Revision: Jan. 15, 2019, 12:55 p.m.
HB 546-FN - AS INTRODUCED
2019 SESSION
19-0409
10/05
HOUSE BILL 546-FN
AN ACT relative to the regulation of art therapists.
SPONSORS: Rep. P. Schmidt, Straf. 19; Sen. Watters, Dist 4
COMMITTEE: Executive Departments and Administration
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ANALYSIS
This bill establishes the regulation and licensure of persons engaged in the practice of professional art therapy by the office of professional licensure and certification and includes licensed professional art therapists in certain insurance coverage provisions.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
19-0409
10/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nineteen
AN ACT relative to the regulation of art therapists.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Professional Art Therapy. RSA 326-L is repealed and reenacted to read as follows:
CHAPTER 326-L
PROFESSIONAL ART THERAPY
326-L:1 Definitions. In this chapter:
I. "Art therapy" means the application of psychotherapeutic principles and methods with specialized training in visual art media, the neurobiological implications of art-making and the creative process, and art-based assessment models to assist individuals, families, or groups to improve cognitive and sensory-motor functions, increase self-awareness and self-esteem, cope with grief and traumatic experience, resolve conflicts and distress, and enhance social functioning.
II. "Credentialed art therapist" means a person holding credentials in good standing with the Art Therapy Credentials Board, Inc., as a registered art therapist (ATR), or a certified art therapist (ATR-BC).
III. "Executive director" means the executive director of the office of professional licensure and certification acting with the advice of the advisory council established in RSA 326-L:7.
IV. "Office" means the office of professional licensure and certification.
V. "Practice of professional art therapy" means to engage professionally and for compensation in art therapy and appraisal activities as an independent or adjunctive therapist using the application of art therapy principles and methods in the assessment, prevention, treatment and amelioration of mental health problems and disorders and cognitive, developmental and behavioral conditions. The term includes therapeutic interventions to facilitate alternative modes of receptive and expressive communication, and evaluation and assessment to define and implement art-based treatment plans to address a client’s cognitive, behavioral, developmental, and emotional needs.
326-L:2 Scope of Practice of a Licensed Professional Art Therapist. The scope of practice of a licensed professional art therapist includes, but is not limited to:
I. The use of psychotherapeutic principles, art media, and the creative process to assist individuals, families, or groups in:
(a) Increasing awareness of self and others;
(b) Coping with symptoms, stress, and traumatic experiences;
(c) Enhancing cognitive abilities; and
(d) Identifying and assessing clients' needs in order to implement therapeutic intervention to meet developmental, behavioral, mental, and emotional needs.
II. The application of art therapy principles and methods in the diagnosis, prevention, treatment, and amelioration of psychological problems and emotional or mental conditions that include, but are not limited to:
(a) Clinical appraisal and treatment activities during individual, couples, family, or group sessions which provide opportunities for expression through the creative process;
(b) Using the process and products of art creation to tap into client's inner fears, conflicts, and core issues with the goal of improving physical, mental, and emotional functioning and well-being; and
(c) Using diagnostic art therapy assessments to determine treatment goals and implement therapeutic art interventions which meet developmental, mental, and emotional needs.
III. The employment of art media, the creative process, and the resulting artwork to assist clients to:
(a) Reduce psychiatric symptoms of depression, anxiety, post traumatic stress, and attachment disorders;
(b) Enhance neurological, cognitive, and verbal abilities, develop social skills, aid sensory impairments, and move developmental capabilities forward in specific areas;
(c) Cope with symptoms of stress, anxiety, traumatic experiences, and grief;
(d) Explore feelings, gain insight into behaviors, and reconcile emotional conflicts;
(e) Improve or restore functioning and a sense of personal well-being;
(f) Increase coping skills, self-esteem, awareness of self, and empathy for others;
(g) Healthy channeling of anger and guilt; and
(h) Improve school performance, family functioning, and the parent/child relationship.
326-L:3 License Required; Penalty; Exceptions.
I. No person unless licensed as a professional art therapist may use the title "art therapist" or "professional art therapist" or make use of any title, words, letters, abbreviations, or insignia indicating or implying that he or she is a professional art therapist.
II. Any person who violates the provisions of this chapter or rules adopted pursuant to this chapter shall, if a natural person, be guilty of a misdemeanor, and any other person shall be guilty of a felony.
III. For purposes of this chapter, each instance of contact or consultation with an individual that is in violation of any provision of this chapter or rules adopted under this chapter shall constitute a separate offense.
IV. The provisions of this chapter shall not apply to a person in another profession or occupation performing any activity or functions included in the definition of the practice of professional art therapy that are within the scope of practice of his or her license and professional training, provided the person does not hold himself or herself out to the public as a professional art therapist or as licensed to practice professional art therapy under the provisions of this chapter, or is a student enrolled in an art therapy educational program with an accredited college or university while practicing art therapy under supervision of a credentialed art therapist if such practice constitutes an integral part of the student’s approved course of study.
326-L:4 Licensure of Professional Art Therapists.
I. To qualify for a license to practice professional art therapy, an applicant shall be an individual who meets the following requirements:
(a) The applicant shall be of good moral character.
(b) The applicant shall be at least 18 years old.
(c) An applicant shall hold a masters or doctoral degree from an accredited college or university in a program in art therapy that was either approved by the American Art Therapy Association or accredited by the Commission on Accreditation of Allied Health Education Programs at the time of the degree was conferred, or a program that is substantially equivalent to an approved or accredited program in art therapy pursuant to rules adopted by the executive director; and:
(1) In the case of an applicant holding a doctoral degree, the applicant shall have completed:
(A) The equivalent of 90 graduate credit hours in a program in art therapy or course of study in art therapy from an accredited college or university approved by the executive director; and
(B) Not less than 2 years of supervised experience in art therapy approved by the executive director, one year of which shall have been completed after the award of the doctoral degree pursuant to rules adopted by the executive director.
(2) In the case of an applicant holding only a master’s degree, the applicant shall have completed:
(A) A master’s degree in art therapy from a program that was either approved by the American Art Therapy Association or accredited by the Commission on Accreditation of Allied Health Education Programs at the time the degree was conferred, or a substantially equivalent program as determined by the executive director pursuant to subparagraph (d).
(d) The executive director may determine that a program is substantially equivalent to an approved or accredited program in art therapy if it included approximately 60 semester credit hours, or quarter-credit equivalent, of graduate level coursework and not less than 700 hours of supervised field experience. Program content and coursework must include graduate-level training in:
(1) Theory and practical applications of art therapy.
(2) Human growth and development.
(3) Testing and assessments.
(4) Art therapy appraisal, diagnosis, and assessments.
(5) Ethical and legal issues of mental health counseling.
(6) Matters of cultural and social diversity.
(7) Group therapy.
(8) Lifestyle and career development.
(9) Research and program development.
II. The applicant for licensure shall pass the examination of the Art Therapy Credentials Board and pay the license fee.
326-L:5 Renewal; Reinstatement.
I. A professional art therapist license shall be valid for 2 years from the date of issuance.
II. The office shall renew the licenses of those who have made a timely application for renewal of licensure, and paid the renewal fee.
III. The office is authorized to reinstate licenses on terms established by the executive director through rulemaking in accordance with RSA 541-A, and to charge a fee for such reinstatement.
IV. The executive director shall waive the requirements for licensure for an applicant to practice professional art therapy if the applicant:
(a) Is licensed as a professional art therapist or its equivalent in good standing in another state or jurisdiction that has requirements equivalent to or exceed the requirements of 326-L:4, and the applicant:
(1) Submits an application on the form that the executive director requires; and
(2) Pays the application fee set by the executive director.
(b) Is a credentialed art therapist who, on or before one year from the effective date of rules adopted by the executive director to carry out the provisions of this chapter, submits an application upon such form and in such manner as determined by the executive director, pays the required application fee, and provides documentation to the executive director that he or she has met the following requirements:
(1) Has engaged in the practice of professional art therapy or in education and training of students in art therapy for not less than 5 years, and has been so engaged in this state for at least 2 years prior to submitting an application, as determined by the executive director; and
(2) Has not had a professional license or credential refused, revoked, suspended, or restricted and does not have a complaint, allegation, or investigation pending in any regulatory jurisdiction in the United States or in another country for unprofessional conduct, unless the executive director finds that the conduct has been corrected or that mitigating circumstances exist that prevent resolution.
326-L:6 Rulemaking. The executive director shall adopt rules for the following:
I. Criteria for eligibility for licensure.
II. Procedures for application and for renewal and reinstatement of licenses.
III. The establishment of fees required by this chapter.
326-L:7 Advisory Council on Professional Art Therapy. The executive director shall establish the advisory council on professional art therapy. The council shall consist of 3 persons who are licensees in the state of New Hampshire in professional art therapy. Each member shall be appointed to a term of 3 years, provided that the initial terms may be staggered. No member shall serve more than 2 consecutive, full terms. Each member of the advisory council shall receive as compensation the sum of $45 for each day actually devoted to the work of the advisory council and shall be reimbursed for necessary traveling expenses incurred in the discharge of such duty. The advisory council shall:
I. Review the educational and experience requirements of the applicants for licensure.
II. Review the continuing education requirements for renewing licensure of professional art therapy.
III. Advise the executive director regarding the implementation of requirements for licensure and regulation of professional art therapy and the adoption of rules, including:
(a) Requirements for supervised practice of professional art therapy; and
(b) Standards of ethics and conduct for licensed professional art therapists.
2 New Subparagraph; Office of Professional Licensure and Certification; Administration. Amend RSA 310-A:1-a, II by inserting after subparagraph (z) the following new subparagraph:
(aa) Professional art therapists under RSA 326-L.
3 Insurance Coverage; Mental Illnesses and Emotional Disorders. Amend RSA 415:18-a, I(a) to read as follows:
I.(a) Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state and whose principal place of employment is in this state, coverage for expenses arising from the treatment of mental illnesses and emotional disorders which, in the professional judgment of:
(1) Psychiatrists;
(2) Licensed psychologists;
(3) Licensed pastoral psychotherapists;
(4) Psychiatric/mental health advanced practice registered nurses;
(5) Licensed clinical mental health counselors;
(6) Licensed alcohol and drug counselors;
(7) Licensed marriage and family therapists; [and]
(8) Licensed clinical social workers; and
(9) Licensed professional art therapists are subject to significant improvement through short-term therapy, and benefits for expenses arising from diagnosis and evaluation of all other mental illnesses and emotional disorders.
4 Insurance Coverage; Mental Illnesses and Emotional Disorders. Amend RSA 415:18-a, III(a) to read as follows:
(a) Benefits arising from treatment, diagnosis and evaluation of mental illnesses and disorders for services of a psychiatrist, licensed psychologist, licensed pastoral psychotherapist, psychiatric/mental health advanced practice registered nurse, licensed clinical mental health counselor, licensed alcohol and drug counselor, licensed marriage and family therapist, [or] licensed clinical social worker, or licensed professional art therapist who customarily bills patients directly shall be subject to terms and conditions at least as favorable as those which apply to the benefits for the services of physicians for other illnesses. The ratio of the benefits to the fees reasonably and customarily charged for the services of such:
(1) Psychiatrists;
(2) Licensed psychologists;
(3) Licensed pastoral psychotherapists;
(4) Psychiatric/mental health advanced practice registered nurses;
(5) Licensed clinical mental health counselors;
(6) Licensed alcohol and drug counselors;
(7) Licensed marriage and family therapists; [or]
(8) Licensed clinical social workers; or
(9) Licensed professional art therapist shall be substantially the same as the ratio of the benefits for services of physicians for other illnesses to the fees reasonably and customarily charged for the services of such physicians for other illnesses.
5 Covered Treatment Expenses. Amend RSA 415:18-a, IV (b) to read as follows:
(b) In this paragraph, covered major medical expenses include the reasonable charges for services and treatment on an inpatient, outpatient or partial hospitalization basis by:
(1) A psychiatrist;
(2) A licensed psychologist;
(3) A licensed pastoral psychotherapist;
(4) A psychiatric/mental health advanced practice registered nurse;
(5) A licensed clinical mental health counselor;
(6) A licensed alcohol and drug counselor;
(7) A licensed marriage and family therapist;
(8) A licensed clinical social worker;
(9) A licensed professional art therapist;
[(9)] (10) A licensed general hospital;
[(10)] (11) A public or licensed mental hospital; or
[(11)] (12) A community mental health center or psychiatric residential program approved according to rules adopted by the commissioner of the department of health and human services.
6 Coverage for Children's Early Intervention Services. Amend RSA 415:18-s to read as follows:
415:18-s Coverage for Children's Early Intervention Services. Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, [and] clinical social workers, and professional art therapists working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child's primary care physician if applicable. The benefits included in this section may be subject to deductibles, copayments, co-insurance, or other terms and conditions of the policy, and may have a cap of $3,200 per child per year not to exceed $9,600 by the child's third birthday. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.
7 Coverage for Treatment of Pervasive Developmental Disorder or Autism. Amend RSA 417-E:2, I(c) to read as follows:
(c) Direct or consultative services provided by a licensed professional including a licensed psychiatrist, licensed advanced practice registered nurse, licensed psychologist, [or] licensed clinical social worker, or licensed professional art therapist; and
8 Effective Date. This act shall take effect July 1, 2019.
19-0409
1/14/19
HB 546-FN- FISCAL NOTE
AS INTRODUCED
AN ACT relative to the regulation of art therapists.
FISCAL IMPACT: [ X ] State [ X ] County [ X ] Local [ ] None
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| Estimated Increase / (Decrease) | ||||
STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 | |
Appropriation | $0 | $0 | $0 | $0 | |
Revenue | Indeterminable | Indeterminable | Indeterminable | Indeterminable | |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable | |
Funding Source: | [ X ] General [ ] Education [ ] Highway [ X ] Other - Office of Professional Licensure and Certification Fund (RSA 310-A:1-e, I (b)) | ||||
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COUNTY: |
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Revenue | $0 | $0 | $0 | $0 | |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable | |
LOCAL:
Revenue | $0 | $0 | $0 | $0 |
Expenditures | Indeterminable | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill repeals and reenacts the statutes governing the practice of professional art therapy and licensure for individuals engaging in such practice. It mandates insurance coverage for this group of practitioners.
The bill allows for license fees to be established through the rulemaking process by the Executive Director of the Office of Professional Licensure and Certification (OPLC). The OPLC indicates the number of potential new licensees overseen by the Board of Mental Health, the amount of the fee and the revenue generated by such licensing fees is indeterminable. The Executive Director is also required to establish a 3 member advisory council to assist in the licensure process and adoption of administrative rules. OPLC states this process would require $2,610 in additional annual expenditures for per diem and mileage expenses, calculated below:
Annual Per Diem Expense Calculation: $45 x 3 members x 6 meetings $810
Mileage Expense Calculation: $100 x 3 members x 6 meetings $1,800
Total Annual Expense $2,610
The Insurance Department assumes the bill would qualify for a review pursuant to RSA 400-A:39-b. To the extent previously non-covered services must now be covered there could be an impact on claims, which may impact premiums and premium tax revenue. The Federal Affordable Care Act specifies that the cost of newly enacted mandates associated with coverage through the exchange must be borne by the State and the department assumes such associated costs of services provided by these providers for exchange based insureds would be funded via the State's general fund.
This bill contains penalties that may have an impact on the New Hampshire judicial and correctional systems. There is no method to determine how many charges would be brought as a result of the changes contained in this bill to determine the fiscal impact on expenditures. However, the entities impacted have provided the potential costs associated with these penalties below.
Judicial Branch | FY 2020 | FY 2021 |
Class B Misdemeanor | $53 | $54 |
Class A Misdemeanor | $76 | $77 |
Routine Criminal Felony Case | $481 | $486 |
Appeals | Varies | Varies |
It should be noted that average case cost estimates for FY 2020 and FY 2021 are based on data that is more than ten years old and does not reflect changes to the courts over that same period of time or the impact these changes may have on processing the various case types. An unspecified misdemeanor can be either class A or class B, with the presumption being a class B misdemeanor. | ||
Department of Corrections |
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FY 2018 Average Cost of Incarcerating an Individual | $40,615 | $40,615 |
FY 2018 Annual Marginal Cost of a General Population Inmate | $4,620 | $4,620 |
FY 2018 Average Cost of Supervising an Individual on Parole/Probation | $571 | $571 |
NH Association of Counties |
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County Prosecution Costs | Indeterminable | Indeterminable |
Estimated Average Daily Cost of Incarcerating an Individual | $105 to $120 | $105 to $120 |
The Department of Justice indicates the department is not generally involved with the prosecution of offenses relating to the type of licensure provisions of this legislation. Such offenses are typically handled by local or county prosecutors. Appeals from any convictions from such offenses would be handled by the Criminal Justice Bureau and could be done within the current budget, therefore there is no fiscal impact. If the Department needs to prosecute significantly more cases or handle more appeals, then costs may increase by an indeterminable amount.
AGENCIES CONTACTED:
Office of Professional Licensure and Certification, Insurance Department, Judicial Branch, Department of Corrections, and New Hampshire Association of Counties