BILL ANALYSIS Ó AB 796 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 796 (Nazarian) As Amended August 16, 2016 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |75-0 |(January 25, |SENATE: |39-0 |(August 24, | | | |2016) | | |2016) | | | | | | | | | | | | | | | -------------------------------------------------------------------- Original Committee Reference: B. & P. 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. The Senate amendments delete provisions that require the BOP to convene a committee to create a list of evidence-based treatment modalities for purposes of developing mandated BHT modalities for PDD/A, add clarifying amendments regarding the definition of a qualified autism service professional, and delete the January 1, 2017 sunset provisions requiring health care service plans to provide health coverage for BHT for PDD/A. AB 796 Page 2 FISCAL EFFECT: According to the Senate Appropriations Committee: 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 the Department of Managed Health Care (Managed Care Fund). 2)Likely costs of less than $100,000 per year for review of health insurance plan filings and enforcement actions by the Department of Insurance (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 the California Public Employees' Retirement System 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. 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 AB 796 Page 3 by the medical professional that knows the child best. 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). The California Health Benefits Review Program 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. AB 796 Page 4 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 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 AB 796 Page 5 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 qualified autism service 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: 0004958