Amended in Assembly January 4, 2016

California Legislature—2015–16 Regular Session

Assembly BillNo. 796


Introduced by Assembly Member Nazarian

(Coauthor: Assembly Member Rendon)

February 26, 2015


An act to amend Section 1374.73 of the Health and Safety Code, and to amend Section 10144.51 of the Insurance Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

AB 796, as amended, Nazarian. Health care coverage: autism and pervasive developmental disorders.

Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. A violation of those provisions is a crime. Existing law provides for the licensure and regulation of health insurers by the Department of Insurance.

Existing law requires every health care service plan contract and health insurance policy to provide coverage for behavioral health treatment for pervasive developmental disorder orbegin delete autism. Existing law requires every health care service plan and health insurance policy to maintain an adequate network that includes qualified autism service providers who supervise and employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. Existing law defines “qualified autism service professional” and “qualified autism service paraprofessional” for this purpose to mean a person who meets specified educational and training requirements.end deletebegin insert autism until January 1, 2017, and defines end insertbegin insert“behavioral health treatmentend insertbegin insert” to mean specified services provided by, among others, a qualified autism service professional supervised and employed by a qualified autism service provider. For purposes of this provision, existing law defines a “qualified autism service professional” to mean a person who, among other requirements, is a behavior service provider approved as a vendor by a California regional center to provide services as an associate behavior analyst, behavior analyst, behavior management assistant, behavior management consultant, or behavior management program pursuant to specified regulations adopted under the Lanterman Developmental Disabilities Services Act.end insert

This bill wouldbegin delete expand the eligibility for a person to be a qualified autism service professional to include a person who possesses a bachelor of arts or science degree and meets other specified requirements, a registered psychological assistant, a registered psychologist, or an associate clinical social worker. The bill would also expand the eligibility for a person to be a qualified autism service paraprofessional to include a person with a high school diploma or equivalent and, among other things, 6 months experience working with persons with developmental disabilities.end deletebegin insert extend the operation of these provisions to January 1, 2022. By extending the operation of these provisions, the violation of which by a health care service plan would be a crime, the bill would impose a state-mandated local program. The bill would require the Board of Psychology, no later than December 31, 2017, and thereafter as necessary, to convene a committee to create a list of evidence-based treatment modalities for purposes of developing mandated behavioral health treatment modalities for pervasive developmental disorder or autism.end insert

begin insert

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

end insert
begin insert

This bill would provide that no reimbursement is required by this act for a specified reason.

end insert

Vote: majority. Appropriation: no. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: begin deleteno end deletebegin insertyesend insert.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

The Legislature finds and declares all of the
2following:

P3    1(a) Autism and other pervasive developmental disorders are
2complex neurobehavioral disorders that include impairments in
3social communication and social interaction combined with rigid,
4repetitive behaviors, interests, and activities.

5(b) Autism covers a large spectrum of symptoms and levels of
6impairment ranging in severity from somewhat limiting to a severe
7disability that may require institutional care.

8(c) One in 68 children born today will be diagnosed with autism
9or another pervasive developmental disorder.

10(d) Research has demonstrated that children diagnosed with
11autism can often be helped with early administration of behavioral
12health treatment.

13(e) There are several forms of evidence-based behavioral health
14treatment, including, but not limited to, applied behavioral analysis.

15(f) Children diagnosed with autism respond differently to
16behavioral health treatment.

17(g) It is critical that each child diagnosed with autism receives
18the specific type of evidence-based behavioral health treatment
19best suited to him or her, as prescribed by his or her physician or
20developed by a psychologist.

21(h) The Legislature intends that all forms of evidence-based
22behavioral health treatment be covered by health care service plans,
23pursuant to Section 1374.73 of the Health and Safety Code, and
24health insurance policies, pursuant to Section 10144.51 of the
25Insurance Code.

26(i) The Legislature intends that health care service plan provider
27networks include qualified professionals practicing all forms of
28evidence-based behavioral health treatment other than just applied
29behavioral analysis.

begin delete
30

SEC. 2.  

Section 1374.73 of the Health and Safety Code is
31amended to read:

32

1374.73.  

(a) (1) Every health care service plan contract that
33provides hospital, medical, or surgical coverage shall also provide
34coverage for behavioral health treatment for pervasive
35developmental disorder or autism no later than July 1, 2012. The
36coverage shall be provided in the same manner and shall be subject
37to the same requirements as provided in Section 1374.72.

38(2) Notwithstanding paragraph (1), as of the date that proposed
39final rulemaking for essential health benefits is issued, this section
40does not require benefits to be provided that exceed the essential
P4    1health benefits that all health plans will be required by federal
2regulations to provide under Section 1302(b) of the federal Patient
3Protection and Affordable Care Act (Public Law 111-148), as
4amended by the federal Health Care and Education Reconciliation
5Act of 2010 (Public Law 111-152).

6(3) This section shall not affect services for which an individual
7is eligible pursuant to Division 4.5 (commencing with Section
84500) of the Welfare and Institutions Code or Title 14
9(commencing with Section 95000) of the Government Code.

10(4) This section shall not affect or reduce any obligation to
11provide services under an individualized education program, as
12defined in Section 56032 of the Education Code, or an individual
13service plan, as described in Section 5600.4 of the Welfare and
14Institutions Code, or under the federal Individuals with Disabilities
15Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing
16regulations.

17(b) Every health care service plan subject to this section shall
18maintain an adequate network that includes qualified autism service
19providers who supervise and employ qualified autism service
20professionals or paraprofessionals who provide and administer
21behavioral health treatment. Nothing shall prevent a health care
22service plan from selectively contracting with providers within
23these requirements.

24(c) For the purposes of this section, the following definitions
25shall apply:

26(1) “Behavioral health treatment” means professional services
27and treatment programs, including applied behavior analysis and
28evidence-based behavior intervention programs, that develop or
29restore, to the maximum extent practicable, the functioning of an
30individual with pervasive developmental disorder or autism and
31that meet all of the following criteria:

32(A) The treatment is prescribed by a physician and surgeon
33licensed pursuant to Chapter 5 (commencing with Section 2000)
34of, or is developed by a psychologist licensed pursuant to Chapter
356.6 (commencing with Section 2900) of, Division 2 of the Business
36and Professions Code.

37(B) The treatment is provided under a treatment plan prescribed
38by a qualified autism service provider and is administered by one
39of the following:

40(i) A qualified autism service provider.

P5    1(ii) A qualified autism service professional supervised and
2employed by the qualified autism service provider.

3(iii) A qualified autism service paraprofessional supervised and
4employed by a qualified autism service provider.

5(C) The treatment plan has measurable goals over a specific
6timeline that is developed and approved by the qualified autism
7service provider for the specific patient being treated. The treatment
8plan shall be reviewed no less than once every six months by the
9qualified autism service provider and modified whenever
10appropriate, and shall be consistent with Section 4686.2 of the
11Welfare and Institutions Code pursuant to which the qualified
12autism service provider does all of the following:

13(i) Describes the patient’s behavioral health impairments or
14developmental challenges that are to be treated.

15(ii) Designs an intervention plan that includes the service type,
16number of hours, and parent participation needed to achieve the
17plan’s goal and objectives, and the frequency at which the patient’s
18progress is evaluated and reported.

19(iii) Provides intervention plans that utilize evidence-based
20practices, with demonstrated clinical efficacy in treating pervasive
21developmental disorder or autism.

22(iv) Discontinues intensive behavioral intervention services
23when the treatment goals and objectives are achieved or no longer
24appropriate.

25(D) The treatment plan is not used for purposes of providing or
26for the reimbursement of respite, day care, or educational services
27and is not used to reimburse a parent for participating in the
28treatment program. The treatment plan shall be made available to
29the health care service plan upon request.

30(2) “Pervasive developmental disorder or autism” shall have
31the same meaning and interpretation as used in Section 1374.72.

32(3) “Qualified autism service provider” means either of the
33following:

34(A) A person, entity, or group that is certified by a national
35entity, such as the Behavior Analyst Certification Board, that is
36accredited by the National Commission for Certifying Agencies,
37and who designs, supervises, or provides treatment for pervasive
38developmental disorder or autism, provided the services are within
39the experience and competence of the person, entity, or group that
40is nationally certified.

P6    1(B) A person licensed as a physician and surgeon, physical
2therapist, occupational therapist, psychologist, marriage and family
3therapist, educational psychologist, clinical social worker,
4professional clinical counselor, speech-language pathologist, or
5audiologist pursuant to Division 2 (commencing with Section 500)
6of the Business and Professions Code, who designs, supervises,
7or provides treatment for pervasive developmental disorder or
8autism, provided the services are within the experience and
9competence of the licensee.

10(4) “Qualified autism service professional” means an individual
11who meets all of the following criteria:

12(A) Provides behavioral health treatment.

13(B) Is employed and supervised by a qualified autism service
14provider.

15(C) Provides treatment pursuant to a treatment plan developed
16and approved by the qualified autism service provider.

17(D) Is a behavioral service provider who meets one of the
18following criteria:

19(i) Is approved as a vendor by a California regional center to
20provide services as an Associate Behavior Analyst, Behavior
21Analyst, Behavior Management Assistant, Behavior Management
22Consultant, or Behavior Management Program as defined in
23Section 54342 of Title 17 of the California Code of Regulations.

24(ii) Possesses a bachelor of arts or science degree and has either
25of the following:

26 (I) Twelve semester units from an accredited institute of higher
27learning in either applied behavioral analysis or clinical coursework
28in behavioral health and one year of experience in designing or
29implementing behavioral health treatment.

30(II) two years of experience in designing or implementing
31behavioral health treatment.

32(iii) The person is a registered psychological assistant or
33registered psychologist pursuant to Chapter 6.6 (commencing with
34Section 2900) of Division 2 of the Business and Professions Code.

35(iv) The person is an associate clinical social worker registered
36with the Board of Behavioral Sciences pursuant to Section 4996.18
37of the Business and Professions Code.

38(E) Has training and experience in providing services for
39pervasive developmental disorder or autism pursuant to Division
404.5 (commencing with Section 4500) of the Welfare and
P7    1Institutions Code or Title 14 (commencing with Section 95000)
2of the Government Code.

3(5) “Qualified autism service paraprofessional” means an
4unlicensed and uncertified individual who meets all of the
5following criteria:

6(A) Is employed and supervised by a qualified autism service
7provider.

8(B) Provides treatment and implements services pursuant to a
9treatment plan developed and approved by the qualified autism
10service provider.

11(C) Meets the criteria set forth in the regulations adopted
12pursuant to Section 4686.3 of the Welfare and Institutions Code
13or meets all of the following:

14(i) Possesses a high school diploma or equivalent.

15(ii) Has six months experience working with persons with a
16developmental disability.

17(iii) Has 30 hours of training in the specific form of
18evidence-based behavioral health treatment administered by a
19qualified autism provider or qualified autism service professional.

20(iv) Has successfully passed a background check conducted by
21a state-approved agency.

22(D) Has adequate education, training, and experience, as
23certified by a qualified autism service provider.

24(d) This section shall not apply to the following:

25(1) A specialized health care service plan that does not deliver
26mental health or behavioral health services to enrollees.

27(2) A health care service plan contract in the Medi-Cal program
28(Chapter 7 (commencing with Section 14000) of Part 3 of Division
299 of the Welfare and Institutions Code).

30(3) A health care service plan contract in the Healthy Families
31Program (Part 6.2 (commencing with Section 12693) of Division
322 of the Insurance Code).

33(4) A health care benefit plan or contract entered into with the
34Board of Administration of the Public Employees’ Retirement
35System pursuant to the Public Employees’ Medical and Hospital
36Care Act (Part 5 (commencing with Section 22750) of Division 5
37of Title 2 of the Government Code).

38(e) Nothing in this section shall be construed to limit the
39obligation to provide services under Section 1374.72.

P8    1(f) As provided in Section 1374.72 and in paragraph (1) of
2subdivision (a), in the provision of benefits required by this section,
3a health care service plan may utilize case management, network
4providers, utilization review techniques, prior authorization,
5copayments, or other cost sharing.

6(g) This section shall remain in effect only until January 1, 2017,
7and as of that date is repealed, unless a later enacted statute, that
8is enacted before January 1, 2017, deletes or extends that date.

9

SEC. 3.  

Section 10144.51 of the Insurance Code is amended
10to read:

11

10144.51.  

(a) (1) Every health insurance policy shall also
12provide coverage for behavioral health treatment for pervasive
13developmental disorder or autism no later than July 1, 2012. The
14coverage shall be provided in the same manner and shall be subject
15to the same requirements as provided in Section 10144.5.

16(2) Notwithstanding paragraph (1), as of the date that proposed
17final rulemaking for essential health benefits is issued, this section
18does not require any benefits to be provided that exceed the
19essential health benefits that all health insurers will be required by
20federal regulations to provide under Section 1302(b) of the federal
21Patient Protection and Affordable Care Act (Public Law 111-148),
22as amended by the federal Health Care and Education
23Reconciliation Act of 2010 (Public Law 111-152).

24(3) This section shall not affect services for which an individual
25is eligible pursuant to Division 4.5 (commencing with Section
264500) of the Welfare and Institutions Code or Title 14
27(commencing with Section 95000) of the Government Code.

28(4) This section shall not affect or reduce any obligation to
29provide services under an individualized education program, as
30defined in Section 56032 of the Education Code, or an individual
31service plan, as described in Section 5600.4 of the Welfare and
32Institutions Code, or under the federal Individuals with Disabilities
33Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing
34regulations.

35(b) Pursuant to Article 6 (commencing with Section 2240) of
36Title 10 of the California Code of Regulations, every health insurer
37subject to this section shall maintain an adequate network that
38includes qualified autism service providers who supervise and
39employ qualified autism service professionals or paraprofessionals
40who provide and administer behavioral health treatment. Nothing
P9    1shall prevent a health insurer from selectively contracting with
2providers within these requirements.

3(c) For the purposes of this section, the following definitions
4shall apply:

5(1) “Behavioral health treatment” means professional services
6and treatment programs, including applied behavior analysis and
7evidence-based behavior intervention programs, that develop or
8restore, to the maximum extent practicable, the functioning of an
9individual with pervasive developmental disorder or autism, and
10that meet all of the following criteria:

11(A) The treatment is prescribed by a physician and surgeon
12licensed pursuant to Chapter 5 (commencing with Section 2000)
13of, or is developed by a psychologist licensed pursuant to Chapter
146.6 (commencing with Section 2900) of, Division 2 of the Business
15and Professions Code.

16(B) The treatment is provided under a treatment plan prescribed
17by a qualified autism service provider and is administered by one
18of the following:

19(i) A qualified autism service provider.

20(ii) A qualified autism service professional supervised and
21employed by the qualified autism service provider.

22(iii) A qualified autism service paraprofessional supervised and
23employed by a qualified autism service provider.

24(C) The treatment plan has measurable goals over a specific
25timeline that is developed and approved by the qualified autism
26service provider for the specific patient being treated. The treatment
27plan shall be reviewed no less than once every six months by the
28qualified autism service provider and modified whenever
29appropriate, and shall be consistent with Section 4686.2 of the
30Welfare and Institutions Code pursuant to which the qualified
31autism service provider does all of the following:

32(i) Describes the patient’s behavioral health impairments or
33developmental challenges that are to be treated.

34(ii) Designs an intervention plan that includes the service type,
35number of hours, and parent participation needed to achieve the
36plan’s goal and objectives, and the frequency at which the patient’s
37progress is evaluated and reported.

38(iii) Provides intervention plans that utilize evidence-based
39practices, with demonstrated clinical efficacy in treating pervasive
40developmental disorder or autism.

P10   1(iv) Discontinues intensive behavioral intervention services
2when the treatment goals and objectives are achieved or no longer
3appropriate.

4(D) The treatment plan is not used for purposes of providing or
5for the reimbursement of respite, day care, or educational services
6and is not used to reimburse a parent for participating in the
7treatment program. The treatment plan shall be made available to
8the insurer upon request.

9(2) “Pervasive developmental disorder or autism” shall have
10the same meaning and interpretation as used in Section 10144.5.

11(3) “Qualified autism service provider” means either of the
12 following:

13(A) A person, entity, or group that is certified by a national
14entity, such as the Behavior Analyst Certification Board, that is
15accredited by the National Commission for Certifying Agencies,
16and who designs, supervises, or provides treatment for pervasive
17developmental disorder or autism, provided the services are within
18the experience and competence of the person, entity, or group that
19is nationally certified.

20(B) A person licensed as a physician and surgeon, physical
21therapist, occupational therapist, psychologist, marriage and family
22therapist, educational psychologist, clinical social worker,
23professional clinical counselor, speech-language pathologist, or
24audiologist pursuant to Division 2 (commencing with Section 500)
25of the Business and Professions Code, who designs, supervises,
26or provides treatment for pervasive developmental disorder or
27autism, provided the services are within the experience and
28competence of the licensee.

29(4) “Qualified autism service professional” means an individual
30who meets all of the following criteria:

31(A) Provides behavioral health treatment.

32(B) Is employed and supervised by a qualified autism service
33provider.

34(C) Provides treatment pursuant to a treatment plan developed
35and approved by the qualified autism service provider.

36(D) Is a behavioral service provider who meets one of the
37following criteria:

38(i) Is approved as a vendor by a California regional center to
39provide services as an Associate Behavior Analyst, Behavior
40Analyst, Behavior Management Assistant, Behavior Management
P11   1Consultant, or Behavior Management Program as defined in
2Section 54342 of Title 17 of the California Code of Regulations.

3(ii) Possesses a bachelor of arts or science degree and has either
4of the following:

5(I) Twelve semester units from an accredited institute of higher
6learning in either applied behavioral analysis or clinical coursework
7in behavioral health and one year of experience in designing or
8implementing behavioral health treatment.

9 (II) Two years of experience in designing or implementing
10behavioral health treatment.

11(iii) The person is a registered psychological assistant or
12registered psychologist pursuant to Chapter 6.6 (commencing with
13Section 2900) of Division 2 of the Business and Professions Code.

14(iv) The person is an associate clinical social worker registered
15with the Board of Behavioral Sciences pursuant to Section 4996.18
16of the Business and Professions Code.

17(E) Has training and experience in providing services for
18pervasive developmental disorder or autism pursuant to Division
194.5 (commencing with Section 4500) of the Welfare and
20Institutions Code or Title 14 (commencing with Section 95000)
21of the Government Code.

22(5) “Qualified autism service paraprofessional” means an
23unlicensed and uncertified individual who meets all of the
24following criteria:

25(A) Is employed and supervised by a qualified autism service
26provider.

27(B) Provides treatment and implements services pursuant to a
28treatment plan developed and approved by the qualified autism
29service provider.

30(C) Meets the criteria set forth in the regulations adopted
31 pursuant to Section 4686.3 of the Welfare and Institutions Code
32or meets all of the following:

33(i) Possesses a high school diploma or equivalent.

34(ii) Has six months experience working with persons with a
35developmental disability.

36(iii) Has 30 hours of training in the specific form of
37evidence-based behavioral health treatment administered by a
38qualified autism provider or qualified autism service professional.

39(iv) Has successfully passed a background check conducted by
40a state-approved agency.

P12   1(D) Has adequate education, training, and experience, as
2certified by a qualified autism service provider.

3(d) This section shall not apply to the following:

4(1) A specialized health insurance policy that does not cover
5mental health or behavioral health services or an accident only,
6specified disease, hospital indemnity, or Medicare supplement
7policy.

8(2) A health insurance policy in the Medi-Cal program (Chapter
97 (commencing with Section 14000) of Part 3 of Division 9 of the
10Welfare and Institutions Code).

11(3) A health insurance policy in the Healthy Families Program
12(Part 6.2 (commencing with Section 12693)).

13(4) A health care benefit plan or policy entered into with the
14Board of Administration of the Public Employees’ Retirement
15System pursuant to the Public Employees’ Medical and Hospital
16Care Act (Part 5 (commencing with Section 22750) of Division 5
17of Title 2 of the Government Code).

18(e) Nothing in this section shall be construed to limit the
19obligation to provide services under Section 10144.5.

20(f) As provided in Section 10144.5 and in paragraph (1) of
21subdivision (a), in the provision of benefits required by this section,
22a health insurer may utilize case management, network providers,
23utilization review techniques, prior authorization, copayments, or
24 other cost sharing.

25(g) This section shall remain in effect only until January 1, 2017,
26and as of that date is repealed, unless a later enacted statute, that
27is enacted before January 1, 2017, deletes or extends that date.

end delete
28begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 1374.73 of the end insertbegin insertHealth and Safety Codeend insertbegin insert is
29amended to read:end insert

30

1374.73.  

(a) (1) Every health care service plan contract that
31provides hospital, medical, or surgical coverage shall also provide
32coverage for behavioral health treatment for pervasive
33developmental disorder or autism no later than July 1, 2012. The
34coverage shall be provided in the same manner and shall be subject
35to the same requirements as provided in Section 1374.72.

36(2) Notwithstanding paragraph (1), as of the date that proposed
37final rulemaking for essential health benefits is issued, this section
38does not require any benefits to be provided that exceed the
39essential health benefits that all health plans will be required by
40federal regulations to provide under Section 1302(b) of the federal
P13   1Patient Protection and Affordable Care Act (Public Law 111-148),
2as amended by the federal Health Care and Education
3Reconciliation Act of 2010 (Public Law 111-152).

4(3) This section shall not affect services for which an individual
5is eligible pursuant to Division 4.5 (commencing with Section
64500) of the Welfare and Institutions Code or Title 14
7(commencing with Section 95000) of the Government Code.

8(4) This section shall not affect or reduce any obligation to
9provide services under an individualized education program, as
10defined in Section 56032 of the Education Code, or an individual
11service plan, as described in Section 5600.4 of the Welfare and
12Institutions Code, or under the federal Individuals with Disabilities
13Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing
14regulations.

15(b) Every health care service plan subject to this section shall
16 maintain an adequate network that includes qualified autism service
17providers who supervise and employ qualified autism service
18professionals or paraprofessionals who provide and administer
19behavioral health treatment. Nothing shall prevent a health care
20service plan from selectively contracting with providers within
21these requirements.

22(c) For the purposes of this section, the following definitions
23shall apply:

24(1) “Behavioral health treatment” means professional services
25and treatment programs, including applied behavior analysis and
26evidence-based behavior intervention programs, that develop or
27restore, to the maximum extent practicable, the functioning of an
28individual with pervasive developmental disorder or autism and
29that meet all of the following criteria:

30(A) The treatment is prescribed by a physician and surgeon
31licensed pursuant to Chapter 5 (commencing with Section 2000)
32of, or is developed by a psychologist licensed pursuant to Chapter
336.6 (commencing with Section 2900) of, Division 2 of the Business
34and Professions Code.

35(B) The treatment is provided under a treatment plan prescribed
36by a qualified autism service provider and is administered by one
37of the following:

38(i) A qualified autism service provider.

39(ii) A qualified autism service professional supervised and
40employed by the qualified autism service provider.

P14   1(iii) A qualified autism service paraprofessional supervised and
2employed by a qualified autism service provider.

3(C) The treatment plan has measurable goals over a specific
4 timeline that is developed and approved by the qualified autism
5service provider for the specific patient being treated. The treatment
6plan shall be reviewed no less than once every six months by the
7qualified autism service provider and modified whenever
8appropriate, and shall be consistent with Section 4686.2 of the
9Welfare and Institutions Code pursuant to which the qualified
10autism service provider does all of the following:

11(i) Describes the patient’s behavioral health impairments or
12developmental challenges that are to be treated.

13(ii) Designs an intervention plan that includes the service type,
14number of hours, and parent participation needed to achieve the
15plan’s goal and objectives, and the frequency at which the patient’s
16progress is evaluated and reported.

17(iii) Provides intervention plans that utilize evidence-based
18practices, with demonstrated clinical efficacy in treating pervasive
19developmental disorder or autism.

20(iv) Discontinues intensive behavioral intervention services
21when the treatment goals and objectives are achieved or no longer
22appropriate.

23(D) The treatment plan is not used for purposes of providing or
24for the reimbursement of respite, day care, or educational services
25and is not used to reimburse a parent for participating in the
26treatment program. The treatment plan shall be made available to
27the health care service plan upon request.

28(2) “Pervasive developmental disorder or autism” shall have
29the same meaning and interpretation as used in Section 1374.72.

30(3) “Qualified autism service provider” means either of the
31following:

32(A) A person, entity, or group that is certified by a national
33entity, such as the Behavior Analyst Certification Board, that is
34accredited by the National Commission for Certifying Agencies,
35and who designs, supervises, or provides treatment for pervasive
36developmental disorder or autism, provided the services are within
37the experience and competence of the person, entity, or group that
38is nationally certified.

39(B) A person licensed as a physician and surgeon, physical
40therapist, occupational therapist, psychologist, marriage and family
P15   1therapist, educational psychologist, clinical social worker,
2professional clinical counselor, speech-language pathologist, or
3audiologist pursuant to Division 2 (commencing with Section 500)
4of the Business and Professions Code, who designs, supervises,
5or provides treatment for pervasive developmental disorder or
6autism, provided the services are within the experience and
7competence of the licensee.

8(4) “Qualified autism service professional” means an individual
9who meets all of the following criteria:

10(A) Provides behavioral health treatment.

11(B) Is employed and supervised by a qualified autism service
12provider.

13(C) Provides treatment pursuant to a treatment plan developed
14and approved by the qualified autism service provider.

15(D) Is a behavioral service provider approved as a vendor by a
16California regional center to provide services as an Associate
17Behavior Analyst, Behavior Analyst, Behavior Management
18Assistant, Behavior Management Consultant, or Behavior
19Management Program as defined in Section 54342 of Title 17 of
20the California Code of Regulations.

21(E) Has training and experience in providing services for
22pervasive developmental disorder or autism pursuant to Division
234.5 (commencing with Section 4500) of the Welfare and
24Institutions Code or Title 14 (commencing with Section 95000)
25of the Government Code.

26(5) “Qualified autism service paraprofessional” means an
27unlicensed and uncertified individual who meets all of the
28following criteria:

29(A) Is employed and supervised by a qualified autism service
30provider.

31(B) Provides treatment and implements services pursuant to a
32treatment plan developed and approved by the qualified autism
33service provider.

34(C) Meets the criteria set forth in the regulations adopted
35pursuant to Section 4686.3 of the Welfare and Institutions Code.

36(D) Has adequate education, training, and experience, as
37certified by a qualified autism service provider.

38(d) This section shall not apply to the following:

39(1) A specialized health care service plan that does not deliver
40mental health or behavioral health services to enrollees.

P16   1(2) A health care service plan contract in the Medi-Cal program
2(Chapter 7 (commencing with Section 14000) of Part 3 of Division
39 of the Welfare and Institutions Code).

4(3) A health care service plan contract in the Healthy Families
5Program (Part 6.2 (commencing with Section 12693) of Division
62 of the Insurance Code).

7(4) A health care benefit plan or contract entered into with the
8Board of Administration of the Public Employees’ Retirement
9System pursuant to the Public Employees’ Medical and Hospital
10Care Act (Part 5 (commencing with Section 22750) of Division 5
11of Title 2 of the Government Code).

12(e) Nothing in this section shall be construed to limit the
13obligation to provide services under Section 1374.72.

14(f) As provided in Section 1374.72 and in paragraph (1) of
15subdivision (a), in the provision of benefits required by this section,
16a health care service plan may utilize case management, network
17providers, utilization review techniques, prior authorization,
18copayments, or other cost sharing.

begin insert

19(g) No later than December 31, 2017, and thereafter as
20necessary, the Board of Psychology, upon appropriation of the
21Legislature, shall convene a committee to create a list of
22evidence-based treatment modalities for purposes of developing
23mandated behavioral health treatment modalities for pervasive
24developmental disorder or autism.

end insert
begin delete

25(g)

end delete

26begin insert(h)end insert This section shall remain in effect only until January 1,begin delete 2017,end delete
27begin insert 2022,end insert and as of that date is repealed, unless a later enacted statute,
28that is enacted before January 1,begin delete 2017,end deletebegin insert 2022,end insert deletes or extends
29that date.

30begin insert

begin insertSEC. 3.end insert  

end insert

begin insertSection 10144.51 of the end insertbegin insertInsurance Codeend insertbegin insert is amended
31to read:end insert

32

10144.51.  

(a) (1) Every health insurance policy shall also
33provide coverage for behavioral health treatment for pervasive
34developmental disorder or autism no later than July 1, 2012. The
35coverage shall be provided in the same manner and shall be subject
36to the same requirements as provided in Section 10144.5.

37(2) Notwithstanding paragraph (1), as of the date that proposed
38final rulemaking for essential health benefits is issued, this section
39does not require any benefits to be provided that exceed the
40essential health benefits that all health insurers will be required by
P17   1federal regulations to provide under Section 1302(b) of the federal
2Patient Protection and Affordable Care Act (Public Law 111-148),
3as amended by the federal Health Care and Education
4Reconciliation Act of 2010 (Public Law 111-152).

5(3) This section shall not affect services for which an individual
6is eligible pursuant to Division 4.5 (commencing with Section
74500) of the Welfare and Institutions Code or Title 14
8(commencing with Section 95000) of the Government Code.

9(4) This section shall not affect or reduce any obligation to
10provide services under an individualized education program, as
11defined in Section 56032 of the Education Code, or an individual
12service plan, as described in Section 5600.4 of the Welfare and
13Institutions Code, or under the federal Individuals with Disabilities
14Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing
15regulations.

16(b) Pursuant to Article 6 (commencing with Section 2240) of
17Title 10 of the California Code of Regulations, every health insurer
18subject to this section shall maintain an adequate network that
19includes qualified autism service providers who supervise and
20employ qualified autism service professionals or paraprofessionals
21who provide and administer behavioral health treatment. Nothing
22shall prevent a health insurer from selectively contracting with
23providers within these requirements.

24(c) For the purposes of this section, the following definitions
25shall apply:

26(1) “Behavioral health treatment” means professional services
27and treatment programs, including applied behavior analysis and
28evidence-based behavior intervention programs, that develop or
29restore, to the maximum extent practicable, the functioning of an
30individual with pervasive developmental disorder or autism, and
31that meet all of the following criteria:

32(A) The treatment is prescribed by a physician and surgeon
33licensed pursuant to Chapter 5 (commencing with Section 2000)
34of, or is developed by a psychologist licensed pursuant to Chapter
356.6 (commencing with Section 2900) of, Division 2 of the Business
36and Professions Code.

37(B) The treatment is provided under a treatment plan prescribed
38by a qualified autism service provider and is administered by one
39of the following:

40(i) A qualified autism service provider.

P18   1(ii) A qualified autism service professional supervised and
2employed by the qualified autism service provider.

3(iii) A qualified autism service paraprofessional supervised and
4employed by a qualified autism service provider.

5(C) The treatment plan has measurable goals over a specific
6timeline that is developed and approved by the qualified autism
7service provider for the specific patient being treated. The treatment
8plan shall be reviewed no less than once every six months by the
9qualified autism service provider and modified whenever
10appropriate, and shall be consistent with Section 4686.2 of the
11Welfare and Institutions Code pursuant to which the qualified
12autism service provider does all of the following:

13(i) Describes the patient’s behavioral health impairments or
14developmental challenges that are to be treated.

15(ii) Designs an intervention plan that includes the service type,
16number of hours, and parent participation needed to achieve the
17plan’s goal and objectives, and the frequency at which the patient’s
18progress is evaluated and reported.

19(iii) Provides intervention plans that utilize evidence-based
20practices, with demonstrated clinical efficacy in treating pervasive
21developmental disorder or autism.

22(iv) Discontinues intensive behavioral intervention services
23when the treatment goals and objectives are achieved or no longer
24appropriate.

25(D) The treatment plan is not used for purposes of providing or
26for the reimbursement of respite, day care, or educational services
27and is not used to reimburse a parent for participating in the
28treatment program. The treatment plan shall be made available to
29the insurer upon request.

30(2) “Pervasive developmental disorder or autism” shall have
31the same meaning and interpretation as used in Section 10144.5.

32(3) “Qualified autism service provider” means either of the
33 following:

34(A) A person, entity, or group that is certified by a national
35entity, such as the Behavior Analyst Certification Board, that is
36accredited by the National Commission for Certifying Agencies,
37and who designs, supervises, or provides treatment for pervasive
38 developmental disorder or autism, provided the services are within
39the experience and competence of the person, entity, or group that
40is nationally certified.

P19   1(B) A person licensed as a physician and surgeon, physical
2therapist, occupational therapist, psychologist, marriage and family
3therapist, educational psychologist, clinical social worker,
4professional clinical counselor, speech-language pathologist, or
5audiologist pursuant to Division 2 (commencing with Section 500)
6of the Business and Professions Code, who designs, supervises,
7or provides treatment for pervasive developmental disorder or
8autism, provided the services are within the experience and
9competence of the licensee.

10(4) “Qualified autism service professional” means an individual
11who meets all of the following criteria:

12(A) Provides behavioral health treatment.

13(B) Is employed and supervised by a qualified autism service
14provider.

15(C) Provides treatment pursuant to a treatment plan developed
16and approved by the qualified autism service provider.

17(D) Is a behavioral service provider approved as a vendor by a
18California regional center to provide services as an Associate
19Behavior Analyst, Behavior Analyst, Behavior Management
20Assistant, Behavior Management Consultant, or Behavior
21Management Program as defined in Section 54342 of Title 17 of
22the California Code of Regulations.

23(E) Has training and experience in providing services for
24pervasive developmental disorder or autism pursuant to Division
254.5 (commencing with Section 4500) of the Welfare and
26Institutions Code or Title 14 (commencing with Section 95000)
27of the Government Code.

28(5) “Qualified autism service paraprofessional” means an
29unlicensed and uncertified individual who meets all of the
30following criteria:

31(A) Is employed and supervised by a qualified autism service
32provider.

33(B) Provides treatment and implements services pursuant to a
34treatment plan developed and approved by the qualified autism
35service provider.

36(C) Meets the criteria set forth in the regulations adopted
37pursuant to Section 4686.3 of the Welfare and Institutions Code.

38(D) Has adequate education, training, and experience, as
39certified by a qualified autism service provider.

40(d) This section shall not apply to the following:

P20   1(1) A specialized health insurance policy that does not cover
2mental health or behavioral health services or an accident only,
3specified disease, hospital indemnity, or Medicare supplement
4policy.

5(2) A health insurance policy in the Medi-Cal program (Chapter
67 (commencing with Section 14000) of Part 3 of Division 9 of the
7Welfare and Institutions Code).

8(3) A health insurance policy in the Healthy Families Program
9(Part 6.2 (commencing with Section 12693)).

10(4) A health care benefit plan or policy entered into with the
11Board of Administration of the Public Employees’ Retirement
12System pursuant to the Public Employees’ Medical and Hospital
13Care Act (Part 5 (commencing with Section 22750) of Division 5
14of Title 2 of the Government Code).

15(e) Nothing in this section shall be construed to limit the
16obligation to provide services under Section 10144.5.

17(f) As provided in Section 10144.5 and in paragraph (1) of
18subdivision (a), in the provision of benefits required by this section,
19a health insurer may utilize case management, network providers,
20utilization review techniques, prior authorization, copayments, or
21other cost sharing.

begin insert

22(g) No later than December 31, 2017, and thereafter as
23necessary, the Board of Psychology, upon appropriation by the
24Legislature, shall convene a committee to create a list of
25evidence-based treatment modalities for purposes of developing
26mandated behavioral health treatment modalities for pervasive
27developmental disorder or autism.

end insert
begin delete

28(g)

end delete

29begin insert(h)end insert This section shall remain in effect only until January 1,begin delete 2017,end delete
30begin insert 2022,end insert and as of that date is repealed, unless a later enacted statute,
31that is enacted before January 1,begin delete 2017,end deletebegin insert 2022,end insert deletes or extends
32that date.

33begin insert

begin insertSEC. 4.end insert  

end insert
begin insert

No reimbursement is required by this act pursuant to
34Section 6 of Article XIII B of the California Constitution because
35the only costs that may be incurred by a local agency or school
36district will be incurred because this act creates a new crime or
37infraction, eliminates a crime or infraction, or changes the penalty
38for a crime or infraction, within the meaning of Section 17556 of
39the Government Code, or changes the definition of a crime within
P21   1the meaning of Section 6 of Article XIII B of the California
2Constitution.

end insert


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