BILL ANALYSIS Ó
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UNFINISHED BUSINESS
Bill No: SB 764
Author: Steinberg (D)
Amended: 8/20/12
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 4-0, 1/10/12
AYES: Liu, Hancock, Wright, Yee
NO VOTE RECORDED: Emmerson, Berryhill, Strickland
SENATE APPROPRIATIONS COMMITTEE : 6-2, 1/19/12
AYES: Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
NOES: Walters, Emmerson
NO VOTE RECORDED: Runner
SENATE FLOOR : 24-13, 1/30/12
AYES: Alquist, Calderon, Corbett, Correa, De León,
DeSaulnier, Evans, Hancock, Hernandez, Leno, Lieu, Liu,
Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio,
Simitian, Steinberg, Vargas, Wolk, Wright, Yee
NOES: Anderson, Berryhill, Blakeslee, Cannella, Dutton,
Emmerson, Fuller, Gaines, Harman, Huff, La Malfa,
Strickland, Walters
NO VOTE RECORDED: Kehoe, Runner, Wyland
ASSEMBLY FLOOR : 54-25, 8/22/12 - See last page for vote
SUBJECT : Developmental services: Autism Telehealth
Program
SOURCE : Author
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DIGEST : This bill establishes a pilot program for the
provision of treatment and intervention services through
the use of telehealth.
Assembly Amendments revise and recast the provisions of the
bill with the same intent as if passed the Senate.
ANALYSIS :
Existing 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.
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, 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.
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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. States legislative intent to do all of the following:
A, Improve access to treatment and intervention
services for individuals with autism spectrum
disorders (ASDs) or other developmental
disabilities and their families in underserved
populations;
B. Provide more cost-effective treatments and
intervention services for individuals with ASDs or
other developmental disabilities and their
families;
C. Maximize the effectiveness of the interpersonal
and face-to-face interactions that are utilized for
the treatment of individuals with ASDs or other
developmental disabilities; and,
D. Continue maintenance and support of the existing
service workforce for individuals with ASDs or
other developmental disabilities.
2. Provides that, to improve access to services for
consumers and family members, including those from
underserved communities, and to facilitate better and
cost-effective services, individual program planning
(IPP) teams shall consider telehealth, whenever
applicable.
3. Requires that telehealth be considered for parent
trainings, including group trainings for parents on
behavioral intervention techniques.
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4. Requires the DDS to implement appropriate vendorization
subcodes for telehealth services and programs.
5. Requires telehealth providers to maintain the privacy
and security of all confidential consumer information.
6. Provides that the provision of a service through the use
of telehealth is voluntary and may be discontinued at
the request of the consumer or, as appropriate, the
consumer's authorized legal representative at any time.
Requires the regional center, upon receiving a request
to discontinue telehealth, to convene an IPP review to
determine alternative, appropriate means for providing
the service.
7. Defines "telehealth" as that term defined in the
Business and Professions Code.
Background
Autism . Autism Spectrum Disorders (ASD) 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. ASD 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, 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 four to five times higher for boys than for
girls.
In 2007, the California DDS reported serving 38,000
individuals with ASD 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
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administered by the 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 DDS 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 IPP or an individualized family service
plan. 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 three 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
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demonstrated that telehealth can result in increased
efficiency, cost savings and comparable treatment outcomes.
Prior/Related Legislation
AB 415 (Logue), Chapter 547, Statutes of 2011, repeals 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 (Evans), 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 defines ABA and IBI treatments and established
a variety of standards and restrictions for vendors
providing ABA services or IBI services, or both.
SB 1665 (M. Thompson), Chapter 864, Statutes of 1996,
enacts 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee, cost
associated with this legislation should be minor and
absorbable within existing resources.
SUPPORT : (Verified 8/22/12)
Applied Behavior Consultants, Inc.
Aspiranet
Association of Regional Center Agencies
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Autism and Behavior Training Associates
Autism Treatment Providers' Insurance Authorization Network
Behavioral Intervention Association
California Association for Health Services at Home
California Association of Marriage and Family Therapists
Capitol Autism Services
Center for Autism and Related Disorders
Center for Reducing Health Disparities, UC Davis
Central Valley Regional Center, Inc.
Developmental Disabilities Area Board 10
DIR/Floortime Coalition of California
Disability Rights California
North Bay Regional Center
Special Education Local Plan Area Administrators
Special Needs Network
Spectrum Center
Tarjan Center at UCLA
Technet
The Children's Partnership
The Help Group
ARGUMENTS IN SUPPORT : According to the author's office,
this bill is intended to enhance and promote the use of
telehealth for the diagnosis and treatment of ASD by DDS
and RCs and support the provision of services in the most
competent and cost effective manner possible. The author's
office notes that there are currently over 53,000 ASD
consumers receiving services through regional centers and
that remote and underserved communities in particular lack
sufficient access to programs and providers to serve these
consumers. The author's office states that telehealth
applications have been established as highly effective in
providing access to services, especially in rural and
underserved communities.
The author's office further asserts that the goals and
objectives of this bill 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.
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The author's office states that, as amended, this bill
intends 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.
ASSEMBLY FLOOR : 54-25, 8/22/12
AYES: Alejo, Allen, Ammiano, Atkins, Beall, Block,
Blumenfield, Bonilla, Bradford, Brownley, Buchanan,
Butler, Charles Calderon, Campos, Carter, Cedillo,
Chesbro, Davis, Dickinson, Eng, Feuer, Fletcher, Fong,
Fuentes, Furutani, Galgiani, Gatto, Gordon, Hall,
Hayashi, Hill, Huber, Hueso, Huffman, Jeffries, Lara,
Bonnie Lowenthal, Ma, Mendoza, Mitchell, Monning, Olsen,
Pan, Perea, V. Manuel Pérez, Portantino, Skinner,
Solorio, Swanson, Torres, Wieckowski, Williams, Yamada,
John A. Pérez
NOES: Achadjian, Bill Berryhill, Conway, Cook, Donnelly,
Beth Gaines, Garrick, Gorell, Grove, Hagman, Halderman,
Harkey, Jones, Knight, Logue, Mansoor, Miller, Morrell,
Nestande, Nielsen, Norby, Silva, Smyth, Valadao, Wagner
NO VOTE RECORDED: Roger Hernández
CTW:do 8/22/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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