BILL ANALYSIS Ó
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: SB 764
S
AUTHOR: Steinberg
B
VERSION: January 4, 2012
HEARING DATE: January 10, 2012
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FISCAL: Appropriations
6
4
CONSULTANT: Sara Rogers
SUBJECT
Developmental Services: Autism TeleHealth Program
SUMMARY
Requires the Department of Developmental Services to
establish the telehealth systems program for the purpose of
expanding the provision of applied behavioral analysis
(ABA) or intensive behavioral intervention (IBI) services
by regional centers or vendors through the use of
telehealth systems (THS). Requires the Department to
implement vendorization codes and/or sub codes for relevant
THS services and programs.
ABSTRACT
Current law
1.Enacts the Telehealth Advancement Act of 2011 and repeals
the Telemedicine Development Act of 1996. Defines
telehealth as a mode of delivering health care and public
health services facilitating the diagnosis, consultation,
treatment, education, care management and self-management
while the patient is at an originating site and the
health care provider is at a distant site.
Continued---
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2.Enacts the Lanterman Developmental Disabilities Service
Act under the Department of Developmental Services (DDS)
affirming a variety of rights and responsibilities for
persons with developmental disabilities, including the
right to treatment and habilitation services and supports
in the least restrictive environment.
3.Establishes regional centers (RC), a network of nonprofit
private corporations that operate under contract with DDS
to provide or direct the provision of services and
supports identified in a client individual program plan.
4.Enacts the California Early Intervention Services Act of
1993 establishing a statewide system of family-centered
interagency programs responsible for providing
appropriate early intervention services and support to
all eligible infants and toddlers and their families,
also known as "Early Start."
5.Enacts, through federal law, the Early Intervention
Program for Infants and Toddlers with Disabilities of
1986 under the Individuals with Disabilities Education
Act (IDEA).
6.Prohibits health care service plans, health insurers, and
the Medi-Cal program from requiring in-person contact to
occur between a health provider and a patient before
payment is made for covered services appropriately
provided through telehealth, subject to the terms and
conditions of plan contract or the reimbursement policies
adopted by the Department of Health Care Services.
This bill
1.Requires the Department of Developmental Services to
establish the telehealth systems program.
2.Authorizes a provider vendorized with a regional center
to provide applied behavioral analysis (ABA) services or
intensive behavioral intervention (IBI) services to
provide such services through telehealth systems (THS),
subject to approval by a regional center.
3.Authorizes a regional center to purchase ABA or IBI
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services through the use of THS if the provider can
demonstrate that the provided services are beneficial for
the consumer and are in compliance with existing ABA and
IBI program requirements, privacy and confidentiality
standards, state and federal requirements and federal
funding participation guidelines.
4.Requires regional centers to consider the use of THS in
implementation of parent training for autism related ABA
or behavior intervention as part of the regional centers
family support services.
5.Requires the department to implement vendorization codes
or subcodes for all applicable THS services and programs.
6.States that a provider shall be responsible for all
expenses and costs related to the THS.
7.Defines telehealth systems as a mode of delivering
services and information that utilizes technologies to
enable evaluation, consultation, and treatment of
individuals and the provision of supports,
self-management and other appropriate services, including
synchronous and asynchronous interactions to individuals
being served by regional centers regardless of the
location of the providers or individuals.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill
According to the author, this bill is intended to enhance
and promote the use of telehealth for the diagnosis and
treatment of Autism Spectrum Disorders (ASD) by DDS and RCs
and support the provision of services in the most competent
and cost effective manner possible. The author notes that
there are currently over 53,000 ASD consumers receiving
services through RCs and that remote and underserved
communities in particular lack sufficient access to
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programs and providers to serve these consumers. The
author states that telehealth applications have been
established as highly effective in providing access to
services, especially in rural and underserved communities.
The author further asserts that the goals and objectives of
SB 764 are consistent with the DDS ASD initiative that has
emphasized the use of innovative methods and technology to
promote best practices in the assessment, diagnosis,
treatment, education and training for individuals with ASD
and their families.
The author states that, as amended, SB 764 is intended to
ensure that the proposed telehealth services comply with
all existing requirements of the Lanterman Act; comply with
all existing privacy and confidentiality requirements and
regulations; and also comply with all relevant federal and
state requirements.
Autism
Autism is defined as a group of neural development
disorders linked to atypical biology and chemistry in the
brain and generally appearing within the first three years
of life. Autism is further characterized by delayed,
impaired or otherwise atypical verbal and social
communication skills, sensitivity to sensory stimulation,
atypical behaviors and body movements, and sensitivity to
changes in routines.
According to the Centers for Disease Control and Prevention
(CDC), the average total ASD prevalence in 2006 (children
born in 1998) was 9.0 per 1,000 children, translating to
one in 110 children. ASD prevalence was found to be 4 to 5
times higher for boys than for girls.
In 2007, the California Department of Developmental
Services (DDS) reported serving 38,000 individuals with
autism reflecting an annual increase of 13.4 percent since
2002, and that, of California children born during
1990-1997, more than 11,000 are enrolled with DDS to
receive services for autism.
Public services for children and adults with autism
The Lanterman Developmental Disabilities Service Act
administered by the Department of Developmental Services
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(DDS) affirms a variety of rights and responsibilities for
persons with developmental disabilities, including the
right to treatment and habilitation services and supports
in the least restrictive environment. Prior to enactment
of the Lanterman Act the majority of children with autism
were placed in state funded institutions for life at higher
average and overall cost to the state.
State law requires the Department of Developmental Services
and Regional Centers, as their contracted local
administrator, to provide a variety of services and
supports necessary to prevent institutionalization and to
assist families caring for their children at home.
Provided services include diagnosis and eligibility
assessment services as well as family support or
community/independent living services in accordance with an
individual program plan (IPP) or an individualized family
service plan (IFSP). Regional centers are permitted to
purchase Applied Behavior Analysis or Intensive Behavior
Intervention services if the service provider uses
evidence-based practices and the services promote positive
social behaviors and help address issues with learning and
social interactions.
DDS additionally administers the Early Start program in
California which provides a broad scope of behavioral
intervention and family support services to infants and
toddlers under the age of 3 who are 'developmentally
delayed' or have an 'established risk' or are 'at high
risk' of a developmental delay.
Telehealth as a treatment modality for autism
Many studies indicate that early diagnosis and intervention
is critical for children with ASD, offering significant
opportunities to improve quality of life for these children
and their families over the short and long term.
Recent studies have evaluated the effectiveness and
efficiency of behavioral intervention treatments,
functional communication training and functional analysis
training for parents conducted through telehealth,
including both synchronous (simultaneous exchange of
information) and asynchronous (information exchange occurs
over a period of time) modalities. These studies have
demonstrated that telehealth can result in increased
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efficiency, cost savings and comparable treatment outcomes.
Related/prior legislation
AB 415 (Logue), Chapter 547, Statutes of 2011 repealed the
Telemedicine Development Act of 1996, changing the
reference from "telemedicine" to "telehealth", revising
confidentiality and privacy standards, consent
requirements, and other health provider and insurance
requirements for telehealth.
ABx4 9, Chapter 9, Statutes of 2009-10, Fourth
Extraordinary Session among other provisions, required the
least costly available provider of comparable service,
including transportation costs, who is able to accomplish
all or parts of the consumer's IPP, consistent with the
needs of the consumer and family as identified in the IPP,
to be selected to deliver services to the consumer.
Statutorily defined ABA and IBI treatments and established
a variety of standards and restrictions for vendors
providing applied behavioral analysis (ABA) services or
intensive behavioral intervention services, or both.
SB 1665 (M. Thompson), Chapter 864, Statutes of 1996
enacted the "Telemedicine Development Act of 1996" imposing
several requirements governing the delivery of health care
services through telemedicine. Prohibited health insurers
from requiring face to face contact between a health care
provider and patient for covered services appropriately
provided through telemedicine.
COMMENTS AND QUESTIONS
1.A previous Senate Health Committee analysis of an earlier
version of this bill noted that a number of terms and
conditions used in this bill are also defined in AB 415
(Chapter 547, 2011). Health Committee staff recommended
this bill use terms that are consistent with that law.
Currently, the definitions of the terms continue to
differ. Staff notes that differences between ABA/IBI
services in comparison to traditional medical services
may necessitate some variance between the definitions;
however staff recommends the author consider bringing the
two definitions into closer alignment.
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(d) For purposes of this section, "telehealth systems"
means a the mode of delivering services and via
information that utilizes and communication technologies
to enable facilitate diagnosis, evaluation, consultation,
and treatment, education, care management, supports, and
self-management and other appropriate services, including
synchronous and a synchronous interactions to individuals
who are within the purview and responsibility of the
regional center regardless of the location of the
providers or individuals consumers. Telehealth includes
synchronous interactions and asynchronous store and
forward transfers.
2.Creation of a new program. This bill calls for the
creation of the telehealth systems program; however, the
substantive effect of the bill makes changes addressing
the administration of existing programs. Staff
recommends the author consider amending or deleting this
provision.
POSITIONS
Support: Behavioral Intervention Association (BIA)
Capitol Autism Services
The Children's Partnership
Oppose: None received
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