BILL ANALYSIS �
SB 1050
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Date of Hearing: June 26, 2012
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Jim Beall Jr., Chair
SB 1050 (Alquist) - As Amended: June 15, 2012
SENATE VOTE : 38-0
SUBJECT : Autism telehealth task force
SUMMARY : Requires the Department of Developmental Services
(DDS) to establish an autism telehealth task force to provide
technical assistance and recommendations in the area of
telehealth services for individuals with autism spectrum
disorders (ASD). Specifically, 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 DDS to establish an autism telehealth task force 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 task force.
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 DDS, who have specified knowledge or
experience that includes, but is not limited to, any of the
following:
a) Early identification and treatment of ASD;
b) Treatment of ASD
c) Early intervention services provided by regional
centers, school districts, and community-based services;
d) Technology or telehealth in the provision of services to
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individuals with ASD;
e) Continuity of care for individuals with ASD,
particularly for those transitioning from developmental
centers to community placements; or,
f) Other areas deemed necessary by DDS.
5)Requires the task force to provide technical assistance and
recommendations to DDS in the area of telehealth services for
individuals with ASD.
6)Provides that the task force recommendations may include
implementation of one or more demonstrations sites that
promote and evaluate any of the following:
a) The use of telehealth and technology to assist and
improve the delivery of services for individuals with ASD
by regional centers;
b) The use of telehealth to provide seamless integration
and coordination of services among regional centers, school
districts, community-based resources, and health care
providers and organizations; or,
c) The use of telehealth to improve the access of services
for individuals with ASD to underserved individuals and to
reduce the "digital divide" in underserved communities.
7)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.
8)Includes a sunset date of January 1, 2019.
EXISTING LAW
1)Establishes the Lanterman Developmental Disabilities Services
Act (Lanterman Act), under which DDS contracts with 21 private
non-profit regional centers to provide case management
services and arrange for, or purchase, services that meet the
needs of individuals with developmental disabilities. Welfare
& Institutions (W&I) Code Section 4500 et seq.
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2)Establishes the California Early Intervention Services Act of
1993 (Early Start) providing early intervention services to
infants and toddlers with disabilities and their families
through a coordinated, family-centered system of services that
are available statewide.
3)Requires DDS to develop evaluation and diagnostic procedures
for the diagnosis of autism disorder and other autistic
spectrum disorders, as specified.
4)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.
5)Defines "telehealth" to mean "the mode of delivering health
care services and public health via information and
communication technologies to facilitate the diagnosis,
consultation, treatment, education, care management, and
self-management of a patient's health care while the patient
is at the originating site and the health care provider is at
a distant site. Telehealth facilitates patient
self-management and caregiver support for patients and
includes synchronous interactions and asynchronous store and
forward transfers." Business & Professions Code Section
2290.5(a)(6).
FISCAL EFFECT : Unknown
COMMENTS :
Purpose of this bill : According to the author, this bill
enhances and promotes the use of telehealth for the diagnosis
and treatment of ASD by DDS and regional centers and supports
the provision of services in the most competent and
cost-effective manner possible. Existing advisory committees
within the DDS relating to ASD, the author says, 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 ASD and their families.
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The author points out 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. There is a significant divide between
the organizations and experts dedicated to telehealth
technologies generally, and the technical expertise of
individuals and organizations dedicated to improving the lives
of individuals with ASD. According to the author, this bill
bridges the divide between these two areas of expertise in order
to help guide DDS as it expands the use of telehealth in serving
individuals with ASD.
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.
DDS Client Development Evaluation Report data, from December
1997 through December 2007, reveals a significant rate of growth
for those with autism compared to the other major categories of
developmental disabilities. While the total number of people
served during that period increased 56%, the number of people
with autism grew 321% from December 1997 through 2007. DDS also
reports that, as of June 2007, 84.5% of all people with autism
served by DDS (including those without purchase-of-service
expenditures) were 3 through 21 years of age. "Since this age
group, on average, has lower per capita costs, there is
increasing concern regarding cost implications for future years
as this growing segment of the population ages." Department of
Developmental Services Fact Book (11th Edition, October 2008).
Services for children and adults with autism : Under the
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Lanterman Act regional centers provide a variety of services and
supports to children and adults with developmental disabilities
necessary to prevent institutionalization and to assist families
caring for their children at home. Provided services include
diagnosis and eligibility assessment services, family support
services, and residential and day programs in accordance with an
individual program plan (IPP). 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. Regional centers also provide services,
pursuant to an individualized family service plan (IFSP) under
the Early Start program, which entail a broad scope of
behavioral intervention and family support services to infants
and toddlers under the age of 3 who have a developmental delay
or disability or an established risk condition with a high
probability of resulting in a 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.
This bill's legislative findings and declarations say that the
use and implementation of telehealth technology would provide:
greater knowledge and information about ASD to consumers and
their families; improved access to underserved communities and
populations; enhanced case management; and increased
coordination of care for ASD.
It is important to note that the use of telehealth as a method
of providing treatment and services to people with developmental
disabilities is not limited to people with ASD. Under the
Lanterman Act, services and supports are based on each
consumer's individual needs and choices as determined through
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the individual program planning process, not only on diagnosis.
Many of the same issues identified in this bill's findings and
declarations-e.g., improved access to underserved communities
and populations, enhanced case management, increased
coordination of care-apply to other consumer groups as well.
Nothing prevents the use of telehealth for regional center
consumers under current law. The Lanterman Act includes
numerous references to the use of innovative and economical
service mechanisms and methods of achieving IPP objectives.
E.g., W&I Code Sections 4651, 4648(e)(3), 4685(c)(3).
Telehealth will often prove to be an efficient and
cost-effective means of providing treatment and services to
people with developmental disabilities other than ASD.
Therefore, much of the information and many of the
recommendations from the telehealth taskforce established
pursuant to this bill will likely have implications for all
consumer groups, not only those with ASD.
Related legislation :
SB 764 (Steinberg, 2012), if passed, would establish a pilot
program for the provision of treatment and intervention services
through the use of telehealth.
AB 171 (Beall 2011), if passed, would confirm that California
requires health plans and insurers to cover screening, diagnosis
and all medically necessary treatment for individuals with ASD
and would prohibit a health care plan from terminating coverage,
or refusing to deliver, execute, issue, amend, adjust, or renew
coverage to an enrollee solely because the individual is
diagnosed with, or has received treatment for, ASD.
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
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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.
DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this committee, it will be referred to the
Assembly Health Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
The Children's Partnership (sponsor)
Aspiranet
Association of Regional Center Agencies (ARCA)
California Disability Services Association (CDSA)
National Multiple Sclerosis Society-California Action Network
(MS-CAN)
Spectrum Center
Prior Opposition
American Federation of State, County and Municipal Employees,
AFL-CIO (not relevant to current amended version)
Analysis Prepared by : Eric Gelber / HUM. S. / (916) 319-2089
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