BILL ANALYSIS Ó
AB 796
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CONCURRENCE IN SENATE AMENDMENTS
AB
796 (Nazarian)
As Amended August 16, 2016
Majority vote
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|ASSEMBLY: |75-0 |(January 25, |SENATE: |39-0 |(August 24, |
| | |2016) | | |2016) |
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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
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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
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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.
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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
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
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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