6456-S AMH HCW H5830.1

SSB 6456  - H COMM AMD
     By Committee on Health Care & Wellness

     Strike everything after the enacting clause and insert the following:

"Sec. 1   RCW 18.19.020 and 2001 c 251 s 18 are each amended to read as follows:
     ((Unless the context clearly requires otherwise,)) The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Agency" means an agency or facility operated, licensed, or certified by the state of Washington.
     (2) "Agency affiliated counselor" means a person registered under this chapter who is engaged in counseling and employed by an agency.
     (3) "Certified adviser" means a person certified under this chapter who is engaged in private practice counseling to the extent authorized in section 4 of this act.
     (4) "Certified counselor" means a person certified under this chapter who is engaged in private practice counseling to the extent authorized in section 4 of this act.
     (5)
"Client" means an individual who receives or participates in counseling or group counseling.
     (((2))) (6) "Counseling" means employing any therapeutic techniques, including but not limited to social work, mental health counseling, marriage and family therapy, and hypnotherapy, for a fee that offer, assist or attempt to assist an individual or individuals in the amelioration or adjustment of mental, emotional, or behavioral problems, and includes therapeutic techniques to achieve sensitivity and awareness of self and others and the development of human potential. For the purposes of this chapter, nothing may be construed to imply that the practice of hypnotherapy is necessarily limited to counseling.
     (((3))) (7) "Counselor" means an individual, practitioner, therapist, or analyst who engages in the practice of counseling to the public for a fee, including for the purposes of this chapter, hypnotherapists.
     (((4))) (8) "Department" means the department of health.
     (((5))) (9) "Hypnotherapist" means a person registered under this chapter who is practicing hypnosis as a modality.
     (10) "Private practice counseling" means the practice of counseling by a certified counselor or certified adviser as specified in section 4 of this act.
     (11) "Psychotherapy" means the practice of counseling using diagnosis of mental disorders according to the fourth edition of the diagnostic and statistical manual of mental disorders, published in 1994, and the development of treatment plans for counseling based on diagnosis of mental disorders in accordance with established practice standards.
     (12)
"Secretary" means the secretary of the department or the secretary's designee.

Sec. 2   RCW 18.19.030 and 2001 c 251 s 19 are each amended to read as follows:
     ((No)) A person may not, ((for a fee or)) as a part of his or her position as an employee of a state agency, practice counseling without being registered to practice as an agency affiliated counselor by the department under this chapter unless exempt under RCW 18.19.040.

NEW SECTION.  Sec. 3   A new section is added to chapter 18.19 RCW to read as follows:
     A person may not, for a fee or as a part of his or her position as an employee of a state agency, practice hypnotherapy without being registered to practice as a hypnotherapist by the department under this chapter unless exempt under RCW 18.19.040.

NEW SECTION.  Sec. 4   A new section is added to chapter 18.19 RCW to read as follows:
     The scope of practice of certified counselors and certified advisers consists exclusively of the following:
     (1) Appropriate screening of the client's level of functional impairment using the global assessment of functioning as described in the fourth edition of the diagnostic and statistical manual of mental disorders, published in 1994. Recognition of a mental or physical disorder or a global assessment of functioning score of sixty or less requires that the certified counselor refer the client to a physician, osteopathic physician, or licensed mental health practitioner, as defined by the secretary, for diagnosis and treatment;
     (2) Certified counselors and certified advisers may counsel and guide a client in adjusting to life situations, developing new skills, and making desired changes, in accordance with the theories and techniques of a specific counseling method and established practice standards, if the client has a global assessment of functioning score greater than sixty;
     (3) Certified counselors may counsel and guide a client in adjusting to life situations, developing new skills, and making desired changes if the client has a global assessment of functioning score of sixty or less if:
     (a) The client has been referred to the certified counselor by a physician, osteopathic physician, or licensed mental health practitioner, as defined by the secretary, and care is provided as part of a plan of treatment developed by the referring practitioner who is actively treating the client. The certified counselor must adhere to any conditions related to the certified counselor's role as specified in the plan of care; or
     (b) The certified counselor referred the client to seek diagnosis and treatment from a physician, osteopathic physician, or licensed mental health practitioner, as defined by the secretary, and the client refused, in writing, to seek treatment from the other provider. The certified counselor may provide services to the client consistent with a treatment plan developed by the certified counselor and the consultant or supervisor with whom the certified counselor has a written consultation or supervisory agreement.

Sec. 5   RCW 18.19.040 and 2001 c 251 s 20 are each amended to read as follows:
     Nothing in this chapter may be construed to prohibit or restrict:
     (1) The practice of a profession by a person who is either registered, certified, licensed, or similarly regulated under the laws of this state and who is performing services within the person's authorized scope of practice, including any attorney admitted to practice law in this state when providing counseling incidental to and in the course of providing legal counsel;
     (2) The practice of counseling by an employee or trainee of any federal agency, or the practice of counseling by a student of a college or university, if the employee, trainee, or student is practicing solely under the supervision of and accountable to the agency, college, or university, through which he or she performs such functions as part of his or her position for no additional fee other than ordinary compensation;
     (3) The practice of counseling by a person ((without a mandatory charge)) for no compensation;
     (4) The practice of counseling by persons offering services for public and private nonprofit organizations or charities not primarily engaged in counseling for a fee when approved by the organizations or agencies for whom they render their services;
     (5) Evaluation, consultation, planning, policy-making, research, or related services conducted by social scientists for private corporations or public agencies;
     (6) The practice of counseling by a person under the auspices of a religious denomination, church, or organization, or the practice of religion itself;
     (7) The practice of counseling by peer counselors who use their own experience to encourage and support people with similar conditions or activities related to the training of peer counselors; and
     (8)
Counselors ((whose residency is not)) who reside outside Washington state from providing up to ten days per quarter of training or workshops in the state, as long as they ((don't)) do not hold themselves out to be registered or certified in Washington state.

Sec. 6   RCW 18.19.050 and 2001 c 251 s 21 are each amended to read as follows:
     (1) In addition to any other authority provided by law, the secretary has the following authority:
     (a) To adopt rules, in accordance with chapter 34.05 RCW, necessary to implement this chapter;
     (b) To set all registration, certification, and renewal fees in accordance with RCW 43.70.250 and to collect and deposit all such fees in the health professions account established under RCW 43.70.320;
     (c) To establish forms and procedures necessary to administer this chapter;
     (d) To hire clerical, administrative, and investigative staff as needed to implement this chapter;
     (e) To issue a registration or certification to any applicant who has met the requirements for registration or certification; and
     (f) To ((develop a dictionary of recognized professions and occupations providing counseling services to the public included under this chapter)) establish education equivalency, examination, supervisory, consultation, and continuing education requirements for certified counselors and certified advisers.
     (2) The uniform disciplinary act, chapter 18.130 RCW, governs the issuance and denial of registrations and certifications and the discipline of registrants under this chapter. The secretary shall be the disciplining authority under this chapter. ((The absence of educational or training requirements for counselors registered under this chapter or the counselor's use of nontraditional nonabusive therapeutic techniques shall not, in and of itself, give the secretary authority to unilaterally determine the training and competence or to define or restrict the scope of practice of such individuals.))
     (3) The department shall publish and disseminate information ((in order)) to educate the public about the responsibilities of counselors, the types of counselors, and the rights and responsibilities of clients established under this chapter. ((Solely for the purposes of administering this education requirement,)) The secretary ((shall)) may assess an additional fee for each application and renewal((, equal to five percent of the fee. The revenue collected from the assessment fee may be appropriated by the legislature for the department's use in educating consumers pursuant to this section. The authority to charge the assessment fee shall terminate on June 30, 1994)) to fund public education efforts under this section.

Sec. 7   RCW 18.19.060 and 2001 c 251 s 22 are each amended to read as follows:
     ((Persons registered under this chapter)) Certified counselors and certified advisers shall provide clients at the commencement of any program of treatment with accurate disclosure information concerning their practice, in accordance with guidelines developed by the department, that will inform clients of the purposes of and resources available under this chapter, including the right of clients to refuse treatment, the responsibility of clients for choosing the provider and treatment modality which best suits their needs, and the extent of confidentiality provided by this chapter, the department, another agency, or other jurisdiction. The disclosure statement must inform the client of the certified counselor's or certified adviser's consultation arrangement or supervisory agreement as defined in rules adopted by the secretary. The disclosure information provided by the certified counselor or certified adviser, the receipt of which shall be acknowledged in writing by the certified counselor or certified adviser and the client, shall include any relevant education and training, the therapeutic orientation of the practice, the proposed course of treatment where known, any financial requirements, referral resources, and such other information as the department may require by rule. The disclosure information shall also include a statement that ((registration)) the certification of an individual under this chapter does not include a recognition of any practice standards, nor necessarily imply the effectiveness of any treatment. Certified counselors and certified advisers must also disclose that they are not credentialed to diagnose mental disorders or to conduct psychotherapy as defined by the secretary by rule. The client is not liable for any fees or charges for services rendered prior to receipt of the disclosure statement.

Sec. 8   RCW 18.19.090 and 1991 c 3 s 24 are each amended to read as follows:
     ((The secretary shall issue a registration to any applicant who submits, on forms provided by the secretary, the applicant's name, address, occupational title, name and location of business, and other information as determined by the secretary, including information necessary to determine whether there are grounds for denial of registration or issuance of a conditional registration under this chapter or chapter 18.130 RCW. Applicants for registration shall register as counselors or may register as hypnotherapists if employing hypnosis as a modality. Applicants shall, in addition, provide in their titles a description of their therapeutic orientation, discipline, theory, or technique.)) (1) Application for agency affiliated counselor, certified counselor, certified adviser, or hypnotherapist must be made on forms approved by the secretary. The secretary may require information necessary to determine whether applicants meet the qualifications for the credential and whether there are any grounds for denial of the credential, or for issuance of a conditional credential, under this chapter or chapter 18.130 RCW. The application for agency affiliated counselor, certified counselor, or certified adviser must include a description of the applicant's orientation, discipline, theory, or technique. Each applicant shall pay a fee determined by the secretary as provided in RCW 43.70.250, which shall accompany the application.
     (2) Applicants for agency affiliated counselor must provide satisfactory documentation that they are employed by an agency or have an offer of employment from an agency.
     (3) At the time of application for initial certification, applicants for certified counselor prior to July 1, 2010, are required to:
     (a) Have been registered for no less than five years at the time of application for an initial certification;
     (b) Have held a valid, active registration that is in good standing and be in compliance with any disciplinary process and orders at the time of application for an initial certification;
     (c) Show evidence of having completed course work in risk assessment, ethics, appropriate screening and referral, and Washington state law and other subjects identified by the secretary;
     (d) Pass an examination in risk assessment, ethics, appropriate screening and referral, and Washington state law, and other subjects as determined by the secretary; and
     (e) Have a written consultation agreement with a credential holder who meets the qualifications established by the secretary.
     (4) Unless eligible for certification under subsection (3) of this section, applicants for certified counselor or certified adviser are required to:
     (a)(i) Have a bachelor's degree in a counseling-related field, if applying for certified counselor; or
     (ii) Have an associate degree in a counseling-related field and a supervised internship, if applying for certified adviser;
     (b) Pass an examination in risk assessment, ethics, appropriate screening and referral, and Washington state law, and other subjects as determined by the secretary; and
     (c) Have a written supervisory agreement with a supervisor who meets the qualifications established by the secretary.
     (5) Each applicant shall include payment of the fee determined by the secretary as provided in RCW 43.70.250.

NEW SECTION.  Sec. 9   A new section is added to chapter 18.19 RCW to read as follows:
     Agency affiliated counselors shall notify the department if they are either no longer employed by the agency identified on their application or are now employed with another agency, or both. Agency affiliated counselors may not engage in the practice of counseling unless they are currently affiliated with an agency.

Sec. 10   RCW 18.19.100 and 1996 c 191 s 5 are each amended to read as follows:
     The secretary shall establish administrative procedures, administrative requirements, continuing education, and fees for renewal of ((registrations)) credentials as provided in RCW 43.70.250 and 43.70.280. When establishing continuing education requirements for agency affiliated counselors, the secretary shall consult with the appropriate state agency director responsible for licensing, certifying, or operating the relevant agency practice setting.

Sec. 11   RCW 18.225.010 and 2001 c 251 s 1 are each amended to read as follows:
     ((Unless the context clearly requires otherwise,)) The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Advanced social work" means the application of social work theory and methods including emotional and biopsychosocial assessment, psychotherapy under the supervision of a licensed independent clinical social worker, case management, consultation, advocacy, counseling, and community organization.
     (2) "Applicant" means a person who completes the required application, pays the required fee, is at least eighteen years of age, and meets any background check requirements and uniform disciplinary act requirements.
     (3) "Associate" means a prelicensure candidate who has a graduate degree in a mental health field under RCW 18.225.090 and is gaining the supervision and supervised experience necessary to become a licensed independent clinical social worker, a licensed advanced social worker, a licensed mental health counselor, or a licensed marriage and family therapist.
     (4)
"Committee" means the Washington state mental health counselors, marriage and family therapists, and social workers advisory committee.
     (((4))) (5) "Department" means the department of health.
     (((5))) (6) "Disciplining authority" means the department.
     (((6))) (7) "Independent clinical social work" means the diagnosis and treatment of emotional and mental disorders based on knowledge of human development, the causation and treatment of psychopathology, psychotherapeutic treatment practices, and social work practice as defined in advanced social work. Treatment modalities include but are not limited to diagnosis and treatment of individuals, couples, families, groups, or organizations.
     (((7))) (8) "Marriage and family therapy" means the diagnosis and treatment of mental and emotional disorders, whether cognitive, affective, or behavioral, within the context of relationships, including marriage and family systems. Marriage and family therapy involves the professional application of psychotherapeutic and family systems theories and techniques in the delivery of services to individuals, couples, and families for the purpose of treating such diagnosed nervous and mental disorders. The practice of marriage and family therapy means the rendering of professional marriage and family therapy services to individuals, couples, and families, singly or in groups, whether such services are offered directly to the general public or through organizations, either public or private, for a fee, monetary or otherwise.
     (((8))) (9) "Mental health counseling" means the application of principles of human development, learning theory, psychotherapy, group dynamics, and etiology of mental illness and dysfunctional behavior to individuals, couples, families, groups, and organizations, for the purpose of treatment of mental disorders and promoting optimal mental health and functionality. Mental health counseling also includes, but is not limited to, the assessment, diagnosis, and treatment of mental and emotional disorders, as well as the application of a wellness model of mental health.
     (((9))) (10) "Secretary" means the secretary of health or the secretary's designee.

Sec. 12   RCW 18.225.020 and 2001 c 251 s 2 are each amended to read as follows:
     A person must not represent himself or herself as a licensed advanced social worker, a licensed independent clinical social worker, a licensed mental health counselor, ((or)) a licensed marriage and family therapist, a licensed social work associate--advanced, a licensed social work associate--independent clinical, a licensed mental health counselor associate, or a licensed marriage and family therapist associate, without being licensed by the department.

NEW SECTION.  Sec. 13   A new section is added to chapter 18.225 RCW to read as follows:
     (1) The secretary shall issue an associate license to any applicant who demonstrates to the satisfaction of the secretary that the applicant meets the following requirements for the applicant's practice area and submits a declaration that the applicant is working toward full licensure in that category:
     (a) Licensed social worker associate--advanced or licensed social worker associate--independent clinical: Graduation from a master's degree or doctoral degree educational program in social work accredited by the council on social work education and approved by the secretary based upon nationally recognized standards.
     (b) Licensed mental health counselor associate: Graduation from a master's degree or doctoral degree educational program in mental health counseling or a related discipline from a college or university approved by the secretary based upon nationally recognized standards.
     (c) Licensed marriage and family therapist associate: Graduation from a master's degree or doctoral degree educational program in marriage and family therapy or graduation from an educational program in an allied field equivalent to a master's degree or doctoral degree in marriage and family therapy approved by the secretary based upon nationally recognized standards.
     (2) Associates may not provide independent social work, mental health counseling, or marriage and family therapy for a fee, monetary or otherwise. Associates must work under the supervision of an approved supervisor.
     (3) Associates shall provide each client or patient, during the first professional contact, with a disclosure form according to RCW 18.225.100, disclosing that he or she is an associate under the supervision of an approved supervisor.
     (4) The department shall adopt by rule what constitutes adequate proof of compliance with the requirements of this section.
     (5) Applicants are subject to the denial of a license or issuance of a conditional license for the reasons set forth in chapter 18.130 RCW.
     (6) An associate license may be renewed no more than four times.

Sec. 14   RCW 18.225.150 and 2001 c 251 s 15 are each amended to read as follows:
     The secretary shall establish by rule the procedural requirements and fees for renewal of a license or associate license. Failure to renew shall invalidate the license or associate license and all privileges granted by the license. If an associate license has lapsed, the person shall submit an updated declaration, in accordance with rules adopted by the department, that the person is working toward full licensure. If a license has lapsed for a period longer than three years, the person shall demonstrate competence to the satisfaction of the secretary by taking continuing education courses, or meeting other standards determined by the secretary. If an associate license has lapsed, the person shall submit an updated declaration, in accordance with rules adopted by the department, that the person is working toward full licensure.

Sec. 15   RCW 18.205.020 and 1998 c 243 s 2 are each amended to read as follows:
     ((Unless the context clearly requires otherwise,)) The definitions in this section apply throughout this chapter unless the context clearly requires otherwise.
     (1) "Certification" means a voluntary process recognizing an individual who qualifies by examination and meets established educational prerequisites, and which protects the title of practice.
     (2) "Certified chemical dependency professional" means an individual certified in chemical dependency counseling, under this chapter.
     (3) "Certified chemical dependency professional trainee" means an individual working toward the education and experience requirements for certification as a chemical dependency professional.
     (4)
"Chemical dependency counseling" means employing the core competencies of chemical dependency counseling to assist or attempt to assist an alcohol or drug addicted person to develop and maintain abstinence from alcohol and other mood-altering drugs.
     (((4))) (5) "Committee" means the chemical dependency certification advisory committee established under this chapter.
     (((5))) (6) "Core competencies of chemical dependency counseling" means competency in the nationally recognized knowledge, skills, and attitudes of professional practice, including assessment and diagnosis of chemical dependency, chemical dependency treatment planning and referral, patient and family education in the disease of chemical dependency, individual and group counseling with alcoholic and drug addicted individuals, relapse prevention counseling, and case management, all oriented to assist alcoholic and drug addicted patients to achieve and maintain abstinence from mood-altering substances and develop independent support systems.
     (((6))) (7) "Department" means the department of health.
     (((7))) (8) "Health profession" means a profession providing health services regulated under the laws of this state.
     (((8))) (9) "Secretary" means the secretary of health or the secretary's designee.

Sec. 16   RCW 18.205.030 and 2000 c 171 s 41 are each amended to read as follows:
     No person may represent oneself as a certified chemical dependency professional or certified chemical dependency professional trainee or use any title or description of services of a certified chemical dependency professional or certified chemical dependency professional trainee without applying for certification, meeting the required qualifications, and being certified by the department of health, unless otherwise exempted by this chapter.

Sec. 17   RCW 18.205.040 and 1998 c 243 s 4 are each amended to read as follows:
     Nothing in this chapter shall be construed to authorize the use of the title "certified chemical dependency professional" or "certified chemical dependency professional trainee" when treating patients in settings other than programs approved under chapter 70.96A RCW.

NEW SECTION.  Sec. 18   A new section is added to chapter 18.205 RCW to read as follows:
     (1) The secretary shall issue a trainee certificate to any applicant who demonstrates to the satisfaction of the secretary that he or she is working toward the education and experience requirements in RCW 18.205.090.
     (2) A trainee certified under this section shall submit to the secretary for approval a declaration, in accordance with rules adopted by the department, that he or she is enrolled in an approved education program and actively pursuing the experience requirements in RCW 18.205.090. This declaration must be updated with the trainee's annual renewal.
     (3) A trainee certified under this section may practice only under the supervision of a certified chemical dependency professional. The first fifty hours of any face-to-face client contact must be under direct observation. All remaining experience must be under supervision in accordance with rules adopted by the department.
     (4) A certified chemical dependency professional trainee provides chemical dependency assessments, counseling, and case management with a state regulated agency and can provide clinical services to patients consistent with his or her education, training, and experience as approved by his or her supervisor.
     (5) A trainee certification may only be renewed four times.
     (6) Applicants are subject to denial of a certificate or issuance of a conditional certificate for the reasons set forth in chapter 18.130 RCW.

NEW SECTION.  Sec. 19   A new section is added to chapter 18.19 RCW to read as follows:
     The Washington state certified counselors and hypnotherapist advisory committee is established.
     (1) The committee is comprised of seven members. Two committee members must be certified counselors or certified advisers. Two committee members must be hypnotherapists. Three committee members must be consumers and represent the public at large and may not hold any mental health care provider license, certification, or registration.
     (2) Two committee members must be appointed for a term of one year, two committee members must be appointed for a term of two years, and three committee members must be appointed for a term of three years. Subsequent committee members must be appointed for terms of three years. A person may not serve as a committee member for more than two consecutive terms.
     (3)(a) Each committee member must be a resident of the state of Washington.
     (b) A committee member may not hold an office in a professional association for their profession.
     (c) Advisory committee members may not be employed by the state of Washington.
     (d) Each professional committee member must have been actively engaged in their profession for five years immediately preceding appointment.
     (e) The consumer committee members must represent the general public and be unaffiliated directly or indirectly with the professions credentialed under this chapter.
     (4) The secretary shall appoint the committee members.
     (5) Committee members are immune from suit in an action, civil or criminal, based on the department's disciplinary proceedings or other official acts performed in good faith.
     (6) Committee members must be compensated in accordance with RCW 43.03.240, including travel expenses in carrying out his or her authorized duties in accordance with RCW 43.03.050 and 43.03.060.
     (7) The committee shall elect a chair and vice-chair.

NEW SECTION.  Sec. 20   To practice counseling, all registered counselors must obtain another health profession credential by July 1, 2010. The registered counselor credential is abolished July 1, 2010.

NEW SECTION.  Sec. 21   Sections 1, 2, 7 through 9, and 11 through 19 of this act take effect July 1, 2009.

NEW SECTION.  Sec. 22   The department of health may not issue any new registered counselor credentials after July 1, 2009.

NEW SECTION.  Sec. 23   (1) The department of health shall report to the legislature and the governor by December 15, 2011, on:
     (a) The number of registered counselors who become certified counselors or certified advisers;
     (b) The number, status, type, and outcome of disciplinary actions involving certified counselors and certified advisers beginning on the effective date of this section; and
     (c) The state of education equivalency, examination, supervisory, consultation, and continuing education requirements established under this act.
     (2) The department of health shall also report on cost savings or expenditures to administer the provisions of this act and make recommendations regarding future reports or evaluations.

NEW SECTION.  Sec. 24   If specific funding for the purposes of this act, referencing this act by bill or chapter number, is not provided by June 30, 2008, in the omnibus appropriations act, this act is null and void."

     Correct the title.

EFFECT:  Establishes the profession of certified adviser that is a profession that can only provide private practice counseling services to clients with a global assessment of functioning score over 60. Establishes credentialing standards for certified advisers that includes an associate degree and a supervised internship as well as specific course requirements and supervisory agreements that are the same as certified counselors.
     Removes the ability of certified counselors to become credentialed with only an associate degree and requires that they at least have a bachelors degree.
     Requires that certified counselors and advisers refer clients with a mental or physical disorder or a global assessment of functioning score of 60 or less to a physician, osteopathic physician, or mental health practitioner instead of recommending that clients with a mental or physical disorder seek diagnosis from an appropriate health care provider.
     Limits certified counselors to counseling clients with a global assessment of functioning score of 60 or less only when: (1) Referred by certain licensed professionals and to the extent provided in a plan of treatment designed by the referring professional or (2) the client refused the referral made by the counselor, in writing, and services are provided to the extent authorized in a plan of treatment developed by the counselor with his or her consultant or supervisor.
     Removes the requirement that certified counselors and advisers disclose to clients that they cannot treat mental disorders and only requires the disclosure that they cannot diagnose mental disorders or conduct psychotherapy.
     Removes the definition of mental disorder which had been defined in relation to a global assessment of functioning score of 60 or less.
     Exempts peer counselor training activities from regulation.
     Requires the Department of Health to report to the Legislature by December 15, 2011, regarding the number of registered counselors that became certified counselors or certified advisers, disciplinary activities related to these professions, and the state of certification requirements for the professions.

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