BILL ANALYSIS �
AB 2041
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Date of Hearing: April 8, 2014
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 2041 (Jones) - As Amended: March 28, 2014
SUBJECT : Developmental services: regional centers: behavioral
health treatment.
SUMMARY : Provides a statutory definition for Behavior
Management Assistants and Behavior Management Consultants for
purposes of providing behavioral health treatment, being
vendorized by regional centers, and receiving health insurance
coverage for providing such services.
Specifically, this bill :
1)Defines Behavior Management Assistant and Behavior Management
Consultant in statute for purposes of regional center
vendorization consistent with the definitions currently
provided for in Section 54342 of Title 17 of the California
Code of Regulations with the addition of individuals who meet
the required amount of education and experience in behavioral
health treatment other than applied behavior analysis (ABA).
2)Deletes references to the current definitions for Behavior
Management Assistant and Behavior Management Consultant in
Title 17 CCR �54342 and instead references the newly proposed
definitions for both professionals for purposes of payment for
behavioral health treatment by health care service plan
contracts and health insurance policies, as specified.
EXISTING LAW
1)Establishes an entitlement to services for individuals with
developmental disabilities under the Lanterman Developmental
Disabilities Services Act (Lanterman Act). (WIC 4500 et seq.)
2)Grants all individuals with developmental disabilities, among
all other rights and responsibilities established for any
individual by the United States Constitution and laws and the
California Constitution and laws, the right to treatment and
habilitation services and supports in the least restrictive
environment. (WIC 4502)
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3)Establishes a system of 21 nonprofit regional centers
throughout the state to identify needs and coordinate services
for eligible individuals with developmental disabilities and
requires the Department of Developmental Services (DDS) to
contract with regional centers to provide case management
services and arrange for or purchase services that meet the
needs of individuals with developmental disabilities, as
defined. (WIC 4620 et seq.)
4)Requires the development of an IPP for each regional center
consumer, which specifies services to be provided to the
consumer, based on his or her individualized needs
determination and preferences, and defines that planning
process as the vehicle to ensure that services and supports
are customized to meet the needs of consumers who are served
by regional centers. (WIC 4512)
5)Creates a process by which regional centers may "vendorize"
service providers, thereby providing a path to contract for
services with that provider and ensuring maximum flexibility
and availability of appropriate services and support for
persons with developmental disabilities. (WIC 4648)
6)Authorizes regional centers to solicit an individual or agency
through a request for proposals or other means to provide
needed services or supports not presently available, provided
it is necessary to expand the availability of needed services
of good quality. (WIC 4648(e)(1))
1)Defines behavioral health treatment, for purposes of payment
under a health care service plan contract or a health
insurance policy, as professional services and treatment
programs, including applied behavior analysis and
evidence-based behavior intervention programs, which develop
or restore, to the maximum extent practicable, the functioning
of an individual with pervasive developmental disorder or
autism, and sets forth criteria that must be met related to
the treatment plan, prescription of the treatment, and the
providers authorized to provide such treatment, which includes
qualified autism service professionals, as specified. (H&S
1374.73(c)(1), INS 10144.51(c)(1))
7)Includes in the definition of a "qualified autism service
professional" a behavioral service provider approved as a
vendor by a California regional center to provide services as
an Associate Behavior Analyst, Behavior Analyst, Behavior
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Management Assistant, Behavior Management Consultant, or
Behavior Management Program as defined in Title 17 CCR �54342.
(H&S 1374.73 (c)(4)(D), INS 10144.51(c)(4)(D))
8)Defines in state regulations, for purposes of regional center
vendorization, Behavior Management Assistant and Behavior
Management Consultant and requires education or experience in
ABA for both professionals, as specified. (17 CCR �54342)
FISCAL EFFECT : Unknown.
COMMENTS : This bill seeks to make training and education
requirements for Behavior Management Assistants and Behavior
Management Consultants who provide behavioral health treatment
to individuals with pervasive developmental disorders and autism
spectrum disorders consistent with the definition of behavioral
health treatment services that are required to be covered under
health care service plan contracts and health insurance
policies.
Background : The Lanterman Act guides the provision of services
and supports for Californians with developmental disabilities.
Each individual under the Act, typically referred to as a
"consumer," is legally entitled to treatment and habilitation
services and supports in the least restrictive environment.
Lanterman Act services are designed to enable all consumers to
live more independent and productive lives in the community.
The term "developmental disability" means a disability that
originates before an individual attains 18 years of age, is
expected to continue indefinitely, and constitutes a substantial
disability for that individual. It includes intellectual
disabilities, cerebral palsy, epilepsy, and pervasive
developmental disorder/autism spectrum disorder (PDD/ASD).
Other developmental disabilities are those disabling conditions
similar to an intellectual disability that require treatment
(i.e., care and management) similar to that required by
individuals with an intellectual disability. This does not
include conditions that are solely psychiatric or physical in
nature, and the conditions must occur before age 18, result in a
substantial disability, be likely to continue indefinitely, and
involve brain damage or dysfunction. Examples of conditions
might include intracranial neoplasms, degenerative brain disease
or brain damage associated with accidents.
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Direct responsibility for implementation of the Lanterman Act
service system is shared by the Department of Developmental
Services (DDS) and 21 regional centers, which are private
nonprofit entities, established pursuant to the Lanterman Act,
that contract with DDS to carry out many of the state's
responsibilities under the Act. The principal roles of regional
centers include intake and assessment, individualized program
plan development, case management, and securing services through
generic agencies or purchasing services provided by vendors.
Regional centers also share primary responsibility with local
education agencies for provision of early intervention services
under the California Early Intervention Services Act.
Regional centers : The 21 regional centers throughout the state
serve over 260,000 consumers who receive services such as
residential placements, supported living services, respite care,
transportation, day treatment programs, work support programs,
and various social and therapeutic activities. Approximately
1,300 consumers reside at one of California's four Developmental
Centers-and one state-operated, specialized community
facility-which provide 24-hour habilitation and medical and
social treatment services.
Services provided to people with developmental disabilities are
determined through an individual planning process. Under this
process, planning teams-which include, among others, the
consumer, his or her legally authorized representative, and one
or more regional center representatives-jointly prepare an
Individual Program Plan (IPP) based on the consumer's needs and
choices. The Lanterman Act requires that the IPP promote
community integration and maximize opportunities for each
consumer to develop relationships, be part of community life,
increase control over his or her life, and acquire increasingly
positive roles in the community. The IPP must give the highest
preference to those services and supports that allow minors to
live with their families and adults to live as independently as
possible in the community.
The vendorization process : Prior to being approved to receive
funding from a regional center for providing services to a
consumer, a service provider must become vendored by the
regional center that oversees the catchment area in which the
provider is located. This "vendorization" process includes
verifying that the provider is qualified to provide the planned
services and meets all other regulatory standards and
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requirements. It is important to note that vendorization makes
a provider eligible to provide services paid for by the regional
center, but does not guarantee the regional center will refer
consumers. Furthermore, there is nothing precluding a vendor
from being vendorized by more than one regional center. There
are over 45,000 vendors that provide services paid for by
regional centers in California.
Autism Spectrum Disorders : Defined as a group of
neurodevelopmental disorders linked to atypical biology and
chemistry in the brain that generally appears within the first
three years of life, autism is a growing epidemic among
children. While there are many "autisms," the diagnosis is
often 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. Although symptoms and
severity differ among individuals with an autism diagnosis, all
individuals affected by the disorder have impaired communication
skills, difficulties initiating and sustaining social
interactions and restricted, repetitive patterns of behavior
and/or interests. Autism spectrum disorder (ASD), is one of the
commonly-used terms to describe the various "autisms" and other
pervasive developmental disorders (PDD), and it more
appropriately captures the array of symptoms and varying levels
in the severity of symptoms experienced by individuals with a
diagnosis within ASD.
Information released in March 2014 by the Centers for Disease
Control (CDC) Autism and Developmental Disabilities Monitoring
(ADDM) Network, estimates prevalence of ASD for children born in
2002 and surveyed in 2010 to be 14.7 per 1,000 children, which
translates to one in 68 children. This is a drastic increase
from CDC data for children born in 2000 and surveyed in 2008,
which estimated the prevalence of children with ASD to be one in
88. Average prevalence for children surveyed in 2006 was one in
110 children. ASD continues to be five times more prevalent for
boys than for girls.<1>
March 2014 DDS data shows that 65,706 regional center consumers
have an autism diagnosis, which is more than double the number
of individuals with the same diagnosis served by regional
centers in 2006. An additional 4,562 regional center consumers
are on the autism spectrum with a diagnosis of pervasive
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<1> http://www.cdc.gov/ncbddd/autism/data.html
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developmental disorder (PDD). Among the individuals with
ASD/PDD served by the regional centers, 12,481 are female and
57,787 are male, and nearly 40% of the population with an autism
or PDD diagnosis is 0 to 9 years old.<2>
Early Intervention Services : Research shows that a child's
development can be greatly impacted by early intervention
treatment services, especially when provided during a child's
first three years. During that time, a child is developing
motor skills and language, and begins to socialize with others.
Early intervention services for babies and toddlers that have
been diagnosed with, or seem to be at risk for, a developmental
delay or disability often include physical, cognitive,
communication, social/emotional and self-help skill building.
While there is no proven cure for ASD, early intervention can
dramatically change the trajectory of a child's life over time,
including his or her ability to learn new skills throughout
childhood and an increased ability to integrate into, and have a
positive relationship with, his or her community.
Need for this bill : As a result of SB 946 (Steinberg) Chapter
650, statutes of 2011, behavioral health treatment for persons
with ASD/PDD is supposed to be covered under health care service
plan contracts and health insurance policies as of July 1, 2012.
Although the definition for "behavioral health treatment"
provided for in statute for purposes of the coverage mandate
includes certain evidence-based, behavior intervention programs
that are not categorized as applied behavior analysis (ABA), the
author and supporters of this bill state that not all health
plans and insurance companies are strictly adhering to the
mandate for some of the frontline service providers because the
definition for those professionals in state regulations
specifies the need for education and experience in ABA.
In support, the author states, "Children with Autism are unique
both in the way they manifest their condition and their response
to treatment. It is imperative that they receive behavioral
health treatment tailored to their individual needs in order to
develop relationship and other social skills and to manage
negative and potentially self-injurious behaviors. This bill
allows health care practitioners to make treatment decisions on
behalf of their patients instead of prejudging children's needs
with a "one size fits all" form of therapy without adding to
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<2>
http://www.dds.ca.gov/FactsStats/docs/QR/March2014_Quarterly.pdf
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State costs or reducing the education or professional experience
requirements for frontline personnel administering behavioral
health therapy to California's children."
In opposition to the measure, the Association of Regional Center
Agencies (ARCA) states, "[This bill] seeks to diminish
requirements for regional center vendors that provide behavior
management services and to no longer require that they be
trained specifically in applied behavior analysis (ABA).
Instead, training in other behavioral health topics could be
substituted. While the bill provides no definition of behavioral
health, it is a term commonly used that includes practices
ranging from substance abuse treatment to counseling and beyond.
Coursework in these areas is not a suitable substitute for
training in evidence-based ABA. This change would also have
unintended consequences because according to regulations (17 CCR
56040 and 56724) professionals that provide important
consultation services to vendors are also held to the existing
standards. For instance, a Behavior Management Consultant may
work with a residential facility to design and monitor a
behavior intervention plan for an individual living in the
facility. That consultation may be the difference between the
success and failure of that residential placement. Without
meeting appropriate ABA training requirements, behavior plans
are far less likely to be successful, and the stability of
individuals is jeopardized."
PROPOSED AMENDMENTS : In order to ensure clarity in the intent
of the bill, committee staff recommends a number of substantive
and technical amendments be made.
1)The author indicates a desire to bring the definitions for two
types of behavioral health professionals into conformity with
the statutory definition of behavioral health treatment.
However, the current bill language does not provide a
definition for behavioral health treatment. In order for the
language to achieve the author's goals, staff recommends the
following amendment:
Amendment #1
On page 10, line 23, before (a) insert:
(a) For purposes of this section, "behavioral health
treatment" shall have the same meaning as provided in Article
5.6 (commencing with Section 1374.60) of Chapter 2.2 of Division
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2 of the Health and Safety Code and Article 2.5 (commencing with
Section 10140) of Chapter 1 of Part 2 of Division 2 of the
Insurance Code.
1)The new definitions for Behavior Management Assistants and
Behavior Management Consultants will clearly include
professionals with education and training in ABA or other
evidence-based programs provided for under the behavioral
health treatment definition. However, a simple
cross-reference to the statutory definition for behavioral
health treatment provided for in the Health and Safety Code
and the Insurance Code could open up the provision of ABA and
other evidence-based treatments to professionals with training
and education in ABA or other evidence-based treatments. In
order to ensure both types of professionals are qualified to
provide the services for which they are classified as a vendor
by a regional center, staff recommends the following
amendments:
Amendment #2
On page 11, after line 12, insert:
(3) For purposes of this section, a regional center shall only
classify as a vendor a Behavior Management Assistant who designs
or implements behavioral health treatments that are consistent
with the vendor's experience and education.
Amendment #3
On page 11, after line 37, insert:
(5) For purposes of this section, a regional center shall only
classify as a vendor a Behavior Management Consultant who
designs or implements behavioral health treatments that are
consistent with the vendor's experience and education.
2)Staff recommends the following technical amendments to ensure
consistency with the cross-referenced sections of the Business
and Professions Code, as well as consistency in terminology:
Amendment #4
On page 11, line 2, after "health" insert:
treatment
Amendment #5
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On page 11, line 7, strikethrough the second "registered" and
insert:
licensed
Amendment #6
On page 11, line 10, strikethrough "licensed"
Amendment #7
On page 11, line 37, after "health" insert:
treatment
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
DIR/Floortime Coalition of California - sponsor
Performing Arts Studio
Professional Child Development Associates
200 Individuals
Opposition
The Association of Regional Center Agencies (ARCA)
Analysis Prepared by : Myesha Jackson / HUM. S. / (916)
319-2089