File No. 869

House of Representatives, April 30, 2009

The Committee on Appropriations reported through REP. GERAGOSIAN of the 25th Dist., Chairperson of the Committee on the part of the House, that the substitute bill ought to pass.

AN ACT CONCERNING LICENSURE OF CLINICAL SOCIAL WORKERS.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 20-195m of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2009):

As used in subsection (c) of section 19a-14, section 19a-18, sections 20-195n to 20-195q, inclusive, sections 2, 6 and 7 of this act and this section:

(1) "Licensed clinical social worker" means a person who has been licensed as a clinical social worker pursuant to this chapter;

(2) "Commissioner" means the Commissioner of Public Health;

(3) "Department" means the Department of Public Health; [and]

(4) "Clinical social work" means the application, by persons trained in social work, of established principles of psychosocial development, behavior, psychopathology, unconscious motivation, interpersonal relationships and environmental stress to the evaluation, assessment, diagnosis and treatment of biopsychosocial dysfunction, disability and impairment, including mental, emotional, behavioral, developmental and addictive disorders, of individuals, couples, families or groups. Clinical social work includes, but is not limited to, counseling, psychotherapy, behavior modification and mental health consultation;

(5) "Licensed master social worker" means a person who has been licensed as a master social worker pursuant to this chapter;

(6) "Independent practice" means the practice of clinical social work without supervision; and

(7) "Under professional supervision" means the practice of clinical social work under the supervision of a licensed mental health, health care, social services or education professional in an individual or group setting.

Sec. 2. (NEW) (Effective October 1, 2009) (a) An individual licensed as a master social worker pursuant to section 20-195n of the general statutes, as amended by this act, may: (1) Practice clinical social work under professional supervision; and (2) offer a mental health diagnosis provided such diagnosis is offered in consultation with a licensed mental health practitioner who is eligible for independent practice in clinical social work, psychology, psychiatry, advanced practice registered nursing or marital and family therapy. Except as provided in subsection (c) of section 20-195q of the general statutes, as amended by this act, a licensed master social worker may not engage in independent practice.

(b) An individual licensed as a clinical social worker pursuant to section 20-195n of the general statutes, as amended by this act, may practice clinical social work. A licensed clinical social worker may perform all functions of a licensed master social worker and, in addition, may engage in independent practice.

Sec. 3. Section 20-195n of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2009):

(a) No person shall practice clinical social work unless such person has obtained a license pursuant to this section.

(b) An applicant for licensure as a licensed master social worker shall: (1) Hold a master's degree from a social work program accredited by the Council on Social Work Education or, if educated outside the United States or its territories, have completed an educational program deemed equivalent by said council; and (2) pass the masters level examination of the Association of Social Work Boards or any other examination prescribed by the commissioner.

(c) [Applicants] An applicant for licensure as a clinical social worker shall: (1) Hold a doctorate or master's degree from a social work program accredited by the Council on Social Work Education or, if educated outside the United States or its territories, have completed an educational program deemed equivalent by said council; (2) have three thousand hours post-master's social work experience which shall include not less than one hundred hours of work under professional supervision by a licensed clinical or certified independent social worker; and (3) pass the clinical level examination of the [American] Association of [State] Social Work Boards or any other examination prescribed by the commissioner. On and after October 1, 1995, any person certified as an independent social worker prior to October 1, 1995, shall be deemed licensed as a clinical social worker pursuant to this section, except a person certified as an independent social worker on and after October 1, 1990, shall not be deemed licensed as a clinical social worker pursuant to this chapter unless such person has satisfied the requirements of subdivision (3) of this [section] subsection.

[(b)] (d) Notwithstanding the provisions of [subsection (a)] subsections (b) and (c) of this section, the commissioner may grant a license by endorsement to an applicant who presents evidence satisfactory to the commissioner that the applicant (1) is licensed or certified as a master social worker or clinical social worker in good standing in another state or jurisdiction whose requirements for practicing in such capacity are substantially similar to or higher than those of this state, and (2) has successfully completed the master or clinical level examination of the Association of Social Work Boards, or its successor organization, or any other examination prescribed by the commissioner. No license shall be issued under this subsection to any applicant against whom professional disciplinary action is pending or who is the subject of an unresolved complaint.

Sec. 4. Section 20-195o of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2009):

(a) Application for licensure shall be on forms prescribed and furnished by the commissioner. Each applicant shall furnish evidence satisfactory to the commissioner that he has met the requirements of section 20-195n, as amended by this act. The application fee for a clinical social worker shall be two hundred fifty dollars. The application fee for a master social worker shall be one hundred seventy-five dollars.

(b) Notwithstanding the provisions of section 20-195n, as amended by this act, concerning examinations, on or before October 1, 2011, the commissioner may issue a license without examination, [prior to January 1, 1998, to any applicant who offers proof to the satisfaction of the commissioner that he met the requirements of subdivisions (1) and (2) of section 20-195n and was an employee of the federal government with not less than three thousand hours postmaster's social work experience prior to October 1, 1986] to any master social worker who demonstrates to the satisfaction of the commissioner that, on or before October 1, 2009, he or she met the licensing requirements for a master social worker as prescribed in section 20-195n, as amended by this act.

(c) [(1)] Each person licensed pursuant to this chapter may apply for renewal of such licensure in accordance with the provisions of subsection (e) of section 19a-88. A fee of one hundred fifty dollars shall accompany each renewal application for a licensed master social worker or a licensed clinical social worker. Each such applicant shall furnish evidence satisfactory to the commissioner of having [participated in] satisfied the continuing education requirements prescribed in section 7 of this act. [The commissioner shall adopt regulations in accordance with chapter 54 to (A) define basic requirements for continuing education programs, (B) delineate qualifying programs, (C) establish a system of control and reporting, and (D) provide for waiver of the continuing education requirement for good cause.

(2) A person licensed pursuant to this chapter who holds a professional educator certificate that is endorsed for school social work and issued by the State Board of Education pursuant to sections 10-144o to 10-149, inclusive, may satisfy the continuing education requirements contained in regulations adopted pursuant to this section by successfully completing professional development activities pursuant to subsection (l) of section 10-145b, provided the number of continuing education hours completed by such person is equal to the number of hours per registration period required by such regulations. For purposes of this subdivision, "registration period" means the one-year period during which a license has been renewed in accordance with section 19a-88 and is current and valid.]

Sec. 5. Section 20-195q of the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2009):

(a) No person shall (1) use the title "licensed master social worker" or any initials associated with such title, or (2) advertise services under the description of a licensed master social worker as defined in section 20-195m, as amended by this act, unless such person is licensed as a master social worker pursuant to this chapter.

[(a)] (b) No [persons, except those licensed pursuant to this chapter,] person shall (1) use the title "licensed clinical social worker" or any initials associated with such [titles] title, or (2) advertise services under the description of a licensed clinical social worker as defined in section 20-195m, as amended by this act, unless such person is licensed as a clinical social worker pursuant to this chapter.

[(b)] (c) Nothing in this section shall prohibit: (1) A student enrolled in a doctoral or master's degree program accredited by the Council on Social Work Education from performing such work as is incidental to his course of study, provided such person is designated by a title which clearly indicates his status as a student; (2) a person holding a doctoral or master's degree from a program accredited by the Council on Social Work Education from gaining social work experience under professional supervision, provided such activities are necessary to satisfy the work experience required by section 20-195n and such person is designated as "social work intern", "social work trainee" or other title clearly indicating the status appropriate to his level of training; (3) a person licensed or certified in this state in a field other than clinical social work from practicing within the scope of such license or certification; (4) a person enrolled in an educational program or fulfilling other state requirements leading to licensure or certification in a field other than social work from engaging in work in such other field; [or] (5) a person who is employed or retained as a social work designee, social worker, or social work consultant by a nursing home or rest home licensed under section 19a-490 and who meets the qualifications prescribed by the department in its regulations from performing the duties required of them in accordance with state and federal laws governing those duties; (6) for the period from October 1, 2009, to October 1, 2012, inclusive, a master social worker from engaging in independent practice, provided after October 1, 2012, a master social worker may not engage in independent practice unless such master social worker has obtained licensure as a clinical social worker; (7) a social worker practicing community organization, policy and planning, research or administration that does not include engaging in clinical social work or supervising a social worker engaged in clinical treatment with clients; (8) an employee of the state, who works in a formal clinical social work trainee or internship program, from practicing clinical social work under supervision and without requiring such employee to attain licensure as a master social worker; and (9) individuals with a baccalaureate degree in social work from a Council on Social Work Education accredited program from performing nonclinical social work functions.

Sec. 6. (NEW) (Effective October 1, 2009) The department may issue a temporary permit to an applicant for licensure as a master social worker who holds a master's degree from a social work educational program, as described in section 20-195n of the general statutes, as amended by this act, but who has not yet taken the licensure examination prescribed in said section. Such temporary permit shall authorize the holder to practice as a master social worker as provided for in section 2 of this act. Such temporary permit shall be valid for a period not to exceed two hundred seventy calendar days after the date of attaining such master's degree and shall not be renewable. Such permit shall become void and shall not be reissued in the event that the applicant fails to pass such examination. The fee for a limited permit shall be fifty dollars.

Sec. 7. (NEW) (Effective October 1, 2009) (a) Except as otherwise provided in this section, each clinical social worker licensed pursuant to the provisions of chapter 383b of the general statutes and, on and after October 1, 2010, each master social worker licensed pursuant to said chapter shall complete a minimum of fifteen hours of continuing education during each registration period. For purposes of this section, "registration period" means the twelve-month period for which a license has been renewed in accordance with section 19a-88 of the general statutes and is current and valid.

(b) Continuing education required pursuant to this section shall be related to the practice of social work. Such continuing education shall consist of courses, workshops and conferences offered or approved by the Association of Social Work Boards, the National Association of Social Workers, a school or department of social work accredited by the Council on Social Work Education or an organization that demonstrates to the department that such organization's standards are substantially similar to the organizations identified in this subsection. A licensee's ability to engage in on-line and home study continuing education shall be limited to not more than six hours per registration period. Within the registration period, an initial presentation by a licensee of an original paper, essay or formal lecture in social work to a recognized group of fellow professionals may account for five hours of continuing education hours of the aggregate continuing education requirements prescribed in this section.

(c) Each licensee shall obtain a certificate of completion from a provider of the continuing education for all continuing education hours that are successfully completed and shall retain such certificate for a minimum of three years following the license renewal date for which the activity satisfies the continuing education requirement. Upon request by the department, the licensee shall submit such certificate to the department. A licensee who fails to comply with the continuing education requirements prescribed in this section may be subject to disciplinary action pursuant to section 20-195p of the general statutes.

(d) A person licensed pursuant to chapter 383b of the general statutes who holds a professional educator certificate that is endorsed for school social work and issued by the State Board of Education pursuant to sections 10-144o to 10-149, inclusive, of the general statutes may satisfy the continuing education requirements contained in this section by successfully completing professional development activities pursuant to subdivision (1) of subsection (l) of section 10-145b of the general statutes, provided the number of continuing education hours completed by such person is equal to the number of hours per registration period required by this section.

(e) A licensee applying for the first time for license renewal pursuant to section 20-195o of the general statutes, as amended by this act, is exempt from the continuing education requirements of this section. The department may, for a licensee who has a medical disability or illness, grant a waiver of the continuing education requirements or may grant the licensee an extension of time in which to fulfill the requirements, provided the licensee submits to the department an application for waiver or extension of time on a form prescribed by the department along with any documentation required by the department. The department may grant a waiver or extension not to exceed one registration period, except that the department may grant additional waivers or extensions if the initial reason for the waiver or extension continues beyond the period of the waiver or extension. A waiver of the continuing education requirement may be granted by the department to a licensee who is not engaged in social work during a given continuing education registration period, provided the licensee submits a waiver request prior to the expiration of the continuing education period, on a form prescribed by the department.

Sec. 8. (NEW) (Effective October 1, 2009) The issuance of all licenses pursuant to chapter 383b of the general statutes shall be accomplished within the existing budgetary resources of the Department of Public Health, and all costs associated with such issuance, including, but not limited to, administrative, personnel, examination and investigative costs, shall be met within such budgetary resources.

Statement of Legislative Commissioners:

In section 1 (1), the phrase "as a clinical social worker" was added for clarity. Likewise, in section 1 (5), the phrase "as a master social worker" was added for clarity. In section 5, subsections (a) and (b) were rewritten to provide additional clarity and consistency in the use of terms "licensed master social worker" and "licensed clinical social worker". In section 7, the effective date was changed to "October 1, 2009" for conformity with the provisions of section 4. In section 7 (a), the phrase "and, on and after October 1, 2010, each master social worker licensed pursuant to said chapter" was added to clarify the continuing education requirements applicable to each of the professions referenced in the subsection.

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact:

Note: GF=General Fund

Municipal Impact: None

Explanation

The bill requires the Department of Public Health (DPH) to create a new licensure category for master social workers, resulting in a cost to DPH of $58,534 in FY 10 and $206,230 in FY 11 for staff and related expenses. These staff positions would prompt associated fringe benefit costs under the Comptroller of $11,646 in FY 10 and $48,199 in FY 11. It would also result in a revenue gain to the General Fund of $152,000 in FY 10 and $272,000 in FY 11.

Costs to DPH to issue these initial and renewal licenses, provide complaint investigation, hearings, and prosecution are detailed below.

Master social workers must be licensed to engage in independent practice by 8/1/2012, according to Sec. 5 of the bill. The initial license fee would be $175 and the renewal license fee, to be paid annually during the month of the licensee's birth, would be $150. It is estimated that 1100 people would apply for initial licenses in FY 10 and FY 11, along with 92 renewals in FY 10 and 1192 renewals in FY 11, resulting in a revenue gain to the General Fund of approximately $206,300 in FY 10 and $371,300 in FY 11. Funds are not included for this purpose in the budget bill, sHB 6365, as favorably reported by the Appropriations Committee.

The requirement that this new licensure category be developed by DPH within existing budgetary resources will likely result in one of four outcomes: (1) DPH will proceed with the establishment of the new licensure category and require a deficiency appropriation in FY 10; (2) DPH will delay the establishment of the new licensure category pending the approval of additional appropriations to meet this mandate in future fiscal years; (3) DPH will shift administrative resources from other departmental priorities to establish the new licensure category, thereby impacting existing departmental programs; or (4) DPH will not establish the new licensure category.

The Out Years

In the out-years costs discussed above, subject to inflation, will continue. It is estimated that revenue from a fully operational licensure program would be approximately $235,050 in the out-years.

OLR Bill Analysis

sHB 6676

AN ACT CONCERNING LICENSURE OF CLINICAL SOCIAL WORKERS.

SUMMARY:

This bill creates a new license category for certain social workers. The new licensure program, known as “master social worker,” is administered by the Department of Public Health (DPH). The bill: (1) establishes licensure requirements and sets fees for initial licenses and renewals, (2) defines the practice of a master social worker, (3) allows for licensure by endorsement or licensure without examination in certain cases, (4) provides for one- time temporary permits to practice, (5) allows independent practice for a limited time, (5) specifies activities certain social workers are allowed to do, and (6) establishes continuing education requirements.

DPH currently licenses clinical social workers and continues to do so under the bill (see “BACKGROUND”).

The bill specifies that DPH must issue licenses to clinical social workers and master social workers within its existing budgetary resources. All costs associated with such issuance (e.g., administrative, personnel, examination and investigative) must be met within these budgetary resources.

EFFECTIVE DATE: October 1, 2009.

MASTER SOCIAL WORKER

Terms and Definitions

Under the bill, a licensed master social worker can (1) practice clinical social work under professional supervision and (2) offer a mental health diagnosis in consultation with a licensed mental health practitioner eligible for independent practice in clinical social work, psychology, psychiatry, advanced practice registered nursing, or marital and family therapy.

The bill defines “under professional supervision” as the practice of social work under the supervision of a licensed mental health, health care, social services, or education professional in an individual or group setting. (It is unclear which health care professionals can provide the supervision and what kind of social services professionals are licensed; also education professionals are certified, not licensed.)

The bill specifies that a licensed clinical social worker can perform all functions of a licensed master social worker and practice independently. Under the bill, a licensed master social worker cannot engage in independent practice, except for a limited period of time (see below). “Independent practice” means the practice of social work without supervision.

License Requirements

The bill requires an applicant for a master social work license to (1) have a master's degree from a social work program accredited by the Council on Social Work Education, or if educated outside the United States or its territories, have completed an educational program the council deems equivalent and (2) pass the masters level examination of the Association of Social Work Boards or any other examination prescribed by DPH.

The application fee for a master social work license is $175. (The law establishes a $250 fee for licensed clinical social workers.) The renewal fee for both licenses is $150.

Licensure by Endorsement

The bill allows the DPH commissioner to grant a license by endorsement to an applicant for a master social work license who (1) is licensed or certified as a master social worker in another state or jurisdiction whose practice requirements are substantially similar to or higher than Connecticut's and (2) has successfully completed the master level examination of the Association of Social Work Boards or any other examination prescribed by the commissioner. The law already allows for licensure by endorsement for clinical social workers. The bill allows the commissioner to prescribe an alternative examination for clinical social workers.

Licensure without Examination

The bill allows DPH, until October 1, 2011, to issue a license without examination to any master social worker who demonstrates to the department's satisfaction that by October 1, 2009 the individual met the requirements for a master social worker license.

Independent Practice

The bill allows a master social worker (presumably one who is licensed as such) to engage in independent practice between October 1, 2009 and October 1, 2012. After October 1, 2012, a master social worker cannot engage in independent practice unless he or she is licensed as a clinical social worker (see BACKGROUND).

Temporary Permit

The bill allows DPH to issue a temporary permit to a license applicant who has a mater's degree from an accredited or equivalent social work program but has not yet taken the required licensure examination. The temporary permit authorizes the holder to work under supervision as a master social worker for up to 270 calendar days after the date of receiving the master's degree. A temporary permit is not renewable; it is void and cannot be reissued if the applicant fails the examination. The temporary permit fee is $50.

Title Protection

The bill prohibits an individual from (1) using the title “licensed master social worker” or any initials associated with it or (2) advertising services under the description of a licensed master social worker, unless the individual has a master social worker license. The law already provides this protection for licensed clinical social workers.

Allowed Activities

The bill specifies that it does not prohibit (1) a social worker from practicing community organization, policy and planning, research, or administration that does not involve engaging in clinical social work or supervising a social worker engaged in clinical treatment with clients; (2) a state employee who works in a formal clinical social work trainee or internship program from practicing clinical social work under supervision without a master social worker license; and (3) individuals with a baccalaureate degree in social work from a Council on Social Work Education accredited program from performing nonclinical social work functions.

CONTINUING EDUCATION

Current Requirements for Licensed Clinical Social Workers

Under existing law, licensed clinical social workers must meet continuing education requirements in order to have their licenses renewed. Currently, DPH must adopt regulations that define basic requirements for continuing education programs, delineate qualifying programs, establish a control and reporting system, and provide for waiving the requirements for good cause. These regulations have been adopted (DPH Regs. § 20-195o(c)-1 to 7).

Current law allows a licensed clinical social worker who also holds a State Board of Education professional educator certificate with a school social worker endorsement to meet continuing education requirements for social workers by completing continuing education activities required for the educator certificate. The number of continuing education hours for maintaining the educator certificate must equal that required for clinical social worker continuing education over a one-year period.

The Bill's Requirements for Licensed Clinical Social Workers and Master Social Workers

The bill eliminates the provision that continuing education requirements be adopted by regulation and instead establishes statutory requirements for both licensed clinical and master social workers. (Some of the bill's requirements reflect those currently in regulation.)

The bill requires each type of social worker to complete a minimum of 15 hours of continuing education during each registration period. A “registration period” is the 12-month period for which a license is current and valid. The requirement for licensed master social workers begins on October 1, 2010. Continuing education must be related to the practice of social work and consist of courses, workshops, and conferences offered or approved by the Association of Social Work Boards, the National Association of Social Workers, a school or department of social work accredited by the Council on Social Work Education or an organization that demonstrates to DPH that its standards are substantially similar to the above organizations.

A person can take up to six hours of on-line and home study continuing education per registration period. During the registration period, an initial presentation by a licensee of an original paper, essay, or formal lecture in social work to a recognized group of fellow professionals may account for five continuing education hours.

Each licensee must get a certificate of completion from the continuing education provider for all hours successfully completed. The social worker must retain these certificates for a minimum of three years following the license renewal date for which the activity satisfies the continuing education requirement. The licensee must submit the certificate to DPH, upon request. A licensee failing to comply with the continuing education requirements may be subject to DPH disciplinary action including license revocation or suspension, censure, letter of reprimand, placement on probation, or a civil penalty.

The bill continues to recognize the professional educator certificate-related continuing education described above and applies it to both licensed clinical and master social workers.

A licensee applying for his or her first renewal is exempt from the continuing education requirements. DPH may grant a waiver from the requirements or an extension of time to a licensee who has a medical disability or illness. The licensee must apply for a waiver or time extension to DPH and submit any documentation the department requires. The waiver or extension cannot exceed one registration period. DPH may grant additional waivers or extensions if the initial reason for the waiver or extension continues beyond the waiver or extension period.

DPH may also grant a continuing education waiver to a licensee who is not engaged in social work during a given registration period, if the licensee submits a waiver request before the continuing education period expires. This must be done on a department form.

BACKGROUND

Licensed Clinical Social Workers

By law, licensed clinical social workers must (1) have a doctorate or master's degree from a social work program accredited by the Council on Social Work Education, or if educated outside of the United States or its territories, have completed an educational program deemed equivalent by the council; (2) have 3,000 hours post-master's social work experience, which must include at least 100 hours of work under professional supervision by a licensed clinical or certified independent social worker; and (3) pass the clinical level examination of the American Association of State Social Work Boards (the bill changes this to Association of Social Work Boards) or any other examination prescribed by DPH (CGS § 20-195n).

Clinical Social Work

The law defines “clinical social work” as the application, by people trained in social work, of established principles of psychosocial development, behavior, psychopathology, unconscious motivation, interpersonal relationships and environmental stress to the evaluation, assessment, diagnosis, and treatment of biopsychosocial dysfunction, disability and impairment, including mental, emotional, behavioral, developmental and addictive disorders, of individuals, couples, families or groups. Clinical social work includes, but is not limited to, counseling, psychotherapy, behavior modification, and mental health consultation (CGS § 20-195m(4)).

COMMITTEE ACTION

Public Health Committee

Joint Favorable Change of Reference

Appropriations Committee

Joint Favorable Substitute

¹ The fringe benefit costs for state employees are budgeted centrally in the Miscellaneous Accounts administered by the Comptroller on an actual cost basis. The following is provided for estimated costs associated with additional personnel. The estimated non-pension fringe benefit rate as a percentage of payroll is 25.43%. Fringe benefit costs for new positions do not initially include pension costs as the state's pension contribution is based upon the 6/30/08 actuarial valuation for the State Employees Retirement System (SERS) which certifies the contribution for FY 10 and FY 11. Therefore, new positions will not impact the state's pension contribution until FY 12 after the next scheduled certification on 6/30/2010.