ARIZONA STATE SENATE
RESEARCH STAFF
1' 0: JOINT LEGISLATIVE AUDIT COMMITTEE HEATHER OWENS
Senator Robert Blendu, Chairman LEGISLATIVE RESEARCH ANALYST
I IEALTH COMMITTEE
Representative John Nelson, Cochair Telephone: ( 602) 926- 3 17 1
I'acsimile: ( 602) 926- 3833
DATE: December 3,2007
SUBJECT: Sunset Review of the Board of Behavioral Health Examiners
Attached is the final report of the sunset review of the Board of Behavioral Health Examiners,
which was conducted by the Senate Health and House of Representatives Health Committee of
Reference.
This report has been distributed to the following individuals and agencies:
Governor of the State of Arizona
The Honorable Janet Napolitano
President of the Senate
Senator Tim Bee
Senate Members
Senator Tom 07Halleran, Cochairman
Senator Barbara Leff
Senator Paula Aboud
Senator Thayer Verschoor
Senator Amanda Aguirre
Board of Behavioral Health Examiners
Arizona State Library, Archives & Public Records
Oflice of the Auditor General
Senate Majority Staff
Senate Research Staff
Senate Minority Staff
Senate Resource Center
Speaker of the Mouse of Representatives
Representative James Weiers
House Members
Representative Bob Stump, Cochairman
Representative Nancy Barto
Representative Rick Murphy
Representative David Bradley
Representative Linda Lopez
House Majority Staff
House Research Staff
House Minority Staff
Chief Clerk
HOljas
Attachment
Senate Health and House of Representatives Health
Committee of Reference Report
BOARD OF BEHA VIORAL HEALTH EXAMNERS
Background
Pursuant to Arizona Revised Statutes ( A. R. S.) 5 41 - 2953, the Joint Legislative Audit Committee
( JLAC) assigned the sunset review of the Board of Behavioral Health Examiners ( Board) to the Senate
Health and House of Representatives I- Iealth Committee of Reference.
The Board was originally established in 1988 to provide voluntary certification to professionals
in the fields of counseling, marriage and family therapy, social work and substance abuse. In 2003, the
Legislature converted this process into mandatory licensure for these four professions. The duties of the
Board are to adopt rules, issue licenses to qualified individuals, establish and collect fees, conduct
investigations and take disciplinary actions as necessary, and establish and enforce compliance with
professional standards and rules of conduct for licensees.
Pursuant to A. R. S. 5 32- 3254, the State Treasurer collects all monies received by the Board and
deposits ten percent of the monies and all civil penalties imposed on licensees into the state General
Fund. The remaining 90 percent of monies received are deposited in the Board of Behavioral Health
Examiners Fund and are used by the Board for all necessary Board expenses.
Committee of Rejkrerzce Surzset Review Procedures
The Committee of Reference held one public meeting on November 6, 2007, to review the
Board's responses to the sunset factors as required by A. R. S. 5 41- 2954, subsections D and F, and to
hear public testimony. The Board's responses to the 12 sunset factors and four additional questions are
attached.
Committee of Reference Recommendations
The Committee of Reference recommends continuing the Board for five years and recommends
that the Joint Legislative Audit Committee consider scheduling a performance audit as soon as possible
with a legislative committee review at the end of such audit.
Attaclzments
1. Staff memo.
2. Sunset report requirements pursuant to A. R. S. 5 41- 2954, subsections D and F.
3. Meeting notice.
4. An excerpt of the minutes of the Committee of Reference meeting relating to the Board.
ARIZONA STATE SENATE
RESEARCH STAFF
TO: MEMBERS OF THE HOUSE AND SENATE HEATHER OWENS
HEALTH COMMITTEE OF REFERENCE ASSISTANT ANALYST
HEALTH COMMITTEE
DATE: October 25,2007
Telephone. ( 602) 926- 3 17 1
Facsimile: ( 602) 926- 3833
SUBJECT: Sunset Review of the Board of Behavioral Health Examiners
The Arizona State Board of Behavioral Health Examiners ( Board) is scheduled to sunset on
July 1,2008. The following is a brief description of the history and duties of the Board, as well as the
Board's response to the sunset questionnaire. In addition to the sunset response, the Board submitted
copies of its adverse action reports, administrative rules, newsletter, meeting minutes and performance
summary. These documents are on file with the Senate Research Staff, should you wish to see them.
A public meeting is scheduled for November 6, 2007, to review, discuss and make a final
recommendation on the Board's continuation. If you have any questions or need further assistance,
please feel free to contact me.
BOARD HISTORY
The Board was originally established in 1988 to provide voluntary certification to professionals
in the fields of counseling, marriage and family therapy, social work and substance abuse. In 2003, the
Legislature converted this process into mandatory licensure for these four professions.
ORGANIZATION AND DUTIES
The Board consists of eight members - four professional members and four public members, all
appointed by the Governor for three- year terms. A Board member may not serve for more than two full
consecutive terms. Each of the four professional members of the Board represents one of the four
behavioral health licensing areas ( social work, counseling, marriage and family therapy, and substance
abuse counseling and treatment) and are appointed from each ofthe four credentialing committees. The
four credentialing committees consist of four professional members and one public member, all
appointed by the Governor for three- year terms.
The duties of the Board are to adopt rules, issue licenses to qualified individuals, establish and
collect fees, conduct investigations and take disciplinary actions as necessary. and establish and enforce
compliance with professional standards and rules of conduct for licensees. The four credentialing
committees review license applications and make recomlnendations to the Board regarding licenses and
disciplinary matters.
Since the enactment of mandatory licensure, the Board has issued a total of 8,281 licenses. The
Board has received an average of 161 complaints per year since 2004. During the first six months of
2007. the Board took disciplinary action against 38 licensed professionals. The Board cul- rently has a
MEMORANDUM
October 25,2007
Page 2
backlog of complaints received and was authorized to hire additional investigative staffbeginning in FY
2007- 2008. With the additional staff, the Board estimates eliminating the backlog by the end of FY
2008- 2009.
FISCAL ISSUES
The Board's total operating budget for FY 2007- 2008 is $ 1,229,300. The Board currently has 17
full- time equivalent ( FTE) positions. Pursuant to A. R. S. § 32- 3254, the State Treasurer collects all
monies received by the Board and deposits ten percent of the monies and all civil penalties imposed on
licensees into the state General Fund. The remaining 90 percent of monies received are deposited in the
Board of Behavioral Health Examiners Fund and are used by the Board for all necessary Board
expenses.
LEGISLATIVE ISSUES
The Board requests three legislative changes in its sunset response. First, the Board requests an
increase in the n~ axin~ ulmic ensing fee it may charge. The current maximum fee is $ 250 and was
established in 1989. The Board states that its workload has increased significantly, resulting in
increased expenses. Because the Board's revenues come from licensing fees, the Board anticipates
requesting an increase in the maximum allowed licensing fee. The Board does not indicate the desired
amount of the increase.
Secondly, the Board states that it will seek statutory authority to establish a confidential
impaired professionals' program for licensees. Currently, licensees with substance abuse or dependency
issues may self- report to the Board and are investigated and reviewed through a public process. The
Board wishes to implement a confidential monitoring program for these licensees.
The third item the Board will request is the authority to issue provisional licenses to applicants
who are licensed in another state but do not qualify for licensure in Arizona. The Board states that
education and supervision requirements vary significantly among states for marriage and family therapy,
professional counseling and substance abuse counseling. The Board states that it wishes to grant a
provisional license so that these applicants may practice under supervision for up to two years while
they complete the necessary education or supervision requirements for Arizona licensure.
AlIDITIONAL BACKGROUND
Senate staff received additional input on the Board from Josefina Ahumada, Chair of the
Arizona Behavioral Health Professionals Coalition, and Terry Gray, a licensed substance abuse
counselor. Both indicated support of continuing the Board. ( Please see letters attached with the sunset
response for more information).
13 Olj as
Attachments
S'I'A'I E <) IT AlilZONA
I3OAlll) OF IiEIIAVIOHAL IIEALTII EXAMIN17RS
3443 N. CENTHAI, AVE., SIIIIE 1700
I'IIOENIX, AZ 85012
PIIONE: 602.542.1882 FAX: 602.364.0890
Web Site: \\\ 1\\. l) l) lrc~.~ t: 1tc.: r7. u~
E- Mail Atlclre\ s: : 111) l, hcin I ) ~ ~ I c . \ ~ ; I ~ ~ . : I ~ . L I \
JANET NAPOI. 1' 1 AN0
Ciovcmor
DEBRA KINAUDO
Exccutive Ll~ rcctor
September 4, 2007
The Honorable Torn 0' 1 lallcran
Arwona State Scnatc
Chairman, Senate 1Iealth Comni~ ttceo f Kcfcrencc
1700 W. Washington
Phoen~ xA, % 85007
The tlonorablc Bob Stump
Arr~ onak lousc of Keprescntatrves
Cha~ rnmanH, ouse Ilcalth Committee of Reference
1700 W. Wasliington
Phoenix, AZ 85007
Rli:: Sunset Review of' Arizona State Board of Behavioral Health Examiners
Dear Senator 0' 1- Iallcran and Representative Stump:
' Thc A1- 1zonaB oard or Behavioral Healtli Exami~ icrsi s pleased to provide ~ O LwI i th its response
to your letter and questionna~ reo f June 20, 2007. In addition, we respectfully encourage the Joint
Health Committee of Reference to recommend that this agency be renewed for a ten year period,
as prcvio~ lsly providcd in past sunset reviews. We are pleased to attach a letter of support from
the Aruona Behavioral Health I'rofcssionals coalition.' Scc Attachment 2.
In response to sunset factors posed under A. R. S. 5 41- 2954:
1. 7' 11 e objective rrndpurl~ osein e. stcrblishing the agency.
Tlic Board or Behavioral Health Examiners (" Board") was established in 1988 ( Laws
1988, Cllaptcr 3 13), and became effective July 1, 1989. Under the original statutes, the
Board provided a voluntary certification in tlic disciplines of professional counseling,
n~ arriagea nd f;- lniilyt herapy, social work, and substance abuse. Accordingly, the Board
I The Arlmna Eehavioral llcaltl~ I ' rofcssionals Coalition is comprised of fhur statc professio~ lala ssociations, Ihc
AI-~ zon( a: ol~ nsclorsA ssociation, the Arizona Association of Drug ancl Alcol~ olA buse Co~ lnselorst, h e Arizona
Main iagc ;~ ntl1 ; amily ' I'lrci- apy Association, and the Arizona chapter of tllc National Association of Social Workers
' l'hcsc l b ~;~~ srs oc~ ationI- se pl- cscnt~ lrcf our tliscipli~~~ csc g ~ ~ l ; ~ byt c t( hle I3oa1- cl.
was rcsponsible for protecting the public by investigating complaints and ensuring that
those behavioral health professionals that voluntarily became certified met minimum
standards for education, expertise and competency.
In 2003 ( Laws 2003, Chapter 65), the Board was converted from a voluntary certification
model to mandatory licensure, consistent with virtually all other health related regulatory
boards in Arizona. Since June 30, 2004, state law has recluired social workers,
professional counselors, marriage and family therapists and substance abuse counselors
engaged in the practice of psychotherapy to be licensed by the Board and made numerous
changes to the regulatory functions of the Board. See Attachment 3.
2. The ejfectiveness with which the agetzcy has tnet its objective arid puryuse, utzd the
ejjiciency with wh icll it has operated.
Since thc onset of l~ censurein 2004, thc Board has issued 8,281 licenses. In issuing new
I~ ccnses, the Board mccts its overall objective to protect public health and safety, whilc
processing liccnsc applications and coniplaints against liccnsecs in a fa~ ran d expedient
manner.
The Board's efSectlveness and efficiency in carrying out its mandated duties is
demonstrated by the following.
a. ' l'hc Hoard received 866 I~ cens~ a~ prpel icat~ onsi n FY 2007. The Board exceeded
its application proccssing t~ n~ eSramine only 15 cascs.
b. The Boarci recc~ vcd3 ,008 rcnewal appl~ cat~ onIns FY 2007. None of the renewal
appl~ cat~ onprso cessed exceeded the renewal applicat~ onti meframe
c. The Board rccc~ vcd6 96 iecl~~ csftosr wr~ ttenl icense verificat~ onsin FY 2007. The
average proccsslng time Sor verifications was 4 days.
d. The Board's average custonier satislaction rating Tor FY 2007 was 6.3.
3. The extent to wlrich the agency hus o~) erateJw ithiti the public itzterest.
The Board has a continuous commitment to operating in the public interest. The
Lcg~ slaturc creatcd the Board to siinultancously provide a fair and effective reg~~ latory
cnvironnicnt for both thc behavioral health professionals it regulates and the general
~ xlblic. Thc Board is comprised of one professional member from each of its four
crcclentialing coniniittces and four members of the public.
Thc liccnscd professional commun~ ty 1s treated fairly by the Board. Allegations of
~~ npsofessmnacl onduct aga~ nst liccnsces that are proven to be without merit are
dismissed. When the Board determines that allegations of unprofessional conduct against
profcssionals arc substantiated, professionals arc treated in a consistent manner to effect
the rehabilitation of the professional and to protect the public. The Board offers Interim
Conscnt Agrccniciits to professionals when a time- out from practice is considered
appropriate to best reliabilitale the professional and safeg~~ arthde public. On occasion,
thc Board, like other health rcgulatory boards in Arizona, has found it necessary to
revoke a license following a fornial hearing anti rights of appeal
The Board's Adverse Action Reports regal- ding disciplinary measures taken against
professionals and applicants arc available for public review at thc Board's web site,
www. bbhe. state. a~. us. T he Board took disciplinary action against 36 professionals in
2005, 54 in 2006, and 38 during the first 6- months of 2007. See Attachment 4.
4. Tlr e extent to wlzick rules rrdopterl by the rlgency ure consistent with the legislative
NI ( 111 dUte.
The Board has established 11 Articlcs of rules at A. A. C. 114- 6- 101 et sell. under the
exemption to rulemaking provision that was included Laws of 2003, Chapter 65. Each
rule is supported by statutory authority provided to the Board by the legislature. While
the Board received an exemption from the formal rulemaking process, as referenced
above, the Board proactively obtained and recelved stakclioldcr Input from the regulated
conimunity. Sce Attachment 5.
In July 2009, the Board 1s required to submit a Fivc- Year Review Report ofall o f ~ trs~ ~ l c s
to the Governor's Regulatory Review Co~ lncil for rcvlew and approval. The Board is
committed to meeting that requlrc~ ncntw ith~ nth e spec~ fiedti me period.
5. The extent to which the ugency 11rr. s encourtrged itij) ut jrom the public hejbre urlopting
its rules, ~ t i dth e e-~ terrtto whiclr it has irrf) rmerl tlro p~ hlicu s to its ( 1ctiotr. s ( ltid their
expected itrrj~ ucto n tlre plrhlic.
Prlor to adopting its licensurc rules, the Board workcd extensively with all of the state
behavioral health professional associations. The Roard also conducted statewide public
hearings to solicit comnlents from the public. Each comment was considered before the
rules were adopted. The Board receivcd no opposition to adoption of its proposed rules.
In order to properly advise behavioral health professionals about its statutory and rule
changes, the Roard mailed a newsletter explaining these changes to all licensees. See
Attachment 6. Currently, tlie Roard provides a copy of the rules to all new licensees.
6. The extent to wlziclz the ugenq lrcrs beet1 able tu investigate and resolve conr~) luint. s
lvhiclz ( Ire withitr itsjcrri. stliction.
During FY 2004, tlie last year durlng which behavioral health practitioners had the option
of voluntary certification with the Board, the Board received 42 complaints.
Since July 1, 2004, the effcctivc date of liccnsure, tlie Board 11as averaged 161 new
complaints in each of tlie following three fiscal years. This represents a fourfold annual
i~ lcrcasei n co~ nplaintso pened per l~ censi~ rfeis cal ycar vcrs~ lse ach certification fiscal
ycar. The Board expects that the n~ linbcro f new co~ nplaintf ilings will remain constant.
While the legislation establishing liccnsure was enacted in 2003, a delayeti cffcctive datc
of July 1, 2004, was provided to behavioral health professionals that did not participate in
the voluntary certification program established in 1988. This dclaycd effective date was
purposely intended to provide such individuals with the opportunity to meet the state's
minimum qualifications for certification, as individuals that held certification as of July 1,
2004, were automatically grandfathered in under the legislation that converted the Board
from voluntary certification to compulsory liccnsure.
As a result, the Board experienced a si~ nificanstu rge in applications, with a large number
of applications being filed towards the very end of the July 1, 2004, deadline. In order
for the Board to accommodate the increase in applications during the delayed effective
date period, Board resources were diverted to concentrate on liccnsure applications.
In addition, during this period, the Board also experienced a large and unanticipated
increase in complaints. With Board resources diverted to the address the surge in last
minute applications, a significant backlog in resolving complaints was expericnccd by the
Board.
Thc Board triages complaints to provide priorlty to professionals who pose a significant
risk to the health and safety of the public. As a result, some of the Board's older
complaints remain pending with longer processing times. The Board recognizes that this
dynaniic has had a significant negative effect on the Board's overall timcframes for
resolving con~ plalnts.
In rcsponse to the backlog in complaints, the Board was authorized in FY 2006 and FY
2007 to h~ rcin dependent contractors to addr- css the complaint backlog. The Board's
cxperlcnce with the use of indcpendcnt contractors was not positive. ' i'lie investigators
approvcd to conduct investigations for tlie Board did not have any cxpertlsc in beliavloral
health or regulatory Issues. As a result, the Board was only ablc to assign siniple
investigations to the independent contractors and even these simple investigations
required a high dcgrcc of Board ovcrsight. In addition, thc indcpendcnt contractors took
signilicantly longcr to conipletc investigations as compared to the Board's internal
investigative staff. Bccausc of their lack of expcrtlse and the resulting cost inefficiencies,
the Board stopped assigning complaint investigations to indcpendent contractors.
Beginning in FY 2008, the Board was authorized to hire additional internal investiga t I' ve
staff. New investigative staff, once propcrly trained, will provide significant increases in
Board resources available to address the complaints backlog. With this incrcase in
resources, the Board anticipates that that it will be able to eliminate the current
complaints backlog by thc cnd of FY 2009.
7. Tite extent to ~ vizich tlte Attorney General or any other upplicahle agency of state
governrt~ ent has the ( iuthority to prosecute uctions irrzrler the enuhling lqislation.
A. R. S. tj 41- 192 authorizes thc Attorncy General's Oflice to prosecute actions and
represent the Board. The Board is currently rcprcscntcd by one f~~ ll- timAes sistant
Attorney General and has cstablishcd an interagency service agrccmcnt for FY 2008 to
ensure consistent and adequate representation to carry out its mandated duties.
In addition, A. R. S. 5 32- 3286( C) provities that a person who engages in the unlicensed
practice of bchavioral health or claims to bc liccnsed by the Board is guilty of a class 2
misdemeanor. In FY 2007, in response to a referral by the Board, the Pima County
Attorney's Office obtaincd a criminal conviction in the Pima County Justice Court based
on the court's determination that the individual referred by the Board engaged in the
unlicensed practice of behavioral health.
8. The e- rterzt to wJiiclz the agency has arlrlresserl de$ ciencies in its eriuhlirig statutes that
prevent it fronz fuljillirzg its statutory ttzunrlate.
Prior to July I , 2004, the Board was only authorized to provide voluntary certi lication to
qualilied bcliavioral health professionals. Because certification was voluntary,
~ rnq~~ alilioer du nethical individuals were allowed to practice psychotherapy absent any
state oversight or review.
In recognition of thc inadequate level of publ~ c protcction available undcr voluntary
certilication, the Arizona Legislature, in 2003, effective lion1 and after Sunc 30, 2004,
significantly modified the Board's authority and established mandatory licensurc for
professional counselors, social workcrs, marriage and family therapists, and substance
abuse counselors engaged in the practice of psychotherapy. Depending upon education
and cxpencnce, the Board now provides q~ lalificda pplicilnts w~ thn lnc opportunities for
licensurc as tcchnicians, supervisces, or independent practit~ oncrsU. nl~ censedi nd~ vic!~~ als
are prohibited from engaging in the practice of psychotherapy unless they are exempt
from Ircensure pursuant to A. R. S. 5 32- 3271.
' The statutory modifications made in 2003 have addressed thc problems crcatcd ~ lnderth e
voluntary certification model that prohibited the Board from providing an appropriate
level of public protcction to consumers of behavioral health services in Arizona.
9. The extent to wliicl~ chunges are rzecessury it1 the laws of the ugericy to udeyuutely
comply with t h> s~ eJ ' a ctors.
Fee Incrcasc:
As a 90110 state regulatory agency, all of tlic Board's revenues arc derived from fees it
cliargcs to applicants, licensees, and others. Thc overwhelming majority of the Board's
revenues result from fees charged for liccnsure and renewal applications. Pursuant to
A. R. S. 5 32- 3272, the Board must establish fccs to produce monies that approximate the
cost of maintaining the Board and its four crcdcntialing committees. Because the Board
has no other source of revenue, the f'ees it charges must be sufficient to pay necessary
Board expenses, as determined through the legislative appropriation process.
The Board's maximum statutory fee of $ 250 for licensure and renewal applied' ions was
set in statutc in 1989. That fee has nevcr bcen increased. Iior the large majority of the
Board's existence since 1989, it has charged the maximum statutory fcc of $ 250 for
licensure and renewal applications.
The Board's workload increased significantly under licensure, as indicated by the
following:
a. Undcr certification, the Board regulated approximately 6,000 certified behavioral
health professionals. As of FY 2007, the Board was responsible for regulating
over 8,100 licensed behavioral health professionals.
b. Under certification, the Board processed approximately 650 certification
applications annually. Under l~ censure, t he Board has rcccived an average of 800
annual licensure applications.
c. Under certification, the Board rcccivcd an averagc of 56 coniplaints annually.
Under liccnsure, the Board has reccivcd an average of 161 complaints annually.
d. Under liccnsure, the Board has been required to absorb a ninnber of new
responsibilities not mandated under certification. For example, the Board is now
required to complete a state and federal criminal htstory records check on all
applicants ( A. R. S. Ij 32- 3280). Tlic Board is also reclirlrcd to proccss tcnlporary
licciisc appl~ cationsa, process not available under certificat~ on.
e. Thc number of approved FTE's for the Board was increased from 13 in FY 2003
to 17 in FY 2008 to address this increased workload.
The cost of provicl~ ng thc incrcascd scrvlces required undcl l~ ccnsure has resultcd in a
significant increase in the Board's expenses. ' lhc Board's revenue has not increasccl as
rapidly as its cxpenscs. As a rcsult, the Board's expenses cxcccdcd its revenue by
$ 309,365 in FY 2007. Bcca~~ soef the $ 250 maxlmuni statutoly fee, the Board has no
statutory authority to generate suffic~ entr evenue to pay for ~ t scu rrent expenses. During
thc 2008 legislatlvc session, the Board antic~ patcs recli~ cstnig thc consideration of an
Increase in its maxlmum statutory fee. This will allow the Hoard to gcncratc sufficient
revcnuc to pay for increased services and workload required as a rcsult of l~ ceiisurc.
Confidcntiaipaired Professionals Program:
A significant number of professionals impaired by silbstance abuseldependency problenis
self- report to the Board. lnvcstigation and Board rcvlcw of these issucs are currently
reviewed through a public proccss. During the 2008 lcg~ slat~ vsces sion, the Board will
scck statutory authority to establish a confidential ilnpa~ rcd profess~ onal's program
similar to that available through the nursing, pharmaceutical, and n~ edical boards. This
will allow the Board to implement a conlidential monitoring program for licensccs who
voluntarily report substance abusc/ dcpendency problems.
Provisional Licenses:
l h e Board's minim~~ lmice nsurc require~ nentsa re set forth in statute and rule. Applicants
must demonstrate that they meet these req~~ irementisn order to obtain liccnsure in
Arizona.
Education and supervision requirements for social work licensure are relatively similar
throughout the country. As a result, applicants licensed as a social worker in another state
face relatively few obstacles in qualifying for 1icensu1- ei n Ari~ ona.
Conversely, education and supervision recluirements for marriage and family therapist,
professional counselor, and substance abuse counselor licensure can vary signilicantly
between the states. In addition, state licensure req~~ iremcnhtasv e changed rapidly during
the last 20 years. As a result, applicants licensed in one of these disciplines in another
state may not necessarily clualify for licensure in A r ~ ~ o n a .
In addition, licensure for behavioral health professionals is relatively recent throughout
the country. Large numbers of practicing professionals, regardless of acadcmic and other
professional credentials, were grand fathered into licensure in other states as those states
adopted mandatory licensure laws. ' I'ypically, professionals grandfathered into licensurc
are not required to comply with education, supervision, or examination recluiremcnts in
order to obtain a license.
For a variety of reasons, Arizona attracts large numbers of professionals liccnsed in
another state who have practiced for a number of years and who now want to obtain
licensure in order to practice in Ar~ zona.
' Thc Board currently offers limited reciprocity to such profess~ onalsa nd req~~ irtehse m to
demonstrate that they substantially meet current req~ iirenients. Some profess~ onals arc
unablc to meet even the Board's substantial equivalency standard and can not obtain a
license until ed~~ cationan dlor supervision deliciencics arc resolved. At present,
professionals licensed in another statc, but not in Arizona, can practice psychotherapy as
long as they work in agencies licensed by the Office of Behavioral Health licensurc.
Of the 46 states that rcgulatc behavioral health professionals, none provide for a straight
reciprocity, as all states require the applicant, regardless of status in other jurisdictions, to
demonstrate that they meet minimum requirements.
A number of concenls have been raised about the difficulty professionals face as they try
to transfer their licensurc status from one state to another. The Board recognizes the need
to balance these concerns against its mandate to protect the public by ensuring that
licensed professionals have sufficient cducatlon and supervision to provide services
safely and competently.
Tlic Board partic~ patedi n a number of stakeliolder meetlngs addressmg these Issues. As a
result of these meetings, during the 2008 legislat~ ves ession, the Board will also recl~~ est
authority to Issue provisional l~ censcs to appltcants who seek liccnsure tliro~~ gli
reciprocity, but who fail to substantially meet minimum qualifications. A provisional
license will enable such applicants to practice in Arizona under supervision as a licensed
professional for up to two years while they cure the existing deficiencies in their
education or supervision.
I O. The extent to which the tertninirtion of the agency would significrrtitly kurtn tlte public
health, safety or welfare.
The Board was authori~ ed to offer voluntary certification to qualified professionals
tl~ rough June 30, 2004. In recognition of the fact that voluntary certification provided an
inadequate level of public protection to an often vulnerable population, as of July 1,
2004, the Arizona Legislature modified the Board's authority to require mandatory
licensure for all those engaged in the practice of psychotherapy.
Tcnnination of state regulation of behavioral health profcss~ onals would significantly
endanger the publlc. In order to obtain licensure, appl~ cants must demonstrate
cornlxtency by meetlng minimum requirements in education, supervision, and
examination. Once l~ censed, professionals remaln within the Board's jurisdict~ on. This
allows the Board to revlew and take appropriate action on compla~ nts filed against
Iiccnsces. Finally, mandatory llcensurc laws allow the Board to revlew and take
appropriate action with regard to individuals practicing psycliotlierapy 111 Arizona without
being licensed to do so. W~ tliout the Hoard's regulatory author~ ty, there would be no
nicclian~ sinI br ensuring that only cli~ alifiedb ehavioral health prolcssionals engage In the
practice of psycliotherapy. S~ m~ larlwyi, t hout the Board's regulatory authority, tlie Board
would have no ability to review and take disc~ pl~ narya ct~ on against unlicensed
ind~ vidi~ awlsh o engage in ~ nappropr~ aoter unetli~ calb chav~ or
11. The extent to wlliclt the level of regulirtion exerciser1 by the ugettcy is uppropriute utzrl
whether less or more stringent 1e1lel. s of regrrlr~ tiotiw o~ ildb e rrpproprirrte.
Tlic Board believes that the current level of reg~~ latioans amelided and added in Laws
2003, Chapter 65, Sect~ on4 0, is appropriate. M: uidatory l~ ccnsuref or behavioral health
profcssionals cnsures that applicants demonstrate competency to practice by meeting
minimum recl~~ ircment11s1 education, supcrvislon, and exaiii~ nat~ oiini order to obtain
licensure in this state. Mandatory licensure also allows the Board to revlew coinpla~ nts
filed against those practicing psychotherapy. This provides a mechanism for the Board to
take appropi- iate disciplinary action against incompctcnt or ~~ neth~ lciaceli isecs. It also
provides a meclianisin for the Board to take action agalnst non- licensed intlividuals who
engage in the pract~ ceo f psychotherapy.
12. The extent to wlziclz the irgency lzas used private contrirctors in the perfornirrnce of' its
duties utid / tow elfkctive use of private contractors coull he irccomplished
In FY 2006 and FY 2007, tlic Board was authorized to hire independent contractors to
address the complaints backlog. The Board's experleiice w~ thth e use oS independent
contractors was not positive. The investigators approved to conduct invest~ gationsf or tl~ c
Board did not have any expertise in behavioral health or regulatory issues. As a result, the
Board was only able to assign simple investigations to the independent contractors and
even these simple investigations required a high degree of Board oversight. In addition,
the independent contractors took significantly longer to complete investigations as
compared to the Board's internal investigative staff. Because of their lack of expertise
and the resulting cost inefficiencies, the Board stopped assigning complaint
investigations to independent contractors. ( See answer # 6 of this section).
In response to agency factors posed under A. K. S. 5 41- 2954( F):
1. Atz irleritificutiorz of tlzeproblem or the tzceds thut the ugerzcy i. s intenrled to riddress.
' The Board's f~~ nctioins to license and investigate complaints agalnst behavioral hcalth
professionals to ensure that they meet minimum clualifications and practice safely and
competently.
2. A stutenletit to the e . ~ t ~ nprtr rcticahle, irr r/ urrrrtitritive utrrl rlurilitritive ternzs, of the
objectives . s$ tlre ugcJncy urzrl its utiticil, citerl ucconi~~ lisl~ rtze~ zts~
FY 2007 OHJEC'I'I. V- ES: / Process licensure applications on a timely b a s ~ ~
ACCOM PJ, lSJIMENTS:
lX(,(, pPlications received.
1 1 15 exceeded applicable
- -- -- -
behavioral liealth professionals
on a tinlely basis. 3,008 applications received.
i 1 None exceeded applicable
time frames --
requests for written license verifications on a 696 verification requests
/ basis / rcccived.
1 ( Average number of days to
Initiate investigations and resolve complaints on a timely basis
Obtain positive customer satisfaction on a scale of 1 - 8.
process verifications is 4 days.
5 15 investigations were
initiated.
169 complaints were filed
with the Board.
Average number of days to
process complaints is 471
days.'
tAver age satisfaction of 6.3 L- I was achieved.
3. An identification of ~ 11yot lzer cigencies huvirzg sinrilur, corzjlicting or rlrrplicutive
ol) jectives, urirl utz ~'~ xplririrrtioon$ tlze r~ z~ rztzeinr whicli the ugency avoids d~ rplicrition
or cotzj7ict with sirch otlrcr ug~ tzcie.~.
Scc explanatloll at piuagraph 6, abovc
The Board has not identified any specific conflicts and/ or duplication of services with
other state agencies. The Board appropriately refers complaints to other state agency or
jurisdictions when necessary. The Board also shares information regarding complaints
and investigative matters with other state agencies as appropnate.
4. An assessnt ettt of the conseyuences of elitn irzrrtirtg tlte ugetzcy or of cortsoliriatirzg it
with attother ugeticy.
The Board first received licensure authority as of July 1, 2004. The need for this level of
state regulation was clearly addressed and deemed appropnate at that time. The
elimination or tcr~ iiination of the Board would have a severe negative impact on the
public as individuals would be free to practice psychotherapy without any state oversight
of their q~ lalificationso r practice.
In recognition that the licensure requirements and practice standards for the master's
level social workers, marrlage and family therapists, profess~ onal counselors, and
substance abuse counselors are somewhat similar, regulation of these four disciplines was
consolidated ~ lndert he Board's authority. It is not clear what benefit, if any, would be
realized by consolidating the Board with another state agency.
' T'he only other regulatory agencles in Arilona that regulate behavioral health
profess~ onals are the Mcd~ cal Board, which I~ censes psych~ atrists, and the Board of
Psycholog~ stE xam~ ncrsw, hich l~ censcsp sycholog~ sts. G~ venth e significant differences
in niin~ ni~ lmcd ucat~ ona nci train~ ngr equlred lor psycli~ atr~ stps, s ycholog~ sts, a nd th~ s
Board's liccnsccs, it IS not clear that any effic~ enc~ ewso uld be realized by consolidation
of the rcgr~ latoryf ~~ nct~ foonr sth ese profess~ ons.
In addition, given the distinctly diffcrcnt professional identities of psychiatrists and
psychologists fro111 the master's and lower level behav~ oralh ealth professionals regi~ lated
by this Board, any attempt to consolidate the regulation of any of these dif'ferent
d~ sciplines would likely produce significant opposition from these licensees and their
professional associations.
5. Copies of F Y 200 7 rtzitlrties j0r tlze ugerl cy ' s following nieetings ctre rrttaclterl ( see
Attachment 7):
1. The Arizona State Board of Behavioral Health Examiners
2. The Counseling Credential~ ngC ommittee
3. The Marr~ agea nd Family Therapy Crcdentialing Committee
4. The Social Work Credentialing Committee
5. The Substance Abuse Credentialing Comniittec
6. Inclurk u copy oftlle r~ gency'sn iost recent atzttual rcyort.
While the Arlzona Board of Behavioral Health Examiners does not have a statutory
rccl~ iircment to prepare an annual rcport, please see Attachment 8 for information that
would typically be provided in an annual report.
1 would likc to per- sonally thank tlie Committee of Reference and staff for their assistance during
this revlew. If you rccl~ iirca ny cluestions or clarifications, please do not hesitate to contact me at
( 602) 542- 1 884 or debra. rinaudo@ bbhe. statc. ai. us.
Thank you in advance for your consideration.
Dcbra Rinaudo
Execut~ veD irector
9
Arizona Behavioral Health Professionals Coalition . .
August 6,2007
Tom O'Ilalleran
State Senator
Chair, Senate Health Committee of Reference
1700 W. Washlngton
Phoenix, AZ 85007
Bob Stump
State Representative
Chair, House Health Committee of Reference
1700 W. Washlngton
Phoenix, AZ 85007
RE: Sunset Review of Arizona State Board of Behavioral Health Examiners
Gentlemen:
On behalf of the Anzona Behav~ oral Health Professionals Coallt~ on, I submt ths letter in support of the
conhnuat~ on of the Anzona State Board of Behav~ oral Health Exanxners for the next ten years, following the
Leg~ slature's Sunset Revlew
The Coalition consists of representatives from the four regulated occupations of social work, counseling, marriage
and family therapy, and substance abuse counseling that comprise the practice of behavioral health in Arizona. The
Coalition worked closely with the Board to require mandatory licensure for behavioral health professionals who are
often responsible for tr- eatlng some of the most vulnerable populations. Mandatory licensure was effective on July I,
2004. Following the establislment of licensure, the Board has assisted a growing base of behavioral health
professionals maintain their credentials and serve the public safely and competently.
We acknowledge that there are occasions when, in the interest of public health and safety, it is necessary to suspend,
revoke, or deny licensure. The Board's efforts to provide a fair and consistent regulatory process in reviewing
co1nplairits aga~ nsptr oblcm practitioners has afforded the profession and the pllblic ihe safety levels we sought W? IC~ I
mandatory licensure was established.
We look forward to the cont~ nuedp rogress of the bchav~ oralh ealth profess~ onr n ~ ooperatronw ~ thth e Arvona State
Board of Behavioral Health Exanxners over the next 10 years
Thank you in advance for your consideration
Josefina Ahumada, LCSW
Chairperson
Ar- izona Behavioral Health I'rofcssionals Coalition
( The following is an email received on October 1, 2007 by Senate Research staff)
I am a Licensed Independent Substance Abuse Counselor (# 0089) in Arizona who oens and
operates an Outpatient Treatment facility in Tucson. I was active in developing the legislation
that established licensure for behavioral health professionals in this state.
Since licensure became law, a great many people have been affected and influenced by the
BBHE, who monitors the licenees and ultimately provide screening and protection for the
vulnerable general public. A number of issues have been raised about the BBHE's performance
and about the mission being addressed.
While I believe that some issues with the BBHE may be valid, the overall performance of this vital
Board has been excellent.
The behavioral health professionals in Arizona need an agencylboard that determines minimal
levels of competency, outlines ethical guidelines, and evaluates the skills and appropriateness of
training for those professionals. These are functions that the BBHE performs.
The public needs an agencylboard that can be responsive to complaints, that will assess the
validity and severity of any professional's ( alleged) misconduct. The BBHE is essential to be the
main organ of defense and of punitive sanctions for any misdeeds perpetrated against those
persons who are in need and are vulnerable psychologically and emotionally.
The balanced representabon on the board helps to assure that the BBHE actions are well
understood, well- rev~ ewed, a nd are balanced. I urge you to support retalnlng this ~ mpotant
element of our State government
Terry Gray, MS., LlSAC
7031 E. Edgemont St.
Tucson, AZ 85710
520- 722- 6262
Interim agendas can be obtained via the Internet at http: llwww. azleg. state. az. usllnterimCommittees. asp
ARIZONA STATE SENATE
INTERIM MEETING NOTICE
OPEN TO THE PUBLIC
SENATE HEALTH AND HOUSE HEALTH COMMITTEE OF REFERENCE
Date: Tuesday, November 6,2007
Time: 9: 30 A. M.
Place: SHR I
AGENDA
1. Call to Order
2. Opening Remarks
3. Sunset Review of the Board of Homeopathic Medical Examiners
Presentation by Auditor General
Response by Board of Homeopathic Medical Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
4. Sunset Review of the Regulatory Board of Physician Assistants
Presentation by Regulatory Board of Physician Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
5. Sunset Review of the Board of Behavioral Health Examiners
Presentation by Board of Behavioral Health Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
6. Sunset Review of the Acupuncture Board of Examiners
Presentation by Acupuncture Board of Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
7. Sunset Review of the Board of Occupational Therapy Examiners
Presentation by Board of Occupational Therapy Examiners
Public Testimony
Discussion
Recommendations by the Committee of Reference
Page 1 of 2
8. Sunrise application of the Arizona Alliance of Non- Physician Surgical Assistants
Presentation by Arizona Alliance of Non- Physician Surgical Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
9. Sunrise application of the Southern Arizona Behavioral Health Coalition
Presentation by Southern Arizona Behavioral Health Coalition
Public Testimony
Discussion
Recommendations by the Committee of Reference
10. Sunrise application of the Arizona Dental Association
Presentation by Arizona Dental Association
Public Testimony
Discussion
Recommendations by the Committee of Reference
1 1. Sunrise application of Radiology Practitioner Assistants
Presentation by Radiology Practitioner Assistants
Public Testimony
Discussion
Recommendations by the Committee of Reference
12. Adjourn
Members:
Senator Tom O'Halleran, Co- Chair
Senator Paula Aboud
Senator Amanda Aguirre
Senator Barbara Leff
Senator Thayer Verschoor
Representative Bob Stump, Co- Chair
Representative Nancy Barto
Representative David Bradley
Representative Linda Lopez
Representative Rick Murphy
Persons with a disability may request a reasonable accommodation such as a sign language interpreter, by contacting the
Senate Secretary's Office: ( 602) 926- 4231 ( voice). Requests should be made as early as possible to allow time to arrange the accommodation.
Page 2 of 2
ARIZONA STATE LEGISLATURE
Forty- eighth Legislature - First Regular Session
SENATE HEALTI1 AND HOUSE HEALTH
COMMITTEE OF REFERENCE
Minutes of Interim Meeting
' I'uesday, November 6,2007
Senate Hearing Room 1 - 9: 30 a. m.
Chairman O'IIalleran called the meeting to order at 9: 32 a. m. and attendance was noted by the
secretary.
Members Present
Senator Tom O'I- Ialleran, Co- Chair Representative Bob Stump, Co- Chair
Senator Amanda Aguirre Representative Nancy Rarto
Senator Barbara LefS Representative David Bradley
Senator Thayer Verschoor Representative Linda Lopez
Representative Rick Murphy
Members Absent
Senator Paula Aboud
Speakers Present
Kim Hildebrand, Performance Audit Manager, Office of the Auditor General
Todd Rowe, Board of Homeopathic Medical Examiners
Christine Springer, Board of I Iomeopathic Medical Examiners
Jerry Weinsheink, representing himself
Marianne Cherney, representing herself
Neil Garfield, Association for Public Access to Medicine
Barney Nugent, representing himself
Linda Heming, CHOICE
Iris Bell, Doctor, Arizona IIomeopathic and Integrative Medical Association
Cliff Heinrich, Doctor, representing himself
Kathleen Fry, Doctor, representing herself
Denise Nugent, representing herself
Lee Bakunin, Attorney, representing herself
Bruce Shelton, Doctor, Arizona 1 Iomeopathic and Integrative Medical Association
Amanya Jacobs, Director of Evolution of Self School of Ho~ neopathy
Cindy Zukerman, representing herself
Shelly Malone, representing herself
Stan Kl~~ skrye, p rcsenting himself
Gladys Conroy, representing herself
SENATE HEALTH AND HOUSE HEALTH
COMMIpI'TEE OF REFEITENCI:
November 6,2007
Joan Reynolds, Regulatory Board of Physician Assistants
Debra Rinaudo, Board of Behavioral 14ealtl. 1 Examiners
Stuart Goodman, Board of Behavioral Health Examiners
Bev I- lermon, BH Consulting
Richard Poppy, Therapeutic Practitioners Alliance of Arizona ( The Alliance)
Rachael Hopkins, representing herself
Ronald Anton, representing himself
Josephine Sbrocca, representing herself
Cedric Davis, Board of Behavioral Health Examiners
Della Estrada, Arizona Acupuncture Board of Examiners
Kathryn Babits, Arizona State Board of Occupational Therapy Examiners
Eugene Smith, Arizona Alliance of Non- Physician Surgical Assistants
Susie Cannata, Arizona Alliance of Non- Physician Surgical Assistants
Rory Hays, Arizona Nurses' Association
Scott L, eckie, Radiology Practitioner Assistants
Jane Van Valkenburg, Certification Board for Radiology Practitioner Assistants ( CBRPA)
Mary Connell, M. D., reprcscnting herself
Christine Lung, American Society of Radiologic Technologists ( ASKT)
John Gray, Grand Canyon University
Joyce Geyser, Arizona Radiological Society
James Abraham, National Society of Radiology Practitioner Assistants
IIeather Owens, Senate Health Analyst
Aubrey Godwin, Medical Radiologic Technology Board of Examiners ( MRTBE)
Teresa Rodgers, Behavioral IIealth Coalition of Southern Arizona
David Giles, Behavioral Health Coalition of Southern Arizona
IIolly Baumann, Southwest Autism Research and Resource Center
John MacDonald, Arizona Dental Association ( ADA)
Rick Murray, Arizona Dental Association
Anita Elliott, Arizona Dental Association
Nicole I, aslavic, Arizona State Dental ITygienists' Association
Janet Midkiff, Arizona State Dental Jlygicnists' Association
Nicole Albo, Arizona Dental Assistants' Association
Alisa Fcugate, Arizona Dental IIygienists' Association
Chairman 0' 1 Ialleran welcomed everyone and requested that the speakers keep their comments
as brief as possible, as the committee members arc well- versed in the issues to be discussed
today.
SUNSET IWVIEW 0
Presentation by Auditor General
Kim I- Tildebrand, Per
p r e s e n t a t i o d n d i n g s issued in August, 2007 ( Attachment 1). She described the history
SENATE I- IEA!, 7fIH AND HOtJSE HEALTI I
COMMITTEE OF fIE1: EIIENCE
2 November 6, 2007
Chairman O'Halleran reconvened the committee at 12: 07 p. m.; all meinbers
Senator Aboud.
SUNSET REVIEW OF THE REGULATORY BOARD OF I'HYS
Presentation by Regulatory Board of Physician A s s i s t a n j d
Joan Reynolds, Regulatory , addressed the committee to describc
the Board composition, the nts in Arizona, and the two training
programs in Arizona. She to protect Arizonans' health and to
monitor, liccnsc, and regulate
Recommendations by thdommittee of Reference
Stump moved that the Senate and House Health Committee of
the continuation of the Regulatory Board of Physician
The motion carried by a voice vote.
SUNSET IIEVIEW OF THE BOARD OF BEHAVIORAI, HEALTH EXAMINERS
I'resentation hy Board of Behavioral Health Examiners
Debra Rinaudo, Board of Behavioral Health Examiners, addressed the committee to explain that
the Board was originally established to off'er a system of voluntary certification in four
disciplines:
1. marriage and family therapy,
2. professional counseling,
3. social work, and
4. substance abuse counseling.
She stated that the Board is responsible for protecting the public by ensuring that certified
professionals met minimum standards in education and training, and investigating and taking
action on complaints. In 2003, mandatory licensure of psychotherapy was added to its
rcsponsibilitics. She stated that grandfathering those with certification into licensed status was
allowed.
Since 2004, due to licensure, there has becn a dramatic increase in complaints and the Board has
a complaints backlog and must triage the complaints in order to address the most serious quickly.
Senator 1, efS asked what happens to the less serious complaints; Ms. Rinaudo replied that all are
investigated, but that those not dealing with client harm are deemed less serious. Ms. Rinaudo
added that additional investigators will be hired in I.' Y 2008 which will allow the Board to
eliminate the bacltlog.
Ms. Iiinaudo discussed the two- year provisional license granted those who are licenscd in other
states and who must work under direct supervision before they can obtain a full license. She
described the confidential impaired professionals program designed to encourage early self-
SENA'l'E HEALTH AND HOUSE HEALTH
COMMII'TEE OF REFERENCI,
November 6,2007
reporting.
She stated that there are concerns from licensed agencies such as Department of Health Services,
which are cxempt from licensing by this Board, but in general there is widespread support for
provisional licenses.
Cochairman Stump relayed that he has received many constituents' concerns about the
requirement for four supervisors to signoff on supervisory hours and the difficulty meeting this
requirement; Ms. Rinaudo explained that training is only required for those seeking independent
licensure, that individuals corning straight out of school at the associate level do not requirc
supervision hours.
Cochairman Stump asked about practitioners waiting on complaint resolution; Ms. Rinaudo
stated that the Board is aware of the complaints, that it does have a backlog due to the
grandfathering in from certification to licensure and a resultant resource problem, and that
additional personnel are being added to address this.
Senator Verschoor asked about the grandfathering situation; Ms. Rinaudo replied that
certification has been offered by the Board since 1988, but that since July of 2004 licensure is
required and anyone with certification would be grandfathered in. Senator Verschoor asked if
the rush to do this reflected a change in standards; Ms. Rinaudo replied that the qualifications
for substance abuse counseling were much more strenuous for licensure and also that there was a
waiver of all of the exams for the grandfathered individuals.
Senator Verschoor asked if now there are licensed individuals with a lower standard of
qualifications than newer practitioners; Ms. Rinaudo replied in the affirmative. Senator
Verschoor askcd if there is an attempt to raise the standards for the grandfathered individuals;
Ms. Rinaudo replied that there has been no attempt to do that.
Stuart Good~ nan, Board of Behavioral IIealth Examiners, addressed the board to explain the
rationale and benefits of grandfathering.
Speaker Verschoor asked the cost of a license and if it might be increased; Ms. Rinaudo replied
that the cost is $ 250 every two years, which reflect 1989 dollars. Discussion ensued about the
need for more funding, and increase in the cap, and an increase in fees in order to avoid a
decrease in services.
Representative Lopez aslted about provisional licenses and what is required to comply in
Arizona; Ms. Rinaudo replied that some people can come into Arizona and obtain their licenses,
but that some disciplines are standardized across the nation and some are not. She went on to
explain that the only restriction with a provisional license is that the practitioner must work
under supervision. Representative Lopez asked if Arizona has reciprocity guidelines with other
states; Ms. Rinaudo replied that in general states do not have reciprocity between health care
boards.
Representative Bradley aslted for a rcmedy lor practitioners who do not have their proof or
supervision; Ms. Rinaudo replied that their licensure file should contain all the supervision
SENATE HEALTH AND HOIJSE HEALTI1
COMMITTEE OF REFERENCE
November 6,2007
forms. She further stated that the provisional license is always the remedy, to provide the time to
fulfill all the requirements.
Public Testimony
Bev Hermon, BII Consulting, addressed the committee to express her concerns about the
Board's operations ( Attachment 10). She stated she is against continuance of the Roard.
Richard Poppy, Therapeutic Practitioners Alliance of Arizona ( The Alliance), expressed his
concerns about how licenses are granted, particularly to those who have been practicing for
many years ( Attachment 11). He stated that his group is worlting on reciprocity guidelines,
supervisory setting requirements, and core course requirements ( standardizing semester hours
and course hours).
Rachael I- lopkins, representing herself, addressed the committee to express her concerns about -
the Board operations. She described her difficulties with the licensing process, explaining that
her application has been held up for one year due to the lack of one credit hour.
Senator Lcff asked if she has taken the exam and passed it; Ms. I- Iopkins replied in the
affirmative.
Ronald Anton, representinx himself, expressed his concerns about the Board, the lack of
reciprocity, and the difficult licensure process. He stated that he may not have moved to Arizona
l~ adh e known of these difficulties, and that he was reluctant to testify for fear of reprisal.
Josephine Sbrocca, representing herself, stated that she was denied licensure due to one book in
one course she tool< at Prescott College; she did state that " there is lire without licensure".
Cedric Davis, Board of Behavioral Health Examiners, a member of the Board for the past six
years, testified in fjvor of continuance of the Roard, stating that the standards were set by
slakeholders and arc similar to those in other states.
Discussion
Cochairman Stump stated that 11c is strongly in favor of a performance audit, as the last one was
in 1997.
Senator Leff stated that she now has concerns that she did not have before, particularly that a
Board should not, under the guise of protecting the public, lteep people from working. She feels
that if someone has passed the exam, that should qualify them, and they should not be held back
by coursework issues about a book or credit hours; she is in favor of a perSormance audit also.
Chairman O'I- Ialleran stated that, even with a long sunset, if the results of an audit require the
Board to be reviewed sooner that can occur; he stated his support for an audit.
Representative Murphy stated that he is in favor of a performance audit, but wondered if the
Auditor General can do this in a timely fashion due to their current worl< load. Discussion ensued
SENATE HEAI.' I'l- I AND HOUSE 1 IEA12' I'I I
COMMII'TEE OF IIEFERENCE
9 November 6,2007
about the length of the continuation.
I< ecommendations by the Committee of Reference
Cochairman Stump moved that the Senate and IJouse Health Committee of
Reference recommend the continuation of the Board of Behavioral Health
Examiners for five years and that the Joint Legislative Audit Committee consider
scheduling a performance audit in due haste.
Senator Leff asked if the committee could reconvene after the audit is completed.
Cochairman Stump withdrew his motion.
Cochairman Stump moved that the Senate and House Health Committee of
Reference recommend the continuation of the Board of Behavioral Health
Examiners for five years and that the Joint Legislative Audit Committee consider
scheduling a performance audit as soon as possible with a legislative committee
review at the end of such audit. The motion carried by a voice vote.
Chairman O'Hallcran recessed the committee at 1 : 3 1 p. m.
Chairman O'Halleran reconvened the committee at 2: 11 p. m.; all members were present except
Senator Aboud and Senator Aguirre.
SUNSET IiEVIEW OF THE ACUPIJNCTURIS HOARD OF EXAMINERS
Presentation by Acupuncture Board of Examiners / Della Estrada, Arizona Acupuncture Board that the Board provides
regulatory oversight of the allnost 450 in Arizona and has
successfully accomplished its mandate the general public
( Attachment 12).
Recommendations by the Committee of M r e n c e
Cochairman that the Senate and House Health Committee of
of the Acupuncture Board of Ex;~ miners for
SUNSET H I I V I E ~ FTH E BOARD OF OCCIJPATIONAI, THERAPY EXAMTNEIIS
Prcsentaticyl/ by Board of Occupational Therapy Examiners
~ a tHa~ bitsn, A rizona State Board of Occupational Therapy Examiners, addressed the board to
ss that thc Board continues to meet its statutory mandate to ensure the public health by
nsing and regulating individuals who provide occupational therapy services.
SENATE HEALTH AND HOUSE HEALTH
COMMITI'EE OF REFERENCE
November 6,2007
Janet Midlciff, Arizona State Dental Hygienists' Association, stated that they support the concept
of training community people to be dental health representatives, and that the definition of the
COHR does make sense to them. She stated concerns about the education, licensing, or
certification of the people who fill the COHR positions. She said that her organization would
like to worlc with the ADA and to be a part of the access to care issue.
Nicole Albo, Arizona Dental Assistants' Association, stated her support for the COIHR program
provided that the positions will be filled by certified dental assistants with additional training
components. She stated that she has been working with the ADA to develop a curriculum for
expanded COI- IR training.
Representative Murphy aslced if the committee could approve the concept but not specify the
details, letting the Legislative process do that. Mr. Murray stated that the supcrvision issue is the
biggest colicern.
Alisa Feugate, Arizona Dental Hygienists' Association, stated that she supports the concept of
the COI- TR but is neutral on the application at this time due to concerns about supervision and
scope of practice.
Recommendations by the Committee of Reference
Cochairman Stump moved that the Senate and House Health Committee of
Reference recommend that the Legislature amend the statutes of the Arizona Board
of Dental Examiners to create a new certified professional, the Community Oral
Health Representative, to coordinate community- based oral health promotion and
provide specified dental care under the general supervision of a licensed dentist.
The motion carried by a voice vote.
Without objection, the meeting adjourned at 4: 15 p. m.
Jane Dooley, Committee Secretary
November 6,2007
( Original minutes, attachments and audio on filc in the Office of the Chief Clerk; video archives
available at http:// www. azle~. gov/)
SENATE HEALTH AND HOUSE HEAL'TI- I
COMMITTEE OF REFERENCE
November 6,2007
