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DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS

BUREAU OF PROFESSIONAL LICENSING

PUBLIC HEARING

October 4, 2019

9:00 a.m. - 5:03 a.m.

Location: G. Mennen Williams Building Auditorium

525 West Ottawa Street

Lansing, Michigan

REPORTED BY: Claudia M. Weekly, CSR-2963

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MS. DITSCHMAN: Hi. My name is Andria

Ditschman. I'm a senior policy analyst for the Bureau of

Professional Licensing in the Department of Licensing and

Regulatory Affairs, and I'll be facilitating the hearing

today. The department staff on the Bureau of

Professional Licensing includes me, Weston MacIntosh,

Tina Marks, Kerry Przybylo, Stephanie Wysick(sp), LeeAnn

Payne and Kimmie Katlyn(sp).

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This is a public hearing on proposed

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administrative rules entitled architects general rules,

counseling general rules, professional engineers general

rules, Board of Occupational Therapists general rules,

and the Board of Pharmacy general rules and continuing

education rules.

The hearing is being conducted under the

authority of the Administrative Procedures Act, Public

Act 306 of 1969 on behalf of the Department of Licensing

and Regulatory Affairs, Bureau of Professional Licensing.

The hearing is being called to order at 9:00 a.m. on

October 4th, 2019 at the G. Mennen Williams Building

auditorium located at 525 Ottawa Street in Lansing,

Michigan.

The notice of public hearing was published in

three newspapers of general circulation, as well as the

Michigan Register Issue Number 17 published on

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October 1st, 2019.

The point of today's hearing is to receive

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comments on the proposed rules. If you wish to speak

please make sure you have signed in. You may use the

cards provided in the lobby for this purpose. Please

hold your card until it is your turn to speak, at which

time you may hand your card to the staff person near the

microphone stand. If you would like to testify and have

not filled out a card please do so now.

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Comments should relate directly to the proposed

rules. If you have questions regarding the rules please

submit your questions as part of your testimony for the

department's review. If you have suggested changes to

the proposed rules please include the specific reasons

why the changes would be in the public interest.

For the record, when you testify please

identify yourself by spelling your name and stating your

organization, if any, that you may be speaking for today.

This will help the department prepare the hearing record

that will go before the joint committee on administrative

rules. Comments will be limited to two minutes per

person to allow everyone an opportunity to speak. If you

submitted a written comment there's no need to orally

repeat that comment on the record. Written and oral

comment count the same.

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Further, a comment received on any issue will

be considered. If you are hearing the same comment

repeated multiple times we ask that you be mindful of the

time and allow others the opportunity to speak on other

issues that have not been raised. Please remain silent

while other comments are being made so that the Court

Reporter can hear them to ensure that the transcript is

accurate. We will also take periodic breaks as needed.

This hearing will close no later than 5:00 p.m.

today. If the hearing is drawing close to 5:00 p.m. you

are encouraged to submit your comments in a written

statement. Written statements can be submitted directly

to me at the table. The department will also accept

written statements e-mailed by 5:00 p.m. today or

postmarked no later than October 4th, 2019.

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We will handle the rule sets in the following

order: Pharmacy general rules, pharmacy CE rules,

professional engineers, architects, occupational therapy,

and counseling. We are going to do our best to group the

comments for each rule set. Please do not get in line to

speak until the rule set you are interested in is

announced.

The first rule set that we'll be taking

comments for is pharmacy general rules. Please get

behind the microphone stand if you wish to speak and hand

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your card to the staff person. That will be me. I'll be

down there. Be mindful of the time cards that announce

how much time you have left to speak. The time cards

will be over on this table over here and we will show you

when you have so much time left and when your time is

done.

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So, we are going to start. One last thing.

Again, because we're doing this a tad bit different than

we usually do, a reminder, please spell your name for the

Court Reporter, speak slowly, and if you have something

that you want to submit in writing and you're going to

read that into the record please just make sure you drop

off a copy of whatever it is that you're saying up here

at the table so we have that as well.

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Okay. So, can you hear me back here? Do we

have anybody from pharmacy general rules that wants to

speak?

SCOTT POPYK: Hi. Good morning. My name is

Scott Popyk, P-O-P-Y-K. And I am here on behalf of my

company, which is Health Dimensions, but also as a member

of MPA, as well as a member of the International Academy

of Compound Pharmacists.

I am here to address Rule 338.533, which

proposes to adopt by reference the compounding standards

of USP Chapter 785, Chapter 787 and 800. And I wanted to

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communicate some issues that have arisen since this rule

was proposed.

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USP has delayed USP 797 and 795. There is some

major technical issues that need to be addressed, and so,

they have delayed the adoption of these or of the

official status of these until further notice, so it

wouldn't make sense for the State to adopt these at this

time.

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Furthermore, USP 800, which is intertwined with

795 and 797 is scheduled to be adopted by the State on

December 1st. Because of the challenge, because of the

issues with USP right now with 795 and 797 800 does not

hold, so it wouldn't make sense for the State of Michigan

to adopt 800 right now, either.

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So, my recommendation is that until the 795,

797 issues are resolved and clarified with USP that they

not be adopted by the State because it's going to change,

and 800 by default should not be adopted until such time

that the foundation of 795 and 797 are resolved. Thank

you.

LARRY WAGENKNECHT: Good morning. My name is

Larry Wagenknecht, W-A-G-E-N-K-N-E-C-H-T. I'm

representing the Michigan Pharmacists Association. I

have a question for Andria. Yesterday I submitted

electronically written comments. I have a couple

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comments that I want to strike from that, and how is the

best way for me to do that? Do you want me to identify

the particular sections that should be changed or submit

a new document? What do you suggest?

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MS. DITSCHMAN: So, there's two ways you can do

that. You can do it on the record, but probably the best

way would be to submit an additional writing today before

5:00 o'clock just saying that you want to modify these

comments. That way I'll have both in writing to submit

to JCAR.

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LARRY WAGENKNECHT: It will just take me one

second. It's relative to Rule 338.534 Sub 1, and Rule

338.534 Sub 4. There's reference to the word shipping a

compound that is sterile. In our document we suggested

changing it to distribute, and that is incorrect, it

should remain ship. So, thank you.

TOM SULLIVAN: I'm Tom Sullivan,

S-U-L-L-I-V-A-N, representing Michigan Surgical Hospital

in Warren, also the Insight Institute for Neurosurgery

and Neurological Sciences, which is our parent company.

We have concerns of Rule 338.501, which defines

compounding. This would be in conflict with the proposed

USP 797, which is essentially -- it is in conflict with

the old version of 797, which is on hold pending appeal,

which as our previous speaker indicated.

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Also, USP 800, which is essentially an

occupational health standard, not enforceable by the FDA,

but USP 797 is enforceable by the FDA. So, the current

version includes the hazardous medication compounding

which will be in conflict with USP 800. So, I would urge

the Board to consider holding the adoption of this until

those discrepancies are resolved.

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I would also urge the Board to consider having

MIOSH consider USP 800 as an occupational health

standard, which is a compounding standard, so it can be

applied equally to all professions and not just pharmacy.

MS. DITSCHMAN: Okay. Is anybody else here to

speak on the pharmacy general rules? No.

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Okay. We're going to move to pharmacy

continuing education rules. If anybody wants to speak on

those rules please come up here at this time. Pharmacy

continuing education?

And also, if someone asks they can always come,

anybody can speak until 5:00 o'clock. So, if somebody

comes in late that still can be fine.

So, I know a lot of you missed the

announcement. I'm just going to quickly kind of go over

some of the highlights. So, what we're doing is we're

taking different professions one at a time. Go ahead and

come up here, make sure you can hand the card to me, and

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then speak in the microphone. And everyone's limited to

two minutes. The time cards are up here. We'll show you

when you have one minute left and when it's time to stop.

And I think that's -- oh. If you have

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something in writing that you're submitting and you're

going to read from that we ask that you put a copy up

here for the Court Reporter so they have that in case

there was issues or questions about that. And I think

that's it.

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We want you to spell your name when you come up

here. Say your name and spell your name and then what

organization you're from at the beginning. So, I'm just

kind of repeating that.

So, once again, pharmacy general rules or

pharmacy CE rules, anybody else?

Professional engineers. Anyone here to speak

for professional engineers? Come on up here.

STEPHEN NICHOLS: Hi. My name is Stephen

Nichols. Steven is spelled S-T-E-P-H-E-N, Nichols,

N-I-C-H-O-L-S. I'm here today representing the American

Council of Engineering Companies of Michigan often

referred to as ACEC/Michigan.

ACEC/Michigan represents more than a hundred

engineering companies in Michigan who employ over 6,000

people. The majority of these are licensed

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professionals. ACEC/Michigan is also registered for

continuing education, a continuing education provider

through the registered continuing education program,

RCEP.net.

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Through ACEC/Michigan programs, conferences,

workshops, seminars there are nearly a hundred hours of

continuing education offered each year to licensed

professionals under the engineering licensure. Many of

the professional engineers have licenses in multiple

states and use the ACEC/Michigan programs to satisfy

these continuing education requirements.

Based on these facts we believe ACEC/Michigan

should be listed under Part 4, Part 339.16041, Rule 41,

Section 1A as a continuing, is an approved continuing

education provider in Michigan, so we would like the

regulations changed to add ACEC/Michigan to that chart.

Thank you.

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MS. DITSCHMAN: Okay. Anybody else here for

professional engineers?

So, we're going to move on to architects.

Anyone here to speak on behalf of the architect rules?

No.

Occupational therapy?

SARA CLARK: Hello. My name is Sara Clark,

S-A-R-A, C-L-A-R-K. I'm a licensed occupational

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therapist in the State of Michigan, and I'm here

representing the Michigan Occupational Therapy

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Association, MIOTA, and the American Occupational Therapy

Association, AOTA. Both organizations try to ensure that

OT services are provided in the best interest of

consumers.

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I'm here today to provide comments on two

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proposed changes to the Board of Occupational Therapists

general rules. The first in regards to Rule 338.1212,

which has been rescinded, we understand this has been

rescinded because it's going to be, it would have been

duplicate language since it's already in the Public

Health Code. MIOTA is requesting that we keep a brief

reference to prohibited conduct being found in the Public

Health Code within our rules. We feel ethical practice

is one of the most important pieces of our profession,

and we want to make sure we our practice is as structured

as much as possible to the definition of prohibited

conduct.

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The other rule we wanted to comment on is

Number, it's Rule 338.1229, Number 4A. The proposed

language states that an occupational therapist who

delegates limited assessments must initiate and direct

the evaluation of the patient or client before delegating

limited assessments to an occupational therapy assistant,

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and we are suggesting to see stronger language that says

that the OT must complete the evaluation before

delegating. We're requesting this because we have

concerns that there's too much room for interpretation in

regards to what the OTA can do in terms of evaluation.

And written comment has been provided by AOTA and MIOTA

on both of these.

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NANCY VANDEWIELE MILLIGAN: I'm Nancy

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Vandewiele Milligan, V-A-N-D-E-W-I-E-L-E, Milligan,

M-I-L-L-I-G-A-N. I am here representing the Michigan

Occupational Therapy Association and the American

Occupational Therapy Association regarding Rule R338.1229

regarding the delegation of limited assessments to the

occupational therapy assistant, OTA.

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Our concerns are while occupational therapy

assistants are trained to assist in the delivery of care

to clients and patients, it is under the supervision of

an occupational therapist as outlined in the standards

established by the American Occupational Therapy

association. The proposed change would allow the OTA to

assess and implement, to assess and implement treatment

prior to the occupational therapist completing the

evaluation. This is a concern because the client and

patient health status and conditions may have changed

since the last treatment or discharge. This could impact

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the client's patient or safety, and it is the ethical

duty of both the OT and OTA to provide the best care for

all clients. It is in the best practice of the OT to

conduct that treatment being rendered, and it is both

client-centered and evidence-based on the patient's

current status.

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In addition, the Medicare Benefit Policy Manual

states that OTAs may not provide evaluative or assessment

services. This rule will be grounds of denial of

coverage for services. I propose that the wording be

changed to initiate and direct the evaluative of the

patient or client before delegating the assessment.

Thank you.

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MS. DITSCHMAN: Okay. Anyone else here to

speak on behalf of occupational therapy?

Okay. We're going to start counseling. So,

what we want you to do is we're going to start lining up

and then speaking. We don't need to have everybody in

line here, but let's line up on this side over here.

Start right here in front of me. Everybody doesn't have

to get up at once because you're just all going to be in

line. So, let's put 30 maybe in line. The rest of you

can kind of fill in then as that line shortens. You're

going to go to that side. So, come around here in front

and go around in back and get in line.

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Everybody does not need to get in line right

now. Just have a seat. What we'll do is then as you

speak then you can go out the door on that side and then

other people can get in line and we'll just keep it

moving.

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So, I'm going to go over just a few things

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again to make sure I touch on -- I know everybody wasn't

in here at the opening. So, everyone is limited to two

minutes to try to get as many people's comments in as we

can. There is time cards up here, one for one minute,

one for stop. I'd like you to please try when the stop

comes up to stop so we get as many people speaking as

possible. When you come up to speak you want to say your

name, spell your name and state the organization that

you're representing. If you're just representing

yourself you just don't have to state the organization.

That's fine. When you're done you can exit at the back

on that side.

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If you're going to read something verbatim from

a sheet of paper you want to submit the paper up here,

the written comment after that so we can have a copy and

make sure it's exactly as you stated.

If you hear the same comment over and over,

it's up to you, but you may want to not repeat that

again, the same comment. Somebody else may have

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something that's different than that that we want to make

sure we address in the rules.

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It does end at 5:00 o'clock today, so if we get

close to 5:00 o'clock and you haven't spoken, which I

think we'll get to everybody here, then put that in

writing and submit that. And I think that's it.

Anything else I missed the first time? Oh.

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The comments should pertain to the rules that are before

you, something in the rules. Otherwise, we can't address

it and take it into consideration. So, you're wasting

your time saying it because we can't do anything with it.

KERRY PRZYBYLO: One last thing. If you are

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reading a comment please be mindful that there is a Court

Reporter here that is trying to take down every word that

you say, and the faster you talk the harder it is for her

to take it down. So, she may reach out to you and tell

you to slow down, so just be mindful. She's sitting

right over to my left, so please be mindful of her as

well. Thank you.

MS. DITSCHMAN: You can hand your card to me,

take the microphone, go for it.

ROBYN EMDE: My name is Robyn Emde, first name

is spelled R-O-B-Y-N, middle initial J, last name is

E-M-D-E. And I am the chair of the Michigan Board of

Counseling. However, I am not standing here as in that

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capacity.

As a private practitioner I was made aware that

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at the June meeting of the Michigan Board of Counseling a

fair compromise to LARA's proposed rules changes was

submitted by the rules subcommittee. This can be clearly

found in the minutes of the June meeting as an attachment

and also attached to this testimony. The endless hours

spent by the rules subcommittee is outlined in distinct

areas of disagreement to the proposal.

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A major inconsistency is the placement of the

terminology of counseling techniques. The placement of

counseling techniques only in the educational section is

completely illegal. I do not state this lightly. Let me

explain the rationale behind this great opposition.

Within the law 333.18101 counseling techniques is listed.

With counseling techniques being a part of the law it

should be within the provisions, not only the education

section of the rules.

It is the law that defines the scope of

practice. In the Public Health Code that counseling

techniques is a developmental approach that systemically

assists an individual through the application of any of

the following procedures, and counseling techniques is

listed.

This results in a grave inconsistency within

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the counseling profession. Per the law, counselors are

required to administer counseling techniques, but per the

provisions it is not listed. The proposed rule changes

suggest that counseling techniques be removed from the

provisions and placed solely in the educational section.

The proposed change of the provisions within

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the counseling profession is not logical. For almost 30

years every Attorney General, board analyst and JCAR

approved the counseling rules. The proposal of the

changes suggests that each one of these individuals were

wrong in their approval. Every one of these trusted

appointed officials were wrong, but now an attorney is

correct? An attorney can testify to the validity of the

counseling profession? An attorney determines the

training and implementation of what makes a counselor?

This is provided to you by the expert witness of the

Michigan Board of Counseling rules committee and approved

by the entire Board of Counseling as seen on their

website.

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HAROLD LOVE: Harold Love. I'm a vice-chair of

the Michigan Board of Counseling sitting here as an LPC.

My name is spelled Harold, H-A-R-O-L-D, Love, L-O-V-E.

Another point of difference between the LARA

advisory staff draft of the rules change and the rules

committee recommendations appears to be LARA's position

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that the majority of definitions currently in the rules

be moved to a new section of the rules that will pertain

to education only. Moving the definitions and thereby

implying they are only applicable to the educational

preparation of counselors loses the important

understanding that some of the definitions apply to

counseling practice and are not solely applicable to

educational preparation; i.e., counseling techniques and

diagnoses.

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The loss of perspective has the potential to

create significant confusion, lack of clarity, and

substantial negative consequences for services provided

to the public by over 10,000 licensed professional

counselors. These 10,000 counselors have provided

counseling services to the public consistent with these

definitions as currently written and approved. The

section of the definition has been in place for over 25

years.

This revision and update to the rules has been

vetted through our prior rules revisions and updating

processes. This included vetting by LARA prior to

meetings of the Board of Counseling, former full Boards

of Counseling, the legislature, and the public. The

current rules committee and the full Board of Counseling

strongly recommends that these definitions remain in

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place in the definition section of the rules applicable

to the counseling section of the Public Health Code.

Another point of difference pertains is the

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training of supervisors, higher educational institutions

throughout Michigan, training individuals that will be

highly effective supervisors and counselors. The

training process includes a thorough supervision

experience for each potentially fully licensed counselor.

The supervision training for LPCs who will be supervising

limited LPCs have recently been required by the rules to

have three years of counseling experience and training

and supervision, serve as an LLP supervisor.

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Prior to January 1st, 2013 the rules specified

that supervisors were required to have training in the

function -- the rest is written down.

MS. DITSCHMAN: I just want to make sure, also,

when you are, if you're reading from something and it's

verbatim and you submit it make sure your name is on

there because we'll also be using that as written

comments. Correct? So, yeah, we'll need copies of all

those. But please make sure your name is on there. And

you may not get the entire thing in the transcript. We

want to make sure you have your name on there and your

organization, if there is one. Thank you.

DIANE PARFITT: Am I coming through? I'm Diane

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Parfitt, D-I-A-N-E, P-A-R-F-I-T-T. I've spent two terms

on the board of counseling. I just finished in June.

I'm also a professor emeritus from Eastern Michigan

University, the counselor of education. I'm also a

private practitioner that does both counseling and

supervision, and I also do supervision training. So, I

speak from a number of hats.

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The training that most counselors within the

State of Michigan receive is in national compliance. The

educational component of the training of counselors in

Michigan includes courses that train counselors within

counselor techniques, counselor techniques and diagnosis.

Licensed professional counselors in Michigan have the

educational background to implement counseling techniques

and diagnosis.

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If the proposed rules go into effect an

estimated 10,000 professional counselors will be affected

and over 10, 100,000 Michigan residents will be without

service from licensed professional counselors. And I

know this well, speaking personally. My life's work is

to serve others. This is an unspoken oath. Every

licensed professional counselor accepts as part of his or

her journey.

If these rules are implemented our clients will

be without a licensed professional counselor. The work

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we have been trained to perform will be null and void.

The citizens of Michigan will suffer greatly without the

expertise of licensed professional counselors. Michigan

has an increasing mental health need.

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These have been recently recognized by the

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educational systems that are to implement funds directed

towards directing the mental health needs within the

schools. Suicide is tragically on the rise and the

second highest death rate among teens in Michigan.

Michigan needs licensed professional

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counselors. The residents of Michigan need the

confidence that this proposal will not go into effect.

For almost 30 years every Attorney General, board

analyst, and JCAR approved the counseling rules. The

proposal of the changes --

MR. MacINTOSH: Time.

DIANE PARFITT: -- suggest that each one --

JIM BLUNDO: My name is James Blundo. I'm the

executive director for the Michigan Mental Health

Counselors Association. Wes and I know each other

because we've had several different meetings in which

we've dealt with things in a different way.

Thank you for this opportunity to provide

comment in the 2019-063 LARA proposed counseling general

rules. As the director of this organization we represent

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licensed professional counselors and the state chapter of

the American Mental Health Counselors. And joining me

today are Napoleon Harrington, MMHCA president, and Irene

Ametrano and Sue Schaeffer, co-chairs of our public

health, our public policy licensure committee.

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MMHCA would like to start by first questioning

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the legal authority of the Department of Licensing and

Regulatory Affairs to promulgate these rules. Through

LARA -- though LARA's staff identify in their draft rules

their assumed authority under ERO Number 1991-9, this

only provides the transfer of statutory authority,

powers, duties, functions and responsibilities from the

previous Department of Commerce to the current Department

of Licensing and Regulatory Affairs, and it specifically

provides that the boards shall retain all of their

statutory authority, powers, duties, functions and

responsibilities.

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Part 161 of the Public Health Code explicitly

states that the department shall not promulgate rules

that constitute the licensure, registration or

examination of health professionals, and that only a

board shall promulgate these rules. Furthermore, the

rule-making authority granted under Part 181 of the

Public Health Code is to the Board Of counseling, itself.

Both Board of Counseling rules committee and the full

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board unanimously opposed these proposed rules. Their

proposed alternative rules were ignored by the LARA

staff.

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With regard to the proposed rule changes,

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themselves, MMHCA recognizes that some do make necessary

and appropriate updates. Thank you very much.

NAPOLEON HARRINGTON: Napoleon Harrington,

current president of the Michigan Health Counselor's

Association. Napoleon, N-A-P-O-L-E-O-N, Harrington,

H-A-R-R-I-N-G-T-O-N.

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With regard to the proposed rule changes,

themselves, MMHCA recognizes that some do make necessary

and appropriate updates. However, we strongly oppose the

proposed rescission of definitions under Rule 338.1751

and the rescission of Rule 338.1757. The unjustified

impact of these rule recessions would significantly limit

a licensed professional counselor's scope of practice and

would directly violate the counseling profession's

ethical standards rendering Michigan's 10,000 licensed

mental health counselors from being able to legally

practice and do so at a time when the need for

professional mental health services in our state could

not be greater.

Additionally, insurance companies will likely

stop reimbursing for the services of LPCs due to the

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significant limits on scope of these rules, these rule

changes would impose.

Sure, counselors could still do case management

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or other such types of work, but they would not be able

to provide any counseling services. This inability for

LPCs to practice in Michigan will not only cause

significant harm to tens of thousands of people across

the state who will immediately lose their counseling

services when the rule changes take effect, it will also

force all Michigan counselors to be in violation of other

professional ethical standards regarding neglect and

abandonment.

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MMHCA objects to the general rationale for

these proposed rule changes. As stated in the regulatory

impact statement, LARA staff claims that these proposed,

these rule changes is to address confusion and

misinterpretation about the scope of practice of the

counseling profession, especially around a counselor's

ability to diagnose.

MMHCA argues there is no confusion or

misinterpretation here. The right of counselors to

practice their profession and employ counseling

techniques, which include diagnosis, consistent with his

or her training and code of ethics, has been guaranteed

in the Public Health Code for ten years before the

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passage of the counselor licensure law.

IRENE AMETRANO: I'm Dr. Irene Ametrano. I'm

representing MMHCA, and I'm also the chair of the

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counseling program at Eastern Michigan University. I'm

continuing on that same document.

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As LARA should be aware, the American

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Counseling Association's code of ethics, which counselors

are legally mandated to adhere to, requires the proper

diagnosis of a client's mental disorder before treatment.

Additionally, under the counselor licensing

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statute, which states that the practice of counseling or

counseling means the rendering to individuals, groups,

families, organizations, or the general public a service

involving the application of clinical counseling

principles, methods or procedures.

Section 18101A clarifies that counseling

principles, methods, or procedures means a developmental

approach that systematically assists an individual

through the application of a variety of specific

procedures, including counseling techniques. The term

counseling techniques, which is explicitly used in the

statute for both the scope of practice provisions and

educational requirements, is a widely understood

professional term that includes a variety of specific

procedures, including diagnosis. Because the term

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counseling techniques is used in the scope of practice,

as well as in the training requirements, it must not be

removed from the definition of scope. There simply is no

rationale, legal rationale for doing so.

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Furthermore, Section 18101 goes on to state

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that the practice of counseling does not include the

practice of psychology, except for those preventive

techniques, counseling techniques, or behavior

modification techniques for which the licensed

professional counselor or limited licensed counselor has

been specifically trained. This language was included in

the statute because these terms were already part of the

psychology licensing statute which permitted counselors

to do these activities in that law's exemption section

for counselors.

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SARA SUE SCHAEFFER: I'm Dr. Sara, S-A-R-A,

Sue, S-U-E, Schaeffer, S-C-H-A-E-F-F-E-R, representing

MMHCA.

In Section 18105-1 of the counseling statute

states that a licensee shall not perform any acts, tasks,

or functions within the practice of counseling unless he

or she is trained to perform such acts, tasks, or

functions. So, the scope of practice for counselors

explicitly includes those acts, tasks, or functions that

a counselor is trained to perform. Under

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Section 18107-1B the program training requirements for

counselors are clarified to include counseling techniques

and other statutory standards for which the board was

required to promulgate rules.

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The rule defining counseling techniques and the

subsequent training and scope of counselors has been in

effect for 30 years. It explicitly states that, quote,

counseling techniques is the application of counseling

and psychotherapy skills and theories in the counseling

process in order to, amongst other things, diagnose and

identify the problem.

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MMHCA also objects to LARA's proposed

rescission of Rule 389.1757, which identifies the

requirements for providing counseling supervision and

specific training in supervision. This training

requirement is a national standard for professional

counseling, which again counselors are legally mandated

to adhere to. If this rule is rescinded counselors who

provide counseling without training would be practicing

in violation of the ACA's code of ethics.

Without the availability of qualified, trained

supervisors Michigan's limited license professional

counselors would also be challenged to meet the ethical

and, therefore, legal licensing requirements to practice

as a fully licensed professional counselor. And LPCs who

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receive their supervision in Michigan would also likely

be ineligible for licensure in other states because their

supervisor would not meet the qualifications in the state

to which the counselor is moving.

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On behalf of MMHCA I would also like to provide

comment on the regulatory impact statement that has been

submitted for the record. We have numerous provisions of

this statement woefully lacking in proper disclosure.

DONALD AMIDON: I'm Dr. Donald Amidon,

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A-M-I-D-O-N, and I'm speaking on behalf of MMHCA.

The Question Number 2 was compare the proposed

rule standards in similarity situated states based on

geographic location, topography, natural resources,

commonalities, or economic similarities. LARA's staff

claims that Michigan's proposed rule standards for

counselors are like other Great Lake states; in essence,

Illinois, Indiana, Minnesota, New York, Ohio,

Pennsylvania, and Wisconsin. However, Indiana,

Minnesota, and Ohio explicitly include the ability to

diagnose in their scope of practice for counselors, along

with 30 other states in the country, while Illinois,

New York, Pennsylvania, and Wisconsin use such terms such

as identify, evaluate, that clearly implies diagnosis.

Number 3 states identify any laws, rules, and

other legal requirements that may duplicate, overlap, or

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conflict with the proposed rules. LARA's staff claim

that there are no laws, rules, or other legal

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requirements that duplicate, overlap, or conflict with

the proposed rules. This is not accurate. As previously

stated, Michigan's Public Health Code requires counselors

to practice their profession, which includes diagnosis as

a component of counseling techniques, consistent with his

or her training and code of ethics. The American

Counseling Association's code of ethics requires the

proper diagnosis of a client's mental disorder before

treatment and requires counselors to be trained in

supervision methods and techniques.

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JESSIKA MARIANO: Jessika, J-E-S-S-I-K-A,

Mariano, M-A-R-I-A-N-O, and I'm speaking on behalf of

MMHCA.

Number 6, identify the behavior and frequency

of behavior that the proposed rules are designed to

alter. LARA staff claim, but fail to document, that the

current location in the rule set causes confusion and

misinterpretation about the scope of practice of the

counseling profession. Again, MMHCA argues there there

is no confusion or misinterpretation here. The right of

counselors to practice their profession, including the

ability to use counseling techniques which encompass

diagnosis, was first established in the Public Health

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Code in 1978 and was maintained with the passage of the

counselor licensing law in 1988.

As previously stated, under Part 181 of the

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Public Health Code, PA421 of 1988, the statute

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specifically defines the practice of counseling to mean a

service involving the application of clinical counseling

principles, methods, or procedures, and the statute also

defines counseling principles, methods, or procedures to

mean, amongst other things, counseling techniques. How

then can LARA staff possibly claim that the definition

for counseling techniques should not be included in the

general rule provisions applying to the scope of

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practice? We are especially curious about this legal

justification, given LARA staff have determined that the

reference to counseling techniques in the education

requirements for LPCs, MCL 333.18107, and then 1B, does

warrant inclusion in the rules related to education.

Finally, these rules have been reviewed and

upheld by the Attorney General, the Legislative Service

Bureau, and the Michigan legislature repeatedly over the

years, including in 1995, 2003 and 2012. Furthermore, in

the more 30 years since the passing of PA421 in 1988

there have been no successful legal challenges to the

counselors' scope of practice under the law and no

successful related complaints filed with the Board of

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Counseling.

ANDREA CASCARILLA: Andrea Cascarilla,

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A-N-D-R-E-A, C-A-S-C-A-R-I-L-L-A, on behalf of MMHCA.

6C, what is the desired outcome? LARA staff

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state the desired outcome of the rules rescission is to

result in fewer questions, fewer regulatory problems, and

greater safety and protection of the public. However,

LARA staff have failed to identify any document any

questions, regulatory problems, or greater public safety

and protection concerns that would warrant these

detrimental rule changes.

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Number 7, identify the harm resulting from the

behavior that the proposed rules are designed to alter

and the likelihood that harm will occur in the absence of

the rule. LARA staff simply fail to identify any harm

that is resulting from Rule 338.1751 or any likelihood

that any harm will occur in the absence of the rule's

rescission other than avoiding confusion, which is

completely unsubstantiated. Further, they identify no

harm that is resulting from Rule 338.177 or would occur

in the absence of the rule rescission. MMHCA again

argues these current rules actually protect against harm

by ensuring counselors are practicing to their ethical

standards and receiving the appropriate supervisions

before practicing independently.

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What is the rationale for changing the rules

instead of leaving them as currently written? While LARA

staff completely claim the rationale is to update

outdated standards, correct typographical errors, supply

clarity to all rules on licensure and reorganize the

rules into a format that is more are user friendly, none

of this rationale applies to the recession of Rule

338.1751 and Rule 338.17757, for they contain no outdated

standards, typographical errors, lack of clarity, or user

unfriendliness.

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I know I'm running out of time. I do just want

to submit for the record, too, a petition, the results of

a petition, over 37,000 signatures opposing these rules.

BRIAN BANKS: Good morning. Before you start

my time I just want to make a point that I did submit a

written comment, so I'm going to stay on a few points

here.

Good morning again. My name is Brian Banks,

and I'm a representative from the American Counseling

Association. I'm here today in opposition of the

proposed rule changes to R338.1751 and R338.1757.

The proposed changes will seriously impede the

ability of at least 10,000 of Michigan's LPCs to provide

services to the state's families, couples, adults,

seniors, veterans, adolescents, and children at crucial

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times in their lives. Rather than improve critical and

much needed mental health services the proposed

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regulatory changes will provide obstacles to the delivery

of quality mental health counseling by LPCs who are

educated, trained, and practice at the highest

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professional standards. Michigan LPCs help at least

150,000 citizens each year who face life's challenges.

Since the promulgation and adoption of Act 368

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of the Public Health Code, creating that LPC credential

in 1988, which includes the diagnosis and identification

of the problem, has been one of the counseling

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profession's core principles. The authorization to

diagnose is essential to providing necessary and

appropriate treatment for clients. Moreover, in Section

E5A, proper diagnosis, of the American Counseling

Association's code of ethics, which governs and defines

ethical behavior and best practices in the profession of

counseling in Michigan, requires the proper diagnosis.

It takes us down a dangerous path. With the

board's mandate to protect the public it is imperative to

have well-trained, experienced, and ethically practicing

LPCs. Eliminating the ability to diagnose will adversely

affect LPCs' professional ethical duties, which are

directly related to the practice of counseling. The

proposed counseling supervision provisions will create

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insurmountable barriers that bar LPCs from providing

needed services to both urban and rural populations in

Michigan.

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I would be remiss if I did not mention the

nation's opioid crisis and the vital role LPCs play in

providing treatment to those affected in Michigan. In

August Governor Whitmer issued executive order 2019-18,

creating the Michigan Opioids Task Force.

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STEPHEN CRAIG: Good morning. I'm Dr. Stephen

Craig, professor and unit director of the counselor

education program in the department of counselor

education and counseling psychology at Western Michigan

University. The name is spelled S-T-E-P-H-E-N,

C-R-A-I-G.

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Thank you for the opportunity to address this

committee. I oppose the proposed rules changes. While

some of the changes are seemingly innocuous and perhaps

necessary to maintain relevance with evolving

accreditation standards, others, including the proposed

change and moving the definitions into the educational

section, only are particularly troubling and will likely

lead to increase confusion and potentially could lead to

substantial costs and overall harm to the public and to

the small business community where many counselors are

employed.

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In a report titled The American State of Mental

Health in America 2018, Nguyen and colleagues estimated

that more than 1.3 million Michigan residents have some

form of mental illness. In the same report it was

estimated that more than 55 percent of Americans with

mental illness never received treatment. More than 20

percent of adults with a mental illness reported they

were not able to obtain the care that they needed. The

four systemic barriers to assessing care that were cited

in the report, it's a lack of insurance, lack of

available treatment levels, lack of financial resources,

and lastly, I quote, a lack of available treatment

providers, end quote.

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The report further cites that although the

Affordable Care Act may have increased the number of

individuals with mental illness who are now able to seek

treatment, those same people are faced with limited

numbers of available providers. The problem, they say,

is that with increasing demand for mental health services

coupled with a high turnover rate of providers due, in

part, to low compensation, it has created a substantial

shortage of mental health professionals. At a time when

1.3 million Michigan residents have some form of mental

illness, at a time when 55 percent of Americans with

mental illness are not receiving treatment, and at a time

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when one of the principle barriers is a lack of available

providers, the Department of Licensing and Regulatory

Affairs is proposing a measure that could effectively

eliminate 10,000 available providers.

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Throughout the regulatory impact statement and

cost-benefit analysis LARA has indicated that the

proposed rules remove confusion about the scope of

practice of the counseling profession. The Bureau of

Professional Licensing has a mission statement that

includes a goal.

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GLINDA RAWLS: Good morning. My name is

Dr. Glinda Rawls, G-L-I-N-D-A, R-A-W-L-S. I'm an

associate professor at Western Michigan University in the

department of counselor education and counseling

psychology. I'm here to complete my colleague's

statement, particularly talking about the role of LARA

and the protection of the public.

In the health professional disciplinary reform

fiscal year 2018 report to the legislature the Board of

Professional Licensure director Pezon in his 2019 report

reported that for the period between 2017 and 2018

identified that there were 5,000 allegations against

licensed health professionals in general received by

LARA, and the grand total of that was 102 allegations

related to licensed professional counselors. And of the

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more than 1500 allegations against the licensed health

professionals that were authorized only 47 were

authorized against LPCs. That means that for the same

reporting period for the 10,000 LPCs who practice in

Michigan the LPCs that were only subject to 3 percent of

those allegations.

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I think that LARA is trying to tell us that

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their role is designed to help the public, but really it

seems to me that the vast majority of counselors are

doing good work and are competent, and including their

roles in diagnosis and to inform the treatment, which

informed the treatment that they provide.

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Many of the proposed rule changes will neither

promote efficiency, nor will it protect the public, and

they will likely create substantial confusion and

potentially cut off Michigan residents to over 10,000

competent mental health professionals.

MS. DITSCHMAN: We're going to take a break in

about three minutes. I'm sorry if you've been standing

in line for 20 minutes. We thought this was the best way

to coordinate it, but we've just been told that everybody

has to get out of the aisle.

So, one last speaker and we'll take about a

ten-minute break. And so, then we'll start back in at

ten after. But the last speaker right now.

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CHRISTINA COLLINS: Hi. My same Christina

Collins, C-O-L-L-I-N-S. And I am an alumni of Western

Michigan University and am here to complete the statement

of two of my biggest advocates and best professors in the

counselor education department at Western Michigan

University.

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I am deeply concerned that a government agency

is actively lobbying against one of the licensed health

professions, ignoring the input of counselors, rejecting

decades-long precedent, and seemingly responding to

pressure from another licensed health profession who

actively seeks to suppress the number of available mental

health providers to serve the needs of Michigan

residents. Rather than showing deference to statutory

language and administrative rules, the latter of which

have been in place for nearly three decades, this

department is attempting to rush through a change that

could have a devastating impact on the mental health

needs of Michigan residents.

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As for the language in the rules associated

with supervision training, we are not, quote, imposing

requirements on a licensee without statutory authority,

end quote. In fact, all licensed professional counselors

have the freedom to decide whether or not they wish to

provide supervision to limited licensed professional

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counselors. We are merely suggesting that for those

individuals who voluntary decide to become a supervisor

of limited licensed professionals they should have the

requisite training to do so.

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Suddenly, after years of scrutiny, review,

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approval, and acceptance, even by this body who seeks to

change it, LARA wishes to unilaterally change the rules

and reject years of precedent.

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For these reasons I stand in opposition to the

proposed rules changes. I respectfully request that LARA

listens to the legitimate concerns raised by LPCs and the

Michigan Board of Counseling and reconsiders their

position on the proposed rules. We are not asking for

what LARA describes as, quote, expanding the scope of

practice, end quote. We're asking for LARA to accept the

nearly 30-year precedent of our licensure law and

administrative rules and allow us to do the important

work that the people of Michigan need us to do. Thank

for the opportunity to express my concerns.

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MS. DITSCHMAN: We are goings to take a break.

This is what needs to happen. If you want to keep your

place as far as speaking you shouldn't leave the room.

It's for the Court Reporter basically so her hands can

rest for a minute. And then when we come back there's

two board members that we're going to let speak. And

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then, as I said, we're not going to use the lines. If

you have already spoken we would ask that you leave the

room because there's many, many counselors outside

waiting to come in and we're limited in numbers. Okay?

(Short recess had from 10:00 AM to 10:09 AM.)

MS. DITSCHMAN: So, we're going to start. We

have a couple board members that are going to go here,

and then we're going by row. So, let's go ahead. We'll

start and we'll go from there.

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CHARLES HUGHES: Hello. All right. My name is

Charles Hughes, C-H-A-R-L-E-S, Hughes, H-U-G-H-E-S. I'm

a board member and also a member of the Star behavior

health providers who are civilians who are trained to

treat veterans. I'm a recently appointed member of the

Michigan Board of Counseling. I'm not speaking as a

board member today but as a representative of my

behavioral health clinic, Munson Grayling Behavioral

Health, and the people that I work with. I work in

Crawford County.

I want to start by telling you of the community

needs assessment and county health rankings in Michigan.

I work in county 83 of 83. Crawford County has the worst

health outcomes in the state. It's a multifaceted

problem, but a large reason why it is ranked so low is

the ratio of mental health providers to patients.

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Crawford County has a ratio of 730 patients to 1 mental

health provider. The state average is 400 to 1 and the

national average is 310 to one. This ratio is with the

current 8 LPCs working in this county. Without LPCs this

county will no longer have any capacity to help the

mentally ill as there are only one MSW currently working

in the county.

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I also work for Oscoda County, who is ranked

81st of 83, and their ratio is 2,070 people to 1 mental

health provider. Many of our patients from Oscoda County

drive to see us, which is a drive of 30 miles, to come

see us at my hospital and my practice.

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My practice has a caseload of over 200

patients. We provide for both Oscoda and for Crawford

County. And we also provide crisis services for the

Grayling emergency room, and without our LPCs there is no

crisis services for private insurance in our counties.

Our small practice took six to nine months to

hire a single LMSW, and without the change or with the

changes we will be unable to serve the people of our

counties.

MS. DITSCHMAN: We have somebody from the

occupational therapy. We're going to have her speak.

The other thing I would like you to do, before she speaks

is if you are in the back row, if you want to move

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forward so you're not waiting you may do that at this

time because we will be filling in with a few more people

in a minute and we're going to be doing this by rows.

So, if you want to move so that you're not waiting longer

feel free to do that right now.

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Okay. Go ahead and have a seat. Just move

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towards the middle. Come on. Move towards the middle

and make space. So, if there is a seat next to you

towards the middle please fill it because we are going to

have more people come in and they are going to be walking

over you in just a minute. So, if you don't want them

walking over you move towards the middle.

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MS. DITSCHMAN: Okay. OT, go for it.

ELIZABETH BENNANI: I'm Elizabeth Bennani. I'm

an occupational therapist. I have submitted my comments

through e-mail, so you should have them.

I basically have some questions. The first

question is how do the proposed rules and changes

coordinate with the existing definitions and functions,

including those defined in the State Operations Manual,

including Paragraph 484.115, condition of participation,

personal qualifications, specialized rehabilitative

services, and medical provider manual. I have attached

in there the various definitions of these.

I also would like to know, and I'm sure

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everybody else, what is the reasoning for rescinding

R3338.1212, which is the prohibited conduct. We also

expect -- okay. Thank you.

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Question 3, will there be a new scope of

practice for occupational therapists, certified

occupation therapy assistants, and the new limited

licensed therapist? How will this new scope of practice

coordinate with AOTA, the American Occupational Therapy

Association.

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And Question 4, with reference to the limited

license what will be the scope of practice of the limited

license therapist?

I have a lot of other comments, but I guess

I'm -- the other concerns that we have is with respect to

the certified occupational therapy assistant. I have

worked with a lot of very knowledgeable and competent

COTAs, but there are no definitions within here as to

what evaluations can be performed and what part of the

evaluation and the training is required.

COURT REPORTER: Could you spell your last

name, please?

ELIZABETH BENNANI: B-E-N-N-A-N-I.

JANET GLAES: Good morning. My name is

Dr. Janet Glaes, and that's spelled G-L-A-E-S, first name

is J-A-N-E-T. I am a member of the Michigan Board of

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Counseling, and today I'm here to speak as a counselor

educator and private practice counselor.

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I'm strongly opposed to the proposed LARA rule

changes. I'd like to point out that the educational

training that counselors in Michigan receive really more

than qualifies them to diagnose and treat their clients.

To give you some understanding of that I'd like to talk

just a little bit about the program I'm most familiar

with, which is Spring Arbor University.

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Some examples of classes my students take are

counseling techniques, clinical psychopathology,

conceptualization and treatment, advanced clinical

psychotherapy and abnormal behavior, and evaluation of

psychopathology, just to name a few of the 60 credit

hours that they take. They go on to complete a 600-hour

internship under the supervision of fully licensed and

trained practitioners, and this is standard practice.

So, a licensed professional counselor within Michigan do

have the experience and the background they need. Our

students go on to work in mental health agencies and

hospitals, family service programs, medical service,

hospice, foster care, and private practice, just to name

a few.

This morning on my way in I heard on the radio

that counselors and counselor educators should have been

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aware of these impending changes. I couldn't disagree

more vehemently. I've been an LPC for almost 30 years

and been a counselor educator for 10. In those 10 years

our students have applied for and been approved for

licensure in the state. I've renewed my license every

three years and paid fees, as we all have.

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All of us have submitted professional

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disclosure statements where we clearly list diagnosis and

treatment as part of our scope of practice and we've been

approved by LARA. I urge you to reconsider these

proposed changes.

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MS. DITSCHMAN: Okay. Anybody in the first

row, start here, would you give me your card and we'll

just kind of move down the rows like this.

JOSEPH GUAJARDO: My name is Joseph,

J-O-S-E-P-H, Guajardo, G-U-A-J-A-R-D-O. I'm here on

behalf of the Michigan Mental Health Providers

Association. I received a Master's of Arts in Counseling

degree from Spring Arbor University. I've been

practicing since 2014. Additionally, I'm a certified

alcohol and drug counselor and certified clinical

supervisor through Michigan Certification Board for

Addiction Professionals. I have worked at two separate

inpatient substance abuse treatment facilities for the

last nine and-a-half years. I've been a clinical

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director and supervisor for the last three.

It is important to me to let you all know that

I've never diagnosed an individual outside my scope of

practice. I've never treated outside of my scope of

practice. If I was treating someone for presenting

problems that I was not specifically trained to provide

treatment or therapy to I would always refer the

individual to a more appropriate helping professional.

This is my DSM-V, and the binding is broken. And I just

wanted to make that very clear.

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As you know, Michigan is experiencing an opioid

epidemic and other significant mental health crises.

Licensed professional counselors are crucial to combat

these issues. The proposed rule changes by LARA to

restrict the scope of practice for LPCs to eliminate the

counselor's ability to diagnose and use counseling

techniques will serve as an injustice to the need to

provide the public substance use disorder and other

mental health treatment populations.

Restricting the LPCs' ability to diagnose

within their scope of practice and counsel will leave

many clients without a treatment provider. These rule

changes will lead to thousands of Michigan residents with

less resources for treatment and therapy that at this

time is very much needed. The families of the clients

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and counselors who work together every day will be

impacted negatively. There's a whole lot of treatment to

be provided and plenty of work to be done. Now is not

the time to limit treatment resources in the State of

Michigan.

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I stand with many, many people, families, and

helping professionals who oppose the rule changes. I ask

the governor to ask LARA not to implement the changes.

MS. DITSCHMAN: I just want a little reminder,

because we just had a few people come in in the back, so

when you are going line by line, when you get up here

what we're doing is make sure you state your name and

then spell it, and organization if you're representing an

organization.

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Once you have spoken we ask that you exit so

somebody else, if you want to, so somebody else can come

in. Because I understand there's lots of people waiting

outside still. If you're hearing the same comment over

and over be mindful that goes into the record here, it

will be reviewed through the process, so you don't need

to, you don't have to make the same comment, just so you

know that.

We're having many more of them. We'll already

know that they were sent in writing. Anything else that

we -- oh. If you are going to read something verbatim