BILL ANALYSIS                                                                                                                                                                                                    ”



                                                                     AB 796


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          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 HernŠndez,      |                    |
          |                |     |Lackey, Nazarian,     |                    |
          |                |     |Patterson,            |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Santiago,  |                    |
          |                |     |Steinorth, Thurmond,  |                    |
          |                |     |Waldron, Wood         |                    |
          |                |     |                      |                    |








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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