BILL ANALYSIS Ó
AB 796
Page 1
ASSEMBLY THIRD READING
AB
796 (Nazarian)
As Amended January 13, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Business & |12-0 |Bonilla, Jones, | |
|Professions | |Baker, Bloom, Campos, | |
| | |Chang, Dodd, Gatto, | |
| | |Holden, Mullin, Ting, | |
| | |Wood | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |18-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, Chiu, | |
| | |Gomez, Gonzalez, | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Patterson, | |
| | | | |
| | | | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
AB 796
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|----------------+-----+----------------------+--------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bloom, Bonilla, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, Eduardo | |
| | |Garcia, Holden, | |
| | |Jones, Quirk, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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SUMMARY: Requires the Board of Psychology (BOP) to convene a
committee to create a list of evidence-based treatment
modalities for purposes of developing mandated behavioral health
treatment (BHT) modalities for pervasive development disorder or
autism (PDD/A). Extends the sunset provisions requiring health
care service plans to provide health coverage for BHT for PDD/A
to January 1, 2022.
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)Costs to BOP 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
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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 (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.
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: According to the author, this bill recognizes that
there is no one size fits all BHT for an individual diagnosed
with autism. Every child on the autism spectrum presents
differently, as such treatment options must reflect that
spectrum. The author states that this bill ensures children
diagnosed with autism will receive insurance coverage for the
type of evidence-based BHT that is right and selected for them
by the medical professional that knows the child best.
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1)DMHC Autism Advisory Task Force. SB 946 (Steinberg), Chapter
650, Statutes of 2011, requires DMHC to convene an Autism
Advisory Task Force (Task Force) by February 1, 2012, to
develop recommendations regarding medically necessary BHT for
individuals with PDD/A, as well as the appropriate
qualifications, training, and supervision for providers of
such treatment. SB 946 also requires the Task Force to
develop recommendations regarding the education, training, and
experience requirements that unlicensed individuals providing
BHT must meet in order to obtain licensure from the state.
The Task Force consisted of 18 members including research
experts, treating providers, health plan representatives,
consumer advocates, and members-at-large, many of whom were
also parents of individuals with PDD/A.
The Task Force concluded that behavioral health 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 PDD/A. The
Task Force determined that 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.
2)Pervasive Developmental Disorders and Autism. PDD/As are
neurodevelopmental disorders that typically become symptomatic
in children aged two to three years. They are chronic
conditions characterized by impairments in social
interactions, communication, sensory processing, repetitive
behaviors or interests, and sometimes cognitive function.
Symptoms range from mild to severe, as reflected by the phrase
"autism spectrum disorders" (ASD). CHBRP estimates that
approximately 87,000 Californians have PDD/A. Many persons
with PDD/A (primarily children) are treated with Intensive
Behavioral Intervention Therapy, which aim to improve
behavior, cognitive function, language, and social skills.
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3)Behavioral Health Treatment. Behavior analysis focuses on the
principles that explain how learning takes place. Positive
reinforcement is one such principle. When a behavior is
followed by some sort of reward, the behavior is more likely
to be repeated. Through decades of research, the field of
behavior analysis has developed many techniques for increasing
useful behaviors and reducing those that may cause harm or
interfere with learning. Applied Behavior Analysis (ABA) is
the use of these techniques and principles to bring about
meaningful and positive change in behavior. ABA emerged in
the early 1960's as a treatment therapy and is therefore one
of the most researched and recognized therapies. However,
PDD/A is a complex disorder that impacts every child
differently and typically involves more than one type of
treatment therapy, of which there are many. Other therapies
include the Early Start Denver Model, a developmental,
relationship-based intervention approach that utilizes
teaching techniques consistent with ABA, Developmental,
Individual-differences, & Relationship-based Floortime
(DIR/Floortime) a specific technique to both follow the
child's natural emotional interests and at the same time
challenge the child towards mastery of the social, emotional,
and intellectual capacities.
Hundreds of individuals writing in support of a previous version
of this bill state that by requiring frontline providers to be
vendored by the regional centers, SB 946 limits treatment for
ASD to only one therapy, ABA. This bill would apply the same
level of requirements to other evidence-based forms of therapy
and will allow parents the opportunity to receive insurance
coverage for the BHT that is the most appropriate for their
child.
The DIR/Floortime Coalition of California writes in strong
support to a previous version of the bill that by allowing
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frontline personnel trained in the specific form of treatment
contained within the scope of the treatment plan developed by
their physician or psychologist, parents, and treatment
providers will be able to seek the most appropriate treatment
for their child with Autism.
Center for Autism & Related Disorders (CARD) states in
opposition to a previous version of this bill, that it will
amend California's landmark autism mandate to expand the
definition of "qualified autism service professional" to include
individuals who are not qualified to provide evidence-based BHT
and who were never intended to be included in the definition of
QAS professional. CARD argues that the effectiveness of
evidence-based autism treatment requires trained and experienced
individuals to oversee and implement it.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0002577