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News & Press: Health Care

NASW-Michigan Submits Comments About Harmful SUD Rule Changes

Tuesday, October 16, 2018   (0 Comments)
Posted by: Allan Wachendorfer
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October 16, 2018


Department of Licensing and Regulatory Affairs

Bureau of Community and Health Systems

P.O. Box 30664

Lansing, MI 48909

Attention: Tammy Bagby

 

Dear Ms. Bagby:

 

On behalf of the National Association of Social Workers – Michigan and the nearly 27,000 social workers in the state of Michigan, thank you for the opportunity to submit formal input regarding the proposed changes to the Substance Use Disorder (SUD) Services Program Licensing Rules dated September 13, 2018 (Proposed Rules).

 

We commend the Department of Licensing and Regulatory Affairs (LARA) for creating a proposed set of rules that brings Michigan SUD licensing requirements closer to current standards and intends to increase access to services. However, some of the proposed changes will cause significant unintended harm by reducing access to services; a particularly troublesome prospect during a full-blown opioid addiction epidemic.

 

We urge the Department to take more time to address our concerns and those of the treatment community before proceeding in a manner that would in any way jeopardize access to services. We believe these adverse consequences can be avoided with a few modifications to the proposed rules (in order of appearance):

 

1)       Expand definition of “certified counselor” to include individuals working under a “development plan” issued by an organization approved and recognized by LARA

 

·       It is critical that individuals working under a development plan be included in the list of permissible providers. A “development plan” is similar to “limited licensure” in the sense that the individual is supervised by a fully certified or licensed supervisor, is gaining the experience required to become fully certified, and provides services in a manner consistent with those who have already obtained certification.

 

·       This rule would make future Certified Alcohol and Drug Counselors (CADCs) obsolete because an individual cannot work toward obtaining full certification without providing SUD services in the field under a development plan. Additionally, under the proposed rule, any future Certified Advanced Alcohol and Drug Counselors (CAADCs) would be required to not only obtain a master’s degree in counseling or social work (as currently required), they would have to become fully licensed LMSW (requires 4,000 hours as a LLMSW) or LPC before working the 2,000 hours required to earn the CAADC.

 

·       If providers cannot utilize counselors operating under development plans to provide services that count towards staffing ratios, providers will likely not hire them. SUD providers in Michigan, both in urban and rural areas, already struggle with recruitment and retention. Development plans act as a career ladder into the profession of addiction treatment (see attached). Many go on to earn master’s degrees in social work or other behavioral health-related fields after or while earning their certification in addiction counseling. If these qualified individuals are ineligible to provide services, we are concerned that Michigan will face a major workforce shortage at a time when we need more individuals available to provide SUD treatment services.

 

Suggested change:

Page 55 - R.325.1301(e) “Certified counselor” is defined as an individual engaged in counseling of recipients in a substance use disorder services program who is either (a) certified as an alcohol and drug counselor by an organization approved and recognized by the department or (b) working as an alcohol and drug counselor under a development plan issued by an organization approved and recognized by the department.

 

2)       Include Limited License Master of Social Work (LLMSW) in definition of Licensed Master of Social Work

 

·       To become a Licensed Master of Social Work (LMSW) an individual must obtain a Master of Social Work degree from a Council on Social Work Education (CSWE) accredited university, apply and be approved for a limited license (LLMSW) from LARA which requires a background check and fingerprinting, work for 4,000 hours under the supervision of an LMSW for 100 hours, and pass a licensing exam.

·       LLMSWs provide services in a manner consistent with that of an LMSW while gaining the experience required to become fully licensed. If providers cannot utilize LLMSWs to provide services that count towards staffing ratios, providers will likely not hire them. If providers do not hire them, they will not be able to obtain the hours required to become fully licensed, cutting out another step of the career ladder similar to that mentioned in the previous section.

·       If these qualified individuals are ineligible to provide services, we are concerned that Michigan will face a major workforce shortage at a time when we need more individuals available to provide SUD treatment services.

 

Suggested change:

Page 56 - R.325.1301 (p) “Licensed master’s social worker” or “LMSW” or “Limited licensed master’s social worker” or (LLMSW) means an individual engaged in counseling of recipients in a substance use disorder services program who is licensed under part 185 of the public health code.

 

3)       Eliminate the 9-month requirement in proposed rule R325.1349(3) for counselors to obtain licensure or certification upon the effective date of these rules.

 

·       Nine months is not feasible for individuals to obtain licensure or certification. Social work licensure requires a minimum of 2 years (4,000 hours) and can last up to 7 years under statute. The department approved certification process through the Michigan Certification Board for Addiction Professionals allows individuals up to three years to work under an approved development plan prior to obtaining full certification.

 

Suggested change: eliminate proposed rule R325.1349 (3)

 

4)       Eliminate the requirement to have medical staff onsite 24 hours per day

 

·       For decades, withdrawal management (more appropriate term than “detoxification”) has been completed successfully and safely without nonstop onsite medical staff. These medical staff are on call and available 24 hours a day. Again, we cannot afford to lose any more treatment providers, especially in the midst of an opioid crisis. This is an expensive, difficult, and unnecessary requirement that will force many providers to close their doors.

 

Suggested changes:

Page 75 - R 325.1383 (7) A licensee shall have a physician, physician’s assistant, advanced practice registered nurse, or registered professional nurse available onsite during all hours that recipients are receiving medication.

 

Page 78 Rule 325.1387 (4) A licensee shall have onsite available during all hours of operation a physician, physician’s assistant, advanced practice registered nurse, or registered professional nurse.

 

5)       Miscellaneous Concerns

 

·       It is unclear what is meant by “equivalent” on Page 78 - Rule 325.1387 and Page 79 R 325.1389 1) An applicant or licensee shall employ the equivalent of a full-time licensed counselor or LMSW. Please clarify.

·       Multiple regulations around medication, staffing, and internal processes require more thoughtful cost analysis to ensure treatment providers can comply in a timely manner without excessive cost burden that will force them to close their doors.

 

Again, we commend the LARA for creating a proposed set of rules that brings Michigan SUD licensing requirements closer to current standards and intends to increase access to services. However, some of the proposed changes will cause significant unintended harm by reducing access to services; a particularly troublesome prospect during a full-blown opioid addiction epidemic. We urge the Department to slow down and take the time to address our concerns and those of the treatment community before proceeding in a manner that would in any way jeopardize access to services.

 

I would appreciate the opportunity to discuss our concerns in person. Please reach out to me at your earliest convenience at policy@nasw-michigan.org or 517.487.1548 ex. 11. I appreciate your time in the critical matter.

 

Sincerely,

 

Allan Wachendorfer, LMSW-Macro

Director of Public Policy

National Association of Social Workers – Michigan Chapter

517-487-1548 ex. 11

awachendorfer.naswmi@socialworkers.org

www.nasw-michigan.org

 

 

 

 

 

 

 

 

 

 

 

 

 

 


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