BILL NUMBER: SB 1563	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senators Perata and Steinberg

                        FEBRUARY 22, 2008

   An act to add Section 1374.73 to the Health and Safety Code, and
to add Section 10144.55 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 1563, as introduced, Perata. Pervasive developmental disorders.

   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law provides
for the regulation of health insurers by the Department of
Insurance. Existing law requires that health care service plan
contracts and health insurance policies provide coverage for the
diagnosis and medically necessary treatment of severe mental
illnesses, including, but not limited to, pervasive developmental
disorder or autism, under the same terms and conditions applied to
other medical conditions, as specified.
   This bill would require the Department of Managed Health Care and
the Department of Insurance to work in conjunction to review the
standards and best practice guidelines adopted by the State
Department of Developmental Services on the screening, diagnosis,
assessment, intervention, and treatment of autism and pervasive
developmental disorders and to develop recommendations on ensuring
that health care service plans and health insurers provide
appropriate and equitable coverage for those illnesses. The bill
would require those departments to submit those recommendations to
the Legislature no later than October 1, 2009.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature hereby finds and declares all of the
following:
   (a) Existing law requires health care service plans and health
insurers to provide coverage for the diagnosis and medically
necessary treatment of severe mental illnesses, including, but not
limited to, pervasive developmental disorder or autism; however, the
roles and responsibilities of health care service plans and health
insurers in providing this coverage are not well defined.
   (b) Due to a lack of consensus about the medical necessity of
treatment for autism, behavioral health care coverage may be denied
or fragmented. In addition, health care service plans and health
insurers do not consistently provide access to professionals with
adequate training and expertise in autism.
   (c) In 2002, in response to direction from the Legislature, the
State Department of Developmental Services adopted guidelines and
best practices to ensure consistency and accuracy in the diagnosis of
autism and other pervasive developmental disorders throughout
California.
   (d) In 2005, the State Department of Developmental Services
initiated a project, in conjunction with multidisciplinary experts,
consumers, stakeholders, and federal resources, including the
National Research Council, the National Autism Center, and the
National Standards Project, to establish recommendations on best
practice guidelines for the intervention and treatment of autism.
These recommendations will be submitted to the department by December
2008.
  SEC. 2.  Section 1374.73 is added to the Health and Safety Code, to
read:
   1374.73.  In conjunction with the Department of Insurance, the
Department of Managed Health Care shall review the standards and best
practice guidelines adopted by the State Department of Developmental
Services on the screening, diagnosis, assessment, intervention, and
treatment of autism and other pervasive developmental disorders and
shall develop recommendations on ensuring that health care service
plans and health insurers provide appropriate and equitable coverage
for those illnesses. The Department of Managed Health Care shall, in
conjunction with the Department of Insurance, submit these
recommendations to the Legislature no later than October 1, 2009.
  SEC. 3.  Section 10144.55 is added to the Insurance Code, to read:
   10144.55.  In conjunction with the Department of Managed Health
Care, the Department of Insurance shall review the standards and best
practice guidelines adopted by the State Department of Developmental
Services on the screening, diagnosis, assessment, intervention, and
treatment of autism and other pervasive developmental disorders and
shall develop recommendations on ensuring that health care service
plans and health insurers provide appropriate and equitable coverage
for those illnesses. The Department of Insurance shall, in
conjunction with the Department of Managed Health Care, submit these
recommendations to the Legislature no later than October 1, 2009.