Note: If you are not already familiar with the process of how bills become laws in Florida, it may be helpful to review one or more of these articles prior to reading the legislative update:
How a Florida bill becomes a law (Tampa Bay Times)
FAQ: How a Bill Becomes a Law in Florida (Spectrum News 13)
Flowchart: How a Bill Becomes a Law (Florida Senate)
How an Idea Becomes a Law (Florida House of Representatives)
There are two branches of Florida's Legislative Branch--the Senate and the House of Representatives. To become a law, a bill written in one branch must pass various committees and then be voted on by legislators. Additionally, a "companion bill" in the other branch of the legislature must successfully navigate the same process.
Please note that Florida's 2021-2022 legislative session has now ended, so pay close attention to find out what happened with all the bill we had our eyes on!
Issue #1: Licensure Portability
SB 358, which we discussed in greater detail in the November 2021 Legislative Update, is the Counseling Compact bill that, if passed, would enable Florida to join the new interstate counseling compact, permitting counselors in Florida to obtain an "interstate license" permitting them to practice in other states that join the compact, whether in-person or via telehealth.
It's companion bill is HB1521.
In order for these bills to pass, SB 590 and HB 1523 also needed to pass. These two bills exempt the activities of the interstate compact board from Florida's Sunshine Laws. This is needed because there is no guarantee that the other states that join the compact, some of which would not have laws similar to Florida's Sunshine Laws, would want to make all of their activities accessible to the public.
All 4 bills passed unanimously with full bipartisan support this legislative session! This is a substantial victory for FMHCA and SMHCA. A HUGE thanks to all of you who answered our "call to action" and voiced your support for the bills to your legislators. These bills still need to be signed into law by Governor DeSantis. If he neither signs nor vetoes them, they will become effective 7/1/22.
In order for Florida to join the Counseling Compact, we will still need to pass two more bills next legislative session to fund the compact. Funds will be obtained through the new multi-state licensing fee, so it is expected to be a self-sustaining program. Also, FMHCA was unable to attach 2 issues to this bill (1) the renaming of "registered interns" as "licensed associates;" and (2) adding 491 board licensees to the state statute that lists qualifications of expert witness appointed by the court. These issues will have to be considered for future legislative sessions.
Issue #2: Licensure Requirements
SB 566 postpones the requirement for LMFT applicants to have a master's degree accredited by COAMFTE or CACREP to 9/1/27, giving graduate programs more time to achieve accreditation. Additionally, the bill would revise the requirement (effective 7/1/25) that all LMHC applicants have a CACREP-accredited degree to permit (1) degrees accredited by CACREP; (2) degrees accredited by the the Masters in Psychology and Counseling Accreditation Council; or (3) "an equivalent accrediting body."
Its companion bill is HB 343.
Both bills have been passed by the Florida legislature with unanimous bipartisan support. These bills still need to be signed into law by Governor DeSantis. If he neither signs nor vetoes them, they will become effective 7/1/22.
Those who support the bill see it as progress because (a) it can take more than two years after a new graduate counseling program to achieve CACREP accreditation (and COVID-19-related delays complicated this problem over the past couple years), which means that some graduates of these programs were in jeopardy of being ineligible to register as interns upon graduation; and/or (b) they do not think that CACREP should have a "monopoly" on graduate programs. However, those who oppose the bill contend that (a) it is harder to advocate for counselors' scope of practice when there is too much variation in their graduate-level training (but easier when there is one universal standard for all counselors); and (b) they view MPCAC programs as being master's-level psychologists and are concerned that the professional identify of counselors will be diluted.
It is important to note that the law still requires MPCAC program graduates to have the same 11 core graduate training areas, the same practicum and internship requirements, and the same examination requirements that Florida has always required.
FMHCA's members will have to determine whether they want to try and revise the statute in the future to restrict accepted graduate degrees to CACREP-accredited degree programs. FMHCA has not taken an official position on this this issue as of this writing.
Registered Interns, Telehealth, and Private Practice
F.S. 491.005(1)(c) currently requires registered interns working in private practice settings to have a licensed mental health professional "on the premises" when conducting clinical services. This statute is problematic for a couple reasons, the most notable of which involves telehealth. Many interns in private practice would like to provide telehealth from home offices, where they would not have a licensed mental health professional on the premises. When it was originally filed, SB 768 and HB 693 were originally going to add the following line to the statute: "When a registered intern provides clinical services through telehealth, a licensed mental health professional must be accessible by telephone or electronic means," effectively making it easier for interns in private practice to conduct telehealth.
Both bills passed unanimously in the House and Senate with bipartisan support. However, the bills were revised to remove the link addressing the intern issue, so we are no longer tracking these bills.
In future legislative session, FMHCA will have to address the issue of private practice interns, telehealth, and the requirement of having a licensed professional on the premises.
"Audio-Only" Telehealth Appointments
SB 312 was originally written to expand the definition of "telehealth" to include "audio-only" sessions, whereas the current definition requires both video and audio. It is my understanding that such a revision in the law would enable counselors to bill Medicaid for audio-only telehealth appointments. Its companion bill is HB 17.
Though both bills passed unanimously with bipartisan support in both the House and Senate, the line that redefines telehealth appointments was redacted with an amendment, so we are no longer tacking this bill.
Note: If you are not already familiar with the process of how bills become federal laws, it may be helpful to review the process at https://www.usa.gov/how-laws-are-made.
Medicare for Counselors and Marriage and Family Therapists
As noted in previous legislative updates, the Mental Health Access Improvement Act (S.828 and companion bill HR.432), if passed, will enable counselors and MFTs to bill Medicare. We consider this bill crucial given that (a) Medicare recipients are struggling to access psychotherapy, and counselors are the single largest group of licensed therapists in the country; and (b) as long as counselors cannot bill Medicare, counselors will never truly be treated equally as our colleagues in psychology and social work, thus perpetuating the myth that counselors are somehow "less than" other professions that can bill Medicare. Click here to learn more from our national parent chapter, the American Mental Health Counselors Association (AMHCA), about how you can support this legislation.
• S.828 was introduced to the Senate on 3/18/21.
• HR.432 was introduced to the House on 1/21/21 referred to the Committee on Energy and Commerce and Committee on Ways and Means on 1/21/21, and referred to the Subcommittee on Health on 2/2/21.
AMHCA issued a “call to action” for counselors to contact their federal legislators in support of this bill on 2/16/22. Click here to read details.
AMHCA and AAMFT are teaming up for a webinar on how to advocate for this legislation on 2/24/22.
"No Surprises Act" (45 CFR, Part 149) Implementation
The No Surprises Act was passed in December 2020 and became effective on 1/1/22. However, the interim rule with the greatest application to counselors was not written until 9/30/21, requiring all healthcare professionals (including counselors) to "to give uninsured and self-pay patients a good faith estimate of costs for services that they offer, when scheduling care or when the patient requests an estimate." Among other requirements, counselors are required to specifically ask all new clients whether they have insurance and whether they intend to use it, provide a "good faith estimate" detailing specific information such as diagnoses, anticipated costs of services, frequency/quantity of sessions, legal disclaimers, etc. to all private pay, uninsured, or out-of-network clients. The standard consent forms that counselors have used in the past are highly unlikely to meet the requirements under the new law.
FMHCA broadcasted a complimentary webinar on how to implement the new law on 1/7/22. This 1-hour webinar can be viewed by clicking here, and handouts and templates can be downloaded here.
Additional resources on implementing this law are listed below:
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Suncoast Mental Health Counselors AssociationP.O. Box 2853 Pinellas Park, Florida 33780