BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
AB 2041 (Jones) - Developmental services: regional centers:
behavioral health treatment.
Amended: June 26, 2014 Policy Vote: Human Services 4-0
Urgency: No Mandate: No
Hearing Date: August 4, 2014
Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: AB 2041 would define the professional activities
and the educational and training requirements necessary for
vendorization by a regional center as a Behavior Management
Assistant or a Behavior Management Consultant.
Fiscal Impact:
One-time costs up to $250,000 to revise regulations and
review the rates paid to vendors defined in the bill
(General Fund).
Unknown potential increased costs for services currently
being provided to regional center consumers (General Fund
and federal funds). The bill broadens some of the criteria
required for vendorization as a Behavior Management
Assistant or a Behavior Management Consultant compared to
current regulations. By doing so, it is possible that some
vendors who are currently providing services to regional
center consumers under different codes would be able to bill
as either a Behavior Management Assistant or a Behavior
Management Consultant. Since those service codes generally
receive higher rates than other behavioral services, this
could increase overall costs for services currently being
provided. For example, if 5 percent of the hours billed to
the regional centers for an Adaptive Skills Trainer were
billed for a Behavior Management Consultant, the annual
costs would be about $670,000 per year. Similarly, if 5
percent of the hours billed to the regional centers for
Community Integration were billed for a Behavior Management
Assistant, the annual costs would be about $3.8 million per
year.
AB 2041 (Jones)
Page 1
No savings to the state are anticipated from shifting costs
from the regional centers to private insurance coverage.
According to an analysis of a prior version of the bill by
the California Health Benefits Review Program, changing the
vendorization criteria for Behavior Management Assistants
and Behavior Management Consultants will not increase either
the coverage or utilization of behavioral health treatment
services by private insurers or health plans in the state.
Therefore, there is no expected shift in costs from the
regional centers to private insurance coverage.
Background: California provides community-based services to
approximately 250,000 persons with developmental disabilities
and their families through a statewide system of 21 regional
centers. Regional centers are private, nonprofit agencies under
contract with the Department of Developmental Services for the
provision of various services and supports to people with
developmental disabilities. As a single point of entry, regional
centers provide diagnostic and assessment services to determine
eligibility; convene planning teams to develop an Individual
Program Plan for each eligible consumer; and either provide or
obtain from generic agencies appropriate services for each
consumer in accordance with the Individual Program Plan.
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. One of the best-known and most commonly accepted as
being an evidence-based practice is Applied Behavioral Analysis.
Current state law (SB 946, Steinberg, Statutes of 2011)
specifically requires health plans and health insurers to cover
behavioral health therapy for pervasive development disorder or
autism. Under current law, behavioral health treatment includes
Applied Behavior Analysis and other evidence-based behavior
intervention programs. Current law defines a "qualified autism
service professional" to include, amongst others, a behavioral
service provider approved as a vendor by a 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
regulation.
AB 2041 (Jones)
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Because state law now mandates coverage for behavioral health
treatment, private insurers and health plans are now responsible
for paying for treatments that had previously been paid for by
regional centers.
Proposed Law: AB 2041 would define the professional activities
and the educational and training requirements necessary for
vendorization by a regional center as a Behavior Management
Assistant or a Behavior Management Consultant.
The bill would require a regional center vendor classified as a
Behavior Management Assistant to do both of the following:
Design or implement behavioral health treatments under the
direct supervision of a Behavior Management Consultant 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 in statute.
Meet specified education and professional requirements.
The bill would require regional centers to 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.
Staff Comments: The author has indicated that health insurers
and health plans are denying coverage for behavior health
treatments that are not Applied Behavioral Analysis because a
provision in SB 946 that defines a "Qualified Autism Service
professional" as a person vendorized by a regional center to
provide certain services, as defined in regulations. The author
indicates that by changing defining in code the qualifications
for Behavior Management Assistants and Behavior Management
Consultants to include behavioral health treatments in addition
to Applied Behavioral Analysis (and requiring the Department of
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Developmental Services to update regulations to reflect these
definitions), this will allow such individuals to provide
behavioral health treatments to individuals covered by private
insurance.
As noted above, the California Health Benefits Review Program
did not find that the bill would increase coverage for or
utilization of behavioral health treatments by private insurers
or health plans.