BILL ANALYSIS �
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UNFINISHED BUSINESS
Bill No: SB 1050
Author: Alquist (D)
Amended: 8/6/12
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 7-0, 4/24/12
AYES: Liu, Emmerson, Berryhill, Hancock, Strickland,
Wright, Yee
SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/7/12
AYES: Kehoe, Walters, Alquist, Dutton, Lieu, Price,
Steinberg
SENATE FLOOR : 38-0, 5/17/12
AYES: Alquist, Anderson, Berryhill, Blakeslee, Calderon,
Cannella, Corbett, Correa, De Le�n, DeSaulnier, Dutton,
Emmerson, Evans, Fuller, Gaines, Hancock, Harman,
Hernandez, Huff, Kehoe, La Malfa, Leno, Lieu, Liu,
Lowenthal, Negrete McLeod, Padilla, Pavley, Price, Rubio,
Simitian, Steinberg, Vargas, Walters, Wolk, Wright,
Wyland, Yee
NO VOTE RECORDED: Runner, Strickland
ASSEMBLY FLOOR : 71-5, 8/21/12 - See last page for vote
SUBJECT : Autism: telehealth taskforce
SOURCE : Author
DIGEST : This bill requires the Department of
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Developmental Services (DDS) to establish an autism
telehealth taskforce to be administered and led 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, and provides that
the taskforce shall provide technical assistance and
recommendations in the area of telehealth services for
individuals with autism spectrum disorder, as specified.
Assembly Amendments make clarifying changes.
ANALYSIS : Existing 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,
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 DDS 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 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 organizations 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."
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6.Enacts, through federal law, the Early Intervention
Program for Infants and Toddlers with Disabilities of
1986 under the Individuals with Disabilities Education
Act.
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.
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 (ASDs).
2.Requires DDS 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 relating to telehealth, and providing
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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 ASDs, use of technology
or telehealth in the provision of services to individuals
with ASDs, 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.
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.
Background
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 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, DDS reported serving 38,000 individuals with
autism reflecting an annual increase of 13.4 percent since
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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 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.
State law requires DDS 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. 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 three 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,
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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/Prior Legislation
SB 764 (Steinberg), 2012, if passed, requires DDS to allow
applied behavioral analysis services, intensive behavioral
intervention services, or both, to be provided through the
use of telehealth systems, 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 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, repeals 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, requires 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,
enacts the "Telemedicine Development Act of 1996," imposing
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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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Assembly Appropriations Committee,
on-going costs between $25,000 and $50,000 GF for the DDS
workload associated with staffing the task force.
SUPPORT : (Verified 8/21/12)
Aspiranet
Association of Regional Center Agencies
National Multiple Sclerosis Society - California Action
Network
Spectrum Center Schools and Programs
The Children's Partnership
ARGUMENTS IN SUPPORT : According to the author's office,
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 support the provision of services
in the most competent and cost effective manner possible.
The author's office states that existing advisory
committees within DDS 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's office 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's office there is a significant divide between
the organizations and experts dedicated to telehealth
technologies generally, and the technical expertise of
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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 DDS as they expand the use
of telehealth in serving individuals with ASDs.
ASSEMBLY FLOOR : 71-5, 08/21/12
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall, Bill
Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Charles Calderon, Campos,
Carter, Cedillo, Chesbro, Conway, Cook, Davis, Dickinson,
Eng, Feuer, Fletcher, Fong, Furutani, Beth Gaines,
Galgiani, Garrick, Gatto, Gordon, Gorell, Grove, Hagman,
Hall, Harkey, Hayashi, Hill, Huber, Hueso, Huffman,
Jeffries, Knight, Lara, Logue, Bonnie Lowenthal, Ma,
Mansoor, Mendoza, Miller, Mitchell, Monning, Nestande,
Olsen, Pan, Perea, V. Manuel P�rez, Portantino, Silva,
Skinner, Smyth, Solorio, Swanson, Torres, Wagner,
Wieckowski, Williams, Yamada, John A. P�rez
NOES: Donnelly, Halderman, Jones, Morrell, Norby
NO VOTE RECORDED: Fuentes, Roger Hern�ndez, Nielsen,
Valadao
CTW:n 8/21/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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