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.begin insert The bill would require the department to amend its regulations as necessary to implement the provisions of the bill.end insert
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.
end deleteThis 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.
end deleteVote: majority.
Appropriation: no.
Fiscal committee: begin deleteno end deletebegin insertyesend insert.
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
P3 1does not require any benefits to be provided that exceed the
2essential health benefits that all health plans will be required by
3federal regulations to provide under Section 1302(b) of
the federal
4Patient Protection and Affordable Care Act (Public Law 111-148),
5as amended by the federal Health Care and Education
6Reconciliation Act of 2010 (Public Law 111-152).
7(3) This section shall not affect services for which an individual
8is eligible pursuant to Division 4.5 (commencing with Section
94500) of the Welfare and Institutions Code or Title 14
10(commencing with Section 95000) of the Government Code.
11(4) This section shall not affect or reduce any obligation to
12provide services under an individualized education program, as
13defined in Section 56032 of the Education Code, or an individual
14service plan, as described in Section 5600.4 of the Welfare and
15Institutions Code, or under the federal Individuals with Disabilities
16Education Act (20 U.S.C. Sec. 1400 et seq.) and
its implementing
17regulations.
18(b) Every health care service plan subject to this section shall
19maintain an adequate network that includes qualified autism service
20providers who supervise and employ qualified autism service
21professionals or paraprofessionals who provide and administer
22behavioral health treatment. Nothing shall prevent a health care
23service plan from selectively contracting with providers within
24these requirements.
25(c) For the purposes of this section, the following definitions
26shall apply:
27(1) “Behavioral health treatment” means professional services
28and treatment programs, including applied behavior analysis and
29evidence-based behavior intervention programs, that develop or
30restore, to the
maximum extent practicable, the functioning of an
31individual with pervasive developmental disorder or autism and
32that meet all of the following criteria:
33(A) The treatment is prescribed by a physician and surgeon
34licensed pursuant to Chapter 5 (commencing with Section 2000)
35of, or is developed by a psychologist licensed pursuant to Chapter
366.6 (commencing with Section 2900) of, Division 2 of the Business
37and Professions Code.
38(B) The treatment is provided under a treatment plan prescribed
39by a qualified autism service provider and is administered by one
40of the following:
P4 1(i) A qualified autism service provider.
2(ii) A qualified autism service professional
supervised and
3employed by the qualified autism service provider.
4(iii) A qualified autism service paraprofessional supervised and
5employed by a qualified autism service provider.
6(C) The treatment plan has measurable goals over a specific
7timeline that is developed and approved by the qualified autism
8service provider for the specific patient being treated. The treatment
9plan shall be reviewed no less than once every six months by the
10qualified autism service provider and modified whenever
11appropriate, and shall be consistent with Section 4686.2 of the
12Welfare and Institutions Code pursuant to which the qualified
13autism service provider does all of the following:
14(i) Describes the patient’s behavioral health impairments or
15developmental
challenges that are to be treated.
16(ii) Designs an intervention plan that includes the service type,
17number of hours, and parent participation needed to achieve the
18plan’s goal and objectives, and the frequency at which the patient’s
19progress is evaluated and reported.
20(iii) Provides intervention plans that utilize evidence-based
21practices, with demonstrated clinical efficacy in treating pervasive
22developmental disorder or autism.
23(iv) Discontinues intensive behavioral intervention services
24when the treatment goals and objectives are achieved or no longer
25appropriate.
26(D) The treatment plan is not used for purposes of providing or
27for the reimbursement of
respite, day care, or educational services
28and is not used to reimburse a parent for participating in the
29treatment program. The treatment plan shall be made available to
30the health care service plan upon request.
31(2) “Pervasive developmental disorder or autism” shall have
32
the same meaning and interpretation as used in Section 1374.72.
33(3) “Qualified autism service provider” means either of the
34following:
35(A) A person, entity, or group that is certified by a national
36entity, such as the Behavior Analyst Certification Board, that is
37accredited by the National Commission for Certifying Agencies,
38and who designs, supervises, or provides treatment for pervasive
39developmental disorder or autism, provided the services are within
P5 1the experience and competence of the person, entity, or group that
2is nationally certified.
3(B) A person licensed as a physician and surgeon, physical
4therapist, occupational therapist, psychologist, marriage and family
5therapist, educational
psychologist, clinical social worker,
6professional clinical counselor, speech-language pathologist, or
7audiologist pursuant to Division 2 (commencing with Section 500)
8of the Business and Professions Code, who designs, supervises,
9or provides treatment for pervasive developmental disorder or
10autism, provided the services are within the experience and
11competence of the licensee.
12(4) “Qualified autism service professional” means an individual
13who meets all of the following criteria:
14(A) Provides behavioral health treatment.
15(B) Is employed and supervised by a qualified autism service
16provider.
17(C) Provides treatment pursuant to a treatment plan developed
18and
approved by the qualified autism service provider.
19(D) Is a behavioral service provider approved as a vendor by a
20California regional center to provide services as an Associate
21Behavior Analyst, Behavior Analyst,
or Behavior Management
22Program as defined in Section 54342 of Title 17 of the California
23Code of Regulations or as a Behavior Management Assistant or
24Behavior Management Consultant pursuant to Section 4648.32 of
25the Welfare and Institutions Code.
26(E) Has training and experience in providing services for
27pervasive developmental disorder or autism pursuant to Division
284.5 (commencing with Section 4500) of the Welfare and
29Institutions Code or Title 14 (commencing with Section 95000)
30of the Government Code.
31(5) “Qualified autism service paraprofessional” means an
32unlicensed and uncertified individual who meets all of the
33following criteria:
34(A) Is employed and supervised by a qualified autism service
35provider.
36(B) Provides treatment and implements services pursuant to a
37treatment plan developed and approved by the qualified autism
38service provider.
39(C) Meets the criteria set forth in the regulations adopted
40pursuant to Section 4686.3 of the Welfare and Institutions Code.
P6 1(D) Has adequate education, training, and experience, as
2certified by a qualified autism service provider.
3(d) This section shall not apply to the following:
4(1) A specialized health care service plan that does not deliver
5mental health or behavioral health services to enrollees.
6(2) A health care service plan contract in the Medi-Cal program
7
(Chapter 7 (commencing with Section 14000) of Part 3 of Division
89 of the Welfare and Institutions Code).
9(3) A health care service plan contract in the Healthy Families
10Program (Part 6.2 (commencing with Section 12693) of Division
112 of the Insurance Code).
12(4) A health care benefit plan or contract entered into with the
13Board of Administration of the Public Employees’ Retirement
14System pursuant to the Public Employees’ Medical and Hospital
15Care Act (Part 5 (commencing with Section 22750) of Division 5
16of Title 2 of the Government Code).
17(e) Nothing in this section shall be construed to limit the
18obligation to provide services under Section 1374.72.
19(f) As provided in Section 1374.72 and in paragraph (1) of
20subdivision (a), in the provision of benefits required by this section,
21a health care service plan may utilize case management, network
22providers, utilization review techniques, prior authorization,
23copayments, or other cost sharing.
24(g) This section shall remain in effect only until January 1, 2017,
25and as of that date is repealed, unless a later enacted statute, that
26is enacted before January 1, 2017, deletes or extends that date.
Section 10144.51 of the Insurance Code is amended
28to read:
(a) (1) Every health insurance policy shall also
30provide coverage for behavioral health treatment for pervasive
31developmental disorder or autism no later than July 1, 2012. The
32coverage shall be provided in the same manner and shall be subject
33to the same requirements as provided in Section 10144.5.
34(2) Notwithstanding paragraph (1), as of the date that proposed
35final rulemaking for essential health benefits is issued, this section
36does not require any benefits to be provided that exceed the
37essential health benefits that all health insurers will be required by
38federal regulations to provide under Section 1302(b) of the federal
39Patient Protection and Affordable
Care Act (Public Law 111-148),
P7 1as amended by the federal Health Care and Education
2Reconciliation Act of 2010 (Public Law 111-152).
3(3) This section shall not affect services for which an individual
4is eligible pursuant to Division 4.5 (commencing with Section
54500) of the Welfare and Institutions Code or Title 14
6(commencing with Section 95000) of the Government Code.
7(4) This section shall not affect or reduce any obligation to
8provide services under an individualized education program, as
9defined in Section 56032 of the Education Code, or an individual
10service plan, as described in Section 5600.4 of the Welfare and
11Institutions Code, or under the federal Individuals with Disabilities
12Education Act (20 U.S.C. Sec. 1400 et seq.) and its implementing
13regulations.
14(b) Pursuant to Article 6 (commencing with Section 2240) of
15Title 10 of the California Code of Regulations, every health insurer
16subject to this section shall maintain an adequate network that
17includes qualified autism service providers who supervise and
18employ qualified autism service professionals or paraprofessionals
19who provide and administer behavioral health treatment. Nothing
20shall prevent a health insurer from selectively contracting with
21providers within these 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
34 and 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.
P8 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 insurer upon request.
28(2) “Pervasive developmental disorder or autism” shall have
29the same meaning and interpretation as used in Section 10144.5.
30(3) “Qualified autism service provider” means either of the
31
following:
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
P9 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:
P10 1(1) A specialized health insurance policy that does not cover
2mental health or behavioral health services or an accident only,
3specified disease, hospital indemnity, or Medicare supplement
4policy.
5(2) A health insurance policy in the Medi-Cal program (Chapter
67 (commencing with Section 14000) of Part 3 of Division 9 of the
7Welfare and Institutions Code).
8(3) A health insurance policy in the Healthy Families Program
9(Part 6.2 (commencing with Section 12693)).
10(4) A health care benefit plan or policy entered into with the
11Board of Administration of the Public Employees’ Retirement
12System pursuant to the Public Employees’ Medical and Hospital
13Care Act (Part 5 (commencing with Section 22750) of Division 5
14of Title 2 of the Government Code).
15(e) Nothing in this section shall be construed to limit the
16obligation to provide services under Section 10144.5.
17(f) As provided in Section 10144.5 and in paragraph (1) of
18subdivision (a), in the provision of benefits required by this section,
19a health insurer may utilize case management, network providers,
20utilization review techniques, prior authorization, copayments, or
21other cost sharing.
22(g) This section shall remain in effect only until January 1, 2017,
23and as of that date is repealed, unless a later enacted statute, that
24is enacted before January 1, 2017, deletes or extends that date.
Section 4648.32 is added to the Welfare and
27Institutions Code, to read:
(a) For purposes of this section, “behavioral health
29treatment” shall have the same meaning as provided in Article 5.6
30(commencing with Section 1374.60) of Chapter 2.2 of Division 2
31of the Health and Safety Code and Article 2.5 (commencing with
32Section 10140) of Chapter 1 of Part 2 of Division 2 of the Insurance
33Code.
34(b) A regional center shall classify a vendor as a Behavior
35Management Assistant if the vendor does both of the following:
36(1) Designs or implements behavioral health treatments under
37the direct supervision of a Behavior Management Consultant,
38classified as provided in subdivision (c), or
assesses the function
39of a behavior of a consumer and designs, implements, and evaluates
40instructional and environmental modifications to produce socially
P11 1significant improvements in the consumer’s behavior through skill
2acquisition and the reduction of behavior, under direct supervision
3of a Behavior Analyst, classified as provided in Section 54342 of
4Title 17 of the California Code of Regulations, or a Behavior
5Management Consultant, classified as provided in subdivision
(c).
6(2) Meets either of the following requirements:
7(A) Possesses a bachelor of arts or science degree and has either
8of the following:
9(i) Twelve semester units of applied behavior analysis or
10behavioral health treatment and one year of experience in designing
11or implementing behavioral health treatment.
12(ii) Two years of experience in designing or implementing
13behavioral health treatment.
14(B) Is either of the following:
15(i) A registered psychological assistant or licensed psychologist
16pursuant to Chapter 6.6 (commencing with
Section 2900) of
17Division 2 of the Business and Professions Code.
18(ii) An associate clinical social worker registered with the Board
19of Behavioral Sciences pursuant to Section 4996.18 of the Business
20and Professions Code.
21(3) For purposes of this section, a regional center shall only
22classify as a vendor a Behavior Management Assistant who designs
23or implements behavioral health treatments that are consistent with
24the vendor’s experience and education.
25(c) A regional center shall classify a vendor as a Behavior
26Management Consultant if the vendor designs or implements
27behavioral health treatments and meets all of the following
28requirements:
29(1) Has
two years of experience designing and implementing
30behavioral health treatments.
31(2) Is licensed as one of the following:
32(A) A psychologist pursuant to Chapter 6.6 (commencing with
33Section 2900) of Division 2 of the Business and Professions Code.
34(B) A licensed clinical social worker pursuant to Chapter 14
35(commencing with Section 4991) of Division 2 of the Business
36and Professions Code.
37(C) A licensed marriage and family therapist pursuant to Chapter
3813 (commencing with Section 4980) of Division 2 of the Business
39and Professions Code.
P12 1(D) Any other licensed professional under the laws of this state
2whose
license permits the design or implementation of behavioral
3health treatments.
4(3) For individuals vendored as a behavior management
5consultant prior to, or as of, December 31, 2006, have completed
612 semester units in applied behavior analysis by December 31,
72008.
8(4) For individuals vendored as a behavior management
9consultant on or after January 1, 2007, completes 12 semester units
10of applied behavior analysis or behavioral health treatment.
11(5) For purposes of this section, a regional center shall only
12classify as a vendor a Behavior Management Consultant who
13designs or implements behavioral health treatments that are
14consistent with the vendor’s experience and education.
15(d) The department shall amend its regulations as necessary to
16implement to this section.
O
96