April 15, 2025 • 24 mins
Ever wondered what happens behind the scenes at the agency that regulates Texas mental health professionals? Executive Director Darrel Spinks pulls back the curtain on the Texas Behavioral Health Executive Council (BHEC) - the unique regulatory body overseeing psychologists, counselors, marriage and family therapists, and social workers across the Lone Star State.
Formed through what Spinks calls "the grand bargain," BHEC operates unlike any other Texas regulatory agency. Created following back-to-back sunset reviews, this relatively new agency maintains a delicate balance between professional standards and public protection. While the professional board still exists, BHEC provides crucial oversight through its public-majority council, performing anti-competitive and good governance analyses that keep the system accountable.
For practitioners and aspiring professionals, understanding BHEC's structure isn't just academic - it directly impacts your career. Spinks shares eye-opening insights about common licensing pitfalls that trip up even the most prepared applicants. From failing to research requirements before starting education to the surprisingly common problem of losing access to critical records, these challenges can delay or derail careers. His practical advice? "Maintain your own record set. Don't rely on your schools, don't rely on your supervisors."
The conversation takes a particularly interesting turn when addressing license portability - a growing concern as workforce shortages plague the mental health professions nationwide. Despite Texas desperately needing qualified practitioners, statutory requirements create frustrating barriers for experienced out-of-state providers. Spinks highlights several legislative solutions currently under consideration that could transform how Texas welcomes mental health professionals from other states.
Whether you're already licensed, pursuing licensure, or simply interested in how mental health professions are regulated, this conversation provides invaluable insider perspective. Subscribe now and join us for part two, where we'll explore the enforcement process and how professionals can protect their licenses!
Get more information, details and resources on Know Your Regulator - https://www.belolaw.com/know-your-regulator
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem, contact
an attorney.
Welcome back to another episodeof Know your Regulator, the
podcast that inspires you toengage.
I am your host, simone Murphy,and co-hosting with me today is
(00:22):
Melissa Hooper.
Hey, melissa.
Speaker 2 (00:24):
Hey Simone, I'm super excited for this podcast.
Speaker 1 (00:28):
Me too.
We are diving into the TexasBehavioral Health Executive
Council, or often referred to asBHEC, which oversees licensing
and enforcement forpsychologists, social workers,
marriage and family therapistsand professional counselors.
Social workers, marriage andfamily therapists and
professional counselors and whobetter to help us break it all
down than Daryl Spinks, bhec'sExecutive Director?
(00:52):
Daryl, thanks for joining us.
Speaker 3 (00:54):
Well, thank you both for having me.
I appreciate it.
It's a pleasure to be here andpresent to you all today, and to
your audience.
Speaker 1 (01:01):
Thank you.
Thank you For those who may notbe familiar, bhec plays a key
role in licensing andenforcement for behavioral
health professionals in Texas.
We're going to talk about whatBHEC does, common licensing
issues and what happens if acomplaint is filed.
So let's get started.
Daryl, we'll start with thebasics.
(01:21):
Can you give us a quickoverview of BHEC and its purpose
?
Speaker 3 (01:25):
Sure, bhec is a relatively new agency in terms
of the state agencies that areout there.
There's probably close to 200state agencies in Texas, and we
are one of the newest, if notthe newest, state agency.
We are the product ofback-to-back sunset reviews,
which I don't know of any otheragency that can say that If you
don't know what sunset is, it's.
(01:46):
Every agency has a built-indeath clock in their enabling
legislation that says if thelegislature doesn't extend them
or continue them, theyautomatically go away by
operation of law.
So the psychology board, thecounseling board, marriage and
family therapy and social workboards were all subject to
sunset review in 2017.
Marriage and family therapy andsocial work boards were all
(02:07):
subject to sunset review in 2017.
Well, that review went on.
It went through the normalprocesses, but instead of
actually being continued, then,due to some procedural
maneuvering on the House floorone evening, our sunset bills
failed and so we actually had tocome back the next session, or
we actually had to be extendedin a special session that
Governor Abbott called, and thenthe next session, they actually
continued the agencies andcreated BHEC, and BHEC was
(02:31):
created really for very twosimple reasons.
One is to correct someadministrative inefficiencies
that were taking place for thoseboards that were housed at the
Health and Human ServicesCommission, hhsc, and that was
the LPC, marriage and FamilyTherapy and Social Work boards.
(02:51):
The psychology board, for whichI was the executive director at
the time, was a true standaloneagency.
It wasn't attached to any otheragency.
So BHEC was created to curethose inefficiencies at HHSC.
But it was also created to curea situation that had come down
from the US Supreme Court, thatsaid, state agencies whose
boards are made up of acontrolling number of market
participants must have activestate supervision.
(03:14):
I won't bore your listeners withwhat all that means because I
can wax on for hours about that.
That's my forte.
But basically what it means is,in order for us to maintain
sovereign immunity from federalantitrust law, we have to have
nonpartisan or nonparticipantsin the profession kind of
control the decision making onregulatory decisions.
(03:36):
And it keeps keeps you fromhaving kind of a thin blue line
mentality of the professionpolicing itself.
You've got outsiders actuallypolicing the profession and
that's what BHEC is designed todo.
It's a public majority council,so five out of the four council
members are actually members ofthe public and they help make
(03:56):
the decisions on how theseprofessions are regulated.
Speaker 2 (04:00):
That's awesome.
I appreciate you sharing someof that In addition to those
that you just mentioned.
How else would you say BHECdiffers from other Texas
regulatory agencies?
Speaker 3 (04:13):
Yeah, we're quite a bit different from most other
agencies.
I would say a lot of agenciesshare a lot of similarities in
the rulemaking process and kindof overall structure.
Rulemaking process and kind ofoverall structure you know you
have a governing board that'smade up of gubernatorial
appointees who are confirmed bythe Senate.
That's true with BHEC and allof its member boards.
But here's where we differ.
So BHEC is the umbrella agencyand all those four boards that
(04:36):
underwent Sunset Review that Italked about, they still exist
and they are still tasked withcertain key functions that I'll
go into here in just a littlebit.
But BHEC is actually the agencythat does the rulemaking.
It's the one that is actuallyresponsible for managing the
budget, the personnel, all theadministrative day-to-day stuff
that an agency has to do.
All of that is tasked orcharged to BHEC, not those
(05:00):
member boards anymore.
Now here's where BHEC reallydiffers Most other agencies.
That board also makes thedecisions about how to regulate
the profession.
Bhec does not in a similarmanner.
So let's just take, for example, psychology.
If psychologists wanted tochange the number of continuing
(05:24):
education hours that they arerequired to have on a per
renewal cycle, bhec could notjust on its own say, we don't
think 40 is enough, we think itneeds to be up to 60.
By statute, each of the member.
If you're going to propose achange in the rules or
regulations that govern aprofession, and those rules or
regs address scope of practice,standard of care, continuing
(05:46):
education, the schedule ofsanctions, those types of rule
changes have to take place firstat the member board level and
then, if the member boardapproves of them, then they go
on up to the council where thecouncil does an anti-competitive
analysis and the statutoryanalysis and what we call a good
governance analysis.
None of that takes place at anyagency other than BHEC.
(06:10):
We're the only one that doesthat kind of an analysis and
that's part of that active statesupervision.
So you've got the member boards,who are made up of controlling
number of market participants,and then you've got BHEC kind of
grading their homework, so tospeak.
So that's the big differencethere, bhec kind of grading
their homework, so to speak.
So that's the big differencethere.
Now BHEC does rulemaking foreverything else you know
(06:33):
licensing, process, enforcement.
They set up all the processes.
If you had a gripe about aprocess at BHEC, you would go to
the council If you have a gripeabout the licensing standards
or the schedule of sanctions,then you go to the member board
first and then, if they see fit,they float that idea or that
change up to the council.
That then kind of grades theirhomework.
So it almost works like anappellate court.
In that instance it's a very.
When you first see it it's notI would almost say it's not an
(06:57):
intuitive process, but it iswhat I call kind of the grand
bargain, which was a compromisestruck between the professions
and the Sunset AdvisoryCommission when BHEC was created
.
You know they had everybody.
There were problems, everybodyacknowledged they had to fix it.
But the boards didn't want togive up too much autonomy in
governing these professions.
(07:18):
So BHEC was the resultingcompromise.
Speaker 1 (07:21):
That is really, really interesting and I'm
really glad that you shared thatwith our viewers because, gosh,
I don't know how many people,even licensed professionals,
would know about that, and Ithink that's really an important
piece to know about how theirgoverning agency functions.
Sort of on that same you knowwavelength for these licensed
(07:44):
professionals that are governedby BHEC.
Why is it so important to befamiliar with the rules and the
processes?
Speaker 3 (07:52):
Well, you know all of the professions that we
regulate.
They are I know this soundsrepetitive, but they are
professions.
So our licensees are allprofessionals.
Now, being a professional, Imean unfortunately I don't know
how to say unfortunately orfortunately, I'm not sure what
the correct terminology is herebut if you're going to be a
professional, it's about morethan just knowing the substance
(08:16):
of what it is that you'repracticing.
So, for me, I'm an attorney.
So being a professional it'smore than just about knowing the
law, the rules of procedure,the rules of evidence.
I also need to know what theregulations are that govern me
as an attorney, what I can andcan't do in my client
relationships, my billingrelationships.
(08:36):
So it's actually it is criticalfor professionals under BHEC to
know not only the science, theevidence-based practices that
they need to use when deliveringmental and behavioral health
services to the, to theeverybody outside my windows
here, but it's also criticallyimportant that they know well
what are the rules governingthat, what can I, can and can't
I do in my relationships?
Can I hire a patient or aclient in a, in a side business
(09:00):
that I have, you know?
Can I have what's?
What's appropriate in terms oftexting, what's appropriate in
terms of billing arrangementsand how do I deal with insurance
and all of that.
So you have to know all that aspart of being a professional
and and I mean it's just one ofthose things that, whether you
like it or not, it's one ofthose things that you kind of
(09:22):
give up as a professional.
You're no longer free range ifyou will.
It's not the Wild West anymore.
If you're going to be aprofessional, there are going to
have to be codes of conduct andjust rules that you have to
follow.
That's what sets you apart frombeing an unregulated occupation
or field.
So that's why it's reallyimportant and it's really
important to understand that wedon't propose and adopt rules
(09:44):
just willy-nilly.
We're not out there just makingthe law.
You know, yeehaw, here we go,let's make a rule.
There's always a very goodreason for why we have done
something.
You may not agree with thereason, but I can assure you
there is a reason behindwhatever the law is that's
governing your conduct as aprofessional.
So it's critically importantthat you know it.
(10:05):
It's better if it's good, ifyou understand the rationale
behind it, but at a minimum, youjust need to know what the law
is so that you can follow it.
Speaker 2 (10:14):
Perfectly said.
Thank you, Now let's talk aboutlicensing.
Now let's talk about licensing.
We know professionals put a lotof work to get into the
professions, but sometimes theycan hit roadblocks.
Daryl, what would you say aresome of the common issues you
see with licensing applications?
Speaker 3 (10:34):
You know, I kind of anticipated this was going to
come up.
This question would come upbecause it comes up all the time
in when I'm givingpresentations around the state,
people always want to know aboutwhat are the problems in
licensing and what are theproblems?
Who do you see getting introuble?
That's always the sexy side ofit, but the big things on the
licensing side are some of theeasiest to cure and avoid, but
(10:58):
they're also some of the mostdifficult from our perspective
the regulator to implement acure or kind of impose a cure on
, and that is, know, read andunderstand the rules governing
licensing criteria and theprocess before you begin.
It would be nice if peoplelooked into this before they
ever started their degreeprogram so that they made sure
(11:21):
they were picking degreeprograms that actually produced
a degree and gave them thetraining and education that they
needed to get the licensure.
Unfortunately, that's notalways the case.
We have people that go, youknow, spend thousands of dollars
and go through the process onlyto find out that the degree
they were pitched and sold doesnot qualify for licensure.
You know who's to blame forthat?
(11:43):
I'm not going to point fingershere today, but there's
definitely a discussion thatneeds to be had on that at some
point, you know, probably at thecapital level, but that's
probably one of the big.
That is, the biggest thing wehave is people just simply not
reading and understanding whatthe rules are that govern
licensure.
This is the second thing is webuild this website, we put all
(12:07):
this information on it, we putFAQs, we put how-tos, we put
checklists, all these kind ofcheat sheet programs, cliff
notes on how to do this andpeople do not read it.
I know they don't read itbecause I can see the web
traffic that goes on this stuff.
So it's not like I'm justsaying they don't read it.
I know they don't read itbecause I can see the web
traffic that goes on this stuff.
So it's not like I'm justsaying they don't read it.
(12:29):
I can actually see that stuffought to be more heavily visited
than what it is.
So that part is a problem thatcauses those two things.
Right, there are the singlebiggest driver of problems on
the licensing side andunfortunately there's not much I
can do to make people read.
I can encourage it, butsometimes it falls on deaf ears.
I would say the third thing.
I've got four items identifiedhere.
(12:54):
The third thing is really,folks, slow down, pay attention
to what you're actually applyingfor.
I cannot tell you how manytimes we have to deal with folks
who have applied for the wronglicense altogether.
That's a little concerning whenyou're looking to enter into a
profession and you've appliedfor a counseling license but you
were really shooting for thesocial work field or whatever
the case may be.
People will take the wrong examand then wonder what happened
(13:19):
there and I'm like well, you'rean LPC, you're not a
psychologist.
You sat for the wrongjurisprudence exam.
Different set of lawsaltogether govern you.
So that is a problem.
And what's particularlyfrustrating for us at this level
is we build in a lot ofsafeties, safety checks and
valves and that you know thingsyou have to click through and
(13:40):
acknowledge before you actuallyjump into that.
So and you can tell when peopleare just clicking through
things to get through it and I'mlike no, stop and read.
I mean stop it and payattention to it.
And then the last thing that Iwould say is a big hang up on
folks is maintain your ownrecord set.
Don't rely on your schools,don't rely on your supervisors.
(14:01):
I cannot tell you the number oftimes I've had people go well,
the hospital burned down, andI'm like, oh, horse feathers,
that building can't be burningdown across this nation.
And it turns out they weretelling the truth.
I mean, there's just this rashof fires that happens every now
and then.
Fires, floods I haven't hadlocusts or any other biblical
plague descend on anybody yet,but just give it time and then
(14:24):
supervisors die.
You know, folks die, move on,you lose contact with them and,
despite the world we live in, itcan be very difficult to track
folks down, especially once theykind of retire and move off the
grid.
They're no longer active inwhatever the circles of where
you used to run originally.
So maintain your own records,keep copies of them, because at
(14:46):
a minimum maybe we can dosomething with that.
If we can't get what we call aprimary source copy of it, there
are still things we can do toget you in.
But we can't do much if we'renot just going to take your word
on if you say, well, I hadthose hours, but the hospital
burned down.
If we're not just going to takeyour word on if you say, well,
I had those hours, but thehospital burned down, okay, well
, I'm sorry.
That's going to be one of thoseinsurmountable obstacles there.
(15:07):
So that was a long-windedanswer to what you asked me, but
those are the four things thatI would say are probably the
biggest problems we see.
Speaker 1 (15:16):
I would think that I mean, man, that's such great
information.
You know, I would hope thatthese applicants are looking at
you know, making sure, like yousaid, they have their records or
get copies of your recordsright now.
You know, go ask for them, gorequest them, because that is
really good information and,like you said, it's all kind of
(15:37):
things that are easy fixes, ofthings that are easy fixes,
right or easy things to DoableExactly.
They're very doable, very easysolutions.
So, thanks, daryl, that'sreally good information for our
applicants and even our licenseholders who are already licensed
with BHEC, to know what aboutthose who are moving to Texas
(16:00):
from out of state?
Can you talk to us about BHAChandles license portability.
Speaker 3 (16:07):
Yes, portability has always been, apart from the
whole FTC.
You know the restraint of tradetype issue that we talked about
earlier.
Portability is kind of one ofmy very near and dear to my
heart.
Just because when you talk toreally any kind of regulator,
all the agencies that regulatethe health professions, and
(16:28):
state you'll see that there is aworkforce shortage in almost
every aspect of healthcare inTexas Doctors, nurses,
podiatrists, you know PTOT, Imean you name it, you just fill
in the blank for the healthcareprofession and there's going to
be a shortage.
The problem is is there's ashortage nationwide on all of
those, which means we just can'tmint enough of them.
(16:51):
And now, so you know, it'ssomething that we look at
constantly at BHEC.
We're trying to figure out.
Okay, if we can't mint enoughproviders in the state of Texas,
what can we do to ease theimportation of them?
Unfortunately, and that soundsvery easy to do.
It just sounds like well, justmake it so that you can
(17:12):
recognize out-of-state licensure.
That way you're not having torun people through the ringer a
second time when Virginia hasalready done it.
Why can't we just rely on whatVirginia has done?
Unfortunately, it doesn't workthat way, excuse me.
Work that way.
Excuse me, little thing calledfederalism means that every
state gets to determine its ownlicensing criteria and what it
(17:33):
what it wants to do in terms ofallowing people to practice
whatever the profession is inthe state.
So one of the things that we wetry to do is we recognize we
take a lot of steps to recognizeout of state supervised
experience.
But we can't just give you alicense based off of an existing
license you have in anotherstate and that's because of
(17:54):
certain statutory requirements.
I'll give you an example.
We have a lot of people come toTexas who want to be LPCs.
Texas has probably one of themore stringent LPC licensing
requirements in the country inthat we require 3,000 hours of
supervised experience.
A lot of states only require2,000 hours.
So we have individuals come herewho have 20 plus years of
(18:16):
experience practicingprofessional counseling in
another state, maybe even serveas a supervisor training new
counselors in that state, andwhen they get here I tell them
you can't have a license, youdon't have enough supervised
experience.
I'm like you got to go backunder supervision and acquire
1000 more additional hours ofsupervised experience and
they're like but I've been acounselor, I'm a known quantity
(18:37):
in my home state and I agree,I'm like, I agree this is a
stupid problem to have, but it'sa problem nevertheless and it's
one that, unfortunately, as theagency, we can't do anything
about it because that's astatutory component.
And you will find that inmarriage and family therapy,
counseling not so much socialwork but to some degree
(18:59):
psychology we get hung up by alot of statutory requirements
that we simply can't waive, andso that really prevents us from
just recognizing or handingsomebody a license based off of
their out-of-state license thatthey have.
The military folks are a littledifferent because the
legislature, there's someuniform laws that get passed by
(19:21):
all the states that deal withthem.
But just for the generalpopulation, the non-military
civilian population, it'sdifficult, it's frustrating for
both applicants and for those ofthe agency because, like I say,
they can apply with me.
I know they're not going to bea problem.
I have zero concerns based offthe fact that they're a 10, 15
year veteran in their home statewith no disciplinary history.
(19:43):
I'm like common sense tells youthis is going to be fine.
Speaker 1 (19:48):
Right.
Speaker 3 (19:48):
We can't do anything about it because there's a
statutory component there.
Fine, we can't do anythingabout it because there's a
statutory component there.
Speaker 1 (19:54):
That's really good information to know.
And just a question that I'dlike to add in how do you see
that being resolved, or do youeven see that problem being?
You know, you yourself see itactually playing out to
resolution?
Speaker 3 (20:16):
You know, as you're talking about this right now,
Simone, there are three, fourbills pending over the
legislature right now.
That would address a lot ofthis.
Senator Sparks has two bills,one and I like both of them.
As an agency I'm prohibitedfrom lobbying, but I can
certainly talk up the benefitsof them and say how easy they
would make my life as aregulator.
It would be very easy to bringpeople into the work, put boots
(20:36):
on the ground.
I mean, that's what you'retalking about is how fast can I
get boots on the ground toaddress the mental and
behavioral health needs of thestate?
So Senator Sparks has severalbills that are pending right now
.
One is a telehealth registry law, whereas if you just want to
practice telehealth in the state, it's very simple.
It's modeled after Florida's.
It's just a simple registration, low fee, low cost to maintain
(21:04):
it, but it's telehealth only.
And then he also has somethingFlorida calls it the mobility
endorsement law, which I'm notsure how Senator Springer refers
to it, but it's modeled afterFlorida as well, and instead of
just getting telehealth kind ofa limited telehealth license,
you get a full license based offof your out-of-state license
elsewhere.
And it's very quick.
It's almost like hey, werecognize you're coming from
(21:25):
another state.
That's kind of similar to us.
We're just going to go and giveyou a Texas license.
That kind of stuff would make itvery quick.
It's a very quick, efficientway to address workforce needs.
The problem is, as both of youprobably know and as a lot of
your audience may know, is thelegislative process is not
(21:45):
designed to push a lot of billsthrough.
It is designed to.
It's designed so that only thestrong survive through.
It is designed to it's designedto so that only the strong
survive.
Only the really good ideas andthe ones that are, you know,
almost immediately or manifestlyneeded by the state make it
through.
So I what I can't do is predictfor any of you you know what the
future of those bills are but,there are several bills like
(22:08):
that that are pending and thattype of stuff has picked up a
lot of momentum in recent yearsbecause I think the workforce
shortage as it becomes more andmore in the forefront of
legislators' thoughts, they'restarting to look at more
solutions.
Plus, when you have states likeFlorida and Arizona who have
already pioneered these thingsand you actually have a working
model one of these islegislature.
(22:29):
I think you're sometimes scaredto do something because you're
like well, this has never beendone before.
I'm not sure I want to be thetest case on it.
Well, here you've already gotseveral states, big states, that
have done it and it's like OK,there were no hiccups, no
problems, a parade of horriblesdidn't happen.
So we've got a working model wecan look at.
So hopefully we'll seesomething there.
Speaker 1 (22:51):
Yeah, yeah, and kind of going back to you know why is
it crucial to to be aware ofwhat's going on with your
regulatory agency?
I mean, this is kind of case inpoint right there.
When you've got some, you knowlegislative action being taking
place, you can make your voiceheard as a license holder and
you know talk about how thatwould affect you and your
(23:15):
profession.
So really great, that's justgood information to know, mr
Spinks.
Thank you Awesome.
Well, thank you again, daryl,for joining us today and walking
us through how BHEC operatesand giving us a better
understanding of the licensingprocess.
This is exactly why it'simportant to stay engaged with
(23:36):
your regulatory agency.
You want to know, you knowwhat's happening with your
license, what's happening withthose laws and rules that can
affect your career as well.
Now we are not done yet.
In part two of thisconversation we're going to dive
into the enforcement side ofthings what happens when a
complaint is filed, howinvestigations work and how you
(23:57):
can protect your license.
So make sure you are subscribedand following.
Know your Regulator, and wewill see you in part two.
Know your Regulator the podcastthat inspires you to engage.
This podcast is for educational purposes only, does
not constitute legal advice anddoes not create an
attorney-client relationship.
If you need legal assistanceabout a legal problem, contact
an attorney.
Welcome back to another episodeof Know your Regulator, the
podcast that inspires you toengage.
I am your host, simone Murphy,and co-hosting with me today is
(00:22):
Melissa Hooper.
Hey, melissa.
Speaker 2 (00:24):
Hey Simone, I'm super excited for this podcast.
Speaker 1 (00:28):
Me too.
We are diving into the TexasBehavioral Health Executive
Council, or often referred to asBHEC, which oversees licensing
and enforcement forpsychologists, social workers,
marriage and family therapistsand professional counselors.
Social workers, marriage andfamily therapists and
professional counselors and whobetter to help us break it all
down than Daryl Spinks, bhec'sExecutive Director?
(00:52):
Daryl, thanks for joining us.
Speaker 3 (00:54):
Well, thank you both for having me.
I appreciate it.
It's a pleasure to be here andpresent to you all today, and to
your audience.
Speaker 1 (01:01):
Thank you.
Thank you For those who may notbe familiar, bhec plays a key
role in licensing andenforcement for behavioral
health professionals in Texas.
We're going to talk about whatBHEC does, common licensing
issues and what happens if acomplaint is filed.
So let's get started.
Daryl, we'll start with thebasics.
(01:21):
Can you give us a quickoverview of BHEC and its purpose
?
Speaker 3 (01:25):
Sure, bhec is a relatively new agency in terms
of the state agencies that areout there.
There's probably close to 200state agencies in Texas, and we
are one of the newest, if notthe newest, state agency.
We are the product ofback-to-back sunset reviews,
which I don't know of any otheragency that can say that If you
don't know what sunset is, it's.
(01:46):
Every agency has a built-indeath clock in their enabling
legislation that says if thelegislature doesn't extend them
or continue them, theyautomatically go away by
operation of law.
So the psychology board, thecounseling board, marriage and
family therapy and social workboards were all subject to
sunset review in 2017.
Marriage and family therapy andsocial work boards were all
(02:07):
subject to sunset review in 2017.
Well, that review went on.
It went through the normalprocesses, but instead of
actually being continued, then,due to some procedural
maneuvering on the House floorone evening, our sunset bills
failed and so we actually had tocome back the next session, or
we actually had to be extendedin a special session that
Governor Abbott called, and thenthe next session, they actually
continued the agencies andcreated BHEC, and BHEC was
(02:31):
created really for very twosimple reasons.
One is to correct someadministrative inefficiencies
that were taking place for thoseboards that were housed at the
Health and Human ServicesCommission, hhsc, and that was
the LPC, marriage and FamilyTherapy and Social Work boards.
(02:51):
The psychology board, for whichI was the executive director at
the time, was a true standaloneagency.
It wasn't attached to any otheragency.
So BHEC was created to curethose inefficiencies at HHSC.
But it was also created to curea situation that had come down
from the US Supreme Court, thatsaid, state agencies whose
boards are made up of acontrolling number of market
participants must have activestate supervision.
(03:14):
I won't bore your listeners withwhat all that means because I
can wax on for hours about that.
That's my forte.
But basically what it means is,in order for us to maintain
sovereign immunity from federalantitrust law, we have to have
nonpartisan or nonparticipantsin the profession kind of
control the decision making onregulatory decisions.
(03:36):
And it keeps keeps you fromhaving kind of a thin blue line
mentality of the professionpolicing itself.
You've got outsiders actuallypolicing the profession and
that's what BHEC is designed todo.
It's a public majority council,so five out of the four council
members are actually members ofthe public and they help make
(03:56):
the decisions on how theseprofessions are regulated.
Speaker 2 (04:00):
That's awesome.
I appreciate you sharing someof that In addition to those
that you just mentioned.
How else would you say BHECdiffers from other Texas
regulatory agencies?
Speaker 3 (04:13):
Yeah, we're quite a bit different from most other
agencies.
I would say a lot of agenciesshare a lot of similarities in
the rulemaking process and kindof overall structure.
Rulemaking process and kind ofoverall structure you know you
have a governing board that'smade up of gubernatorial
appointees who are confirmed bythe Senate.
That's true with BHEC and allof its member boards.
But here's where we differ.
So BHEC is the umbrella agencyand all those four boards that
(04:36):
underwent Sunset Review that Italked about, they still exist
and they are still tasked withcertain key functions that I'll
go into here in just a littlebit.
But BHEC is actually the agencythat does the rulemaking.
It's the one that is actuallyresponsible for managing the
budget, the personnel, all theadministrative day-to-day stuff
that an agency has to do.
All of that is tasked orcharged to BHEC, not those
(05:00):
member boards anymore.
Now here's where BHEC reallydiffers Most other agencies.
That board also makes thedecisions about how to regulate
the profession.
Bhec does not in a similarmanner.
So let's just take, for example, psychology.
If psychologists wanted tochange the number of continuing
(05:24):
education hours that they arerequired to have on a per
renewal cycle, bhec could notjust on its own say, we don't
think 40 is enough, we think itneeds to be up to 60.
By statute, each of the member.
If you're going to propose achange in the rules or
regulations that govern aprofession, and those rules or
regs address scope of practice,standard of care, continuing
(05:46):
education, the schedule ofsanctions, those types of rule
changes have to take place firstat the member board level and
then, if the member boardapproves of them, then they go
on up to the council where thecouncil does an anti-competitive
analysis and the statutoryanalysis and what we call a good
governance analysis.
None of that takes place at anyagency other than BHEC.
(06:10):
We're the only one that doesthat kind of an analysis and
that's part of that active statesupervision.
So you've got the member boards,who are made up of controlling
number of market participants,and then you've got BHEC kind of
grading their homework, so tospeak.
So that's the big differencethere, bhec kind of grading
their homework, so to speak.
So that's the big differencethere.
Now BHEC does rulemaking foreverything else you know
(06:33):
licensing, process, enforcement.
They set up all the processes.
If you had a gripe about aprocess at BHEC, you would go to
the council If you have a gripeabout the licensing standards
or the schedule of sanctions,then you go to the member board
first and then, if they see fit,they float that idea or that
change up to the council.
That then kind of grades theirhomework.
So it almost works like anappellate court.
In that instance it's a very.
When you first see it it's notI would almost say it's not an
(06:57):
intuitive process, but it iswhat I call kind of the grand
bargain, which was a compromisestruck between the professions
and the Sunset AdvisoryCommission when BHEC was created
.
You know they had everybody.
There were problems, everybodyacknowledged they had to fix it.
But the boards didn't want togive up too much autonomy in
governing these professions.
(07:18):
So BHEC was the resultingcompromise.
Speaker 1 (07:21):
That is really, really interesting and I'm
really glad that you shared thatwith our viewers because, gosh,
I don't know how many people,even licensed professionals,
would know about that, and Ithink that's really an important
piece to know about how theirgoverning agency functions.
Sort of on that same you knowwavelength for these licensed
(07:44):
professionals that are governedby BHEC.
Why is it so important to befamiliar with the rules and the
processes?
Speaker 3 (07:52):
Well, you know all of the professions that we
regulate.
They are I know this soundsrepetitive, but they are
professions.
So our licensees are allprofessionals.
Now, being a professional, Imean unfortunately I don't know
how to say unfortunately orfortunately, I'm not sure what
the correct terminology is herebut if you're going to be a
professional, it's about morethan just knowing the substance
(08:16):
of what it is that you'repracticing.
So, for me, I'm an attorney.
So being a professional it'smore than just about knowing the
law, the rules of procedure,the rules of evidence.
I also need to know what theregulations are that govern me
as an attorney, what I can andcan't do in my client
relationships, my billingrelationships.
(08:36):
So it's actually it is criticalfor professionals under BHEC to
know not only the science, theevidence-based practices that
they need to use when deliveringmental and behavioral health
services to the, to theeverybody outside my windows
here, but it's also criticallyimportant that they know well
what are the rules governingthat, what can I, can and can't
I do in my relationships?
Can I hire a patient or aclient in a, in a side business
(09:00):
that I have, you know?
Can I have what's?
What's appropriate in terms oftexting, what's appropriate in
terms of billing arrangementsand how do I deal with insurance
and all of that.
So you have to know all that aspart of being a professional
and and I mean it's just one ofthose things that, whether you
like it or not, it's one ofthose things that you kind of
(09:22):
give up as a professional.
You're no longer free range ifyou will.
It's not the Wild West anymore.
If you're going to be aprofessional, there are going to
have to be codes of conduct andjust rules that you have to
follow.
That's what sets you apart frombeing an unregulated occupation
or field.
So that's why it's reallyimportant and it's really
important to understand that wedon't propose and adopt rules
(09:44):
just willy-nilly.
We're not out there just makingthe law.
You know, yeehaw, here we go,let's make a rule.
There's always a very goodreason for why we have done
something.
You may not agree with thereason, but I can assure you
there is a reason behindwhatever the law is that's
governing your conduct as aprofessional.
So it's critically importantthat you know it.
(10:05):
It's better if it's good, ifyou understand the rationale
behind it, but at a minimum, youjust need to know what the law
is so that you can follow it.
Speaker 2 (10:14):
Perfectly said.
Thank you, Now let's talk aboutlicensing.
Now let's talk about licensing.
We know professionals put a lotof work to get into the
professions, but sometimes theycan hit roadblocks.
Daryl, what would you say aresome of the common issues you
see with licensing applications?
Speaker 3 (10:34):
You know, I kind of anticipated this was going to
come up.
This question would come upbecause it comes up all the time
in when I'm givingpresentations around the state,
people always want to know aboutwhat are the problems in
licensing and what are theproblems?
Who do you see getting introuble?
That's always the sexy side ofit, but the big things on the
licensing side are some of theeasiest to cure and avoid, but
(10:58):
they're also some of the mostdifficult from our perspective
the regulator to implement acure or kind of impose a cure on
, and that is, know, read andunderstand the rules governing
licensing criteria and theprocess before you begin.
It would be nice if peoplelooked into this before they
ever started their degreeprogram so that they made sure
(11:21):
they were picking degreeprograms that actually produced
a degree and gave them thetraining and education that they
needed to get the licensure.
Unfortunately, that's notalways the case.
We have people that go, youknow, spend thousands of dollars
and go through the process onlyto find out that the degree
they were pitched and sold doesnot qualify for licensure.
You know who's to blame forthat?
(11:43):
I'm not going to point fingershere today, but there's
definitely a discussion thatneeds to be had on that at some
point, you know, probably at thecapital level, but that's
probably one of the big.
That is, the biggest thing wehave is people just simply not
reading and understanding whatthe rules are that govern
licensure.
This is the second thing is webuild this website, we put all
(12:07):
this information on it, we putFAQs, we put how-tos, we put
checklists, all these kind ofcheat sheet programs, cliff
notes on how to do this andpeople do not read it.
I know they don't read itbecause I can see the web
traffic that goes on this stuff.
So it's not like I'm justsaying they don't read it.
I know they don't read itbecause I can see the web
traffic that goes on this stuff.
So it's not like I'm justsaying they don't read it.
(12:29):
I can actually see that stuffought to be more heavily visited
than what it is.
So that part is a problem thatcauses those two things.
Right, there are the singlebiggest driver of problems on
the licensing side andunfortunately there's not much I
can do to make people read.
I can encourage it, butsometimes it falls on deaf ears.
I would say the third thing.
I've got four items identifiedhere.
(12:54):
The third thing is really,folks, slow down, pay attention
to what you're actually applyingfor.
I cannot tell you how manytimes we have to deal with folks
who have applied for the wronglicense altogether.
That's a little concerning whenyou're looking to enter into a
profession and you've appliedfor a counseling license but you
were really shooting for thesocial work field or whatever
the case may be.
People will take the wrong examand then wonder what happened
(13:19):
there and I'm like well, you'rean LPC, you're not a
psychologist.
You sat for the wrongjurisprudence exam.
Different set of lawsaltogether govern you.
So that is a problem.
And what's particularlyfrustrating for us at this level
is we build in a lot ofsafeties, safety checks and
valves and that you know thingsyou have to click through and
(13:40):
acknowledge before you actuallyjump into that.
So and you can tell when peopleare just clicking through
things to get through it and I'mlike no, stop and read.
I mean stop it and payattention to it.
And then the last thing that Iwould say is a big hang up on
folks is maintain your ownrecord set.
Don't rely on your schools,don't rely on your supervisors.
(14:01):
I cannot tell you the number oftimes I've had people go well,
the hospital burned down, andI'm like, oh, horse feathers,
that building can't be burningdown across this nation.
And it turns out they weretelling the truth.
I mean, there's just this rashof fires that happens every now
and then.
Fires, floods I haven't hadlocusts or any other biblical
plague descend on anybody yet,but just give it time and then
(14:24):
supervisors die.
You know, folks die, move on,you lose contact with them and,
despite the world we live in, itcan be very difficult to track
folks down, especially once theykind of retire and move off the
grid.
They're no longer active inwhatever the circles of where
you used to run originally.
So maintain your own records,keep copies of them, because at
(14:46):
a minimum maybe we can dosomething with that.
If we can't get what we call aprimary source copy of it, there
are still things we can do toget you in.
But we can't do much if we'renot just going to take your word
on if you say, well, I hadthose hours, but the hospital
burned down.
If we're not just going to takeyour word on if you say, well,
I had those hours, but thehospital burned down, okay, well
, I'm sorry.
That's going to be one of thoseinsurmountable obstacles there.
(15:07):
So that was a long-windedanswer to what you asked me, but
those are the four things thatI would say are probably the
biggest problems we see.
Speaker 1 (15:16):
I would think that I mean, man, that's such great
information.
You know, I would hope thatthese applicants are looking at
you know, making sure, like yousaid, they have their records or
get copies of your recordsright now.
You know, go ask for them, gorequest them, because that is
really good information and,like you said, it's all kind of
(15:37):
things that are easy fixes, ofthings that are easy fixes,
right or easy things to DoableExactly.
They're very doable, very easysolutions.
So, thanks, daryl, that'sreally good information for our
applicants and even our licenseholders who are already licensed
with BHEC, to know what aboutthose who are moving to Texas
(16:00):
from out of state?
Can you talk to us about BHAChandles license portability.
Speaker 3 (16:07):
Yes, portability has always been, apart from the
whole FTC.
You know the restraint of tradetype issue that we talked about
earlier.
Portability is kind of one ofmy very near and dear to my
heart.
Just because when you talk toreally any kind of regulator,
all the agencies that regulatethe health professions, and
(16:28):
state you'll see that there is aworkforce shortage in almost
every aspect of healthcare inTexas Doctors, nurses,
podiatrists, you know PTOT, Imean you name it, you just fill
in the blank for the healthcareprofession and there's going to
be a shortage.
The problem is is there's ashortage nationwide on all of
those, which means we just can'tmint enough of them.
(16:51):
And now, so you know, it'ssomething that we look at
constantly at BHEC.
We're trying to figure out.
Okay, if we can't mint enoughproviders in the state of Texas,
what can we do to ease theimportation of them?
Unfortunately, and that soundsvery easy to do.
It just sounds like well, justmake it so that you can
(17:12):
recognize out-of-state licensure.
That way you're not having torun people through the ringer a
second time when Virginia hasalready done it.
Why can't we just rely on whatVirginia has done?
Unfortunately, it doesn't workthat way, excuse me.
Work that way.
Excuse me, little thing calledfederalism means that every
state gets to determine its ownlicensing criteria and what it
(17:33):
what it wants to do in terms ofallowing people to practice
whatever the profession is inthe state.
So one of the things that we wetry to do is we recognize we
take a lot of steps to recognizeout of state supervised
experience.
But we can't just give you alicense based off of an existing
license you have in anotherstate and that's because of
(17:54):
certain statutory requirements.
I'll give you an example.
We have a lot of people come toTexas who want to be LPCs.
Texas has probably one of themore stringent LPC licensing
requirements in the country inthat we require 3,000 hours of
supervised experience.
A lot of states only require2,000 hours.
So we have individuals come herewho have 20 plus years of
(18:16):
experience practicingprofessional counseling in
another state, maybe even serveas a supervisor training new
counselors in that state, andwhen they get here I tell them
you can't have a license, youdon't have enough supervised
experience.
I'm like you got to go backunder supervision and acquire
1000 more additional hours ofsupervised experience and
they're like but I've been acounselor, I'm a known quantity
(18:37):
in my home state and I agree,I'm like, I agree this is a
stupid problem to have, but it'sa problem nevertheless and it's
one that, unfortunately, as theagency, we can't do anything
about it because that's astatutory component.
And you will find that inmarriage and family therapy,
counseling not so much socialwork but to some degree
(18:59):
psychology we get hung up by alot of statutory requirements
that we simply can't waive, andso that really prevents us from
just recognizing or handingsomebody a license based off of
their out-of-state license thatthey have.
The military folks are a littledifferent because the
legislature, there's someuniform laws that get passed by
(19:21):
all the states that deal withthem.
But just for the generalpopulation, the non-military
civilian population, it'sdifficult, it's frustrating for
both applicants and for those ofthe agency because, like I say,
they can apply with me.
I know they're not going to bea problem.
I have zero concerns based offthe fact that they're a 10, 15
year veteran in their home statewith no disciplinary history.
(19:43):
I'm like common sense tells youthis is going to be fine.
Speaker 1 (19:48):
Right.
Speaker 3 (19:48):
We can't do anything about it because there's a
statutory component there.
Fine, we can't do anythingabout it because there's a
statutory component there.
Speaker 1 (19:54):
That's really good information to know.
And just a question that I'dlike to add in how do you see
that being resolved, or do youeven see that problem being?
You know, you yourself see itactually playing out to
resolution?
Speaker 3 (20:16):
You know, as you're talking about this right now,
Simone, there are three, fourbills pending over the
legislature right now.
That would address a lot ofthis.
Senator Sparks has two bills,one and I like both of them.
As an agency I'm prohibitedfrom lobbying, but I can
certainly talk up the benefitsof them and say how easy they
would make my life as aregulator.
It would be very easy to bringpeople into the work, put boots
(20:36):
on the ground.
I mean, that's what you'retalking about is how fast can I
get boots on the ground toaddress the mental and
behavioral health needs of thestate?
So Senator Sparks has severalbills that are pending right now
.
One is a telehealth registry law, whereas if you just want to
practice telehealth in the state, it's very simple.
It's modeled after Florida's.
It's just a simple registration, low fee, low cost to maintain
(21:04):
it, but it's telehealth only.
And then he also has somethingFlorida calls it the mobility
endorsement law, which I'm notsure how Senator Springer refers
to it, but it's modeled afterFlorida as well, and instead of
just getting telehealth kind ofa limited telehealth license,
you get a full license based offof your out-of-state license
elsewhere.
And it's very quick.
It's almost like hey, werecognize you're coming from
(21:25):
another state.
That's kind of similar to us.
We're just going to go and giveyou a Texas license.
That kind of stuff would make itvery quick.
It's a very quick, efficientway to address workforce needs.
The problem is, as both of youprobably know and as a lot of
your audience may know, is thelegislative process is not
(21:45):
designed to push a lot of billsthrough.
It is designed to.
It's designed so that only thestrong survive through.
It is designed to it's designedto so that only the strong
survive.
Only the really good ideas andthe ones that are, you know,
almost immediately or manifestlyneeded by the state make it
through.
So I what I can't do is predictfor any of you you know what the
future of those bills are but,there are several bills like
(22:08):
that that are pending and thattype of stuff has picked up a
lot of momentum in recent yearsbecause I think the workforce
shortage as it becomes more andmore in the forefront of
legislators' thoughts, they'restarting to look at more
solutions.
Plus, when you have states likeFlorida and Arizona who have
already pioneered these thingsand you actually have a working
model one of these islegislature.
(22:29):
I think you're sometimes scaredto do something because you're
like well, this has never beendone before.
I'm not sure I want to be thetest case on it.
Well, here you've already gotseveral states, big states, that
have done it and it's like OK,there were no hiccups, no
problems, a parade of horriblesdidn't happen.
So we've got a working model wecan look at.
So hopefully we'll seesomething there.
Speaker 1 (22:51):
Yeah, yeah, and kind of going back to you know why is
it crucial to to be aware ofwhat's going on with your
regulatory agency?
I mean, this is kind of case inpoint right there.
When you've got some, you knowlegislative action being taking
place, you can make your voiceheard as a license holder and
you know talk about how thatwould affect you and your
(23:15):
profession.
So really great, that's justgood information to know, mr
Spinks.
Thank you Awesome.
Well, thank you again, daryl,for joining us today and walking
us through how BHEC operatesand giving us a better
understanding of the licensingprocess.
This is exactly why it'simportant to stay engaged with
(23:36):
your regulatory agency.
You want to know, you knowwhat's happening with your
license, what's happening withthose laws and rules that can
affect your career as well.
Now we are not done yet.
In part two of thisconversation we're going to dive
into the enforcement side ofthings what happens when a
complaint is filed, howinvestigations work and how you
(23:57):
can protect your license.
So make sure you are subscribedand following.
Know your Regulator, and wewill see you in part two.
Know your Regulator the podcastthat inspires you to engage.
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