Senate Bill (SB) 60, a bill creating a certified mental health assistant role with prescriptive authority, had a third hearing in the Senate Workforce and Higher Education Committee on May 31. The Ohio Academy of Family Physicians’ (OAFP) concern lies in the prescriptive authority assigned in the bill without defined educational requirements to satisfy certification. There are no similar programs from which to draw curriculum standards.
Written testimony was submitted on behalf of the OAFP for the consideration of the committee. The text of the testimony appears below:
Chairman Jerry Cirino, Vice Chair Michael Rulli, Ranking Member Catherine Ingram, and Members of the Ohio Senate Workforce and Higher Education Committee:
Thank you for the opportunity to provide opponent testimony against SB 60 on behalf of the OAFP.
The OAFP is a statewide professional association with 5,200 members, including practicing family physicians, family medicine residents, and medical students. Since 1948, the OAFP has represented the professional interests of Ohio family physicians, provided postgraduate medical education, and encouraged medical students to enter this field and to advance the patient-physician relationship. The mission of the OAFP is to improve the health of patients by advocating for and advancing the specialty of family medicine.
For over 75 years, our work has been guided by foundational values, including collaboration. We value and encourage a team-based care approach to provide comprehensive care delivery. Team-based care allows a licensed physician to lead care of patients supported by processes that empower non-physician staff to utilize their skills, training, and abilities to the full extent of their professional capacity. This approach allows for effective, efficient, and accessible evidence-based care for patients. We champion best practices and evidenced-based methods to provide outstanding patient care and we also consider the broad spectrum of interests impacting healthcare and work to collaborate effectively with peer organizations to enhance the quality of care for Ohioans.
Unfortunately, SB 60 provides a problematic framework for dealing with the mental health crisis facing our state. This bill would create a new allied practitioner with prescriptive authority; however, it does not set forth any educational requirements within the bill itself. While proponents for this legislation have mentioned it would require a masters level educational track, this is not actually included within the provisions of the bill. Ohio physicians are trained to exercise their professional, clinical judgement in order to assess and manage the medications prescribed to their patients, including analysis of risks on an individualized basis. Proponents on this bill have asserted that the proposed Certified Mental Health Assistant (CMHA) can merely follow clinical practice guidelines and algorithms when exercising the discretion this bill provides them to prescribe medications to patients suffering from mental health and substance abuse disorders.
Further, supporters of this bill have also characterized this proposed new practitioner as a physician extender; however, the program creates a duplicative licensure where this role can already be filled by a physician’s assistant or advanced practice registered nurse, licenses for which educational and other requirements have already been strenuously vetted. In light of these concerns, we question why Ohio would create a new licensure for this program that does not exist anywhere else in the country.
As family physicians, we see our patients, your neighbors, struggle with the effects of mental health disorders, and we understand the reasons why the bill would seem like a good idea on the surface. However, dig a little deeper and understand that to provide high quality mental healthcare, the physician must be able to understand a patient’s context and the interplay of family dynamics, social relationships, cultural background, and economics in the causation and presentation of any illness and the response to any given treatment. Simply creating another provider with prescriptive authority, whose education is not clearly defined, is not the solution you seek.
As family physicians, we must always consider what is in the best interest of patients. We thank the committee for its careful consideration of this bill and opportunity to present our concerns.
- Establishes licensure by the State Medical Board of Ohio (SMBO) for certified mental health assistants (CMHAs).
- Authorizes CMHAs to provide mental health care under the supervision, control, and direction of a physician with whom the CMHA has entered into a supervision agreement.
- Authorizes CMHAs to prescribe and personally furnish drugs and therapeutic devices in the exercise of physician-delegated prescriptive authority, including certain identified controlled substances.
- Requires the SMBO to establish a process by which a person that seeks to operate an education program for CMHAs can apply to the SMBO for approval and specifies minimum course subject areas that must be covered.
- Authorizes the SMBO to discipline CMHAs in a manner similar to that of other SBMO licensees.
The full bill text and analysis of SB 60 can be accessed on the Ohio legislature website.