BILL ANALYSIS
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|Hearing Date:May 3, 2010 |Bill No:SB |
| |1282 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: SB 1282Author:Steinberg
As Amended:April 28, 2010 Fiscal: No
SUBJECT: Applied behavior analysis services: California Behavioral
Certification Organization.
SUMMARY: Creates the California Behavioral Certification Organization
(CBCO) and provides for the certification of applied behavior analysts
and applied behavior analyst assistants by the CBCO.
Existing law:
1) Licenses and regulates the practice of psychotherapy preformed by
marriage and family therapists (MFTs), licensed educational
psychologists (LEPs), and licensed clinical social workers (LCSWs)
by the Board of Behavioral Sciences (BBS) within the Department of
Consumer Affairs (DCA). Beginning January 1, 2012, the BBS will
additionally license professional clinical counselors (LPCCs).
2) Licenses and regulates various health care professions including
physicians and surgeons, psychologists, speech-language
pathologists, occupational therapists, physical therapists by the
various healing arts boards within the DCA.
3) California law does not license, certify or specifically regulate
applied behavioral analysis services.
This bill:
1) Defines the following terms:
a) "Applicant" means a person who applies for certification
pursuant to the chapter.
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b) "Applied behavior analyst" as a person provides applied
behavior analysis services and who may be certified by the CBCO.
c) "Applied behavior analyst assistant" as a person provides
applied behavior analysis services under the supervision of an
applied behavioral analyst and who may be certified by the CBCO.
d) "ANSI" as the American National Standards Institute.
e) "BACB" as the Behavior Analyst Certification Board.
f) "CBCO" as the California Behavioral Certification Organization
established by the chapter.
g) "NCCA" as the National Commission for Certifying Agencies.
2) Provides that "applied behavior analysis services" includes the
following functions:
a) Designing, implementing, and evaluating systematic
instructional and environmental modifications to produce social
improvements in the behavior of individuals or groups.
b) Applying the principles, methods, and procedures of behavior
analysis.
c) Utilizing contextual factors and establishing operations,
antecedent stimuli, positive reinforcement, other consequences,
and other behavior analysis procedures to help people develop new
behaviors, increase or decrease existing behaviors, and emit
behaviors under specific environmental conditions.
d) Assessing functional relations between behavior and
environmental factors.
e) Using procedures based on scientific research and the direct
observation and measurement of behavior and environment.
f) Determining whether a nonlicensed or noncertified individual
shall be deemed as qualified to perform all of the functions
under this subdivision subject to his or her supervision.
g) Excludes from the specified functions: psychological testing,
neuropsychology, psychotherapy, sex therapy, psychoanalysis,
hypnotherapy, and long-term counseling.
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h) Applies the definition regardless of the source of payment or
reimbursement.
3) Establishes the CBCO and specifies that the CBCO shall be a
nonprofit corporation exempt from taxation under Section
501(c)(3) of Title 26 of the United States Code. Provides that
the CBCO may commence authorized activities once it has
submitted a request to the Internal Revenue Service and the
Franchise Tax Board seeking the exemption. Authorizes the CBCO
to take any reasonable actions to carry out the responsibilities
and duties in the chapter, including, but not limited to, hiring
staff and entering into contracts.
4) Provides that the CBCO shall include the following members:
a) Two representatives from each professional society,
association, or other entity whose membership is comprised of
applied behavior analysts and that has a membership in
California or on a national basis of at least 1,000
individuals for the last three years and that requires its
members to abide by a code of ethics.
b) Additional persons shall be included on the board of
directors as established by the CBCO bylaws.
c) Additional members of the board of directors may include
certified behavior analysts and at least two consumer or
public members.
5) Provides that the CBCO shall establish certification fees that are
reasonably related to the cost of providing services and carrying
out its ongoing responsibilities and duties.
6) Provides that the meetings of the CBCO shall be subject to the
Bagley-Keene Open Meetings Act.
7) Requires the CBCO to issue an " applied behavior analyst "
certificate to an applicant who submits a written application, pays
the required fees, and provides satisfactory evidence that he or
she meets either of the following requirements:
a) Holds a current, valid certification in applied behavior
analysis from the BACB or another organization accredited by the
NCCA or ANSI whose mission is to meet professional credentialing
needs identified by behavior analysts, governments, and consumers
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of behavior analysis services.
b) Meets all of the following requirements:
i) Possesses a master's or doctorate degree in applied
behavior analysis or a related field.
ii) Demonstrates 3 years of experience in the last 5
years of providing those functions specified in Item #2) above,
to individuals, either as an independent professional or as an
employee of an organization.
8) Requires the CBCO to issue an " applied behavior analyst assistant "
certificate to an applicant who submits a written application, pays
the required fees, and provides satisfactory evidence that he or
she meets either of the following requirements:
a) Holds a current, valid certification as an assistant behavior
analysis from the BACB or another organization accredited by the
NCCA or ANSI whose mission is to meet professional credentialing
needs identified by behavior analysts, governments, and consumers
of behavior analysis services.
b) Meets all of the following requirements:
i) Possesses a bachelor's degree in applied behavior analysis
or a related field.
ii) Demonstrates 3 years of experience in the last 5
years of providing those functions specified in Item #2) above,
to individuals, either as an independent professional or as an
employee of an organization.
9) Provides that a certificate shall be subject to renewal in a manner
prescribed by the CBCO and shall expire unless renewed every two
years. Further, authorizes the CBCO to provide for the late
renewal of a certification.
10)Authorizes the CBCO to receive factual information as a condition
of taking any action, and to conduct oral interviews or make any
investigation deemed necessary to establish the accuracy of any
information.
11)Provides that an applied behavior analyst shall maintain that
certification only by meeting the CBCO requirements for continuing
education and ethical standards.
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12)Prohibits the CBCO from issuing certificates prior to September 1,
2011.
13)Provides for the CBCO to require an applicant to submit
fingerprints, and establish a procedure consistent with state law
to obtain background information on applicants.
14)Authorizes the CBCO to discipline a certificate holder by any, or a
combination of, the following methods: probation; certificate
suspension; certificate revocation; conditional certificate
suspension; and, any other appropriate action.
15)Establishes various grounds for discipline against a certificate
holder or for denial of a certificate to an applicant, including:
unprofessional conduct; procurement of certificate by fraud,
misrepresentation or mistake, conviction of a felony or misdemeanor
substantially related to their qualifications, functions or duties,
or committing any fraudulent, dishonest, or corrupt act that is
substantially related, and committing any act punishable as a
sexually related crime.
16)Provides that discipline or denial of a certificate or registration
by CBCO must be in keeping with specific procedures, and that
denial or discipline not in keeping with the procedures is void and
without effect. Establishes the following procedures for
discipline:
a) The denial or discipline shall be done in good faith and in a
fair and reasonable manner, as described below; however, a court
may also find other procedures to be fair and reasonable when the
full circumstances of the denial or discipline are considered.
b) A procedure is fair and reasonable if the procedure is: Set
forth in the CBCO articles or bylaws; provides for 15 days notice
prior to the denial or discipline and the reasons therefore;
provides an opportunity for the person denied or disciplined to
be heard, orally or in writing, not less than five days before
the effective date by a person or body authorized to decide that
the proposed denial or discipline not take place.
c) Notice may be given by a method reasonably calculated to
provide actual notice, as specified.
d) Any action challenging a denial or discipline, shall be
commenced within one year after the date of the denial or
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discipline. If the challenge is successful, the court may order
any relief, including reinstatement, it finds equitable under the
circumstances.
e) A person who is denied or disciplined shall be liable for any
charges incurred, services or benefits actually rendered, dues,
assessments, or fees incurred before the denial or discipline or
arising from contract or otherwise.
17)Provides that it is an unfair business practice for any person to
advertise or represent to the public, that he or she is certified,
registered, or licensed by a governmental agency as an applied
behavior analyst or applied behavior analyst assistant.
18)Provides that it is an unfair business practice for any person to
hold himself or herself out or use the title of "certified applied
behavior analyst" or "certified applied behavior analyst assistant"
or any other term, such as "licensed," "registered," "CABA" or
"CABAA" or any term that implies or suggests that the person is
certified as an applied behavior analyst or applied behavior
analyst assistant without meeting the certification requirements.
19)Provides that the superior court in and for the county in which any
person acts as an applied behavior analyst or applied behavior
analyst assistant in violation of the chapter, may, upon a petition
by any person, issue an injunction or other appropriate order
restraining the conduct.
20)Requires the CBCO to make available to the public the current
status certificate holders; requires the CBCO to maintain on its
Internet Website information updated annually related to
implementation of the chapter.
21)Provides that nothing under this law shall be construed to:
a) Prevent behavior analysis service providers who are vendorized
by one of the California Regional Centers or hold state
accredited nonpublic agency status from developing, providing, or
supervising applied behavior analysis consistent with the
requirements of their Regional Center vendorization or nonpublic
agency certification or accreditation, provided their practice of
behavior analysis is commensurate with their level of training
and experience, and they do not hold themselves out to the public
by any title or description stating or implying that they are
Certified Behavior Analysts, that they are "certified" to
practice behavior analysis if they are not in fact certified, or
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that they are recognized or certified by the state to practice
applied behavior analysis.
b) Require certification, licensure, recognition, or
authorization to provide applied behavior analysis services nor
to add to or increase requirements for providing those services.
22)Subjects the CBCO to the "sunset review process" conducted by the
Joint Committee on Boards, Commissions, and Consumer Protection
(Joint Committee), and accordingly sunsets these provisions on
January 1, 2017.
FISCAL EFFECT: None. This bill has been keyed "nonfiscal" by
Legislative Counsel.
COMMENTS:
1.Purpose. This bill was introduced by the Author to establish a
process, as well as standards and criteria, by which the state
confers recognition (based on the education, training and experience
of the applicants) upon individuals that provide applied behavior
analysis (ABA) services to individuals with medical conditions such
as autism spectrum disorders (ASD) and other disorders that are
responsive to ABA.
2.Background. According to the Author, "Currently there are no
standards, criteria, or professional requirements that indicate the
level of education, training, experience and other professional
factors that reflect on the background and qualifications of
individuals who currently provide ABA services. Furthermore, the
ABA profession lacks any form of recognition or standing within the
California Business and Professions Code. During the past decade,
there has been increasing evidence that ABA therapy is an important
and valuable therapeutic intervention in the treatment of medical
conditions such as ASD. Consequently, there has been an extensive
increase in the practices of this profession throughout California.
However, consumers may face significant difficulties and challenges
in making an informed decision with regard to these programs and
services. Specifically, some consumers may lack adequate
information by which they can choose an ABA provider and/or ABA
services in an informed manner. Consequently, in some cases, these
ABA programs may be designed, supervised, and/or implemented by
individuals who lack the appropriate training and educational
background. SB 1282 is an initial step in providing professional
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standards and guidelines for ABA services that will assist consumers
in making more informed decisions."
3.Autism and Autism Spectrum Disorder (ASD). Autism and ASDs are
neurodevelopment disorders that typically last throughout a person's
lifetime and may cause significant impairments in language,
communications, play and social interactions, abnormalities in
behaviors, and other physical manifestations. ASDs represent the
spectrum of these disabilities and include Autistic Disorder (or
classic autism), Asperger Syndrome, Pervasive Developmental Syndrome
and others. ASD manifests itself in various ways, including
difficulty in using and understanding language; poorly developed
social skills; over- and-under sensitivity to sound, sight, taste,
touch or smell; repetitive behaviors; difficulty with changes in
surroundings or routines; and uneven skill development.
a) Increase of ASDs. According to the Centers for Disease
Control and Prevention (CDC), more children than ever before are
being classified as having ASDs. It is unclear, however, how
much of this increase may be attributed to changes in identifying
and classifying ASDs. The CDC states, that by current standards
ASDs are the second most common serious developmental disability
after mental retardation/intellectual impairment, but still less
common than other conditions that affect children's development,
such as speech and language impairments, learning disabilities,
and attention deficit/hyperactivity disorder (ADHD). According
to data from the California Health Interview Survey, it is
estimated that more than 36,000 children age 3-11 had autism in
2005. The State Department of Developmental Services (DDS)
indicates that the population of persons with autism in
California's developmental services system rose by 634% from 1987
and 2002, and nearly doubled in the four years from 1998 to 2002.
ASDs is the fastest growing serious developmental disability and
now impacts one out of every 150 children in the United States;
also, most school districts in California have seen a doubling of
students with ASDs in the past five years.
b) Resources for Families with Autistic Children. Children with
autism are served by a number of government and private entities:
regional centers and the Department of Developmental Services;
schools, school districts, and the Department of Education.
Health care service plans and insurers are required under mental
health parity laws to provide benefits on a par with physical
illness, although coverage of specific benefits and treatments
has been unclear. In addition, the California Center for Autism
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and Developmental Disabilities Research and Epidemiology
(CADDRE), a government-provider partnership, conducts
surveillance and research on ASD, as well as creates information
on autism in multiple languages.
i) Lanterman Act and Regional Centers. In the late 1960s and
'70s, the Lanterman Act established California's system of care
for persons with developmental disabilities, including ASD,
which consists of 21 regional centers and five state
developmental centers where people are assessed for
developmental disabilities and, if they qualify, are served for
life by a regional center. Children age three and older may be
served through this system.
A Senate Human Services Committee analysis of AB 1478 of 2006 (an
autism-related measure) notes that, over the last decade,
overall regional center caseload has grown by 68.9 percent, as
compared to the state's overall growth rate of 17.2 percent for
a comparable period. The Department of Developmental Service's
Fact Book for 2005, indicates that currently 15.1 percent of
the regional center caseload is described as autistic while
only 5.3 percent were so described a decade ago.
ii) Early Start. Implemented by DDS and regional centers, in
collaboration with the Department of Education, local education
agencies, and other state agencies, the Early Start program
serves children under the age of three, who may receive early
intervention services if they have a developmental delay in
either cognitive, communication, social or emotional, adaptive,
or physical and motor development, including vision and
hearing, or have certain risk conditions for these delays.
Under Early Start, eligible individuals may receive screening and
assessment; case management; family training, counseling, and
home visits; health, nutrition, nursing, physical therapy,
psychological, speech and language, and transportation
services, among other services.
iii) Local Education Agencies. Children age 3 to 21 may
receive specialized instruction and related services through
local education agencies, through the development of an
individualized education program (IEP).
4.Legislative Emphasis on Autism and Related Disorders. In 2005, SCR
51 (Perata, Resolution Chapter 124, Statutes of 2005) established,
until November 30, 2007, the Legislative Blue Ribbon Commission on
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Autism. Pursuant to its mandate, the commission submitted its
report, An Opportunity to Achieve Real Change for Californians with
Autism Spectrum Disorders, to the Governor and Legislature in 2007.
The report provided specific findings and recommendations to: (a)
Establish models of integrated, comprehensive services for early
identification and intervention of ASDs. (b) Ensure appropriate and
equitable coverage for ASDs by private health plans and insurers.
(c) Improve access to services and navigating complex systems of
care. (d) Prepare teachers and other school-based personnel to
educate children with ASDs. (e) Resolve service disputes
effectively and equitably. (f) Design new employment and housing
strategies for individuals with ASDs.
(g) Increase awareness and knowledge of ASDs among law enforcement
officers and other first responders.
In 2009, the Senate established the Senate Select Committee on Autism
and Related Disorders (Select Committee), chaired by Senator
Steinberg. The Select Committee was authorized and directed to:
(a) Provide a legislative forum for research, analysis,
deliberations, and outreach in order to promote policies and
legislation to better assist individuals with ASDs and their
families. (b) Advance the work of the Legislative Blue Ribbon
Commission on Autism. (c) Address the issues that were identified
within the 2007-08 California Autism Legislative Package, which
included SB 527 , SB 1175 , SB 1364 , SB 1475 , SB 1531 , SB 1563 , AB
1872 , and AB 2302 of the 2007-2008 Legislative Session. (d) Deal
with the fiscal challenges that confront the state in providing the
necessary and crucial services for individuals with ASDs.
The Select Committee has appointed regional autism taskforces
comprised of consumers and consumer family members, advocates,
providers, researchers, and other experts in the area of ASDs, and
other stakeholders, to provide assistance to, and to support the
work of, the select committee. The Select Committee has established
the Statewide Coordinating Council of Autism Taskforces consisting
of the chairs and co-chairs of the regional autism taskforces and
which will meet periodically to review the input from the various
regional autism taskforces and develop integrated recommendations
for consideration by the Select Committee.
The Legislature recognizes that public information and awareness
efforts are of paramount importance in accelerating early
identification efforts and the proliferation of early intervention
programs and services.
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5.Title Act vs. Practice Act Protection. It is important to note the
distinction between "title act" and certification or registration
regulation versus "practice act" and licensing regulation. A
practice act along with licensure confers the exclusive right to
practice a given profession on practitioners who meet specified
criteria related to education, experience, and examination, and
often is embodied in a statutory licensing act (i.e., those who are
not licensed cannot lawfully practice the profession). A practice
act is the highest and most restrictive form of professional
regulation, and is intended to avert severe harm to the public
health, safety or welfare that could be caused by unlicensed
practitioners.
A title act and a certification or registration program, on the other
hand, reserves the use of a particular professional (named)
designation to practitioners who have demonstrated specified
education, experience or other criteria such as certification by
another organization. A title act typically does not restrict the
practice of a profession or occupation and allows others to practice
within that profession; it merely differentiates between
practitioners who meet the specified criteria, and are authorized by
law to represent themselves accordingly, (usually by a specified
title) and those who do not. Some title acts also include a state
certification or registration program, or reliance on a national
certification or registration program, so that those who use the
specified title, and hold themselves out to the public, have been
certified or registered by a state created or national entity as
having met the specified requirements. This entity may also
regulate to some extent the activities of the particular profession
by setting standards for the profession to follow, and to also
provide oversight of the practice of the profession by reporting
unfair business practices or violations of the law and either
denying or revoking a certification or registration if necessary.
SB 1282 does not establish a licensing practice act; it instead
establishes a title act. The bill authorizes those who engage in
the functions described as applied behavior analysis and who are
certified by CBCO to use the title "applied behavior analyst" or
"applied behavior analyst assistant" and prohibits, by making it an
unfair business practice, a person not certified by CBCO from using
the title of "certified applied behavior analyst" or "certified
applied behavior analyst assistant." In addition, SB 1282 does not
create a state-operated certification or a program under a state
agency to provide oversight of this profession; there is instead a
provision to establish a private non-profit corporation to certify
individuals who meet certain requirements for performing applied
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behavioral analysis services.
6.Prior Legislation. California's leadership in providing services
and treatment for individuals with ASDs began with the passage of
the Lanterman Developmental Disabilities Services Act of 1969 and AB
3854 (Burton) in 1974, relating to autism and public education.
Numerous other legislation has been enacted or proposed in the
succeeding years that provided funding, recognition, awareness and
support of individuals with ASDs and the numerous organizations that
serve these individuals.
SB 527 (Steinberg, 2008) would have required the Department of
Developmental Services (DDS) to work with one or more regional
centers to establish the Autism Spectrum Disorders (ASD) Early
Screening, Intervention, Pilot Program (pilot program), a two-year
program to improve services for children with ASD. The bill was
vetoed by the Governor, stating that the bill's provisions can be
accomplished administratively with funding from private, non-state
general fund sources, and that given the state's ongoing fiscal
challenges, it is not the time to be enacting new programs in
statute.
AB 1478 (Frommer, 2006) would have required DDS, in consultation with
specified state departments, to develop guidelines for the treatment
of autism spectrum disorders and to disseminate the information to
parents. This bill was vetoed by the Governor.
AB 2513 (Pavley, Chapter 783, Statutes of 2006) requires the
Superintendent of Public Instruction to convene, with input from
certain entities, an advisory committee to develop specified
recommendations that would identify the means by which public and
nonpublic schools, including charter schools, may better serve
children with autism. Appropriated $100,000 from the General Fund
to the Superintendent for this purposes and required the committee
to submit its recommendations to the Legislature and to the Governor
by November 1, 2007.
SB 749 (Speier, 2005) would have required a health care service plan
or a disability insurer to cover the diagnosis of pervasive
developmental disorders or autism that follows current best practice
standards developed by the Department of Developmental Services.
The bill would also have required the Department of Managed Health
Care Services and the Department of Insurance to enact regulations
determining responsibility for reimbursement of diagnostic services.
The bill was pulled by the Author, and held in Senate Health
Committee.
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AB 857 (Frommer, 2004) would have created the Autism Information
Resource Center within DDS to assist in the coordination of services
for autistic people and their families. This measure was vetoed by
Governor.
AB 636 (Frommer, 2003) would have created the Autism Information
Resource Center within DDS to assist in the coordination of services
for autistic people and their families. This measure was held in
Assembly Appropriations.
AB 88 (Thomson, Chapter 534, Statutes of 1999) requires a health care
service plan contract or disability insurance policy to provide
coverage for severe mental illnesses, and for the serious emotional
disturbances of a child, including pervasive developmental disorders
or autism.
7.Behavior Analyst Certification Board (BACB). Under this bill, one
way in which the CBCO would grant a certificate as an applied
behavior analyst or an applied behavior analyst assistant in
California is for the applicant to be previously certified by BACB.
The applicant would submit to the CBCO a written application, along
with the required fees and evidence of BACB certification.
Applicants would also be required to submit fingerprint images to
CBCO in order to conduct background checks.
The BACB is national association based in Florida, and is a nonprofit
501(c)(3) corporation established in 1998 to meet professional
credentialing needs identified by behavior analysts, governments,
and consumers of behavior analysis services. According to the
BACB's Internet Website, the BACB adheres to the national standards
for boards that grant professional credentials. BACB states that
its certification procedures and content undergo regular
psychometric review and validation, pursuant to a job analysis
survey of the profession and standards established by content
experts in the field.
The BACB program is based on a Behavior Analysis Certification Program
developed by the State of Florida. Similar programs were previously
established in California, Texas, Pennsylvania, New York and
Oklahoma; however, each of these programs transferred their
certification and credentialing responsibilities to the BACB and
closed.
The BACB credentials practitioners at three levels. (1) Board
Certified Behavior Analysts (BCBA) must possess at least a masters
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degree, have 225 classroom hours of specific graduate-level
coursework, meet experience requirements, and pass the behavior
analyst certification examination. (2) Board Certified Assistant
Behavior Analysts (BCaBA) must have at least a bachelor's degree,
have 135 classroom hours of specific coursework, meet experience
requirements, and pass the assistant behavior analyst certification
examination. (3) Board Certified Behavior Analyst-Doctoral must be
BCBAs with doctorate degrees and meet other criteria. BACB
certificate holders must accumulate continuing education credit to
maintain their credentials.
8.National Accrediting Organizations. In addition to certification by
the BACB, the bill would also authorize the CBCO to issue
certification to an individual certified as an applied behavior
analyst or an applied behavior analyst assistant from another
organization accredited by the NCCA or ANSI whose mission is to meet
professional credentialing needs identified by behavior analysts,
governments, and consumers of behavior analysis services.
National Commission for Certifying Agencies (NCCA) . The NCCA was
created in 1987 as the accreditation body of Institute for
Credentialing Excellence (ICE) to help ensure the health, welfare,
and safety of the public through the accreditation of a variety of
certification programs and organizations that assess professional
competence. Certification programs that receive NCCA accreditation
demonstrate compliance with the NCCA's Standards for the
Accreditation of Certification Programs. NCCA uses a peer review
process to establish accreditation standards, evaluate compliance
with the standards, recognize organizations or programs which
demonstrate compliance, and serve as a resource on quality
certification. Certification organizations that submit their
programs for accreditation are evaluated based on the process and
products, not the content, and are therefore applicable to numerous
professions and industries.
According to NCCA, accredited programs certify individuals in a wide
range of professions and occupations including nurses, automotive
professionals, respiratory therapists, counselors, emergency
technicians, crane operators and more. To date, NCCA has accredited
over 200 programs from more than 100 organizations.
American National Standards Institute (ANSI) . ANSI is a private
non-profit 501(c)(3) organization headquartered in Washington, DC
that oversees the development of voluntary consensus standards for
products, services, processes, systems, and personnel in the United
States. ANSI coordinates U.S. standards with international
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standards for a wide variety of products, and accredits standards
that are developed by representatives of standards developing
organizations, government agencies, consumer groups, companies, and
others. ANSI also accredits organizations that carry out product or
personnel certification in accordance with requirements defined in
international standards.
9.Arguments in Opposition. The California Psychological Association
(CPA) has taken an "Oppose Unless Amended" position on the bill.
CPA contends that certification by a private, nonprofit entity does
not appear to be in the best interests of consumers, who are
currently protected by state regulatory agencies through licensing.
CPA believes that the bill would permit unlicensed, masters level
individuals to independently practice ABA with poor consumer
protection mechanisms or the ability to adequately regulate the
scope of practice. CPA is further concerned that while allowing
certified practitioners to work with persons with developmental
disabilities, the bill would also allow treatment of behaviors
associated with depression, anxiety, psychosis, or trauma thereby
practicing outside their scope of competence.
This bill is opposed by the California Association of Health Plans
(CAHP), who states that those dealing with developmental
disabilities and mental health conditions often need additional
supportive services to help them with housing, everyday living
skills and education. Unfortunately, the state lacks clear
guidelines for who is responsible for providing many of these
services, creating great confusion for families and those living
with developmental disabilities and mental illness. CAHP opposes
the bill because it appears to require health plans to pay for
educational services in addition to the health care and mental
health care that health plans already provide. Shifting
responsibility for educational and other non-medical services to
health plans would create a costly new mandate that would cause
already increasing health insurance costs to skyrocket, according to
CAHP.
CAHP is concerned that while the bill focuses on the certification of
providers of ABA, the bill links those providers to payments by
health plans and insurers. CAHP states that because ABA helps
children learn everyday life and social skills, most health plans do
not consider educational services like ABA to be a covered service
under the terms and conditions of their contracts, and notes that
the American Academy of Pediatrics lists ABA as an educational
service.
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CAHP further cites a California Department of Managed Health Care
(DMHC) memorandum issued March 9, 2009 regarding compliance with
mental health parity laws by health plans, which states in part that
health plans must "Provide mental health services only through
providers who are licensed or certified in accordance with
applicable California law." CAHP is concerned that the language in
SB 1282 is intended to compel the DMHC to require coverage of ABA
services, and is, in effect, a benefit mandate.
10.Other Policy Issues to be Addressed by the Author. The primary
purview of the BP&ED Committee is not the health issues of applied
behavior analysis (ABA) services or autism spectrum disorders (ASD).
The Committee's primary purview with reference to this bill is the
regulatory scheme for certification of individuals who perform these
services. As such, Committee staff has worked with the Author to
establish a framework and consumer protections consistent with other
regulatory frameworks found in the Business and Professions Code.
Other models for certification by a private non-profit certifying
organization are: Certified Interior Designers (BPC 5800-5812);
Tax Preparers (BPC 22250-22259); Massage Therapists (BPC
4600-4620); Common Interest Development Managers (BPC
11500-11506).
The latest amendments to the bill were drafted by Committee staff at
the request of the Author to more clearly conform the bill's
provisions to existing certification models. The Author recognizes
that the bill will be a process of continued discussions with the
stakeholders and interested parties in ABA services and treatment of
ASDs. The Author is committed to working cooperatively with all
parties to enact a bill which best meets the needs of all affected
parties.
As such, it is anticipated that a number of issues will still need to
be addressed by the Author, including, but not limited to:
Composition of the CBCO Board . The composition of the CBCO's
board of directors will have to be addressed so that it is
appropriately balanced to represent the interests and needs of
providers of ASD services, as well as consumers, and related
professional associations and groups.
Transparency of CBCO Operations . Currently the bill requires
the meetings of the CBCO to be subject to the Bagley-Keene Open
Meetings Act, and to make available to the public information
regarding certified persons, and publish certain information on
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the CBCO's Internet Website. The Author may wish to consider
whether the CBCO should be additionally subject to public
inspection of records.
Clarify Definition of ABA Services . The bill currently
excludes psychological testing, neuropsychology, psychotherapy,
sex therapy, psychoanalysis, hypnotherapy, and long-term
counseling from the definition of a certified applied behavior
analyst. The Author may wish to consider amending the bill to
address the concerns of CPA by clarifying that the definition of
a certified applied behavior analyst does not also include
treatment of behaviors associated with depression, anxiety,
psychosis, or trauma.
Clarify Titles Used by Certified Persons . The bill currently
defines the titles "applied behavior analyst" and "applied
behavior analyst assistant" and prohibits a person not certified
by CBCO from using the title of "certified applied behavior
analyst" or "certified applied behavior analyst assistant." It
has been pointed out that these terms may be in conflict with the
titles currently used by persons certified by BACB. Therefore,
these terms should be clarified to insure there is no
infringement on those terms utilized by BACB.
Education Requirement for Assistants . Currently the bill
provides for a two-tiered certification by authorizing the CBCO
to issue an assistant certification to a person who possesses a
bachelor's degree, and can demonstrate 3 years experience in the
last 5 years. Persons certified as assistants must practice
under supervision, as specified. Concern has been raised that a
bachelor's degree may not be an adequate criteria for issuing a
certificate as an assistant. Going forward, the Author may wish
to consider an acceptable level of education for certification of
a behavioral therapist assistant.
SUPPORT AND OPPOSITION:
Support:
None received as of April 28, 2010
Support if Amended:
Alliance of California Autism Organizations
Behavioral intervention Association
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Center for Autism and Related Disorders
Sacramento based ABC Schools
Oppose Unless Amended:
California Psychological Association
Opposition:
California Association of Health Plans
Consultant:G. V. Ayers