority for the Bureau in exercising its licensing, regulatory and disciplinary functions. Whenever the protection of the public is inconsistent with other interest sought to be promoted, the protection of the public shall be paramount.
3. Authorizes the DCA director to appoint a chief with the approval of the Director of Finance, whose duty is to enforce and administer the Bureau’s laws.
4. Requires that the Bureau be subject to review by the appropriate policy committee of the Legislature.
5. Authorizes the Bureau to establish necessary rules and regulations for the administration and enforcement of this bill, and such laws shall be adopted, amended, or repealed in accordance with the provisions of the Administrative Procedures Act.
6. Establishes title protection for the title “licensed alcohol and drug counselor” (counselor).
7. Requires an applicant for licensure to have the following minimum requirements for licensure, which are not exhaustive:
   1. Has earned a master of arts, master of science, or doctoral degree in addiction counseling, psychology, social work, counseling, marriage and family therapy, counseling psychology, clinical psychology, or other clinically focused major that requires no less than 21 semester units, or equivalent, of addiction specific education approved by a certifying organization recognized by the department, from an institution of higher learning accredited by a regional accrediting agency, or a board for private postsecondary education.
   2. Has demonstrated competence by passing a master’s level exam accepted by a certifying organization approved by the Department of Health Care Services. (DHCS)
   3. Is currently credentialed as an advanced alcohol and drug counselor and in good standing with a certification organization recognized by DHCS, as specified, and has no history of revocation by a certifying organization, licensure board, or certifying entity.
   4. Establishes minimum course requirements for coursework in psychopharmacology and physiology of addiction, clinical evaluation and psychopathology, counseling and psychotherapy for addiction, case management, client education, professional responsibility law and ethics, and supervised fieldwork, as specified.
   5. Has submitted to a state and federal level criminal offender record information search as part of a criminal background check.
8. Establishes specified exemptions for a period of one year from the date of accepting applications for the license for applicants with 12,000 hours experience.
9. Requires applicants who do not meet specified requirements sit for the master’s level exam before the first renewal period and provide proof of passing the exam to the certifying organization before one year after the end of the first renewal period.
10. Establishes that a license for a counselor is valid for two years unless at any time during that period it is revoked or suspended. The license may be renewed prior to the expiration of the two-year period.
11. Requires 36 hours of continuing education for license renewal, which shall include six hours of ethics and law, six hours of instructions on co-occurring disorders, and three hours of cultural competency.
12. Authorizes the Bureau to revoke the license of a counselor if either of the following occurs:
    1. The licensee loses his or her credential granted by the certifying organization.
    2. The licensee has been convicted of a felony charge that is substantially related to the qualifications, functions, or duties of a licensed alcohol and drug counselor.
13. Establishes the license fee for a counselor license and the license renewal fee to be reasonably related to the Bureau’s actual costs in performing its duties under this part, but shall not exceed $200.
14. Requires the Bureau to review an applicant’s state and federal criminal history prior to issuing a license.
15. Requires the DCA to deny, suspend, delay, or set aside a person’s license if, at the time of the DCA’s determination, the person has a criminal conviction or criminal charge pending, relating to an offense, the circumstances of which substantially relate to actions as a licensed alcohol and drug counselor.
16. Requires that an applicant who has a criminal conviction or pending criminal charge to request the appropriate authorities to provide information about the conviction or charge directly to the DCA in sufficient specificity to enable the DCA to make a determination as to whether the conviction or charge is substantially related to actions as a licensed alcohol and drug counselor.
17. Authorizes the DCA, after a hearing or review of documentation demonstrating that the applicant meets the specified criteria for a waiver, to waive the criminal background requirements if the DCA finds any of the following:
    1. For waiver of a felony conviction, more than five years has elapsed since the date of the conviction. At the time of the application, the applicant is not incarcerated, on work release, on probation, on parole, on post-release community supervision, or serving any part of a suspended sentence and the applicant is in substantial compliance with all court orders pertaining to fines, restitution, or community service.
    2. For waiver of a misdemeanor conviction or violation, at the time of the application, the applicant is not incarcerated, on work release, on probation, on parole, on post-release community supervision, or serving any part of a suspended sentence and the applicant is in substantial compliance with all court orders pertaining to fines, restitution, or community service.
    3. The applicant is capable of practicing licensed alcohol and drug treatment counselor services in a competent and professional manner.
    4. Granting the waiver will not endanger the public health, safety, or welfare.
    5. The applicant has not been convicted of a felony sexual offense.
18. States that the bill does not constrict, limit, or prohibit a facility or program that is licensed or certified by this state, a county-contracted alcohol and drug treatment facility or program, or a driving-under-the-influence program from employing or contracting with a counselor who is certified by a certifying organization accredited and approved by this state, as specified.
19. States that this chapter does not require a facility or program licensed or certified by this state, a county-operated or contracted alcohol and drug treatment program or facility, or a driving-under-the-influence program to utilize the services of a licensed counselor.

FISCAL EFFECT:

Unknown. This bill has been keyed “fiscal” by Legislative Counsel.

COMMENTS:

1. Purpose. This bill is co-sponsored by the California Consortium of Addiction Programs and Professionals, the California Association for Alcohol and Drug Educators, and the California Association of DUI Treatment Programs. According to the Author’s office, “Legislation is necessary to create a simple, self-sustaining licensure program, and provide statutory authority for strengthening the counselor certification system in California. Modeled after the Genetic Counselor Licensing Act, the bill would differentiate Master’s level counselors from other certified counselors. It would restrict the use of the title ‘licensed alcohol [and] drug counselor’ thereby enabling consumers and payers to readily identify counselors capable of providing service at an advanced level, independent from a licensed or certified facility.
   
   
   “In 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) published national “Scopes of Practice & Career Ladders for Substance Use Disorder Counseling.” Certifying organizations are working toward adopting a multi-level professional career ladder for the counselors they certify. The state issued ‘license’ for counselors with a Master’s degree (or higher) proposed by this bill would establish the license level featured in the SAMSHA Career Ladder – an important first step in creating a comprehensive career ladder for the entire profession in California.
   
   “The combination of the state-licensed category established in this bill and the envisioned privately certified counselor categories would complete the career ladder for the entire workforce, from entry-level individuals with a high school or GED to those with an advanced degree.”
   
2. Sunrise Review.  The Legislature uses a “Sunrise Model” for the purpose of assessing requests for new or increased occupational regulation, including the creation of any new licensing scheme or licensing entity within the DCA. Government Code Sections 9148 et seq. require that “Prior to consideration by the Legislature of legislation . . . creating a new category of licensed professional, a plan for the establishment and operation of the proposed . . . new category of licensed professional shall be developed by the author or sponsor of the legislation.”  The Code further states:  “The necessary data and other information required by this section shall be provided to the Legislature with the initial legislation and forwarded to the policy committees in which the bill will be heard.”
   
   Correspondingly, the Committee Rules of this Committee require:  “Prior to hearing any bill or other measure that proposes to create a new state licensing agency or a new category of licensed or regulated professional, the Author or sponsor of the legislation shall develop a plan for the establishment and operation of the agency or creation of the new licensed category in accordance with the requirements of Government Code Section 9148 et seq.  The plan shall include the completion of a regulation proposal review worksheet titled the “Sunrise Questionnaire” by the Author or sponsor of the legislation.”
   
   This questionnaire is designed to assist proponents of new regulatory programs to collect and organize information that is necessary for an objective evaluation of the need and justification for the proposal.  If a new program is to be established within the DCA or any other agency under this Committee’s jurisdiction, the Committee is better informed based on responses in the questionnaire and in a better position to properly evaluate and respond to the proposal.  Typically the completion of the Sunrise process is a multi-year effort, with meetings and hearings being convened during the fall Interim Recess in order for the Committee to hear testimony from the stakeholders in a legislative proposal, including both the proponents and the opponents.  This enables the Committee to ascertain the level of need for regulation, the type of regulation that is needed, any impediments to adopting the proposed regulatory scheme, and whether the proposed regulation is adequate to address the identified level of consumer harm, and is the least onerous way to efficiently regulate in that area.
   
   The author submitted a Sunrise questionnaire, which has aided this analysis, but does not fully explain the decisions made in the current version of the bill.

According to information provided by the Sunrise Questionnaire, California currently does not require licensure for alcohol and drug counselors. DHCS requires certification for alcohol and drug counselors employed by certain inpatient programs, but outpatient treatment programs -- where 70% of Californians seek treatment -- are not regulated by any state agency, according to a 2008 report by the Little Hoover Commission.

DHCS recognizes three agencies to provide certification, and each program develops its own classroom curriculum, training, supervisor and work experience requirements. Background checks are not performed and there is no central repository of counselor information, including disciplinary action taken to suspend or revoke certification for misconduct. DHCS can direct a certifying organization to take action against a counselor for misconduct, but there is nothing to prevent a counselor who has had certification suspended or revoked from obtaining certification from another organization.

Approximately 36,000 registered or certified alcohol and drug counselors work in 2,534 private and publicly funded drug and alcohol programs in California. With the implementation of the ACA, many newly-insured people are expected to seek treatment. The federal government and insurers, meanwhile, may impose greater standards on providers. In combination, these developments are likely to lead to greater scrutiny of California’s system of overseeing those who provide drug and alcohol treatment.

According to a 2013 report by the Office of Statewide Health Planning and Development California Workforce Investment Board, “California is already experiencing statewide and regional shortages and mal-distribution in many critical mental health professions. In particular, California’s historically underfunded, Public Mental Health System (PMHS) suffers from a critical shortage of qualified mental health personnel to meet the needs of the diverse population they serve, in addition to mal-distribution, lack of diversity, and under-representation of practitioners with consumer and family member lived experience. Healthcare reform implementation and other key trends, such as population growth and aging, will exacerbate these challenges.”

1. Practice Act (Licensure/Scope of Practice) vs. Title Act Protection. A practice act along with licensure confers the exclusive right to practice a given profession on practitioners who meet specified criteria related to education, experience, and examination, and often is embodied in a statutory licensing act (i.e., those who are not licensed cannot lawfully practice the profession).  A practice act is the highest and most restrictive form of professional regulation, and is intended to avert severe harm to the public health, safety or welfare that could be caused by unlicensed practitioners. 
   
   A title act and a certification or registration program, on the other hand, reserves the use of a particular professional (named) designation to practitioners who have demonstrated specified education, experience or other criteria such as certification by another organization.  A title act typically does not restrict the practice of a profession or occupation and allows others to practice within that profession; it merely differentiates between practitioners who meet the specified criteria, and are authorized by law to represent themselves accordingly, (usually by a specified title) and those who do not.  Some title acts also include a state certification or registration program, or reliance on a national certification or registration program, so that those who use the specified title, and hold themselves out to the public, have been certified or registered by a state created or national entity as having met the specified requirements.  This entity may also regulate to some extent the activities of the particular profession by setting standards for the profession to follow, and to also provide oversight of the practice of the profession by reporting unfair business practices or violations of the law and either denying or revoking  a certification or registration if necessary.
2. California Senate Office of Oversight and Outcomes (CSOOO) Report. A 2013 report by CSOOO extensively examined the current process to become an AADC, and noted some of the systemic flaws. "California is one of only two states among the nation’s 15 largest that makes no attempt to review counselors’ criminal backgrounds. Even within California, alcohol and drug counselors are the only health-related profession not required to undergo these checks. Among those who submit to screening are acupuncturists, dental hygienists, optometrists, and veterinarians.
   
   "In 2004, Governor Gray Davis directed the California Department of Alcohol and Drug Programs (DADP) to come up with regulations for certifying counselors. [Current regulations require 30% of staff providing alcohol and drug counseling in any program must be certified by 2010, and counselors who work in privately-run facilities that do not receive public funds are exempt.]"

The CSOOO cross-checked lists of counselor names against individuals who have been excluded from receiving Medicare and Medi-Cal payments because of misconduct, including fraud or other criminal activity. CSOOO found several counselors who were able to keep working despite having their registrations or certifications revoked; they simply signed up with a different certifying organization. The organizations are supposed to check with their counterparts to make sure that an applicant has not been ordered revoked by DHCS. However, the regulation states that the check must be done only when the organization certifies counselors, not when they register, providing for a regulatory loophole. Regulations allow counselors to work for five years without being certified, meaning that a revoked counselor could go that long without being detected. After five years, that same counselor might be able to register with another of the certifying organizations and keep working.

This bill is sponsored by the three accredited alcohol and drug counselor certifying organizations approved by the DHCS.

1. Cost of substance abuse. According to the CSOOO report, "Substance abuse is a key driver of California’s most costly problems. As many as two-thirds of all parents who enter the state’s $19-billion child welfare system are affected by substance abuse, while an estimated 60,000 to 70,000 children who are born each year in California have been exposed in the womb to alcohol, tobacco or other drugs."

"California hospitals incur $1.3 billion in costs due to alcohol-related incidents. Studies conducted by Kaiser Permanente in California show that the health maintenance organization’s members who sought substance abuse treatment had medical costs more than four times that of other clients prior to seeking treatment.

"Severe overcrowding in California’s $10-billion prison system has prompted federal judges to consider taking control of the system away from the state. County jail policies in 20 counties are guided by court-imposed population caps, which force sheriffs, every day, to release offenders early. Approximately 80 percent of the offenders in these over-packed prisons and jails are involved with substance abuse, and for many, addiction is an integral part of their criminal lifestyles….

"In California, substance abuse treatment is a sound investment. According to data collected by the state Department of Alcohol and Drug Programs, Californians who entered treatment in 2006 reduced their contact with the criminal justice system by 57 percent, and the number who had a job grew from 24,433 upon entering treatment to 30,198 upon exiting treatment, a 24 percent increase in employment. Both of these statistics illustrate positive results not only for individuals and families, but also for public coffers.

"A long-term study conducted on northern California patients in the addiction treatment system run by Kaiser Permanente, the state’s largest health maintenance organization, showed that providing substance abuse treatment reduces the health care costs of those struggling with addiction while adding only minimal costs to the system. Medical care costs decreased by $155 per month, five years after admission to treatment for the patients who sought help, while costs for a comparison group remained stable. The study found that while the average medical costs for those with substance abuse problems was four times higher than the comparison group in the six months before the study group was admitted to treatment, average costs were only twice as high five years later, even with the addition of the treatment costs."

Maximizing the effectiveness of treatment programs must begin with confidence in the treatment provider, but the current regulatory system for AADCs provides inconsistent consumer protection.

1. Questions for the Committee. The Committee members and Author may wish to consider the following issues as this bill moves forward:
   1. Independent bureau within DCA. This bill essentially establishes an independent licensing bureau within DCA to regulate a title protection act. If a bill only protects a title, a bureau is not necessary for licensure or enforcement.

The Board of Behavioral Sciences currently licenses and regulates Licensed Marriage and Family Therapists (MFTs), Licensed Clinical Social Workers (LCSWs), and Licensed Professional Clinical Counselors (LPCCS) – other allied health professionals also trained in mental and social health services. These licenses have similar work and experience requirements and enforcement concerns.

However, BBS has expressed resistance to adding another license to its regulation authority due to insufficient resources. Licensing boards are required to be self-sustaining, and receive no General Fund money. The Committee may wish to consider whether it is appropriate to have a completely separate bureau to administer a license similar to existing regulatory programs, or whether it would be more efficient to create a committee within BBS which could provide expert guidance while the BBS board could continue to manage enforcement and discipline.

• 1. No scope of practice. This bill does not establish what a licensed alcohol and drug counselor may and may not do, or how the practitioner’s profession intersects with other licensed professionals. The Author should specify what the practice of alcohol and drug counseling constitutes.
  2. Master's level education and experience requirements. This bill creates a license for mental health treatment of a single diagnosis – alcohol and substance abuse. This license requires a master's level education and experience similar to these requirements for a LPCC, MFT, and LCSW. There is no uniform educational requirement for certification, and many certification bodies do not require a bachelor's degree.
     
     The Committee may wish to consider whether the educational and experience requirements are commensurate with the level of expertise needed for sufficient alcohol and drug treatment, given the current levels required for other, similar license types that are trained to handle a myriad of other mental health issues, and the current standards for certified alcohol and drug counselors.
  3. Criminal provisions. The Author may wish to consider expanding the bill’s consideration of felony charges. Because the duties of an alcohol and drug counselor are not defined, it is unclear which felonies may substantially relate. Is murder or sexual assault permissible under certain circumstances?
  4. Builds upon a broken system. While this legislation compliments the existing certification programs, it is building upon a flawed system, as noted in the reports cited above. The Author may wish to improve regulations on the lower-levels of providers and ensure quality control across a greater number of facilities. The Author may also want to consider consolidating oversight of the certification programs so that the Bureau would have primary responsibility for determining the education requirements for counselors.

1. Arguments in Support. Soroptimist House of Hope writes, “California needs the same level of professionalism from our workforce which is common in 32 states and most developed countries. Because California does not license alcohol drug counselors, our programs are unable to participate fully in funding provided for addiction treatment under the ACA. We suffer chronic shortages of qualified staff and we contend with tremendous turnover as talented practitioners leave the profession to become licensed as mental health practitioners.”

SUPPORT AND OPPOSITION:

Support:

California Consortium of Addiction Programs and Professionals (co-sponsor)

California Association for Alcohol and Drug Educators (co-sponsor)

California Association of DUI Treatment Programs (co-sponsor)

Alpha Project

Associated Rehabilitation Program for Women, Inc.

California Society of Addiction Medicine

Clean and Sober Transitional Living

Community Social Model Advocates, Inc.

Inland Valley Recovery Services

International Certification and Reciprocity Consortium

MARSTE Training

Sacramento Recovery House, Inc.

Skyway House

Soroptimist House of Hope

Strategies for Change

Sun Street Centers

Visions of the Cross, Inc.

Opposition: None on file as of April 14, 2016.

-- END --

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: SB 1101

SUBJECT: Alcohol and drug counselors: regulation

SUMMARY:

Requires the Department of Health Care Services (DHCS) to issue licenses for alcohol and drug counselors, as specified, and prohibits a person from using the title “licensed alcohol and drug counselor,” unless the person has applied for and obtained a license from DHCS, and meets all of the criteria for licensure.

Existing law:

1. Provides for the registration, certification, and licensure of various healing arts professionals.

1. Creates, within the Department of Consumer Affairs (DCA), the Board of Behavioral Sciences (BBS), which licenses marriage and family therapists, clinical social workers, professional clinical counselors, and educational psychologists, and sets, communicates, and enforces standards for safe and competent mental health practice.
2. Gives DHCS sole authority in state government to determine the qualifications, including the appropriate skills, education, training, and experience, of personnel working within any substance use disorder (SUD) facility or program licensed or certified by DHCS.
3. Requires DHCS to require individuals providing counseling services, except as specified, at a DHCS-licensed or certified facility or program to be registered with or certified by a certifying organization (CO) approved by DHCS. Requires COs to be accredited by the National Commission for Certifying Agencies.
4. Prohibits DHCS from approving a CO that does not, prior to registering or certifying an individual, contact other DHCS-approved COs to determine whether an individual has ever had registration or certification revoked.
5. Gives DHCS authority to conduct periodic reviews of COs to determine compliance with all applicable laws and regulations, and to take actions for noncompliance, including revocation of DHCS’s approval.

This bill:

1. Requires DHCS to issue licenses for alcohol and drug counselors and prohibits a person from using the title “licensed alcohol and drug counselor” (LADC) unless the person has applied for and obtained a license from DHCS.
2. Requires an applicant for LADC licensure to meet minimum qualifications that include, but are not limited to the following:
   1. Has earned a master of arts, master of science, or doctoral degree in addiction counseling, psychology, social work, counseling, marriage and family therapy, counseling psychology, clinical psychology, or other clinically focused major that requires no less than 21 semester units, or equivalent, of addiction specific education approved by a CO recognized by DHCS, from an institution of higher learning accredited by a regional accrediting agency, or a board for private postsecondary education;
   2. Has demonstrated competence by passing a master’s level exam accepted by a DHCS-approved CO;
   3. Has a current credential as an advanced alcohol and drug counselor and is in good standing with a DHCS-approved CO, and has no history of revocation by a CO, licensure board, or certifying entity;
   4. Has documented to the CO that three semester units, or the equivalent, of the following courses have been completed:
      1. Psychopharmacology and physiology of addiction, as specified;
      2. Clinical evaluation and psychopathology, as specified;
      3. Counseling/psychotherapy for addiction, as specified;
      4. Case management, as specified;
      5. Client education, as specified.
      6. Professional responsibility law and ethics, as specified;
      7. Supervised fieldwork; and,
   5. Has submitted to a state and federal level criminal offender record information search as part of a criminal background check.
3. Provides that, for a period not to exceed one year from the date DHCS accepts applications for licensure, applicants with 12,000 hours of experience are not required to meet the education requirements in a), b), or d) of 2) above. Requires these applicants to sit for the master’s level exam required in b) of 2) above before the first renewal period of licensure and to provide proof of passing the exam to the CO before one year after the end of the first renewal period.
4. Authorizes DHCS to revoke an LADC license if either of the following occurs: a) the licensee loses his or her credential granted by a CO, or b) the licensee is convicted of a felony charge that is substantially related to the qualifications, functions, or duties of an LADC.
5. Requires DHCS to review an applicant’s state and federal criminal history before issuing a license. Requires DHCS to deny, suspend, delay, or set aside a person’s license if at the time of DHCS’s determination the person has a criminal conviction or criminal charge pending relating to an offense with circumstances that are substantially related to actions as an LADC. Requires applicants who have a criminal conviction or pending criminal charge to request the appropriate authorities to provide information about the conviction or charge directly to DHCS in sufficient specificity to enable DHCS to make a determination as to whether the conviction or charge is substantially related to actions as an LADC.
6. Allows DHCS, after a hearing or review of documentation demonstrating that an applicant meets specified criteria, to waive the requirements in 5) above as follows:
   1. For a waiver of a felony conviction, more than five years have elapsed since the date of the conviction;
   2. For a waiver of a felony or for a waiver of a misdemeanor conviction or violation, at the time of application, prohibits the applicant from being incarcerated, on work release, on probation, on parole, or serving any part of a suspended sentence. Requires the applicant to be in substantial compliance with all court orders pertaining to fines, restitution, and community service;
   3. The applicant is capable of practicing LADC treatment services in a competent and professional manner, and the applicant has not been convicted of a felony sexual offense; and,
   4. The granting of the waiver will not endanger the public health, safety, or welfare.
7. Establishes criteria for DHCS to oversee the disciplinary actions of COs, including requiring COs to maintain national accreditation by the Institute for Credentialing Excellence (ICE) or another accrediting agency if ICE no longer performs its functions to DHCS’s satisfaction, and adopting a uniform code of conduct, uniform disciplinary guidelines, and consumer complaint procedures for LADCs.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, SB 1101 will bolster the mental health treatment workforce and improve the quality of addiction treatment for Californians by strengthening DHCS’s current certification program and establishing title protection for substance use disorder (SUD) counselors. By implementing a licensure program within the existing certification program under DHCS, California will make quality treatment a priority in the state’s mental health treatment delivery system, including in outpatient, residential, and private-practice settings. The current lack of professional standards, along with a disregard for the public’s health and safety by not requiring a criminal background check, has created a statewide system that lacks consistent employee retention, and places patients in dangerous situations when unknowingly seeking treatment from unscreened counselors. Requiring licensees to prove educational qualifications, advanced alcohol and drug counseling skills, and experience, and to pass a nationally recognized exam, will improve the quality of our addiction treatment delivery system, keep dedicated counselors in the profession, and generate career opportunities for higher wages.
2. Background. According to the author’s background information, in 2011, the Substance Abuse and Mental Health Services Administration (SAMHSA) published the “Scopes of Practice & Career Ladders for Substance Use Disorder Counseling.” Certifying organizations are working toward adopting a multi-level professional career ladder for the counselors they certify. A state-issued license for counselors with a master’s degree (or higher) proposed by this bill would establish the license level featured in SAMHSA’s career ladder. The combination of licensure and the current certification process would complete the career ladder for the entire workforce, from entry-level individuals with a high school or general education development level education to those with an advanced degree.
3. Suspect Treatment: State’s lack of scrutiny allows unscreened sex offenders and unethical counselors to treat addicts. This May 2013 Senate Office of Oversight and Outcomes report stated that for three decades the state and the SUD treatment industry have been unable to agree on a framework to give the state authority to credential counselors. The report concludes that California’s public-private hybrid system precludes criminal background checks and leaves gaps that can be exploited by SUD counselors who move between seven DHCS-approved COs that register and certify them. (As of March 2016, DHCS’s Web site only lists three approved COs.) While the report acknowledged that many counselors draw from their own struggles with SUD to excel at jobs with not much pay, some come to the profession with serious criminal backgrounds, which the report states raises questions about their fitness to treat clients, who are often at the most vulnerable time of their lives.

1. SUD counselor certification. To meet current counselor requirements, individuals must be registered with or certified by one of three DHCS-approved COs. (Current regulations adopted in 2005 list 10 COs.) In order for a CO to issue certification, individuals must meet requirements established in regulations, which include completion of at least 155 hours of formal classroom education, as defined; have documented completion of at least 160 hours of supervised alcohol or other drug program counseling and 2,080 or more hours of work experience; and received a score of at least 70% on an approved exam. Regulations allow for individuals who are registered with a CO to provide counseling services while working toward completion of certification requirements. Certification is valid for two years and a counselor is required to complete 40 hours of continuing education every two years for renewal.
2. Recent DHCS administrative changes. Prior to its elimination and transfer of its programs to DHCS, the Department of Alcohol and Drug Programs (ADP) approved as many as nine COs. Each CO had its own code of conduct and disciplinary guidelines, which, as noted in the SOOO report, made it difficult for ADP to be consistent in enforcement. Since the transfer of ADP programs to DHCS, the three currently approved COs have agreed to a uniform code of conduct and disciplinary guidelines, which DHCS enforces. According to the sponsors of this bill, the three COs have requested DHCS to incorporate both the uniform code of conduct and the uniform disciplinary guidelines in DHCS’s upcoming redrafting of counselor certification regulations. DHCS also now has a Web page that lists the current approved COs and a page that lists counselors that have had their certification revoked, which according to DHCS is updated monthly.
3. Prior legislation. SB 570 (DeSaulnier of 2013), would have established the Advanced Alcohol and Drug Counselor Licensing Act and created a licensing and certification system for SUD counselors to be administered by a newly created board within DCA. SB 570 was held on suspense in the Assembly Appropriations Committee.

AB 2007 (Williams of 2012), would have established a licensing and certification system for AOD counselors to be administered by the Department of Public Health. AB 2007 was held in the Assembly Health Committee.

SB 1203 (DeSaulnier of 2010), would have established a licensing and certification structure for AOD counselors by ADP. SB 1203 was held in the Assembly Rules Committee.

SB 707 (DeSaulnier of 2009), was substantially similar to SB 1203. SB 707 died on the Assembly Appropriations Committee suspense file.

AB 239 (DeSaulnier of 2008), would have established two categories of licensed SUD counselors for persons licensed to practice SUD counseling under clinical supervision, and persons licensed to conduct an independent practice of SUD counseling, and to provide supervision to other counselors, both to be overseen by BBS. AB 239 was vetoed by Governor Schwarzenegger who stated in his veto message that he was directing ADP to work to craft a uniform standard for all alcohol and drug counselors whether in private practice or in facilities.

AB 1367 (DeSaulnier of 2007), would have provided for the licensing, registration, and regulation of Alcoholism and Drug Abuse Counselors, as defined, by BBS. AB 1367 died on Assembly Appropriations Committee suspense file.

AB 2571 (Longville of 2004), would have created the Board of Alcohol and Other Drugs of Abuse Professionals within DCA and established requirements for licensure of SUD counselors. AB 2571 failed passage in the Assembly Health Committee.

AB 1100 (Longville of 2003), would have enacted the Alcohol and Drug Abuse Counselors Licensing Law, to be administered by BBS. AB 1100 was held in the Assembly Business and Professions Committee.

SB 1716 (Vasconcellos of 2002), would have required BBS to license and regulate SUD counselors. SB 1716 was held in the Assembly Business and Professions Committee.

SB 537 (Vasconcellos of 2001), would have required DCA to initiate a comprehensive review of the need for licensing SUD counselors. SB 537 was vetoed by Governor Davis due to cost concerns. In his veto message, the Governor directed ADP to require counselors in drug and alcohol treatment facilities to be certified for quality assurance purposes.

1. Support. The California Narcotic Officers’ Association (CNOA) states that there are an estimated 3.5 million people with an SUD diagnosis who receive treatment in more than 2,500 private and public SUD programs throughout the state. CNOA also states that California is among a minority of states that do not have a state-administered licensing program for SUD counselors, and one of only two large states that do not perform criminal background checks on SUD counselors. Community Social Model Advocates, Inc. and MARSTE Training Services state that this bill allows SUD specialists to become full partners in the integrated treatment teams required for the future of health care, and that SUD professionals will be encouraged to continue to obtain a greater degree of skill and education while allowing program owners and directors to use a mixture of licensed and certified counselors according to the treatment parameters of each program.
2. Technical amendments. Provisions in this bill reference counselor certification regulations that list COs not currently approved by DHCS. Other provisions in this are not consistent in the use of terminology. In order to ensure consistency and avoid referencing outdated regulations, the author may wish to accept the following technical amendments:
   1. Section 1179.80:

(b) A person shall not use the title of licensed alcohol and drug counselor “licensed advanced alcohol and drug counselor” unless the person has applied for and obtained a license from the State Department of Public Health. department.

(c) The applicant for an advanced alcohol and drug counselor license shall meet minimum qualifications that include, but are not limited to, all of the following:

(3) Is currently credentialed as an advanced alcohol and drug counselor and in good standing with a certification organization recognized by the Department of Health Care Services department pursuant to Section 13035 of Title 9 of the California Code of Regulations, as it read on January 1, 2017, and has no history of revocation by a certifying organization, licensure board, or certifying entity.

• 1. Section 1179.82:

(a) A license for an advanced alcohol and drug counselor shall be valid for two years unless at any time during that period it is revoked or suspended. The license may be renewed prior to the expiration of the two-year period.

(c) The department may revoke the license of a licensed advanced alcohol and drug counselor who is licensed pursuant to subdivision (b) (c) of Section 1179.80 if either of the following occurs:

(2) The licensee has been convicted of a felony charge that is substantially related to the qualifications, functions, or duties of a licensed advanced alcohol and drug counselor. A plea of guilty or nolo contendere to a felony charge shall be deemed a conviction for the purposes of this paragraph.

• 1. Section 1179.84:

(b) (1) The department shall deny, suspend, delay, or set aside a person’s license if, at the time of the department’s determination, the person has a criminal conviction or criminal charge pending, relating to an offense, the circumstances of which substantially relate to actions as a licensed advanced alcohol and drug counselor. Applicants who have a criminal conviction or pending criminal charge shall request the appropriate authorities to provide information about the conviction or charge directly to the department in sufficient specificity to enable the department to make a determination as to whether the conviction or charge is substantially related to actions as a licensed advanced alcohol and drug counselor.

(C) The applicant is capable of practicing licensed advanced alcohol and drug treatment counseling services in a competent and professional manner.

(D) The granting of the waiver will not endanger the public public’s health, safety, or welfare.

• 1. Section 1179.87:

(a) This part shall not be construed to constrict, limit, or prohibit state licensed or certified facilities or programs, county contracted alcohol and drug treatment facilities or programs, or driving-under-the-influence programs from employing or contracting with alcohol and drug counselors registered with or certified by a certifying organization that is accredited and state approved under Chapter 8 (commencing with Section 13000) of Division 4 of Title 9 of the California Code of Regulations as it read on January 1, 2017.

SUPPORT AND OPPOSITION:

Support: California Association of Alcohol & Drug Educators (cosponsor)

California Association of DUI Treatment Programs (cosponsor)

California Consortium of Addiction Programs and Professionals (cosponsor)

California Narcotic Officers’ Association

Community Social Model Advocates, Inc.

MARSTE Training Services

Sacramento Recovery House, Inc.

Sun Street Centers

Oppose: None received

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