Revision: March 31, 2020, 2:27 p.m.
HB 546-FN - AS AMENDED BY THE HOUSE
8Jan2020... 2836h
11Mar2020... 0981h
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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AMENDED ANALYSIS
This bill adds the licensure and regulation of art therapists under the board of mental health practice. The bills repeal the current provisions for regulating art therapists.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
8Jan2020... 2836h
11Mar2020... 0981h 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 New Paragraph; Mental Health Practice; Definitions; Art Therapy. Amend RSA 330-A:2 by inserting after paragraph I the following new paragraph:
I-a. “Art therapy” means the integrated application of psychotherapeutic principles and methods with evidence-based use of art, including art media, the creative process, and produced artwork, to accomplish individualized goals within a therapeutic relationship between a client and an art therapist.
2 Definitions; References Added. Amend RSA 330-A:2, V-VIII to read as follows:
V. "Mental health discipline" means the disciplines of those licensed as pastoral psychotherapists, clinical social workers, clinical mental health counselors, [and] marriage and family therapists, and art therapists.
VI. "Mental health practice" means the observation, description, evaluation, interpretation, diagnosis, and modification of human behavior by the application of psychological and systems principles, methods, and procedures for the purpose of preventing or eliminating symptomatic, maladapted, or undesirable behavior and of enhancing interpersonal relationships, work and life adjustments, personal effectiveness, behavioral health, and mental health, as well as the diagnosis and treatment of the psychological and social aspects of physical illness, accident, injury, or disability. Mental health practice may include, but shall not be limited to, those services based on diagnosis and treatment of mental and emotional disorders and psycho-educational or consultative techniques integral to the treatment of such disorders when diagnosis is specified in the most current edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, or an equivalent of such manual as determined by the board. Notwithstanding any other provision to the contrary, no person licensed or registered under this chapter shall assess the need for medications, prescribe medications, or otherwise practice medicine as defined in RSA 329.
VII. "Mental health practitioner" means persons licensed under this chapter as pastoral psychotherapists, clinical social workers, clinical mental health counselors, [or] marriage and family therapists, or art therapists. For purposes of this chapter, the term clinical social worker shall include independent clinical social worker.
VII-a. "Professional conduct investigator" means a trained mental health practitioner licensed by the board who acts as the agent of the board under the guidance of the board investigator and is authorized to discover facts and make reports to the board.
VIII. "Psychotherapist" means a clinical social worker, pastoral psychotherapist, clinical mental health counselor, [or] marriage and family therapist, or art therapist licensed under this chapter who performs or purports to perform psychotherapy. This definition shall include psychiatrists licensed as physicians under RSA 329 and advanced registered nurse practitioners licensed under RSA 326-B:18 as psychiatric nurse practitioners.
3 Board of Mental Health Practice; Art Therapist Added. Amend RSA 330-A:3, I to read as follows:
I. There shall be a board of mental health practice composed of the following members: one licensed pastoral psychotherapist, one licensed clinical social worker, one licensed marriage and family therapist, one licensed clinical mental health counselor, one member from a community mental health center, one member from a community health center, one licensed art therapist, and 3 public members. The members shall be appointed to a term of 3 years by the governor with the approval of the council. The members of the board shall elect a chairperson on an annual basis. No discipline's representative and no individual public member shall serve as chairperson for more than 2 years consecutively.
4 Board Meetings; Quorum. Amend RSA 330-A:9, I to read as follows:
I. The board shall hold regular annual meetings. Other meetings of the board shall be held at such times and upon such notice as the rules of the board provide. [Five] Six members shall constitute a quorum.
5 New Paragraph; Board Responsibilities; Rulemaking. Amend RSA 330-A:10 by inserting after paragraph X the following new paragraph:
X-a. Ethical standards, including those promulgated by the Art Therapy Credentials Board, required to be met by each licensed art therapist, and how a license may be revoked for violations of these standards.
6 Fees; Reference Added. Amend RSA 330-A:12, I to read as follows:
I. The board shall establish fees pursuant to RSA 541-A for review of applicants for licensure; supervisory agreements; applications for licensed pastoral psychotherapist, independent clinical social worker, clinical mental health counselor, [and] marriage and family therapist, and art therapist; renewal of license; renewal of dual license; reinstatement of license; inactive license status; reactivation of an inactive license; examination of applicants; transcribing and transferring records; and other services, including investigations and hearings conducted under this chapter.
7 New Sections; Art Therapists; Scope of Practice; Licensure. Amend RSA 330-A by inserting after section 21 the following new sections:
330-A:21-a Art Therapists; Scope of Practice. 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 facilitate clients’ exploration of inner fears, conflicts, and core issues with the goal of improving physical, mental, and emotional functioning and well-being.
(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) Improve management of anger and guilt.
(h) Improve school performance, family functioning, and the parent/child relationship.
330-A:21-b Art Therapists; Requirements for Licensure. The board shall issue an art therapist license to any person who meets all of the following requirements or their equivalent:
I. Has 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 substantially equivalent program as determined by the board pursuant to paragraph V. An applicant holding a doctoral degree shall have completed 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 board.
II. Has completed not less than 2 years and 3,000 hours of supervised experience in art therapy by a board-approved licensee.
(a) An applicant holding a doctoral degree shall complete one year of the supervised experience after the award of the doctoral degree pursuant to rules adopted by the board.
(b) Supervised hours accepted for licensure in New Hampshire as a mental health practitioner by the board of mental health practice under this chapter, a master licensed alcohol and drug counselor (MLADC) by the board of licensing for alcohol and other drug use professionals under RSA 330-C, or a psychologist licensed by the board of psychology under RSA 329-A, may be substituted for up to 1,500 hours of the required 3,000 hours of supervised clinical experience. Where substitution of the full 1,500 hours is denied by the board, the applicant shall be provided the rationale for the board’s denial. The board shall not deny the substitution of hours solely based on the applicant’s clinical supervisor holding a license in a discipline other than art therapy.
III. Has passed the examination of the Art Therapy Credentials Board.
IV. Has paid the license fee established by the board.
V. The board 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 shall include graduate-level training in:
(a) Theory and practical applications of art therapy.
(b) Human growth and development.
(c) Testing and assessments.
(d) Art therapy appraisal, diagnosis, and assessments.
(e) Ethical and legal issues of mental health counseling.
(f) Matters of cultural and social diversity.
(g) Group therapy.
(h) Lifestyle and career development.
(i) Research and program development.
8 Unlawful Practice; References Added. Amend RSA 330-A:23, I and II to read as follows:
I. Except as provided in RSA 330-A:34, it shall be unlawful for any person to be engaged in mental health practice unless that person is licensed by the board, working as a candidate under the direct supervision of a person licensed by the board, or engaged in the practice of other mental health services as an alternative provider as defined in RSA 330-A:2, I. The license or the registration of such person shall be current and valid. It shall be unlawful for any person to practice as or to refer to oneself as a pastoral psychotherapist, a clinical social worker, a clinical mental health counselor, [or] a marriage and family therapist, or an art therapist, or use the word "psychotherapist," or any variation thereof, in such person's title unless that person is licensed by the board or working as a candidate under the direct supervision of a person licensed by the board. Psychiatrists licensed under RSA 329 and psychiatric nurse practitioners licensed under RSA 326-B:18 may refer to themselves as psychotherapists.
II. Except as otherwise provided in this chapter, any person who violates paragraph I or paragraph III of this section or who violates any of the other provisions of this chapter relating to pastoral psychotherapy, clinical social work, clinical mental health counseling, [or] marriage and family therapy, or art therapy, or, having had his or her license suspended or revoked, shall continue to represent himself or herself as a licensed pastoral psychotherapist, clinical social worker, clinical mental health counselor, [or] marriage and family therapist, or art therapist, or as a psychotherapist, shall be guilty of a class A misdemeanor if a natural person, and a felony if any other person, and each violation shall be deemed a separate offense.
9 New Section; Prior Credentialing; Art Therapists. Amend RSA 330-A by inserting after section 33 the following new section:
330-A:33-a Prior Credentialing; Art Therapists. A credentialed art therapist who, on or before January 1, 2022, submits an application upon such form and in such manner as determined by the board, pays the required application fee, and provides documentation to the board that he or she has met the following requirements, shall be issues a license by the board:
I. 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 board; and
II. 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 board finds that the conduct has been corrected or that mitigating circumstances exist that prevent resolution.
10 New Subparagraph; Persons Exempted. Amend RSA 330-A:34, I by inserting after subparagraph (e) the following new subparagraph:
(f) The activities of an art teacher, professional artist, professional entertainer, or any no profit/nonprofit entity or person who does not represent himself or herself as an art therapist.
11 Repeal. RSA 326-L, relative to the regulation of professional art therapy, is repealed.
12 Effective Date. This act shall take effect July 1, 2020.
19-0409
Amended 3/20/20
HB 546-FN- FISCAL NOTE
AS AMENDED BY THE HOUSE (AMENDMENT #2020-0981h)
AN ACT relative to the regulation of art therapists.
FISCAL IMPACT: [ X ] State [ X ] County [ ] Local [ ] None
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| Estimated Increase / (Decrease) | |||
STATE: | FY 2020 | FY 2021 | FY 2022 | FY 2023 |
Appropriation | $0 | $0 | $0 | $0 |
Revenue | $0 | Indeterminable | Indeterminable | Indeterminable |
Expenditures | $0 | 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 | $0 | Indeterminable | Indeterminable | Indeterminable |
METHODOLOGY:
This bill repeals the statutes (RSA 326-L) governing the practice of professional art therapy and licensure for individuals engaging in such practice, and establishes the practice of art therapy within the Mental Health Practice statutes (RSA 330-A) and under the umbrella of the Board of Mental Health Practice. The bill mandates insurance coverage for this group of practitioners.
The bill allows for license fees to be established through the rulemaking process by the Board of Mental Health Practice. The Office of Professional Licensure and Certification 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. A licensed art therapist will also be added to the membership of the Board, who shall be eligible for $100 per diem expenses and mileage pursuant to RSA 330-A:7.
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 2021 | FY 2022 |
Violation Level Offense | $52 | $54 |
Class B Misdemeanor | $54 | $56 |
Class A Misdemeanor | $77 | $79 |
Simple Criminal Case | $300 | $314 |
Routine Criminal Felony Case | $484 | $498 |
Appeals | Varies | Varies |
It should be noted that average case cost estimates for FY 2021 and FY 2022 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. | ||
Judicial Council |
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Public Defender Program | Has contract with State to provide services. | Has contract with State to provide services. |
Contract Attorney – Felony | $825/Case | $825/Case |
Contract Attorney – Misdemeanor | $300/Case | $300/Case |
Assigned Counsel – Felony | $60/Hour up to $4,100 | $60/Hour up to $4,100 |
Assigned Counsel – Misdemeanor | $60/Hour up to $1,400 | $60/Hour up to $1,400 |
It should be noted that a person needs to be found indigent and have the potential of being incarcerated to be eligible for indigent defense services. The majority of indigent cases (approximately 85%) are handled by the public defender program, with the remaining cases going to contract attorneys (14%) or assigned counsel (1%). | ||
Department of Corrections |
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FY 2019 Average Cost of Incarcerating an Individual | $44,400 | $44,400 |
FY 2019 Annual Marginal Cost of a General Population Inmate | $5,071 | $5,071 |
FY 2019 Average Cost of Supervising an Individual on Parole/Probation | $576 | $576 |
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, Judicial Council, Department of Corrections, and New Hampshire Association of Counties