BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: SB 1050
S
AUTHOR: Alquist
B
VERSION: April 12, 2012
HEARING DATE: April 24, 2012
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FISCAL: Yes
0
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CONSULTANT: Sara Rogers
0
SUBJECT
Autism: telehealth taskforce.
SUMMARY
Requires the Department of Developmental Services to
establish an autism telehealth taskforce administered and
lead by a public or nonprofit entity responsible for the
activities and work of the taskforce. Provides that the
lead administrator shall appoint members of the taskforce
who shall have knowledge or experience, as specified.
Provides that the taskforce shall provide technical
assistance and recommendations in the area of telehealth
services for individuals with autism spectrum disorder, as
specified.
ABSTRACT
Current law
1.Enacts the Telehealth Advancement Act of 2011 and repeals
the Telemedicine Development Act of 1996. Defines
telehealth as a mode of delivering health care and public
health services facilitating the diagnosis, consultation,
Continued---
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treatment, education, care management and self-management
while the patient is at an originating site and the
health care provider is at a distant site.
2.Requires the California Department of Developmental
Services to develop evaluation and diagnostic procedures
for the diagnosis of autism disorder and other autistic
spectrum disorders, as specified.
3.Enacts the Lanterman Developmental Disabilities Service
Act under the Department of Developmental Services (DDS)
affirming a variety of rights and responsibilities for
persons with developmental disabilities, including the
right to treatment and habilitation services and supports
in the least restrictive environment.
4.Establishes regional centers, a network of 21 nonprofit
private orgranizations that operate under contract with
DDS to provide or direct the provision of services and
supports identified in a client-individual program plan.
5.Enacts the California Early Intervention Services Act of
1993 establishing a statewide network of family-centered
interagency programs responsible for providing
appropriate early intervention services and support to
all eligible infants and toddlers and their families,
also known as "Early Start."
6.Enacts, through federal law, the Early Intervention
Program for Infants and Toddlers with Disabilities of
1986 under the Individuals with Disabilities Education
Act (IDEA).
7.Prohibits health care service plans, health insurers, and
the Medi-Cal program from requiring in-person contact to
occur between a health provider and a patient before
payment is made for covered services appropriately
provided through telehealth, subject to the terms and
conditions of plan contract or the reimbursement policies
adopted by the Department of Health Care Services.
8.Requires health care service plan contracts and health
insurance policies to include coverage for behavioral
health treatment, as defined, for pervasive developmental
disorder or autism.
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9.Establishes the Autism Advisory Task Force under the
Department of Managed Health Care (DMHC) in conjunction
with the Department of Insurance for the purpose of
providing assistance to the DMHC on topics related to
behavioral health treatment and to develop
recommendations relating to the education, training, and
experience requirements to secure licensure from the
state.
This bill
1.Makes various findings and declarations regarding the
efficacy of telehealth services and the potential for
telehealth technology to improve consumer access, health
care delivery and care coordination for persons diagnosed
with Autism Spectrum Disorders (ASD).
2.Requires the state Department of Developmental Services
to establish an autism telehealth taskforce and to
identify a public or nonprofit entity to act as lead
administrator which is responsible for all of the
activities and work of the taskforce.
3.Requires the public or nonprofit administrator to have
knowledge or experience in telehealth, community based
clinical trials, and providing services to under-served
populations.
4.Requires the lead administrator to appoint members of the
task force, with approval from the department, who have
specified knowledge or experience with early
identification and treatment of ASD, use of technology or
telehealth in the provision of services to individuals
with ASD, or other areas deemed necessary by the
department.
5.Requires the taskforce to provide technical assistance
and recommendations to the department in the area of
telehealth services for individuals with ASDs, including
the implementation of at least one demonstration site
that promotes or evaluates the use of telehealth and
technology to improve delivery, coordination of, or
access to ASD services as specified.
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6.Provides that no general fund monies shall be
appropriated for the project and that the establishment
of responsibilities of the taskforce shall be contingent
upon identification of appropriate or adequate funding
sources.
7.Includes a sunset date of January 1, 2019.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
This bill requires that no monies shall be appropriated
from the General Fund for this project and that the
establishment and responsibilities of the taskforces shall
be contingent upon identification of appropriate and
adequate funding sources. This bill additionally states
that members of the task force shall serve without
compensation, except for appropriate travel, food and
lodging reimbursement.
BACKGROUND AND DISCUSSION
Purpose of the bill
According to the author, this bill is intended to enhance
and promote the use of telehealth for the diagnosis and
treatment of Autism Spectrum Disorders (ASD) by DDS and
Regional Centers and support the provision of services in
the most competent and cost effective manner possible.
The author states that existing advisory committees within
the Department of Developmental Services relating to ASDs
lack specific expertise regarding telehealth and
technology, and have not been structured for the purpose of
making recommendations to the department on how best to
expand use of telehealth in providing services to
individuals with ASDs and their families.
The author states that there are significant ongoing
technological advancements in the use of telehealth in a
variety of clinical settings, and many organizations
dedicated to the development of best practices to guide
implementation of telehealth technologies. According to
the author there is a significant divide between the
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organizations and experts dedicated to telehealth
technologies generally, and the technical expertise of
individuals and organizations dedicated to improving the
lives of individuals with ASDs. The stated purpose of this
bill is to bridge the divide between these two areas of
expertise in order to help guide the Department of
Developmental Services as they expand the use of telehealth
in serving individuals with ASDs.
Definition and prevalence of autism
Autism is defined as a group of neural development
disorders linked to atypical biology and chemistry in the
brain and generally appearing within the first three years
of life. Autism is further characterized by delayed,
impaired or otherwise atypical verbal and social
communication skills, sensitivity to sensory stimulation,
atypical behaviors and body movements, and sensitivity to
changes in routines.
The Centers for Disease Control and Prevention (CDC)
recently published data from 2008 which indicates a 23%
increase in the estimated prevalence of ASD since 2006 and
a 78% increase since 2002. For 2008, the overall estimated
prevalence of ASDs was 11.3 per 1,000 (one in 88) children
aged eight years compared with 9.0 per 1,000 in 2006. ASD
prevalence was found to be four to five times higher for
boys than for girls.
In 2007, the California Department of Developmental
Services (DDS) reported serving 38,000 individuals with
autism reflecting an annual increase of 13.4 percent since
2002, and that, of California children born during
1990-1997, more than 11,000 are enrolled with DDS to
receive services for autism.
Public services for children and adults with autism
The Lanterman Developmental Disabilities Service Act
administered by the Department of Developmental Services
(DDS) affirms a variety of rights and responsibilities for
persons with developmental disabilities, including the
right to treatment and habilitation services and supports
in the least restrictive environment.
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State law requires the Department of Developmental Services
and Regional Centers, as their contracted local
administrator, to provide a variety of services and
supports necessary to prevent institutionalization and to
assist families caring for their children at home.
Provided services include diagnosis and eligibility
assessment services as well as family support or
community/independent living services in accordance with an
individual program plan (IPP) or an individualized family
service plan (IFSP). Regional centers are permitted to
purchase Applied Behavior Analysis or Intensive Behavior
Intervention services if the service provider uses
evidence-based practices and the services promote positive
social behaviors and help address issues with learning and
social interactions.
DDS additionally administers the Early Start program in
California which provides a broad scope of behavioral
intervention and family support services to infants and
toddlers under the age of 3 who are 'developmentally
delayed' or have an 'established risk' or are 'at high
risk' of a developmental delay.
Telehealth as a treatment modality for autism
Many studies indicate that early diagnosis and intervention
is critical for children with ASD, offering significant
opportunities to improve quality of life for these children
and their families over the short and long term.
Recent studies have evaluated the effectiveness and
efficiency of behavioral intervention treatments,
functional communication training and functional analysis
training for parents conducted through telehealth,
including both synchronous (simultaneous exchange of
information) and asynchronous (information exchange occurs
over a period of time) modalities. These studies have
demonstrated that telehealth can result in increased
efficiency, cost savings and comparable treatment outcomes.
Related legislation
SB 764 (Steinberg, 2012), if passed, would require DDS to
allow applied behavioral analysis (ABA) services, intensive
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behavioral intervention (IBI) services, or both, to be
provided through the use of telehealth systems (THS), as
defined, as part of a consumer's individual program plan
upon approval of a regional center and the voluntary
approval of the consumer or specified persons. SB 764 is
currently in the Assembly pending referral.
SB 946 (Steinberg), Chapter 650, Statutes of 2011 mandates
health insurance coverage for behavioral health treatment
services related to pervasive developmental disorder or
autism effective July 1, 2012.
AB 415 (Logue), Chapter 547, Statutes of 2011 repealed the
Telemedicine Development Act of 1996, changing the
reference from "telemedicine" to "telehealth", revising
confidentiality and privacy standards, consent
requirements, and other health provider and insurance
requirements for telehealth.
ABx4 9, Chapter 9, Statutes of 2009-10, Fourth
Extraordinary Session among other provisions, required the
least costly available provider of comparable service,
including transportation costs, who is able to accomplish
all or parts of the consumer's IPP, consistent with the
needs of the consumer and family as identified in the IPP,
to be selected to deliver services to the consumer.
Statutorily defined applied behavioral analysis and
intensive behavioral intervention treatments and
established a variety of standards and restrictions for
vendors providing applied behavioral analysis services or
intensive behavioral intervention services, or both.
SB 1665 (M. Thompson), Chapter 864, Statutes of 1996
enacted the "Telemedicine Development Act of 1996,"
imposing several requirements governing the delivery of
health care services through telemedicine. Prohibited
health insurers from requiring face-to face contact between
a health care provider and patient for covered services
appropriately provided through telemedicine.
POSITIONS
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Support: none received
Oppose: none received
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