BILL ANALYSIS Ó
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 764
S
AUTHOR: Steinberg
B
AMENDED: April 14, 2011
HEARING DATE: May 4, 2011
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CONSULTANT:
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Trueworthy
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SUBJECT
Developmental services: Autism TeleHealth Program
SUMMARY
Requires the Department of Development Services to
implement the Autism TeleHealth Program (ATH) by requesting
proposals from, and executing memorandums of understanding
with, one or more regional centers that promote the use of
or utilize telehealth systems.
CHANGES TO EXISTING LAW
Existing law:
Establishes the Telemedicine Development Act of 1996 and
imposes several requirements governing the delivery of
health care services through telemedicine, which is broadly
defined as the use of information technology to deliver
medical services and information from one location to
another.
Further defines telemedicine as the practice of health care
delivery, diagnosis, consultation, treatment, transfer of
medical data, and education, using interactive audio,
video, or data communications.
Establishes the Lanterman Development Disabilities Services
Continued---
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Act under Department of Development Services (DDS) which
sets out the rights and responsibilities of persons with
developmental disabilities, and creates the agencies,
including regional centers, responsible for planning and
coordinating services and supports for persons with
developmental disabilities and their families.
Establishes regional centers (RC), nonprofit private
corporations which contract with DDS to provide or
coordinate services and supports for individuals with
developmental disabilities.
Requires coverage for diagnosis and medically necessary
treatment of severe mental illnesses, autism and pervasive
developmental disorders (A/PDD) for persons of any age
under California's mental health parity law.
Prohibits health insurers and the Medi-Cal program from
requiring face-to-face contact between a patient and a
health care provider for services that may be appropriately
provided through telemedicine.
Requires the Medi-Cal program to cover the appropriate use
of telemedicine for services that could otherwise be
covered by the Medi-Cal program.
This bill:
Establishes various definitions related to telehealth.
Establishes the Autism TeleHealth Program (ATHP) under the
Department of Development Services (DDS).
Requires the department to implement the ATHP program by
requesting proposals from, and executing memorandums of
understanding (MOUs) with, one or more regional centers
(RCs) that promote the use of or utilize telehealth systems
(THS).
Allows the department to enter into contracts or MOUs
directly with other entities such as federally qualified
health centers, community hospitals, or nonprofit
organizations.
Requires proposals submitted and MOUs entered into to meet
certain standards as defined, and to include various
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components as defined.
Requires regional centers participating in an MOU pursuant
to the bill to provide an annual report on the progress of
the program to the department
Establishes the ATHP advisory board with members appointed
by the DDS director and outlines their various duties to
include providing assistance and expertise in the area of
THS. Members of the advisory board are not compensated and
only receive reimbursement for travel expenses.
Requires DDS to implement the ATHP program using existing
state General Fund resources but allows DDS to seek
additional funding from federal or public and private
sources.
Sunsets the provisions of this bill on January 1, 2017.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
According to the author, the goal of SB 764 is to promote and
encourage the use of telehealth applications for the diagnosis
and treatment of Autism Spectrum Disorders (ASD) by DDS and RCs.
There are currently over 51,000 ASD consumers receiving
services through the state's RCs and there are not enough
programs and providers to serve these consumers, particularly in
remote communities and among underserved populations.
Telehealth applications have been established as highly
effective in providing access to services, especially in remote
and rural communities. The author states that California has
been a leader in telehealth, and autism experts and healthcare
professionals have recommended that these applications and
systems be used for the evaluation and treatment of ASD.
The author states that DDS and RCs face increasing
challenges to provide services that are mandated by the
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Lanterman Act, and funding ASD services is estimated to be
three to four times more costly than other developmental
disabilities. Telehealth has the potential to provide
cost-effective services and treatments, and should also be
used to assist in providing services and support to RC
consumers and their families. The author believes SB 764
will encourage public-private partnerships to bring
additional non-state funding and resources for the
development of telehealth applications for the diagnosis
and treatment of ASD.
Autism
Autism is a developmental disorder that appears in the
first three years of life and affects the brain's normal
development of social and communication skills. Most
researchers believe autism is a physical condition linked
to abnormal biology and chemistry in the brain. The exact
causes of these abnormalities remain unknown. According to
the sponsor, it is estimated that 1 in every 110 children
is diagnosed with autism, making it more common than
childhood cancer, juvenile diabetes and pediatric AIDS
combined. An estimated 1.5 million individuals in the
U.S., and tens of millions worldwide, are
affected by autism. Autism is now the second most common
childhood developmental disorder, behind only mental
retardation, and recent studies have shown that an average
of 1 percent of all children in the United States are
affected by ASD.
Telehealth
In 1996, California enacted the Telemedicine Development
Act of 1996 (Act) which defines telemedicine as "the
practice of health care delivery, diagnosis, consultation,
treatment, transfer of medical data, and education using
interactive audio, video, or data communications."
The Act also prohibits health plans and health insurers,
public and private, from requiring face-to-face contact
between a patient and a provider for services appropriately
provided through telemedicine, including Medi-Cal.
Subsequent telehealth legislation in California has amended
provisions of the Act, including a requirement that
Medi-Cal cover teleophthalmology and teledermatology
services delivered via store and forward technologies.
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Regional centers
California has 21 regional centers that are nonprofit
private corporations that contract with DDS to provide or
coordinate services and supports for individuals with
developmental disabilities. RCs provide diagnosis and
assessment of eligibility and help plan, access, coordinate
and monitor the services and supports that are needed
because of a developmental disability. To be eligible for
services, a person must have a disability that begins
before the person's 18th birthday, expected to continue
indefinitely and that presents a substantial disability as
defined in current law. Eligibility is established through
diagnosis and assessment performed at the RCs.
Related bills
AB 415 (Logue) makes numerous changes to state telemedicine
statutes, including changing references to "telemedicine"
to "telehealth," revising health plan, health insurance and
Medi-Cal provisions relating to telemedicine, and making
permanent Medi-Cal coverage for teleophthalmology and
teledermatology by store and forward. AB 415 is scheduled
to be heard in the Assembly Health Committee on May 3, 2011
SB 136 (Yee) extends, from January 1, 2013, to January 1,
2018, Medi-Cal coverage for teleophthalmology and
teledermatology by store and forward, where a physician or
optometrist is transmitted medical information for review
at a later time. SB 136 will be heard in Senate Health
Committee on May 4, 2011.
Prior legislation
AB 2120 (Galgiani), Chapter 260, Statutes 2008, extended
authorization of the Medi-Cal "teleophthalmology and
teledermatology by store and forward" program, to the
extent federal financial participation is available until
January 1, 2013.
AB 329 (Nakanishi), Chapter 386, Statutes of 2007, requires
the Medical Board of California (MBC) to establish a pilot
program to expand the practice of telemedicine in
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California, and authorizes the MBC to implement this pilot
program by convening a working group.
AB 116 (Nakano), Chapter 20, Statutes of 2003, clarifies
that the Telemedicine Development Act applies to dentists,
podiatrists, psychologists, marriage and family therapists,
and clinical social workers, so that they may deliver
health care services using interactive audio, video, or
data communications without person to person contact.
SB 1665 (Thompson), Chapter 864, Statutes of 1996, enacted
the Telemedicine Development Act of 1996, setting standards
for the use of telemedicine by health care practitioners
and insurers. Prohibited health insurers from requiring
face-to-face contact between a health care provider and
patient for services appropriately provided through
telemedicine, subject to the terms of the contract.
Arguments in support
The Children's Partnership states that telehealth is a
powerful and important tool that helps overcome major
obstacles low-income and underserved children and families
face in getting the health care and support services they
need. Telehealth can be particularly beneficial for
children with developmental disabilities, such as autism,
and children with other special needs. Supporters state
there is a significant shortage of pediatric subspecialists
in California and ATHP has the potential to benefit people
with autism who face geographic challenges in accessing
necessary services. California has the opportunity to
reestablish itself as a leader in telehealth, and to
demonstrate how to uniquely harness technology to meet the
health and other needs of its most vulnerable children.
Supporters contend SB 764 will improve lives of the growing
number of children with autism by bringing care to them.
Disability Rights of California supports SB 764 and
requests the advisory board be required to include people
from rural areas.
COMMENTS
1. Definitions. AB 415 (Logue) includes a number terms
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and definitions that are also used in SB 764. Currently
the definitions of the terms differ between the two bills.
Staff recommends that the terms in SB 764 be amended to be
consistent with AB 415.
POSITIONS
Support: The Children's Partnership
Disability Rights California
Oppose: None on file.
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