AB 2041, as amended, Jones. Developmental services: regional centers: behavioral health treatment.
The Lanterman Developmental Disabilities Services Act requires the State Department of Developmental Services to enter into contracts with private nonprofit corporations to operate regional centers for the provision of community services and supports for persons with developmental disabilities and their families. Regulations adopted under that act require a regional center to classify a vendor of services provided by the regional center as a behavior management consultant or behavior management assistant if the vendor designs or implements behavior management intervention services, possesses specified experience in designing or implementing those services, and meets other specified licensure and education requirements.
This bill would require that a regional center classify a vendor as a behavior management consultant or behavior management assistant if the vendor designs or implements behavioral health treatment, has a specified amount of experience in designing or implementing that treatment, and meets other licensure and education requirements.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plan contracts and health insurance policies to provide coverage for behavioral health treatment for pervasive developmental disorder or autism until January 1, 2017, and defines behavioral health treatment to mean specified services provided by, among others, a qualified autism service professional supervised and employed by a qualified autism service provider. For purposes of this provision, existing law defines a “qualified autism service professional” to mean a person who, among other requirements, is a behavior service provider approved as a vendor by a California regional center to provide services as an associate behavior analyst, behavior management assistant, behavior management consultant, or behavior management program pursuant to specified regulations adopted under the Lanterman Developmental Disabilities Services Act.
This bill would instead require that the behavior management assistant or behavior management consultant be approved as a California regional center vendor under the provisions described above.
Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 1374.73 of the Health and Safety Code
2 is amended to read:
(a) (1) Every health care service plan contract that
4provides hospital, medical, or surgical coverage shall also provide
5coverage for behavioral health treatment for pervasive
6developmental disorder or autism no later than July 1, 2012. The
7coverage shall be provided in the same manner and is subject to
8the same requirements as provided in Section 1374.72.
9(2) Notwithstanding paragraph (1), as of the date that proposed
10final rulemaking for essential health benefits is issued, this section
11does not require any benefits to be provided that exceed the
12essential health benefits that all health plans will be required by
13federal regulations to provide under Section 1302(b) of
the federal
P3 1Patient Protection and Affordable Care Act (Public Law 111-148),
2as amended by the federal Health Care and Education
3Reconciliation Act of 2010 (Public Law 111-152).
4(3) This section shall not affect services for which an individual
5is eligible pursuant to Division 4.5 (commencing with Section
64500) of the Welfare and Institutions Code or Title 14
7(commencing with Section 95000) of the Government Code.
8(4) This section shall not affect or reduce any obligation to
9provide services under an individualized education program, as
10defined in Section 56032 of the Education Code, or an individual
11service plan, as described in Section 5600.4 of the Welfare and
12Institutions Code, or under the federal Individuals with Disabilities
13Education Act (20 U.S.C. Sec. 1400 et seq.) and
its implementing
14regulations.
15(b) Every health care service plan subject to this section shall
16maintain an adequate network that includes qualified autism service
17providers who supervise and employ qualified autism service
18professionals or paraprofessionals who provide and administer
19behavioral health treatment. Nothing shall prevent a health care
20service plan from selectively contracting with providers within
21these requirements.
22(c) For the purposes of this section, the following definitions
23shall apply:
24(1) “Behavioral health treatment” means professional services
25and treatment programs, including applied behavior analysis and
26evidence-based behavior intervention programs, that develop or
27restore, to the
maximum extent practicable, the functioning of an
28individual with pervasive developmental disorder or autism and
29that meet all of the following criteria:
30(A) The treatment is prescribed by a physician and surgeon
31licensed pursuant to Chapter 5 (commencing with Section 2000)
32of, or is developed by a psychologist licensed pursuant to Chapter
336.6 (commencing with Section 2900) of, Division 2 of the Business
34and Professions Code.
35(B) The treatment is provided under a treatment plan prescribed
36by a qualified autism service provider and is administered by one
37of the following:
38(i) A qualified autism service provider.
39(ii) A qualified autism service professional
supervised and
40employed by the qualified autism service provider.
P4 1(iii) A qualified autism service paraprofessional supervised and
2employed by a qualified autism service provider.
3(C) The treatment plan has measurable goals over a specific
4timeline that is developed and approved by the qualified autism
5service provider for the specific patient being treated. The treatment
6plan shall be reviewed no less than once every six months by the
7qualified autism service provider and modified whenever
8appropriate, and shall be consistent with Section 4686.2 of the
9Welfare and Institutions Code pursuant to which the qualified
10autism service provider does all of the following:
11(i) Describes the patient’s behavioral health impairments or
12developmental
challenges that are to be treated.
13(ii) Designs an intervention plan that includes the service type,
14number of hours, and parent participation needed to achieve the
15plan’s goal and objectives, and the frequency at which the patient’s
16progress is evaluated and reported.
17(iii) Provides intervention plans that utilize evidence-based
18practices, with demonstrated clinical efficacy in treating pervasive
19developmental disorder or autism.
20(iv) Discontinues intensive behavioral intervention services
21when the treatment goals and objectives are achieved or no longer
22appropriate.
23(D) The treatment plan is not used for purposes of providing or
24for the reimbursement of
respite, day care, or educational services
25and is not used to reimburse a parent for participating in the
26treatment program. The treatment plan shall be made available to
27the health care service plan upon request.
28(2) “Pervasive developmental disorder or autism” shall have
29
the same meaning and interpretation as used in Section 1374.72.
30(3) “Qualified autism service provider” means either of the
31following:
32(A) A person, entity, or group that is certified by a national
33entity, such as the Behavior Analyst Certification Board, that is
34accredited by the National Commission for Certifying Agencies,
35and who designs, supervises, or provides treatment for pervasive
36developmental disorder or autism, provided the services are within
37the experience and competence of the person, entity, or group that
38is nationally certified.
39(B) A person licensed as a physician and surgeon, physical
40therapist, occupational therapist, psychologist, marriage and family
P5 1therapist, educational
psychologist, clinical social worker,
2professional clinical counselor, speech-language pathologist, or
3audiologist pursuant to Division 2 (commencing with Section 500)
4of the Business and Professions Code, who designs, supervises,
5or provides treatment for pervasive developmental disorder or
6autism, provided the services are within the experience and
7competence of the licensee.
8(4) “Qualified autism service professional” means an individual
9who meets all of the following criteria:
10(A) Provides behavioral health treatment.
11(B) Is employed and supervised by a qualified autism service
12provider.
13(C) Provides treatment pursuant to a treatment plan developed
14and
approved by the qualified autism service provider.
15(D) Is a behavioral service provider approved as a vendor by a
16California regional center to provide services as an Associate
17Behavior Analyst, Behavior Analyst,
or Behavior Management
18Program as defined in Section 54342 of Title 17 of the California
19Code of Regulations or as a Behavior Management Assistant or
20Behavior Management Consultant pursuant to Section 4648.32 of
21the Welfare and Institutions Code.
22(E) Has training and experience in providing services for
23pervasive developmental disorder or autism pursuant to Division
244.5 (commencing with Section 4500) of the Welfare and
25Institutions Code or Title 14 (commencing with Section 95000)
26of the Government Code.
27(5) “Qualified autism service paraprofessional” means an
28unlicensed and uncertified individual who meets all of the
29following criteria:
30(A) Is employed and supervised by a qualified autism service
31provider.
32(B) Provides treatment and implements services pursuant to a
33treatment plan developed and approved by the qualified autism
34service provider.
35(C) Meets the criteria set forth in the regulations adopted
36pursuant to Section 4686.3 of the Welfare and Institutions Code.
37(D) Has adequate education, training, and experience, as
38certified by a qualified autism service provider.
39(d) This section shall not apply to the following:
P6 1(1) A specialized health care service plan that does not deliver
2mental health or behavioral health services to enrollees.
3(2) A health care service plan contract in the Medi-Cal program
4 (Chapter 7 (commencing with Section 14000) of Part 3 of Division
59 of the Welfare and Institutions Code).
6(3) A health care service plan contract in the Healthy Families
7Program (Part 6.2 (commencing with Section 12693) of Division
82 of the Insurance Code).
9(4) A health care benefit plan or contract entered into with the
10Board of Administration of the Public Employees’ Retirement
11System pursuant to the Public Employees’ Medical and Hospital
12Care Act (Part 5 (commencing with Section 22750) of Division 5
13of Title 2 of the Government Code).
14(e) Nothing in this section shall be construed to limit the
15obligation to provide services under Section 1374.72.
16(f) As provided in Section 1374.72 and in paragraph (1) of
17subdivision (a), in the provision of benefits required by this section,
18a health care service plan may utilize case management, network
19providers, utilization review techniques, prior authorization,
20copayments, or other cost sharing.
21(g) This section shall remain in effect only until January 1, 2017,
22and as of that date is repealed, unless a later enacted statute, that
23is enacted before January 1, 2017, deletes or extends that date.
Section 10144.51 of the Insurance Code is amended
25to read:
(a) (1) Every health insurance policy shall also
27provide coverage for behavioral health treatment for pervasive
28developmental disorder or autism no later than July 1, 2012. The
29coverage shall be provided in the same manner and shall be subject
30to the same requirements as provided in Section 10144.5.
31(2) Notwithstanding paragraph (1), as of the date that proposed
32final rulemaking for essential health benefits is issued, this section
33does not require any benefits to be provided that exceed the
34essential health benefits that all health insurers will be required by
35federal regulations to provide under Section 1302(b) of the federal
36Patient Protection and Affordable
Care Act (Public Law 111-148),
37as amended by the federal Health Care and Education
38Reconciliation Act of 2010 (Public Law 111-152).
39(3) This section shall not affect services for which an individual
40is eligible pursuant to Division 4.5 (commencing with Section
P7 14500) of the Welfare and Institutions Code or Title 14
2(commencing with Section 95000) of the Government Code.
3(4) This section shall not affect or reduce any obligation to
4provide services under an individualized education program, as
5defined in Section 56032 of the Education Code, or an individual
6service plan, as described in Section 5600.4 of the Welfare and
7Institutions Code, or under the federal Individuals with Disabilities
8Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing
9regulations.
10(b) Pursuant to Article 6 (commencing with Section 2240) of
11Title 10 of the California Code of Regulations, every health insurer
12subject to this section shall maintain an adequate network that
13includes qualified autism service providers who supervise and
14employ qualified autism service professionals or paraprofessionals
15who provide and administer behavioral health treatment. Nothing
16shall prevent a health insurer from selectively contracting with
17providers within these requirements.
18(c) For the purposes of this section, the following definitions
19shall apply:
20(1) “Behavioral health treatment” means professional services
21and treatment programs, including applied behavior analysis and
22evidence-based behavior intervention
programs, that develop or
23restore, to the maximum extent practicable, the functioning of an
24individual with pervasive developmental disorder or autism, and
25that meet all of the following criteria:
26(A) The treatment is prescribed by a physician and surgeon
27licensed pursuant to Chapter 5 (commencing with Section 2000)
28of, or is developed by a psychologist licensed pursuant to Chapter
296.6 (commencing with Section 2900) of, Division 2 of the Business
30and Professions Code.
31(B) The treatment is provided under a treatment plan prescribed
32by a qualified autism service provider and is administered by one
33of the following:
34(i) A qualified autism service provider.
35(ii) A qualified autism service professional supervised and
36employed by the qualified autism service provider.
37(iii) A qualified autism service paraprofessional supervised and
38employed by a qualified autism service provider.
39(C) The treatment plan has measurable goals over a specific
40timeline that is developed and approved by the qualified autism
P8 1service provider for the specific patient being treated. The treatment
2plan shall be reviewed no less than once every six months by the
3qualified autism service provider and modified whenever
4appropriate, and shall be consistent with Section 4686.2 of the
5Welfare and Institutions Code pursuant to which the qualified
6autism service provider does all of the following:
7(i) Describes the patient’s behavioral health impairments or
8developmental challenges that are to be treated.
9(ii) Designs an intervention plan that includes the service type,
10number of hours, and parent participation needed to achieve the
11plan’s goal and objectives, and the frequency at which the patient’s
12progress is evaluated and reported.
13(iii) Provides intervention plans that utilize evidence-based
14practices, with demonstrated clinical efficacy in treating pervasive
15developmental disorder or autism.
16(iv) Discontinues intensive behavioral intervention services
17when the treatment goals and objectives are achieved or no longer
18appropriate.
19(D) The treatment plan is not used for purposes of providing or
20for the reimbursement of respite, day care, or educational services
21and is not used to reimburse a parent for participating in the
22treatment program. The treatment plan shall be made available to
23the insurer upon request.
24(2) “Pervasive developmental disorder or autism” shall have
25the same meaning and interpretation as used in Section 10144.5.
26(3) “Qualified autism service provider” means either of the
27
following:
28(A) A person, entity, or group that is certified by a national
29entity, such as the Behavior Analyst Certification Board, that is
30accredited by the National Commission for Certifying Agencies,
31and who designs, supervises, or provides treatment for pervasive
32developmental disorder or autism, provided the services are within
33the experience and competence of the person, entity, or group that
34is nationally certified.
35(B) A person licensed as a physician and surgeon, physical
36therapist, occupational therapist, psychologist, marriage and family
37therapist, educational psychologist, clinical social worker,
38professional clinical counselor, speech-language pathologist, or
39audiologist pursuant to Division 2 (commencing with Section 500)
40of the Business and
Professions Code, who designs, supervises,
P9 1or provides treatment for pervasive developmental disorder or
2autism, provided the services are within the experience and
3competence of the licensee.
4(4) “Qualified autism service professional” means an individual
5who meets all of the following criteria:
6(A) Provides behavioral health treatment.
7(B) Is employed and supervised by a qualified autism service
8provider.
9(C) Provides treatment pursuant to a treatment plan developed
10and approved by the qualified autism service provider.
11(D) Is a behavioral service provider approved as a vendor by a
12California
regional center to provide services as an Associate
13Behavior Analyst, Behavior Analyst,
or Behavior Management
14Program as defined in Section 54342 of Title 17 of the California
15Code of Regulations or as a Behavior Management Assistant or
16Behavior Management Consultant pursuant to Section 4648.32 of
17the Welfare and Institutions Code.
18(E) Has training and experience in providing services for
19pervasive developmental disorder or autism pursuant to Division
204.5 (commencing with Section 4500) of the Welfare and
21Institutions Code or Title 14 (commencing with Section 95000)
22of the Government Code.
23(5) “Qualified autism service paraprofessional” means an
24unlicensed and uncertified individual who meets all of the
25following criteria:
26(A) Is employed and supervised by a qualified autism service
27provider.
28(B) Provides treatment and implements services pursuant to a
29treatment plan developed and approved by the qualified autism
30service provider.
31(C) Meets the criteria set forth in the regulations adopted
32pursuant to Section 4686.3 of the Welfare and Institutions Code.
33(D) Has adequate education, training, and experience, as
34certified by a qualified autism service provider.
35(d) This section shall not apply to the following:
36(1) A specialized health insurance policy that does not cover
37mental health or behavioral health services or an accident only,
38specified disease, hospital indemnity, or Medicare supplement
39policy.
P10 1(2) A health insurance policy in the Medi-Cal program (Chapter
27 (commencing with Section 14000) of Part 3 of Division 9 of the
3Welfare and Institutions Code).
4(3) A health insurance policy in the Healthy Families Program
5(Part 6.2 (commencing with Section 12693)).
6(4) A health care benefit plan or policy entered into with the
7Board of Administration of the Public Employees’ Retirement
8System pursuant to the Public Employees’ Medical and Hospital
9Care Act (Part 5 (commencing with Section 22750) of Division 5
10of Title 2 of the Government Code).
11(e) Nothing in this section shall be construed to limit the
12obligation to provide services under Section 10144.5.
13(f) As provided in Section 10144.5 and in paragraph (1) of
14subdivision (a), in the provision of benefits required by this section,
15a health insurer may utilize case management, network providers,
16utilization review techniques, prior authorization, copayments, or
17other cost sharing.
18(g) This section shall remain in effect only until January 1, 2017,
19and as of that date is repealed, unless a later enacted statute, that
20is enacted before January 1, 2017, deletes or extends that date.
Section 4648.32 is added to the Welfare and
22Institutions Code, to read:
(a) begin insertFor purposes of this section, “behavioral health
24treatmentend insertbegin insert” shall have the same meaning as provided in Article
255.6 (commencing with Section 1374.60) of Chapter 2.2 of Division
262 of the Health and Safety Code and Article 2.5 (commencing with
27Section 10140) of Chapter 1 of Part 2 of Division 2 of the
28Insurance Code.end insert
29begin insert(b)end insert A regional center shall classify a vendor as a Behavior
30Management Assistant if the vendor does both of the following:
31(1) Designs or implements behavioral health treatments under
32the direct supervision of a Behavior Management Consultant,
33classified as provided in subdivisionbegin delete (b)end deletebegin insert (c)end insert, or assesses the function
34of a behavior of a consumer and designs, implements, and evaluates
35instructional and environmental modifications to produce socially
36significant improvements in the consumer’s behavior through skill
37acquisition and the reduction of behavior, under direct supervision
38of a Behavior Analyst, classified as provided in Section 54342 of
39Title 17 of the California Code of Regulations, or a Behavior
P11 1Management Consultant, classified as provided in subdivisionbegin delete (b)end delete
2begin insert
(c)end insert.
3(2) Meets either of the following requirements:
4(A) Possesses a bachelor of arts or science degree and has either
5of the following:
6(i) Twelve semester units of applied behavior analysis or
7behavioral healthbegin insert treatmentend insert and one year of experience in designing
8or implementing behavioral health treatment.
9(ii) Two years of experience in designing or implementing
10behavioral health treatment.
11(B) Is either of the following:
12(i) A
registered psychological assistant orbegin delete registeredend deletebegin insert licensedend insert
13 psychologist pursuant to Chapter 6.6 (commencing with Section
142900) of Division 2 of the Business and Professions Code.
15(ii) An associatebegin delete licensedend delete clinical social worker registered with
16the Board of Behavioral Sciences pursuant to Section 4996.18 of
17the Business and Professions Code.
18(3) For purposes of this section, a regional center shall only
19classify as a vendor a Behavior Management Assistant who designs
20or implements behavioral
health treatments that are consistent
21with the vendor’s experience and education.
13 22(b)
end delete
23begin insert(c)end insert A regional center shall classify a vendor as a Behavior
24Management Consultant if the vendor designs or implements
25behavioral health treatments and meets all of the following
26requirements:
27(1) Has two years of experience designing and implementing
28behavioral health treatments.
29(2) Is licensed as one of the following:
30(A) A psychologist pursuant to Chapter 6.6 (commencing with
31Section 2900) of Division 2 of the Business and Professions Code.
32(B) A licensed clinical social worker pursuant to Chapter 14
33(commencing with Section 4991) of Division 2 of the Business
34and Professions Code.
35(C) A licensed marriage and family therapist pursuant to Chapter
3613 (commencing with Section 4980) of Division 2 of the Business
37and Professions Code.
38(D) Any other licensed professional under the laws of this state
39whose license permits the design or implementation of behavioral
40health treatments.
P12 1(3) For individuals vendored as a behavior management
2consultant prior to, or as of,
December 31, 2006, have completed
312 semester units in applied behavior analysis by December 31,
42008.
5(4) For individuals vendored as a behavior management
6consultant on or after January 1, 2007, completes 12 semester units
7of applied behavior analysis or behavioral healthbegin insert treatmentend insert.
8(5) For purposes of this section, a regional center shall only
9classify as a vendor a Behavior Management Consultant who
10designs or implements behavioral health treatments that are
11consistent with the vendor’s experience and education.
O
97