BILL ANALYSIS �
SENATE HUMAN
SERVICES COMMITTEE
Senator Jim Beall, Chair
BILL NO: AB 2041
A
AUTHOR: Jones
B
VERSION: June 9, 2014
HEARING DATE: June 24, 2014
2
FISCAL: Yes
0
4
CONSULTANT: Mareva Brown
1
SUBJECT
Developmental services: regional centers: behavioral health
treatment.
SUMMARY
This bill defines for the purposes of regional center
vendorization a behavior management consultant or behavior
management assistant, including the amount and nature of
experience and education required. The bill would require
the department to amend its regulations as necessary to
implement the provisions of the bill.
ABSTRACT
Existing law:
1) Establishes the Lanterman Developmental
Disabilities Services Act, which states that
California is responsible for providing an array of
services and supports sufficiently complete to meet
the needs and choices of each person with
developmental disabilities, regardless of age or
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degree of disability, and at each stage of life and to
support their integration into the mainstream life of
the community. (WIC 4500, et al)
2) Establishes a system of nonprofit Regional Centers,
overseen by the Department of Developmental Services
(DDS), to provide fixed points of contact in the
community for all persons with developmental
disabilities and their families, to coordinate
services and supports best suited to them throughout
their lifetime. (WIC 4620)
3) Establishes an Individual Program Plan (IPP) 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)
4) Requires a regional center shall secure services
and supports that meet the needs of the consumer, as
determined in the IPP, and to give highest preference
to those which would allow minors with developmental
disabilities to live with their families, adult
persons with developmental disabilities to live as
independently as possible in the community, and that
allow all consumers to interact with persons without
disabilities in positive, meaningful ways. (WIC 4648)
5) Establishes a process for regional centers to
"vendorize" or contract with service providers to
serve consumers IPP-identified service needs based on
the vendor's qualifications and other requirements
necessary in order to provide the service, and
specifies the process and requirements for becoming a
regional center vendor. (WIC 4648 (3) (a))
6) 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 (ABA) and evidence-based behavior
intervention programs, which develop or restore, to
the maximum extent practicable, the functioning of an
individual with pervasive developmental disorder (PDD)
or autism, and sets requirements for the treatment
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plan, prescription of the treatment, and the providers
authorized to provide such treatment, including
qualified autism service professionals, as specified.
(HSC 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 Management Assistant,
Behavior Management Consultant, or Behavior Management
Program as defined in Title 17 CCR �54342. (HSC
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)
This bill:
1) Establishes in the Lanterman Act under a new
section, WIC 4648.32, the same definition of
"behavioral health treatment" for vendors as is
defined in health and insurance codes for purposes of
payment under a health care service plan contract or
health insurance policy.
2) Requires that a regional center vendor classified
as a Behavior Management Consultant must do both of
the following:
a. Design or implement behavioral health
treatments under the direct supervision of a
Behavior Management Consultant, as defined, or
assess the function of a behavior of a consumer
and design, implement, and evaluate instructional
and environmental modifications to produce
socially significant improvements in the
consumer's behavior through skill acquisition and
the reduction of behavior, under direct
supervision of a Behavior Analyst, as defined in
Title 17 of the California Code of Regulations,
or a Behavior Management Consultant, as defined
STAFF ANALYSIS OF ASSEMBLY BILL 2041 (Jones)
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in statute.
b. Meet specified education and professional
requirements.
3) Defines the education and professional requirements
of a Behavior Management Consultant to be either:
a. Possesses a bachelor of arts or science
degree and has either of the following:
i. Twelve semester units of
applied behavior analysis or behavioral
health treatment and one year of experience
in designing or implementing behavioral
health treatment.
ii. Two years of experience in
designing or implementing behavioral health
treatment.
b. Or is one of the following:
i. A registered psychological
assistant or licensed psychologist, as
defined in Business and Professions Code.
ii. An associate clinical social
worker registered with the Board of
Behavioral Sciences.
4) Requires regional centers classify a vendor as a
Behavior Management Consultant if the vendor has two
years of experience designing and implementing
behavioral health treatments and is a licensed
psychologist, licensed clinical social worker,
licensed marriage and family therapist, as defined, or
other licensed professional in California whose
license permits the design or implementation of
behavioral health treatments.
5) Requires that individuals vendored as a behavior
management consultant as of December 31, 2006, must
have completed 12 semester units in ABA by December
31, 2008; or, for individuals vendored after that
date, 12 units of either ABA or behavioral health
treatment.
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6) Requires that a regional center classify a vendor
as a Behavior Management Consultant only if the vendor
designs or implements behavioral health treatments
that are consistent with the vendor's experience and
education.
7) Requires DDS to amend its regulations as necessary
to implement to this section.
FISCAL IMPACT
This bill has not been heard by a fiscal committee.
BACKGROUND AND DISCUSSION
Purpose of the bill:
The author writes that despite the intent of the
Legislature in passing SB 946, which mandated insurance
companies cover ABA therapy for regional consumers with
autism, many Californians are still being denied coverage
for the specific type of treatment they need, if the
treatment is an evidence-based treatment prescribed by
their physician or psychologist that is not ABA. The author
states that while ABA has proven essential to the
development of many children, not all children respond to
it.
The author states that some Californians with Autism are
being denied the treatment prescribed by their physician or
psychologist because SB 946, in specifying which providers'
services were to be covered, referenced existing
definitions in Title 17 that refer only to ABA as the
frontline providers and their supervisors. This bill will
expand those definitions to include other forms of
evidence-based behavioral health treatment, ensuring that
all Californians with autism can receive the evidence-based
treatment their physician has prescribed, the author
states.
Regional Centers
California's 21 regional centers are non-profit
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organizations that provide local services and supports to
approximately 270,000 individuals through contracts with
DDS. Regional centers provide diagnosis and assessment of
eligibility and help plan, access, coordinate and monitor
the services and supports that are needed because of an
individual's developmental disability. Services for
consumers are determined through an individual program plan
(IPP). Additionally, regional centers share primary
responsibility with local education agencies for provision
of early intervention services under the California Early
Intervention Services Act.
A developmental disability is defined as 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
autism spectrum disorders (ASD).
Autism
Autism is a neurodevelopmental disorder characterized by
impairments in social relating, language, and by the
presence of repetitive and stereotyped behaviors. The
National Institutes of Health describes autism as the most
severe form of a range of conditions that together make up
ASD. Other conditions along the spectrum include a milder
form known as Asperger syndrome, and childhood
disintegrative disorder and pervasive developmental
disorder not otherwise specified (usually referred to as
PDD-NOS). Although ASD varies significantly in character
and severity, it occurs in all ethnic and socioeconomic
groups and affects every age group. Experts estimate that
1 in 88 children age 8 will have an ASD.<1> Males are four
times as likely to have an ASD than females.
The hallmark feature of ASD is impaired social interaction,
according to the National Institutes of Health. An infant
with ASD may not respond to people or may focus intently on
one item to the exclusion of others for long periods of
time. Children with an ASD may fail to respond to their
names and often avoid eye contact with other people. They
may have difficulty interpreting what others are thinking
-------------------------
<1> Centers for Disease Control and Prevention: Morbidity
and Mortality Weekly Report, March 30, 2012
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or feeling because they can't understand social cues, such
as tone of voice or facial expressions. Although symptoms
and severity vary broadly among individuals with autism,
all individuals affected by the disorder have difficulties
beginning and maintaining social interactions, impaired
communication skills, and repetitive patterns of behavior
or interests.
Data from DDS in March 2014 indicates approximately 70,000
regional center consumers had a diagnosis of autism or
PDD-NOS, more than twice as many as had the same diagnosis
in 2006. Overall, 3 in 10 regional center consumers have a
diagnosis of autism or PDD, although many consumers have
multiple conditions.
Behavioral treatments for autism
Over the past several years, there have been a number of
medical entities that have concluded that intensive
behavioral treatments are effective in treating children
and adults with autism. There are a several different types
of behavioral health treatment; however one of the
best-known and most commonly accepted as being an
evidence-based practice is ABA.
While the term ABA encompasses several different treatment
modalities, there are also other interventions that have
been scientifically studied and found to be effective. One
of those is the Early Start Denver Model, which is a
relationship-based intervention provided in the home by
trained therapists and parents during natural play and
daily routines. Researchers at the UC Davis MIND Institute
have been studying the ESDM's effectiveness. Additionally,
there are a number of behavioral treatments in practice
that have not yet met other criteria to be considered
"evidence-based."
Related legislation:
SB 946 (Steinberg) Chapter 650, statutes of 2011 required
health plans and insurers to pay for behavioral health
treatment when a consumer's IPP identified the need.
AB 171 (Beall) 2011, would have required health plans and
insurers to cover the screening, diagnosis and treatment of
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ASD. This bill died in the Senate Health committee.
AB 1205 (Bill Berryhill) 2011, would have required
behavioral analysts and assistant behavioral analysts to be
licensed by the state Board of Behavioral Sciences. It was
held on suspense in the Assembly Appropriations committee.
COMMENTS
This bill codifies current Title 17 regulations that define
the criteria for vendorization as Behavior Management
Assistant and Behavior Management Consultant, and adds
reference to language in health and insurance codes that
also includes broader categories of behavioral treatment
therapists. These definitions pre-date passage of SB 946
and are centered around ABA treatment as the identified
therapy for autism treatment.
Although "behavioral health treatment" was defined in
statute through SB 946 to include evidence-based, behavior
intervention programs that are not categorized as applied
behavior analysis (ABA), the author and supporters of this
bill say that some health plans and insurance companies are
strictly adhering to regulations, which define
professionals classifications to include the need for
education and experience in ABA.
Opponents of this bill, including the Association of
Regional Center Agencies, which was a co-sponsor of SB 946,
express concern that the bill diminishes requirements for
regional center vendors by eliminating the requirement
providers be trained in ABA. "It would adversely affect the
quality of services for a wide range of individuals," ARCA
writes in its letter of opposition.
In order to clarify the intent of this bill and of SB 946,
which is to provide evidence-based behavioral treatment to
regional center consumers through their health plans, staff
recommends the following clarifying amendment on page 12 of
this bill:
4648.32 (c)(5) For purposes of this section, a regional
center shall only classify as a vendor a Behavior
Management Consultant who designs or implements
evidence-based behavioral health treatments that are
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consistent with the vendor's experience and education.
PRIOR VOTES
Assembly Floor 71 - 3
Assembly Human Services 6 - 0
POSITIONS
Support: Autism Speaks
California Association for Behavior Analysis
Child Development Institute
Disability Rights California
Professional Child Development Associates
Southern California Consortium for Behavior
Analysis
WAPADH
3 individuals
Oppose: ACT Today
Association of Regional Center Agencies
Autism Research Group
Center for Autism and Related Disorders
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