BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 796|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
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THIRD READING
Bill No: AB 796
Author: Nazarian (D), et al.
Amended: 8/16/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 6-2, 6/15/16
AYES: Hernandez, Hall, Monning, Pan, Roth, Wolk
NOES: Nguyen, Nielsen
NO VOTE RECORDED: Mitchell
SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/28/16
AYES: McGuire, Berryhill, Hancock, Liu, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 5-0, 8/11/16
AYES: Lara, Beall, Hill, McGuire, Mendoza
NO VOTE RECORDED: Bates, Nielsen
ASSEMBLY FLOOR: 75-0, 1/25/16 - See last page for vote
SUBJECT: Health care coverage: autism and pervasive
developmental disorders
SOURCE: DIR/Floortime Coalition of California
DIGEST: This bill eliminates the sunset date on the health
insurance mandate to cover behavioral health treatment for
pervasive developmental disorder or autism.
ANALYSIS:
Existing law:
1)Establishes the Department of Managed Health Care (DMHC) to
regulate health plans under the Knox-Keene Health Care
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Services Plan Act of 1975; the California Department of
Insurance (CDI) to regulate health insurers under; and, the
California Health Benefit Exchange (Exchange) to compare and
make available through selective contracting health insurance
for individual and small business purchasers as authorized
under the federal Patient Protection and Affordable Care Act
(ACA).
2)Establishes as California's essential health benefits (EHBs)
benchmark the Kaiser Small Group Health Maintenance
Organization plan, existing California mandates, and 10 ACA
mandated benefits, which include mental health and substance
use disorder services, including behavioral health treatment.
3)Requires every health plan contract that provides hospital,
medical, or surgical coverage and health insurance policy to
also provide coverage for behavioral health treatment for
pervasive developmental disorder or autism no later than July
1, 2012. Requires the coverage to be provided in the same
manner and to be subject to the same requirements as provided
in California's mental health parity law.
4)Establishes a definition for "qualified autism service
professional" which includes a requirement that the individual
is a behavioral 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 as defined in existing law and regulations;
and a definition for "qualified autism service
paraprofessional" which includes a requirement to meet
criteria set forth in different section of existing law and
regulations.
5)Exempts from 3) above a specialized health plan or health
insurance policy that does not deliver mental health or
behavioral health services to enrollees, or an accident only,
specified disease, hospital indemnity, or Medicare supplement
policy, a health plan contract or health insurance policy
under Medi-Cal or Healthy Families program, and a health care
benefit plan or contract pursuant to the Public Employees'
Retirement System (CalPERS).
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6)Sunsets the provisions above on January 1, 2017.
7)Establishes a system of nonprofit Regional Centers, overseen
by the State Department of Developmental Services (DDS), to
provide fixed points of contact in the community for all
persons with developmental disabilities and their families, to
coordinate services and supports best suited to them
throughout their lifetime.
8)Defines in state regulations, for purposes of regional center
vendorization, Behavior Management Assistant, Behavior
Management Consultant, Behavior Analyst and Associate Behavior
Analyst and requires education or experience in applied
behavioral analysis, as specified.
This bill deletes the January 1, 2017 sunset date.
Comments
1)Author's statement. According to the author, this bill would
ensure that children diagnosed with autism continue to have
access to medically necessary treatments to increase their
quality of life and functional independence by removing the
2017 sunset on the requirement for health plans and insurers
to provide behavioral health treatments to children with
autism.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: Yes
According to the Senate Committee on Appropriations:
1)One-time costs of about $50,000 and ongoing costs of $15,000
per year to review health plan filings for compliance with the
requirements of the bill and to undertake any necessary
enforcement actions by DMHC (Managed Care Fund).
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2)Likely costs of less than $100,000 per year for review of
health insurance plan filings and enforcement actions by CDI
(Insurance Fund).
3)No state costs are anticipated due to the elimination of the
existing sunset on the benefit mandate. Current law exempts
Medi-Cal managed care plans and CalPERS coverage from the
benefit mandate. This bill does not eliminate those
exemptions,
While existing law specifically mandates coverage for
behavioral health treatment, separate federal and state mental
health parity requirements and requirements for the provision
of essential health benefits implicitly require coverage for
behavioral health treatment for autism and related disorders.
Therefore, elimination of the statutory sunset will not
materially impact coverage for behavioral health treatment.
Nor will eliminating the sunset require the state to pay for
the costs to subsidize coverage for behavioral health
treatment coverage for subsidized Covered California plans.
SUPPORT: (Verified8/10/16)
DIR/Floortime Coalition of California (source)
Association of Regional Center Agencies
Occupational Therapy Association of California
Several hundred individuals
OPPOSITION: (Verified8/10/16)
Department of Developmental Disabilities
ARGUMENTS IN SUPPORT: The DIR Floortime Coalition of
California writes that as supporters of SB 946, they are
familiar with the intent of the legislation. The DMHC was
tasked with convening a task force to provide recommendations
concerning the legislation, and they unanimously adopted the
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guiding principle that behavioral health interventions should be
highly individualized and that the choice of treatment should be
grounded in scientific evidence, clinical practice guidelines,
and/or evidence-based practice. (This support argument is based
on a prior version of this bill.)
ARGUMENTS IN OPPOSITION: DDS writes in opposition that it
recognizes that timely and effective behavioral health treatment
reduces the lifelong costs associated with providing services to
individuals with Autism Spectrum Disorders (ASD) and that
conversely, the absence of effective interventions, or use of
ineffective or harmful treatment modalities, can inhibit
meaningful progress. The determination of effectiveness of
treatment modalities must be based on sound, scientifically
validated principles and supported by empirical data. Several
well-established sources of information already exist regarding
evidence-based practices for ASD. (This opposition argument is
based on a prior version of this bill.)
ASSEMBLY FLOOR: 75-0, 1/25/16
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley,
Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer,
Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
Mayes, McCarty, Medina, Mullin, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Quirk, Rendon, Ridley-Thomas,
Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond,
Ting, Wagner, Waldron, Weber, Williams, Wood, Atkins
NO VOTE RECORDED: Dababneh, Eduardo Garcia, Melendez, Wilk
Prepared by:Teri Boughton / HEALTH / (916) 651-4111
8/16/16 17:38:44
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