BILL ANALYSIS �
AB 1205
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Date of Hearing: May 4, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 1205 (Bill Berryhill) - As Amended: April 4, 2011
Policy Committee: Business and
Professions Vote: 9-0
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires the Board of Behavioral Sciences (BBS) to
license behavioral analysts (BA) and assistant BAs, on and after
January 1, 2015. Standards for licensure include specified
higher education and training, fieldwork, passage of relevant
examinations, and national board accreditation. The bill also
requires the licensure program to be supported through fees on
licensees.
FISCAL EFFECT
1)Estimated first-year costs to the BBS of $250,000 to establish
the licensure program, and estimated annual ongoing costs of
$200,000, fully funded through fees on licensees. License
fees would likely be between $100 and $200 per licensee.
2)There is potential for indirect cost impacts on health care
service plans statewide. Costs could increase to the extent
that licensure of BAs enhances the likelihood that ABA
services are covered through managed care plans.
Alternatively, if this bill reduces the number of providers
who receive payment for ABA services because only a portion of
the current provider community would qualify for licensure,
costs may be reduced.
COMMENTS
1)Rationale . This bill intends to confer state licensure upon
individuals that provide applied behavior analysis (ABA)
services to individuals with medical conditions such as autism
spectrum disorders (ASD) and other disorders that are
AB 1205
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responsive to ABA. According to the California Association of
Behavioral Analysts, the sponsor of this bill, state licensure
will increase the professional legitimacy of ABA services and
will open the possibility of getting insurance companies to
cover behavior analysis.
2)Applied Behavioral Analysis . Applied behavior analysis is the
process of systematically applying interventions based upon
the principles of learning theory to improve socially
significant behaviors to a meaningful degree, and to
demonstrate that the interventions employed are responsible
for the improvement in behavior. Socially significant
behaviors include reading, academics, social skills,
communication, and adaptive living skills like motor skills,
eating and food preparation, personal self-care, domestic
skills, home and community orientation, and work skills.
3)Coverage of ABA Services . ABA professionals indicate that ABA
services have been proven effective at treating autism
spectrum disorders. ABA requires intensive treatments of over
25 hours each week and cost around $50,000 each year. There
have been complaints related to the refusal of health care
service plans to cover ABA services. In some cases, health
plans have maintained that ABA services were not a covered
benefit because they were provided by unlicensed individuals.
Health plans have also contended that ABA services are
educational in nature and not a matter of medical necessity.
Some independent medical reviews of health plan coverage
denials for ABA services for children diagnosed with autism
overturned the health plan's decision to deny coverage.
The coverage of ABA has also been the subject of a recent
lawsuit. The suit challenges a recent policy shift at the
state Department of Managed Health Care (DMHC), clarified in a
March 2009 memo issued by the department, that permits
insurers to deny coverage for ABA. The DMHC memo indicated
that plans must provide mental health services only through
providers who are licensed and/or certified by the state. The
suit alleged that DMHC had wrongfully allowed insurance
companies to refuse to pay for autism treatments, resulting in
the denial of critically needed, medically necessary treatment
for autistic children. It further alleged that denial of
coverage for ABA services is in violation of the California
Mental Health Parity Act, which requires health plans to cover
and pay for all medically necessary treatments for autism.
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The Los Angeles County Superior Court ruled in January 2011
that the DMHC violated the Administrative Procedure Act by
issuing the memo instead of adopting such policy changes by
regulation. However, the court did not address whether DMHC's
permission for health plans to deny coverage was legal, or the
impact of BA licensure. The plaintiffs are expected to appeal.
Thus, at this time it is unknown what impact BA licensure
will have on health care coverage of ABA services.
4)Concerns . Autism advocacy groups point out that the
requirements for licensure in the bill, as currently drafted,
exclude a number of highly qualified individuals who currently
provide ABA services. If licensure indirectly shrinks the
pool of available providers, there is concern that there may
be difficulty accessing ABA services for the approximately
100,000 children with autism in the state.
5)Related Legislation . AB 171 (Beall) requires health care
service plan contracts and health insurance policies to
provide coverage for the screening, diagnosis, and treatment
of autism spectrum disorders. This bill is pending in the
Assembly Appropriations Committee.
SB 1282 (Steinberg) in 2010 created a state certification
program for applied behavior analysts. SB 1282 was
significantly amended in the Assembly and never heard by a
policy committee.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081