BILL ANALYSIS �
AB 2041
Page A
ASSEMBLY THIRD READING
AB 2041 (Jones)
As Amended April 22, 2014
Majority vote
HUMAN SERVICES 6-0
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|Ayes:|Stone, Maienschein, | | |
| |Ammiano, | | |
| |Ian Calderon, Garcia, | | |
| |Grove | | |
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| | | | |
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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)Aligns the definitions of Behavior Management Assistant and
Behavior Management Consultant for purposes of regional center
vendorization with the definition for behavioral health
treatment provided for in current statute related to health
plan and insurance coverage of specified treatments for
individuals with pervasive developmental disorder or autism.
2)Deletes references to the current definitions for Behavior
Management Assistant and Behavior Management Consultant in
Title 17 of the California Code of Regulations (CCR) Section
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). (Welfare and
Institutions Code (WIC) Section 4500 et seq.)
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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 Section 4502)
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 Section 4620 et seq.)
4)Requires the development of an Individual Program Plan (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 Section
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 Section 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 Section 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
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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. (Health
and Safety Code (H&S) Section 1374.73(c)(1), Insurance Code
(INS) Section 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
Management Assistant, Behavior Management Consultant, or
Behavior Management Program as defined in Title 17 CCR Section
54342. (H&S Section 1374.73(c)(4)(D), INS Section
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
an applied behavior analysis (ABA) for both professionals, as
specified. (Title 17 CCR Section 54342)
FISCAL EFFECT : Unknown. This bill is keyed non-fiscal by the
Legislative Counsel.
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 or 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 Lanterman 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.
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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.
Direct responsibility for implementation of the Lanterman Act
service system is shared by 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 Lanterman 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
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consumer, his or her legally authorized representative, and one
or more regional center representatives-jointly prepare an 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
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. ASD is one of the commonly-used terms to
describe the various "autisms" and other PDDs, 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.
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Information released in March 2014, by the Centers for Disease
Control and Prevention (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 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 zero to nine 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.
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<1> http://www.cdc.gov/ncbddd/autism/data.html
<2>
http://www.dds.ca.gov/FactsStats/docs/QR/March2014_Quarterly.pdf
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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 ABA, the author of this bill states
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.
Analysis Prepared by : Myesha Jackson / HUM. S. / (916)
319-2089
FN:
0003181