What the HELL is Happening in Michigan? How HB 4325 will improve access to mental health

HB 4325 Michigan counselors

From Joe: Special thanks to Jeremy Zug from Practice Solutions for this article. Jeremy is also a consultant with Practice of the Practice and our in-house specialist on adding insurance to private practice. He’s hosting a webinar all about insurance billing, sign up free here. Here’s what I don’t understand, why is i that the American Counseling Association or NBCC isn’t working to help local governments. It’s bad enough that an ultrasound tech can travel the country everywhere with one license, but every state has their own process? As you can see, I’m fired up that in a world where we have a genuine need to help those with mental health issues, more is being restricted, graduate schools will be shut down, and people will have less access to help.

Main Points on HB 4325

  • What is HB 4325?
  • Where is all the conflict coming from about HB 4325?
  • Why does HB 4325 matter and how does this impact reimbursement?

By now, you may have heard about an intense legislative battle happening right now in the Michigan legislature over the Licensed Professional Counselor’s scope of practice. There has been a lot said about this bill and its interactions with the proposed LARA changes.

We are hoping to outline for you the apparent conflict that is happening, what HB 4325 says, and the impact this legislation has on your practice and overall reimbursement.

First, we will start with a simple question; What is HB 4325?

House Bill 4325 is a measure that was introduced by Representative Aaron Miller in March of 2019 that would help to clarify the Licensed Professional Counselor’s role, supervision, and education requirements.

This bill would update the “scope of practice” for counselors largely to mirror those provisions in the Administrative Rules for counseling. In simple language, the industry has changed and the language needs to be updated. By and large, this is an innocuous process that is necessary from time to time.

For example, the definition for “counseling methods” or “counseling principles” was last updated in 1989. We can all agree that much has changed since 1989 and we ought to update our thinking about those process occasionally. Nothing too alarming there!

The bill would also amend the descriptions in statute of the scopes of practice of several other counseling professions. Essentially, it says that an LPC would be licensed to engage in counseling without supervision. Again, nothing too alarming.

Finally, the bill clarifies the rules around required training to be an LPC in the state of Michigan. Under the bill, this person must be at least 18 (not 21), have a degree that has been approved by LARA, and the degree would be from a qualified program.

A qualified program is a program that is CACREP accredited or a program that is not CACREP accredited but includes all equivalent coursework.

Again, nothing too alarming here. In fact, most of that sounds a lot like the rules that exist now with some minor revisions. By and large, the revisions within the bill seem like simple, necessary, and unassuming changes.

In fact, to verify these changes, Jeremy Zug of Practice Solutions called Aaron Miller’s office to clarify that these changes were in fact true and motivated by intentions that would enable therapists and LPCs to continue to practice and get paid by insurance. Indeed, that is the case.

So where is all the conflict and fire coming from for Michigan Counselors?

That is a good question! The conflict arises when we look at LARA’s proposed changes to the licensing requirements and the scope of practice that would inhibit the LPC’s right to practice.

According to the statement issued by LARA:

The current counseling rules are outdated and are in need of an update. In particular, one of the issues being addressed in the rule is the use of the words “diagnose and psychotherapy” which are used in definitions of the current rules. The pending rules seek to move the definitions from one section to the proper section under the education portion of the rules to provide the clarity needed to align with the statutory authority. The current placement of the “diagnose and psychotherapy” has caused concerns with the manner in which the Board of Counselors and the counseling profession have been interpreting the rules to mean that licensees are allowed to diagnose and use psychotherapy techniques, despite the statute not allowing this practice under the profession’s scope.

Emphasis added by the author of this blog.

This is the alarming section of the updates because with limitations placed on LPC for diagnosing and treatment, there is a valid concern about reimbursement from third party payers and insurance companies.

If LPCs are held in a legal and ethical position where it would be considered beyond their craft to diagnose and treat mental illnesses, insurance companies may consider services provided by an LPC to be not medically necessary. This would render LPCs as one provider put it, “as glorified life coaches”.

This is where HB 4325 enters in a meaningful way.

Why does HB 4325 matter and how does this impact reimbursement?

It is thought by supporters of HB 4325 that this piece of legislation would negate and would officially codify the LPC scope of practice to diagnose.

The key clause of the bill that would help clarify the scope of practice is found on Page 2 of the bill itself when it states:

  1. Psychotherapy, the diagnosis and treatment planning for mental and emotional disorders and evaluation.

  2. Selecting, administering, scoring, and interpreting assessments, tests, and appraisals that are designed to assess an individual’s aptitudes, interests, attitudes, abilities, achievements, and personal characteristics in order to use appraisal and diagnostic results in helping processes

On page 3 the bill states:

Diagnose the problem means to identify the problem through the application of recognized counseling techniques and psychotherapy skills and theories, including the use of the Diagnostic and Statistical Manual for Mental Disorders, obtained through the successful completion of a qualified program. Diagnose the problem does not include the identification of other medical or physical conditions of the identification is not included within recognized counseling techniques and psychotherapy skills and theories

The key wording here is that LPCs and therapists are not qualified to treat or diagnose other medical diseases since that falls outside of their scope, but they are qualified to diagnose and treat mental illnesses.

Based on the committee meeting on 09/19/2019 there seems to be quite a bit of push back from other medical organizations about this particular statute.

If HB 4325 passes and becomes a law, then it appears that LPCs would have the legal and ethical footing granted to them by the state to continue treating the 150,000+ patients that are seeing providers in the state of Michigan and warrant payment from third party insurers.

What is the process from here for counselors?

HB 4325 passed through committed on September 19, 2019 and it is now going to the House of Representatives. A representative is guessing that HB 4325 will pass through the House with little to no roadblocks, but the legislative landscape in the Senate is different.

Senator Vanderwall, who chairs the Health Policy and Human Services Committee and Lee Chatfield are the senators to convince, along with the Majority Leader Mike Shirkey.

According to an therapist that interviewed a House representative:

Last year, the House passed the bill, but the Senate tore the bill apart during the lame duck session and essentially killed the bill. So if anyone is thinking this is going to be easy, it’s not.

“The state representative told me that some legislators do not like “expanding scope of practice” legislation. He said he was not a supporter of the bill until he was educated about it. He now understands that the bill does not “expand” our scope of practice, but rather clarifies and defines what we’ve already been doing for 30 years. Now that he understands this, he will vote to pass HB 4325”

The bill must pass through both houses and then go to the governor to be passed into law.

What you can do to help counselors?

Dr. Burns, Associate Professor of Counselor Education at Western Michigan University wrote this letter to advocate for what is happening to counselors in Michigan. The red sections are for you to change. 

Feel free to change any and all of this as you wish. Text in red contains instructions and points to consider as you draft a letter of your own. Make sure in the 4th paragraph from the bottom of the letter template that you really make this yours and document your own specifics about how this will impact you and the clients you serve. Good luck! 

Send the email to: BPL-BoardSupport@Michigan.gov

Make the subject of the email: Public comment on Counseling – General Rules (ORR 2019-063 LR)

Your name, your credentials

Your address

Your phone

Your email

X/XX/19

Dear Michigan Board of Professional Licensing Policy Analyst:

The proposed Licensed Professional Counselor (LPC) rules changes formally submitted by the Department of Licensing and Regulatory Affairs (LARA) this summer has significant negative consequences and threatens the livelihood of all LPCs and the mental health status of clients currently seeing counselors in the state of Michigan. As such, LARA’s proposed changes are not only a cause for serious concern to LPCs but also current counseling clients and the general public.

Despite the unanimous objections of the Board of Counseling Rules Committee, LARA is recommending the repeal of virtually all the rules that define an LPC’s scope of practice under R338.1751 via Counseling – General Rules (ORR 2019-063 LR). These are rules that have been recognized as part of the LPC scope of practice after the passage of our LPC statute in 1988. LARA insists these definitions should apply only to the educational preparation of counselors and not to counseling practice. This change would artificially limit LPC’s current scope of practice.

Included in LARA’s repeal is the practice of “counseling techniques” and the related ability to “diagnose and identify the problem.” Without these and numerous other definitions, the LPC scope of practice is severely limited. Restricting LPC’s scope of practice in this way will most certainly reduce the availability of mental health counseling services in Michigan and at a time when there is a growing demand for these services.

The Institute of Medicine states that there is a “conspicuous lack” of national attention to ensuring sufficient numbers of mental health service providers to Americans. Matters are further complicated by 54% of Michigan counties being designated as a mental health service coverage shortage area by the Health Resources and Services Administration. With the citizens of Michigan currently struggling to get access to counseling services, LARA’s proposed LPC Scope of Practice Rules changes will put all LPCs immediately out of practice and will ensure that the citizens of Michigan will have less access to mental health care.

Further, LARA’s proposed changes in the LPC scope of practice would put LPCs in violation of ACA’s Code of Ethics standard E.5.a. Proper Diagnosis, which requires the proper diagnosis of a client’s mental disorder before treatment. Furthermore, third-party payors will immediately stop paying for the counseling services provided by LPCs because the billing process REQUIRES a diagnosis for a counseling services third party claim to be paid.

This means that when LARA’s proposed Scope of Practice Rules change goes into effect, thousands of people across the state of Michigan will immediately be stripped of current counseling services. This will immediately place all LPCs in the state of Michigan in violation of the American Counseling Association’s (ACA) Code of Ethics standard A.12. Abandonment and Client Neglect, which states that “Counselors do not abandon or neglect clients in counseling.” If LPCs cannot bill third party payers because they can no longer diagnose clients, clients will not be able to pay for counseling services in full out of their own pocket, which will result in client abandonment and neglect by LPCs as was legally caused by LARA’s LPC Scope of Practice Rules change.

LARA is also pursuing the repeal of the rules identifying the requirements for providing counseling supervision (R338.1757), one of which is specific training in supervision. If LARA makes the proposed changes, LPCs who received their supervision in Michigan may not be eligible for licensure in other states because their supervisor would not be qualified in the state to which the counselor is moving. This would occur because supervision training is a national standard for LPCs. Additionally, if LARA makes the proposed changes, counselors who provide supervision without appropriate training (as would now be allowed under LARA’s new proposed changes) would be practicing in violation of the ACA’s Code of Ethics standard F.2.a Supervisor Preparation.

It is the job of state licensing boards to protect the citizens of the state. LARA’s proposed Scope of Practice Rules change via Counseling – General Rules (ORR 2019-063 LR) will place thousands of citizens in Michigan who are currently in counseling treatment to immediately lose needed counseling services and experience abandonment and neglect. Since HB 4325 is currently in process in the legislature and appropriately addresses the updates needed to the LPC license, I would ask that LARA allow the legislative process to provide the necessary changes.

LARA’s proposed LPC Scope of Practice Rules change via Counseling – General Rules (ORR 2019-063 LR) must not be adopted. The legislature should instead pass HB 4325, introduced by Rep. Aaron Miller (R Sturgis), which would address legitimate concerns and needed updates and negate the need for LARA’s LPC Scope of Practice Rules changes altogether.

I hope that my letter will help inform the Board of Professional Licensing about the negative consequences of LARA’s proposed LPC Scope of Practice Rules change. If you desire additional information from me, please contact me via phone at XXX-XXX-XXX or e-mail XXXX.

Sincerely,

Your name and credentials

 

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