Michigan's Fight For LPC
Main Points
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?
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:
Psychotherapy, the diagnosis and treatment planning for mental and emotional disorders and evaluation.
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?
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.
Feel free to reach out to Aaron Miller's office or reach out to your local representative to express your concerns with HB 4325 or you can arrive at the public LARA hearing on October 4th, 2019 to express your concerns in person.
If you find any inconsistencies within this blog please reach out to us at info@practicesol.com!
If you would like to schedule a consultation to talk about how this bill will impact your practice or strategies to mitigate this risk, feel free to reach out to us here.
