BILL ANALYSIS Ó
AB 796
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Date of Hearing: January 21, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
796 (Nazarian) - As Amended January 13, 2016
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|Policy |Business and Professions |Vote:|12-0 |
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| |Health | |18 - 0 |
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Urgency: No State Mandated Local Program: YesReimbursable:
No
SUMMARY:
This bill requires the Board of Psychology (BOP), no later than
December 31, 2017, and thereafter as necessary, upon
appropriation of the Legislature, to convene a committee to
create a list of evidence-based treatment modalities for
purposes of behavioral health treatment for pervasive
developmental disorder or autism (PDD/A, hereafter referred to
as autism).
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It also extends the sunset on the existing behavioral health
treatment (BHT) mandate for an additional five years, from
January 1, 2017 to January 1, 2022.
FISCAL EFFECT:
1)Costs to the Board of Psychology of under $50,000 for each
update to the list of evidence-based BHT models for an
unspecified number of updates between 2017 and the bill's
sunset in 2022.
2)The California Health Benefits Review Program (CHBRP)
estimated no impact on private insurance premium cost or on
public health from a previous bill (SB 126 (Steinberg),
Chapter 680, Statutes of 2013) that extended the sunset on the
BHT mandate from January 1, 2014 to January 1, 2017, given
that state mental health parity laws already require coverage
for this treatment. Although a CHBRP analysis was not
performed on the current version of this bill, it appears as
through the same reasoning would hold, and there would be no
premium cost impact from a provision extending the mandate for
additional years.
3)Potential minor and absorbable costs to the Department of
Managed Health Care (DMHC) (Managed Care Fund) and the
California Department of Insurance (CDI) (Insurance Fund) to
oversee compliance with the existing mandate for an additional
five years. Compliance costs for coverage of BHT generally are
due to state and federal mental health parity laws, and not to
this mandate. However, extending this mandate would extend
important definitions of qualified providers and network
requirements, as well as some specificity in what must be
covered, for an additional five years.
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4)The creation of a state-sanctioned list of evidence-based
treatments is intended to lead to coverage of more types of
behavioral health treatment by health plans and insurers.
Although the current mandate already requires coverage of BHT,
which is defined to include "evidence-based behavior
intervention programs," to the extent this bill increases
coverage for and utilization of various BHTs, it could result
in unknown cost pressure to premiums in the private market.
State-provided health insurance, including Medi-Cal and plans
offered by CalPERS, are exempt from this mandate.
COMMENTS:
1)Purpose. The purpose of this bill is to provide expert
guidance on what constitutes evidence-based treatment for
autism with the intent that such guidance leads to greater
coverage of different types of BHT, as well as to extend the
existing BHT coverage mandate for five years. The author
indicates autism treatment should not be one-size-fits-all,
and this bill is intended to provide guidance that will allow
children to receive coverage for the type of evidence-based
treatment that is appropriate for their unique needs.
Specifically, it appears this bill is attempting to establish
a basis for what types of coverage must be offered by health
plans, as well as a basis upon which families can challenge
coverage denials, by having BOP, a third party made up of
psychological professionals, establish a list of what
treatments are evidence-based.
This bill is sponsored by the DIR Floortime Coalition,
practitioners of an autism treatment called Developmental,
Individual-differences, & Relationship-based (DIR) Floortime.
DIR Floortime is a developmental model of treatment used for
autism that attempts to build healthy foundations for social,
emotional, and intellectual capacities by following the
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child's lead (which for young children often means interacting
with them through play on the floor).
2)Autism Treatment. The most well-known and studied treatment
for autism is Applied Behavioral Analysis (ABA), a behavioral
model that uses learning techniques to increase desirable
behaviors and reduce harmful ones. There are also other, less
widely-used treatments, some of which use a developmental
model and others that are a hybrid of both models. A recent
evidence review in the Journal of Clinical Child and
Adolescent Psychology notes the evidence base for
interventions has grown substantially since 2008, and that an
increasing number of interventions have some empirical
support, while others are emerging as potentially effective.
3)Coverage for BHT. SB 946 (Steinberg), Chapter 650, Statutes of
2011, instituted the current BHT mandate, which this bill
proposes to extend for an additional five years. The mandate
requires health plans and insurers to cover BHT for autism if
certain criteria are met. The sunset on the mandate was
extended once in 2013 by SB 126, as noted above. Regulators
maintain that even without this mandate, in order to comply
with mental health parity laws, BHT would have to be covered.
Both state and federal mental health parity laws apply, and
they generally require mental health benefits to be covered at
"parity" with medical benefits, or subject only to limits that
are no more restrictive than those on medical benefits.
California's mental health parity law, AB 88 (Thomson),
Chapter 534, Statutes of 1999, specifically lists autism as a
covered condition. Anecdotally, this bill's proponents have
indicated difficulty in securing health care coverage for
treatment other than ABA. According to figures obtained from
CDI and DMHC, the vast majority of independent medical review
(IMR) decisions about coverage denials have been resolved in
favor of the families seeking coverage.
4)DMHC Autism Advisory Task Force. When the BHT mandate was put
into place, SB 946 also required DMHC to convene an Autism
Advisory Task Force (Task Force) by February 1, 2012, to
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develop recommendations regarding medically necessary BHT for
individuals with autism, as well as the appropriate
qualifications, training, and supervision for providers of
such treatment.
The Task Force declined to develop a list of BHTs for autism.
The report instead concluded that BHT interventions need to be
highly individualized and that treatment selection should be
made by a team of individuals who can consider the unique
needs and history of the individual with autism. It further
states it would not be informative to state policy makers to
merely develop a list of BHTs that are determined to be
effective, based solely on current scientific literature. It
states many scientific studies have addressed the efficacy of
BHTs for autism, and that the choice of treatment should be
grounded in scientific evidence, clinical practice guidelines,
or evidence-based practice.
5)Staff Comments. Treatment and research for autism are rapidly
evolving. CHBRP notes in their April 21, 2015 analysis of a
previous version of this bill that while a preponderance of
evidence suggests that intensive autism treatments are more
effective than usual treatments in increasing IQ and improving
adaptive behaviors, outcomes for individual children vary
widely, and the literature on effectiveness is limited in
several respects, including that most studies are not
randomized. Further, there seems to be consensus that
individual cases are unique and may respond differently to the
same treatment. Given the confusing, limited, and rapidly
evolving evidence base, it is perhaps no surprise providers,
parents, and plans have difficulty definitively identifying
what may appropriate for an individual child.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
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