BILL ANALYSIS �
SB 1050
Page 1
Date of Hearing: July 3, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 1050 (Alquist) - As Amended: June 15, 2012
SENATE VOTE : 38-0
SUBJECT : Autism: telehealth task force.
SUMMARY : Directs the Department of Developmental Services (DDS)
to establish an autism telehealth task force to provide
technical assistance and recommendations relating to the use of
telehealth services for individuals with autism spectrum
disorders (ASD). Specifically, this bill :
1)Makes a number of legislative findings and declarations
regarding the use of telehealth services as a tool for
increasing the effectiveness of treatment and improving access
for children and young adults diagnosed with ASD and the
potential for telehealth technology to revolutionize the care
available to persons with ASD in a health care climate that is
characterized by limited resources.
2)Requires DDS to establish an autism telehealth task force and
to designate a public or nonprofit entity to act as the lead
administrator responsible for all of the activities and work
of the task force, including identifying financial support for
the task force's costs.
3)Requires the lead administrator to have knowledge or
experience in providing telehealth services, community-based
clinical trials, and services to under-served populations.
4)Requires the lead administrator to appoint members of the task
force, subject to approval from DDS, who have specified
knowledge or experience that includes, but is not limited to,
any of the following:
a) Early identification of children with ASD;
b) Treatment of ASD;
c) Early intervention services provided by regional
centers, school districts, and community-based services;
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d) Technology or telehealth in providing services to
individuals with ASD;
e) Continuity of care for individuals with ASD,
specifically for those transitioning from developmental
centers to community placements; and,
f) Other areas deemed necessary by DDS.
5)Specifies that members of the task force serve without
compensation, other than appropriate travel, food, and lodging
reimbursement.
6)Requires the task force to provide technical assistance and
recommendations to DDS in the area of telehealth services for
individuals with ASD.
7)Specifies that the task force recommendations may include
implementation of one or more demonstration sites that promote
or 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; and,
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.
8)Requires any recommendations regarding the demonstration sites
in 7) above to disclose information about potential sources of
funding that may be available to DDS to support the
demonstration site.
9)Prohibits any General Fund (GF) monies from being appropriated
for the provisions of this bill and makes the establishment
and responsibilities of the task force contingent upon
identification of appropriate or adequate funding sources.
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10)Sunsets the provisions of this bill on 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,
including ASD.
2)Requires DDS to develop evaluation and diagnostic procedures
for the diagnosis of ASD, as specified.
3)Establishes the Autism Advisory Task Force (Task Force) under
the Department of Managed Health Care (DMHC), in conjunction
with the Department of Insurance, for the purpose of
developing recommendations regarding medically necessary
behavioral health treatment for individuals with ASD, as well
as the appropriate qualifications, training, and education for
providers of such treatment. DMHC is directed to submit a
report of the Task Force recommendations to the Legislature by
December 31, 2012, at which time the Task Force ceases to
exist.
4)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.
FISCAL EFFECT : According to the Senate Appropriations Committee
analysis, minor costs to appoint the lead administrator of the
task force and approve proposed members (GF); and unknown costs
to implement a demonstration site (unknown funds).
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
intended to enhance and promote the use of telehealth for the
diagnosis and treatment of ASD by DDS and regional centers and
to support the provision of services in the most competent and
cost-effective manner possible. The author states that
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existing advisory committees within DDS relating to ASD lack
specific expertise regarding telehealth and technology and
have not been structured for the purpose of making
recommendations to DDS on how best to expand use of telehealth
in providing services to individuals with ASD and their
families. The author maintains that there is a significant
divide between the organizations and experts dedicated to
telehealth technologies in general and the technical expertise
of individuals and organizations dedicated to improving the
lives of individuals with ASD, and this bill seeks to bridge
that divide in order to help guide DDS as it expands the use
of telehealth in serving individuals with ASD.
2)ASD . The developmental disorders known as ASDs include
autism, Asperger's syndrome, Rett's syndrome, childhood
disintegrative disorder, and pervasive developmental disorder
not otherwise specified. ASDs are characterized by three
distinctive types of behavior, which can range from mild to
disabling. The main features of ASDs are impaired social
interaction and communication, an inability to empathize, and
failure to understand social cues. Other characteristics
include repetitive behaviors, such as rocking, twirling, and
head banging; and narrow, obsessive interests. Persons with
ASDs also often have numerous co-occurring conditions,
including behavioral disorders and particular health problems,
such as sleep disorders, gastrointestinal problems, and immune
system deficiencies.
The National Institute of Mental Health (NIMH) estimates that,
between two and six out of 1,000 children have ASDs and males
are three to four times more likely to have ASDs than females.
NIMH states that ASDs can often be reliably detected at three
years of age and in some cases as early as 18 months. Early
diagnosis is crucial because, although there is no cure for
ASDs, evidence indicates that intensive early intervention in
optimal educational settings for at least two years during the
preschool years results in improved outcomes in most young
children with ASDs. While there is no single best treatment
package for individuals with ASDs, most respond best to highly
structured, specialized programs.
3)THE ROLE OF REGIONAL CENTERS . Under the 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
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for their children at home. Services include diagnosis and
eligibility assessment services, family support services, and
residential and day programs in accordance with an individual
program plan. Applied Behavior Analysis services can be
purchased by regional centers if the service provider uses
evidence-based practices, the services promote positive social
behaviors, and help address issues that interfere with
learning and social interactions.
4)RECENT INFORMATIONAL HEARING . On February 23, 2012, the
Senate Select Committee on Autism & Related Disorders convened
an informational hearing that focused on technology and ASD.
At that hearing, the committee heard testimony on the
challenges of delivering supportive services to people with
ASD, especially in rural areas. To address these challenges,
the committee invited panelists to discuss the role of
telehealth in providing home-based behavioral services,
professional development services, and parent training
supports and services, with an emphasis on assisting persons
in hard to reach areas of the state, and requested that
panelists provide an overview of the types of technology that
are applicable to the delivery of ASD services such as laptop
computers, internal and external web-cameras and microphones,
high-speed Internet connections, and videoconferencing
software. According to background materials provided by the
committee, research indicates high family and consumer
satisfaction when telehealth is used to provide services for
ASD as it allows for availability of immediate interactive
assistance when a problem arises and parents, in particular,
are able to rely on regular access to professionals who can
provide direct observation, evaluation, and feedback in a
child's natural environment regardless of geographic location.
The committee reports that, each year, DDS receives 3,000 new
cases of ASD, which account for two-thirds of all new cases
and the use of telehealth as a service delivery model for
those with ASD could result in increased efficiency, added
cost savings, and improved treatment outcomes.
5)SUPPORT . The sponsor of this bill, The Children's
Partnership, writes in support that this bill is a step toward
the wise deployment of telehealth and will enable children
with ASD and their families to get health care and other
support services that they need. The sponsor states that, by
deploying technology to improve care for these children and
their families, this bill will ensure that California makes
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measurable improvements in its health and social service
systems. Spectrum Center Schools and Programs notes in
support that this bill will bring telehealth technology within
reach of DDS and provide the department with new capacity to
help families who are most in need and those consumers with
ASD who live the furthest away from any type of early
intervention and support service. Supporters, including
foster care providers and regional centers, add that this bill
will advance health care for the ASD community as well as help
to create a larger foundation for the use of telehealth across
the state.
6)RELATED LEGISLATION .
a) SB 764 (Steinberg) requires DDS to establish a five-year
pilot program to evaluate the effectiveness and
appropriateness of telehealth in providing services to
regional center consumers. SB 764 is pending in the
Assembly Human Services Committee.
b) AB 171 (Beall) affirms that California requires health
plans and insurers to cover screening, diagnosis, and all
medically necessary treatment for individuals with ASD and
prohibits a health 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. AB
171 is pending in the Senate Health Committee.
7)PRIOR LEGISLATION .
a) SB 946 (Steinberg), Chapter 650, Statutes of 2011,
mandates health insurance coverage for behavioral health
treatment services related to ASD, effective July 1, 2012.
b) AB 415 (Logue), Chapter 547, Statutes of 2011, repeals
and recasts the Telemedicine Development Act of 1996 (TDA)
to, among other things, change references from
"telemedicine" to "telehealth;" revise confidentiality,
privacy, and consent requirements; and, specify various
other health provider and insurance requirements for
telehealth.
c) SB 1665 (Thompson), Chapter 864, Statutes of 1996,
establishes the TDA to set standards for the use of
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telemedicine by health care practitioners and insurers,
and, among other provisions, prohibit health insurers from
requiring face-to-face contact between a health care
provider and patient for covered services appropriately
provided through telemedicine.
8)AUTHOR'S AMENDMENT . To address a concern raised by committee
staff that the requirement in this bill for the lead
administrator entity to have knowledge or experience in
community-based clinical trials is too broad, the author has
agreed to the following clarifying amendment:
On page 3, line 2, after "trials" insert "relating to
telehealth".
9)DOUBLE REFERRAL . This bill has been double-referred. It
passed the Assembly Human Services Committee with a vote of
4-0 on June 26, 2012.
REGISTERED SUPPORT / OPPOSITION :
Support
The Children's Partnership (sponsor)
Aspiranet
Association of Regional Center Agencies
National Multiple Sclerosis Society-California Action Network
Spectrum Center Schools and Programs
Opposition
None on file.
Analysis Prepared by : Cassie Royce / HEALTH / (916) 319-2097