Amended in Assembly August 1, 2016

Amended in Assembly June 30, 2016

Amended in Senate May 31, 2016

Amended in Senate April 26, 2016

Senate BillNo. 1034


Introduced by Senator Mitchell

February 12, 2016


An act to amend Section 1374.73 of the Health and Safety Code, to amend Sections 10144.51 and 10144.52 of the Insurance Code, and to amend Section 14132.56 of the Welfare and Institutions Code, relating to health care coverage.

LEGISLATIVE COUNSEL’S DIGEST

SB 1034, as amended, Mitchell. Health care coverage: autism.

Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. A violation of those provisions is a crime. Existing law provides for the licensure and regulation of health insurers by the Department of Insurance.

Existing law requires every health care service plan contract and health insurance policy to provide coverage for behavioral health treatment for pervasive developmental disorder or autism until January 1, 2017, and defines “behavioral health treatment” to mean specified services provided by, among others, a qualified autism service professional supervised and employed by a qualified autism service provider. Existing law defines a “qualified autism service professional” to mean a person who, among other requirements, is a behavior 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 pursuant to specified regulations adopted under the Lanterman Developmental Disabilities Services Act. Existing law requires a treatment plan to be reviewed no less than once every 6 months. Under existing law, the above provisions do not apply to certain types of health care coverage, including health care service plans and health insurance policies in the Medi-Cal program.

This bill would, among other things, modify requirements to be a qualified autism service professional to include providing behavioral health treatment,begin delete such as clinical management and case supervision.end deletebegin insert which may include clinical management and case supervision under the direction and supervision of a qualified autism service provider.end insert The bill would requirebegin delete that a treatment plan be reviewedend deletebegin insert that, unless a treatment plan is modified by a qualified autism service provider, utilization review be conductedend insert no more than once every 6begin delete months, unless a shorter period is recommended by the qualified autism service provider.end deletebegin insert months. The bill would also provide that coverage for behavioral health treatment for pervasive developmental disorder or autism would be dependent on medical necessity, subject to utilization review, and required to be in compliance with federal mental health parity requirements.end insert The bill would extend the operation of these provisions to January 1, 2022. The bill would require behavioral health treatment for purposes of the Medi-Cal program to expressly comply with the approved Medicaid state plan. The bill also would make clarifying and conforming changes.

By extending the operation of these provisions, the violation of which by a health care service plan would be a crime, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 1374.73 of the Health and Safety Code
2 is amended to read:

P3    1

1374.73.  

(a) (1) Every health care service plan contract that
2provides hospital, medical, or surgical coverage shall also provide
3coverage for behavioral health treatment for pervasive
4developmental disorder or autism no later than July 1, 2012. The
5coverage shall be provided in the same manner and shall be subject
6to the same requirements as provided in Section 1374.72.

7(2) Notwithstanding paragraphbegin delete (1), as of the date that proposed
8final rulemaking for essential health benefits is issued,end delete
begin insert (1),end insert this
9section does not require any benefits to be provided that exceed
10the essential health benefits that all health plans will be required
11by federal regulations to provide under Section 1302(b) of the
12federal Patient Protection and Affordable Care Act (Public Law
13111-148), as amended by the federal Health Care and Education
14Reconciliation Act of 2010 (Public Law 111-152).

15(3) This section shall not affect services for which an individual
16is eligible pursuant to Division 4.5 (commencing with Section
174500) of the Welfare and Institutions Code or Title 14
18(commencing with Section 95000) of the Government Code.

19(4) This section shall not affect or reduce any obligation to
20provide services under an individualized education program, as
21defined in Section 56032 of the Education Code, or an individual
22service plan, as described in Section 5600.4 of the Welfare and
23Institutions Code, or under the federal Individuals with Disabilities
24Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing
25regulations.

begin insert

26
(5) This section shall not be construed to require a health care
27service plan to provide reimbursement for services delivered by
28school personnel pursuant to an enrollee’s individualized
29educational program unless otherwise required by law.

end insert

30(b) Every health care service plan subject to this section shall
31maintain an adequate network that includes qualified autism service
32providers who supervise qualified autism service professionals or
33paraprofessionals who provide and administer behavioral health
34treatment. Nothingbegin insert hereinend insert shall prevent a health care service plan
35from selectively contracting with providers within these
36requirements.

37(c) For the purposes of this section, the following definitions
38shall apply:

39(1) “Behavioral health treatment” means professional services
40and treatment programs, including applied behavior analysis and
P4    1other evidence-based behavior intervention programs, that develop,
2 keep, or restore, to the maximum extent practicable, the functioning
3of an individual with pervasive developmental disorder or autism
4and that meet all of the following criteria:

5(A) The treatment is prescribed by a physician and surgeon
6licensed pursuant to Chapter 5 (commencing with Section 2000)
7of, or is developed by a psychologist licensed pursuant to Chapter
86.6 (commencing with Section 2900) of, Division 2 of the Business
9and Professions Code.

10(B) The treatment is provided under a treatment plan prescribed
11by a qualified autism service provider and is administered by one
12of the following:

13(i) A qualified autism service provider.

14(ii) A qualified autism service professional supervised by the
15qualified autism service provider.

16(iii) A qualified autism service paraprofessional supervised by
17a qualified autism service provider.

18(C) The treatment plan has measurable goals over a specific
19timeline that is developed and approved by the qualified autism
20service provider for the specific patient being treated. The treatment
21plan shall be reviewed nobegin delete moreend deletebegin insert lessend insert than once every six months
22by the qualified autism servicebegin delete provider, unless a shorter period
23is recommended by the qualified autism serviceend delete
provider, and
24modified whenever appropriate, and shall be consistent with
25Section 4686.2 of the Welfare and Institutions Code pursuant to
26which the qualified autism service provider does all of the
27following:

28(i) Describes the patient’s behavioral health impairments or
29developmental challenges that are to be treated.

30(ii) begin deleteDesigns an intervention plan that includes end deletebegin insertIncludes end insertthe
31service type, number of hours, and parent or caregiver participation
32recommended by the qualified autism service provider to achieve
33the plan’s goal andbegin delete objectives, and the frequency at which the
34patient’s progress is evaluated and reported. Lack of parent or
35caregiver participation shall not be used to deny or reduce
36medically necessary behavioral health treatment.end delete
begin insert objectives.end insert

37(iii) begin deleteProvides intervention plans that utilize end deletebegin insertUtilizes end insert
38evidence-based practices, with demonstrated clinical efficacy in
39treating pervasive developmental disorder or autism.

P5    1(iv) Discontinues intensive behavioral intervention services
2when the treatment goals and objectives are achieved or no longer
3appropriate, and continued therapy is not necessary to maintain
4function or prevent deterioration.

begin insert

5
(v) Makes the treatment plan available to the health care service
6plan upon request.

end insert

7(D) begin delete(i)end deletebegin deleteend deleteThe treatment plan is not used for purposes of providing
8or for the reimbursement of respite, day care, or academic services
9and is not used to reimburse a parent for participating in the
10treatment program.

begin delete

11(ii) The setting, location, or time of treatment shall not be used
12as a reason to deny medically necessary behavioral health
13treatment.

14(iii) The treatment plan shall be made available to the health
15care service plan upon request.

end delete

16(2) “Pervasive developmental disorder or autism” shall have
17the same meaning and interpretation as used in Section 1374.72.

18(3) “Qualified autism service provider” means either of the
19following:

20(A) A person, entity, or group that is certified by a national
21entity, such as the Behavior Analyst Certification Board, that is
22accredited by the National Commission for Certifying Agencies,
23and who designs, supervises, or provides treatment for pervasive
24developmental disorder or autism, provided the services are within
25the experience and competence of the person, entity, or group that
26is nationally certified.

27(B) A person licensed as a physician and surgeon, physical
28therapist, occupational therapist, psychologist, marriage and family
29therapist, educational psychologist, clinical social worker,
30professional clinical counselor, speech-language pathologist, or
31audiologist pursuant to Division 2 (commencing with Section 500)
32of the Business and Professions Code, who designs, supervises,
33or provides treatment for pervasive developmental disorder or
34autism, provided the services are within the experience and
35competence of the licensee.

36(4) “Qualified autism service professional” means an individual
37who meets all of the following criteria:

38(A) Provides behavioral healthbegin delete treatment, including clinical
39management and case supervision.end delete
begin insert treatment, which may include
P6    1clinical management and case supervision under the direction and
2supervision of a qualified autism service provider.end insert

3(B) Is supervised by abegin insert person, entity, or group that is aend insert qualified
4autism service provider.

5(C) Provides treatment pursuant to a treatment plan developed
6and approved by the qualified autism service provider.

7(D) Is a behavioral service provider who meets the education
8and experience qualifications defined in Section 54342 of Title 17
9of the California Code of Regulations for an Associate Behavior
10Analyst, Behavior Analyst, Behavior Management Assistant,
11Behavior Management Consultant, or Behavior Management
12Program.

13(E) Has training and experience in providing services for
14pervasive developmental disorder or autism pursuant to Division
154.5 (commencing with Section 4500) of the Welfare and
16Institutions Code or Title 14 (commencing with Section 95000)
17of the Government Code.

18(5) “Qualified autism service paraprofessional” means an
19unlicensed and uncertified individual who meets all of the
20following criteria:

21(A) Is supervised by abegin delete qualified autism service provider.end deletebegin insert person,
22 entity, or group that is a qualified autism service provider or
23qualified autism service professional.end insert

24(B) Provides treatment and implements services pursuant to a
25treatment plan developed and approved by the qualified autism
26service provider or qualified autism service professional.

27(C) Meets the education and training qualifications defined in
28
begin delete the regulations adopted pursuant to Section 4686.3 of the Welfare
29and Institutions Code.end delete
begin insert Section 54342 of Article 3 of Subchapter 2
30of Chapter 3 of Division 2 of Title 17 of the California Code of
31Regulations.end insert

32(D) Has adequate education, training, and experience, as
33certified by a qualified autism service provider.

34(d) This section shall not apply to the following:

35(1) A specialized health care service plan that does not deliver
36mental health or behavioral health services to enrollees.

37(2) A health care service plan contract in the Medi-Cal program
38(Chapter 7 (commencing with Section 14000) of Part 3 of Division
399 of the Welfare and Institutions Code). The provision of
40behavioral health treatment in the Medi-Cal program, including
P7    1any associated obligation of a health care service plan in the
2Medi-Cal program, is governed by Section 14132.56 of the Welfare
3and Institutions Code, the approved Medi-Cal state plan and
4waivers, and applicable federal Medicaid law.

5(e) This section does not limit the obligation to provide services
6pursuant to Section 1374.72.

7(f) As provided in Section 1374.72 and in paragraph (1) of
8subdivision (a), in the provision of benefits required by this section,
9a health care service plan may utilize case management, network
10providers, utilization review techniques, prior authorization,
11copayments, or other cost sharing.

begin insert

12
(1) Unless a treatment plan is modified by a qualified autism
13service provider, utilization review shall be conducted no more
14often than every six months and shall be conducted in accordance
15with good professional practice and consistent with the
16requirements of Section 1363.5.

end insert
begin insert

17
(2) The setting, location, or time of treatment recommended by
18the qualified autism service provider shall not be used as a reason
19to deny or reduce coverage for medically necessary services.

end insert
begin insert

20
(3) Lack of parent or caregiver participation shall not be used
21as the sole basis for denying or reducing coverage of medically
22necessary services.

23
(4) Notwithstanding paragraphs (2) and (3), all services shall
24remain covered only to the extent that the services are medically
25necessary and subject to utilization review as described in this
26subdivision.

27
(5) Provision of services under this section, including any limits
28on the scope or duration of these services, shall be in compliance
29with the Paul Wellstone and Pete Domenici Mental Health Parity
30and Addiction Equity Act of 2008 (Public Law 110-343), and all
31rules, regulations, or guidance issued pursuant to Section 2726
32of the federal Public Health Service Act (42 U.S.C. Sec. 300gg-26).

end insert

33(g) This section shall not be construed to require coverage for
34services that are included inbegin delete a patient’send deletebegin insert an enrollee’send insert individualized
35education program.

36(h) This section shall remain in effect only until January 1, 2022,
37and as of that date is repealed, unless a later enacted statute, that
38is enacted before January 1, 2022, deletes or extends that date.

39

SEC. 2.  

Section 10144.51 of the Insurance Code is amended
40to read:

P8    1

10144.51.  

(a) (1) Every health insurance policy shall also
2provide coverage for behavioral health treatment for pervasive
3developmental disorder or autism no later than July 1, 2012. The
4coverage shall be provided in the same manner and shall be subject
5to the same requirements as provided in Section 10144.5.

6(2) Notwithstanding paragraphbegin delete (1), as of the date that proposed
7final rulemaking for essential health benefits is issued,end delete
begin insert (1),end insert this
8section does not require any benefits to be provided that exceed
9 the essential health benefits that all health insurers will be required
10by federal regulations to provide under Section 1302(b) of the
11federal Patient Protection and Affordable Care Act (Public Law
12111-148), as amended by the federal Health Care and Education
13Reconciliation Act of 2010 (Public Law 111-152).

14(3) This section shall not affect services for which an individual
15is eligible pursuant to Division 4.5 (commencing with Section
164500) of the Welfare and Institutions Code or Title 14
17(commencing with Section 95000) of the Government Code.

18(4) This section shall not affect or reduce any obligation to
19provide services under an individualized education program, as
20defined in Section 56032 of the Education Code, or an individual
21service plan, as described in Section 5600.4 of the Welfare and
22Institutions Code, or under the federal Individuals with Disabilities
23Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing
24regulations.

begin insert

25
(5) This section shall not be construed to require a health
26insurer to provide reimbursement for services delivered by school
27personnel pursuant to an insured’s individualized educational
28program unless otherwise required by law.

end insert

29(b) Pursuant to Article 6 (commencing with Section 2240) of
30Title 10 of the California Code of Regulations, every health insurer
31subject to this section shall maintain an adequate network that
32includes qualified autism service providers who supervise qualified
33autism service professionals or paraprofessionals who provide and
34administer behavioral health treatment. Nothingbegin insert hereinend insert shall
35prevent a health insurer from selectively contracting with providers
36within these requirements.

37(c) For the purposes of this section, the following definitions
38shall apply:

39(1) “Behavioral health treatment” means professional services
40and treatment programs, including applied behavior analysis and
P9    1other evidence-based behavior intervention programs, that develop,
2keep, or restore, to the maximum extent practicable, the functioning
3of an individual with pervasive developmental disorder or autism,
4and that meet all of the following criteria:

5(A) The treatment is prescribed by a physician and surgeon
6licensed pursuant to Chapter 5 (commencing with Section 2000)
7of, or is developed by a psychologist licensed pursuant to Chapter
86.6 (commencing with Section 2900) of, Division 2 of the Business
9and Professions Code.

10(B) The treatment is provided under a treatment plan prescribed
11by a qualified autism service provider and is administered by one
12of the following:

13(i) A qualified autism service provider.

14(ii) A qualified autism service professional supervised by the
15qualified autism service provider.

16(iii) A qualified autism service paraprofessional supervised by
17a qualified autism service provider.

18(C) The treatment plan has measurable goals over a specific
19timeline that is developed and approved by the qualified autism
20service provider for the specific patient being treated. The treatment
21plan shall be reviewed nobegin delete moreend deletebegin insert lessend insert than once every six months
22by the qualified autism servicebegin delete provider, unless a shorter period
23is recommended by the qualified autism serviceend delete
provider, and
24modified whenever appropriate, and shall be consistent with
25Section 4686.2 of the Welfare and Institutions Code pursuant to
26which the qualified autism service provider does all of the
27following:

28(i) Describes the patient’s behavioral health impairments or
29developmental challenges that are to be treated.

30(ii) begin deleteDesigns an intervention plan that includes end deletebegin insertIncludes end insertthe
31service type, number of hours, and parent or caregiver participation
32recommended by a qualified autism service provider to achieve
33the plan’s goal andbegin delete objectives, and the frequency at which the
34patient’s progress is evaluated and reported. Lack of parent or
35caregiver participation shall not be used to deny or reduce
36medically necessary behavioral health treatment.end delete
begin insert objectives.end insert

37(iii) begin deleteProvides intervention plans that utilize end deletebegin insertUtilizes end insert
38evidence-based practices, with demonstrated clinical efficacy in
39treating pervasive developmental disorder or autism.

P10   1(iv) Discontinues intensive behavioral intervention services
2when the treatment goals and objectives are achieved or no longer
3appropriate, and continued therapy is not necessary to maintain
4function or prevent deterioration.

begin insert

5
(v) Makes the treatment plan available to the health insurer
6upon request.

end insert

7(D) begin delete(i)end deletebegin deleteend deleteThe treatment plan is not used for purposes of providing
8or for the reimbursement of respite, day care, or academic services
9and is not used to reimburse a parent for participating in the
10treatment program.

begin delete

11(ii) The setting, location, or time of treatment shall not be used
12as a reason to deny medically necessary behavioral health
13treatment.

end delete
begin delete

14(iii) The treatment plan shall be made available to the insurer
15upon request.

end delete

16(2) “Pervasive developmental disorder or autism” shall have
17the same meaning and interpretation as used in Section 10144.5.

18(3) “Qualified autism service provider” means either of the
19following:

20(A) A person, entity, or group that is certified by a national
21entity, such as the Behavior Analyst Certification Board, that is
22accredited by the National Commission for Certifying Agencies,
23and who designs, supervises, or provides treatment for pervasive
24developmental disorder or autism, provided the services are within
25the experience and competence of the person, entity, or group that
26is nationally certified.

27(B) A person licensed as a physician and surgeon, physical
28therapist, occupational therapist, psychologist, marriage and family
29therapist, educational psychologist, clinical social worker,
30professional clinical counselor, speech-language pathologist, or
31audiologist pursuant to Division 2 (commencing with Section 500)
32of the Business and Professions Code, who designs, supervises,
33or provides treatment for pervasive developmental disorder or
34autism, provided the services are within the experience and
35competence of the licensee.

36(4) “Qualified autism service professional” means an individual
37who meets all of the following criteria:

38(A) Provides behavioral healthbegin delete treatment, including clinical
39management and case supervision.end delete
begin insert treatment, which may include
P11   1clinical management and case supervision under the direction and
2supervision of a qualified autism service provider.end insert

3(B) Is employed and supervised by abegin insert person, entity, or group
4that is aend insert
qualified autism service provider.

5(C) Provides treatment pursuant to a treatment plan developed
6and approved by the qualified autism service provider.

7(D) Is a behavioral service provider who meets the education
8and experience qualifications defined in Section 54342 of Title 17
9of the California Code of Regulations for an Associate Behavior
10 Analyst, Behavior Analyst, Behavior Management Assistant,
11Behavior Management Consultant, or Behavior Management
12Program.

13(E) Has training and experience in providing services for
14pervasive developmental disorder or autism pursuant to Division
154.5 (commencing with Section 4500) of the Welfare and
16Institutions Code or Title 14 (commencing with Section 95000)
17of the Government Code.

18(5) “Qualified autism service paraprofessional” means an
19unlicensed and uncertified individual who meets all of the
20following criteria:

21(A) Is supervised by abegin delete qualified autism service provider.end deletebegin insert person,
22entity, or group that is a qualified autism service provider or
23qualified autism service professional.end insert

24(B) Provides treatment and implements services pursuant to a
25treatment plan developed and approved by the qualified autism
26service provider or qualified autism service professional.

27(C) Meets the education and training qualifications defined in
28
begin delete the regulations adopted pursuant to Section 4686.3 of the Welfare
29and Institutions Code.end delete
begin insert end insertbegin insertSection 54342 of Article 3 of Subchapter 2
30of Chapter 3 of Division 2 of Title 17 of the California Code of
31Regulations.end insert

32(D) Has adequate education, training, and experience, as
33certified by a qualified autism service provider.

34(d) This section shall not apply to the following:

35(1) A specialized health insurance policy that does not cover
36mental health or behavioral health services or an accident only,
37specified disease, hospital indemnity, or Medicare supplement
38policy.

39(2) A health insurance policy in the Medi-Cal program (Chapter
407 (commencing with Section 14000) of Part 3 of Division 9 of the
P12   1Welfare and Institutions Code). The provision of behavioral health
2treatment in the Medi-Cal program, including any associated
3obligation of a health insurance policy in the Medi-Cal program,
4is governed by Section 14132.56 of the Welfare and Institutions
5Code, the approved Medi-Cal state plan and waivers, and
6applicable federal Medicaid law.

7(e) As provided in Section 10144.5 and in paragraph (1) of
8subdivision (a), in the provision of benefits required by this section,
9a health insurer may utilize case management, network providers,
10utilization review techniques, prior authorization, copayments, or
11other cost sharing.

begin insert

12
(1) Unless a treatment plan is modified by a qualified autism
13service provider, utilization review shall be conducted no more
14often than every six months and shall be conducted in accordance
15with good professional practice and consistent with the
16requirements of subdivision (f) of Section 10123.135.

17
(2) The setting, location, or time of treatment recommended by
18the qualified autism service provider shall not be used as a reason
19to deny or reduce coverage for medically necessary services.

20
(3) Lack of parent or caregiver participation shall not be used
21as the sole basis for denying or reducing coverage of medically
22necessary services.

23
(4) Notwithstanding paragraphs (2) and (3), all services shall
24remain covered only to the extent that the services are medically
25necessary and subject to utilization review as described in this
26subdivision.

27
(5) Provision of services under this section, including any limits
28on the scope or duration of these services, shall be in compliance
29with the federal Paul Wellstone and Pete Domenici Mental Health
30Parity and Addiction Equity Act of 2008 (Public Law 110-343),
31and all rules, regulations, or guidance issued pursuant to Section
322726 of the federal Public Health Service Act (42 U.S.C. Sec.
33300gg-26).

end insert

34(f) This section shall not be construed to require coverage for
35services that are included inbegin delete a patient’send deletebegin insert an insured’send insert individualized
36education program.

37(g) This section shall remain in effect only until January 1, 2022,
38and as of that date is repealed, unless a later enacted statute, that
39is enacted before January 1, 2022, deletes or extends that date.

P13   1

SEC. 3.  

Section 10144.52 of the Insurance Code is amended
2to read:

3

10144.52.  

(a) For purposes of this part, the terms “provider,”
4“professional provider,” “network provider,” “mental health
5provider,” and “mental health professional” shall include the term
6“qualified autism service provider,” as defined in subdivision (c)
7of Section 10144.51.

8(b) This section shall remain in effect only until January 1, 2022,
9and as of that date is repealed, unless a later enacted statute, that
10is enacted before January 1, 2022, deletes or extends that date.

begin delete
11

SEC. 4.  

Section 14132.56 of the Welfare and Institutions Code
12 is amended to read:

13

14132.56.  

(a) (1) Only to the extent required by the federal
14government and effective no sooner than required by the federal
15government, behavioral health treatment (BHT) shall be a covered
16Medi-Cal service for individuals under 21 years of age.

17(2) It is the intent of the Legislature that, to the extent the federal
18government requires BHT to be a covered Medi-Cal service, the
19department shall seek statutory authority to implement this new
20benefit in Medi-Cal.

21(3) For purposes of this section, “behavioral health treatment”
22or “BHT” means professional services and treatment programs,
23including applied behavior analysis and evidence-based behavior
24intervention programs that develop or restore, to the maximum
25extent practicable, the functioning of an individual with pervasive
26developmental disorder or autism, and are administered as
27described in the approved state plan.

28(b) The department shall implement, or continue to implement,
29this section only after all of the following occurs or has occurred:

30(1) The department receives all necessary federal approvals to
31obtain federal funds for the service.

32(2) The department seeks an appropriation that would provide
33the necessary state funding estimated to be required for the
34applicable fiscal year.

35(3) The department consults with stakeholders.

36(c) The department shall develop and define eligibility criteria,
37provider participation criteria, utilization controls, and delivery
38system structure for services under this section, subject to
39limitations allowable under federal law, in consultation with
40stakeholders.

P14   1(d) Notwithstanding Chapter 3.5 (commencing with Section
211340) of Part 1 of Division 3 of Title 2 of the Government Code,
3the department, without taking any further regulatory action, shall
4implement, interpret, or make specific this section by means of
5all-county letters, plan letters, plan or provider bulletins, or similar
6instructions until regulations are adopted. The department shall
7adopt regulations by July 1, 2017, in accordance with the
8 requirements of Chapter 3.5 (commencing with Section 11340) of
9Part 1 of Division 3 of Title 2 of the Government Code.
10Notwithstanding Section 10231.5 of the Government Code,
11beginning six months after the effective date of this section, the
12department shall provide semiannual status reports to the
13Legislature, in compliance with Section 9795 of the Government
14Code, until regulations have been adopted.

15(e) For the purposes of implementing this section, the department
16may enter into exclusive or nonexclusive contracts on a bid or
17negotiated basis, including contracts for the purpose of obtaining
18subject matter expertise or other technical assistance. Contracts
19may be statewide or on a more limited geographic basis. Contracts
20entered into or amended under this subdivision shall be exempt
21from Part 2 (commencing with Section 10100) of Division 2 of
22the Public Contract Code and Chapter 6 (commencing with Section
2314825) of Part 5.5 of Division 3 of the Government Code, and
24shall be exempt from the review or approval of any division of the
25Department of General Services.

26(f) The department may seek approval of any necessary state
27plan amendments or waivers to implement this section. The
28department shall make any state plan amendments or waiver
29requests public at least 30 days prior to submitting to the federal
30Centers for Medicare and Medicaid Services, and the department
31shall work with stakeholders to address the public comments in
32the state plan amendment or waiver request.

33(g) This section shall be implemented only to the extent that
34federal financial participation is available and any necessary federal
35approvals have been obtained.

end delete
36begin insert

begin insertSEC. 4.end insert  

end insert

begin insertSection 14132.56 of the end insertbegin insertWelfare and Institutions Codeend insert
37
begin insert is amended to read:end insert

38

14132.56.  

(a) (1) Only to the extent required by the federal
39government and effective no sooner than required by the federal
40government, behavioral health treatmentbegin delete (BHT), as defined by
P15   1Section 1374.73 of the Health and Safety Code,end delete
begin insert (BHT)end insert shall be a
2covered Medi-Cal service for individuals under 21 years of age.

3(2) It is the intent of the Legislature that, to the extent the federal
4government requires BHT to be a covered Medi-Cal service, the
5department shall seek statutory authority to implement this new
6benefit in Medi-Cal.

begin insert

7
(3) For purposes of this section, “behavioral health treatment”
8or “BHT” means professional services and treatment programs,
9including applied behavior analysis and evidence-based behavior
10intervention programs that develop or restore, to the maximum
11extent practicable, the functioning of an individual with pervasive
12developmental disorder or autism, and are administered as
13described in the approved state plan.

end insert

14(b) The department shall implement, or continue to implement,
15this section only after all of the following occurs or has occurred:

16(1) The department receives all necessary federal approvals to
17obtain federal funds for the service.

18(2) The department seeks an appropriation that would provide
19the necessary state funding estimated to be required for the
20applicable fiscal year.

21(3) The department consults with stakeholders.

22(c) The department shall develop and define eligibility criteria,
23provider participation criteria, utilization controls, and delivery
24system structure for services under this section, subject to
25limitations allowable under federal law, in consultation with
26stakeholders.

27(d) (1) The department, commencing on the effective date of
28the act that added this subdivision until March 31, 2017, inclusive,
29may make available to individuals described in paragraph (2)
30contracted services to assist those individuals with health insurance
31enrollment, without regard to whether federal funds are available
32for the contracted services.

33(2) The contracted services described in paragraph (1) may be
34provided only to an individual under 21 years of age whom the
35department identifies as no longer eligible for Medi-Cal solely due
36to the transition of BHT coverage from the waiver program under
37Section 1915(c) of the federal Social Security Act to the Medi-Cal
38state plan in accordance with this section and who meets all of the
39following criteria:

P16   1(A) He or she was enrolled in the home and community-based
2services waiver for persons with developmental disabilities under
3Section 1915(c) of the Social Security Act as of January 31, 2016.

4(B) He or she was deemed to be institutionalized in order to
5establish eligibility under the terms of the waiver.

6(C) He or she has not been found eligible under any other
7federally funded Medi-Cal criteria without a share of cost.

8(D) He or she had received a BHT service from a regional center
9for persons with developmental disabilities as provided in Chapter
105 (commencing with Section 4620) of Division 4.5.

11(e) Notwithstanding Chapter 3.5 (commencing with Section
1211340) of Part 1 of Division 3 of Title 2 of the Government Code,
13the department, without taking any further regulatory action, shall
14implement, interpret, or make specific this section by means of
15all-county letters, plan letters, plan or provider bulletins, or similar
16instructions until regulations are adopted. The department shall
17adopt regulations by July 1, 2017, in accordance with the
18requirements of Chapter 3.5 (commencing with Section 11340) of
19Part 1 of Division 3 of Title 2 of the Government Code.
20Notwithstanding Section 10231.5 of the Government Code,
21beginning six months after the effective date of this section, the
22department shall provide semiannual status reports to the
23Legislature, in compliance with Section 9795 of the Government
24Code, until regulations have been adopted.

25(f) For the purposes of implementing this section, the department
26may enter into exclusive or nonexclusive contracts on a bid or
27negotiated basis, including contracts for the purpose of obtaining
28subject matter expertise or other technical assistance. Contracts
29may be statewide or on a more limited geographic basis. Contracts
30entered into or amended under this subdivision shall be exempt
31from Part 2 (commencing with Section 10100) of Division 2 of
32the Public Contract Code, Section 19130 of the Government Code,
33and Chapter 6 (commencing with Section 14825) of Part 5.5 of
34Division 3 of the Government Code, and shall be exempt from the
35review or approval of any division of the Department of General
36Services.

37(g) The department may seek approval of any necessary state
38plan amendments or waivers to implement this section. The
39department shall make any state plan amendments or waiver
40requests public at least 30 days prior to submitting to the federal
P17   1Centers for Medicare and Medicaid Services, and the department
2shall work with stakeholders to address the public comments in
3the state plan amendment or waiver request.

4(h) This section shall be implemented only to the extent that
5federal financial participation is available and any necessary federal
6approvals have been obtained.

7

SEC. 5.  

No reimbursement is required by this act pursuant to
8Section 6 of Article XIII B of the California Constitution because
9the only costs that may be incurred by a local agency or school
10district will be incurred because this act creates a new crime or
11infraction, eliminates a crime or infraction, or changes the penalty
12for a crime or infraction, within the meaning of Section 17556 of
13the Government Code, or changes the definition of a crime within
14the meaning of Section 6 of Article XIII B of the California
15Constitution.



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