SB 946 (Steinberg) - Coverage for Autism Treatment by Lou Vismara, M.D.

1. Advisory Commission on Special EducationMay 24, 2012California Department of Education1430 N Street, Room 1101Sacramento, California SB 946 (Steinberg) - Coverage for Autism Treatment by Lou Vismara, M.D. Policy Consultant to Senator Darrell Steinberg Ph. 916 651-4189 Fax. 916 327-8867 louis.vismara@sen.ca.gov

2. Medical Insurance Coverage for ASD AB 88 – Mental Health Parity Law implemented in the year 2000 (H&S Code1374.72) states: • Every health care service plan contract… • Shall provide coverage for the diagnosis and medically necessary treatment …(outpatient; inpatient; partial hospitalization; prescription drugs)…of severe mental illnesses of a person of any age, . . • “Severe mental illnesses’’ shall include: . . . Pervasive Developmental Disorder or Autism. . . • Other disorders…Schizophrenia; Schizoaffective disorder; Bipolar disorder; Major depressive disorders; Panic disorders; Obsessive-compulsive disorder; Borderline personality disorder; Anorexia nervosa; Bulimia nervosa.

3. The California Legislative Blue Ribbon Commission on Autism:Report to the Governor & Legislature (Sept. 2007) Findings onMedical Insurance Coverage for ASD • Coverage of health care, behavioral, and psychotherapeutic services is limited, inconsistent or excluded altogether • The roles and responsibilities of health plans and insurers for ASD services are not well defined • Frequently there is lack of consensus about the “medical necessity” • When health plans and insurers contract (“carve out”) behavioral health services, there is often fragmentation and/or denial of services • Health plans and insurers frequently lack access to professionals with adequate training and expertise in ASD

4. Senate Bill 166 (Steinberg) in 2011To provide coverage for behavioral health treatment for ASDSponsor: Alliance of California Autism Organizations • Behavioral health treatment (BHT): ~ effective medical treatment • Many health plans deny BHT as educational & not a covered benefit • Coverage issues: Not reviewed by physicians or other medical providers • SB 166 requires coverage for BHT services that meet defined standards • SB 166 closes a dangerous loophole • Ensures that healthcare professional provide treatment for ASD • SB 166 was held in Senate Health Committee (2 year bill)

5. SB 946 (Steinberg)Actions & Requirements of the Autism Insurance Mandate • Every health care service plan contract that provides hospital, medical, or surgical coverage shall also provide coverage for behavioral health treatment for pervasive developmental disorder or autism no later than July 1, 2012 • Does not require any benefits to be provided that exceed the essential health benefits required the federal Patient Protection and Affordable Care Act of 2010 • This section shall not affect or reduce any obligation of any IEP or IPP • Every health care service plan subject to this section shall maintain an adequate network that includes qualified autism service providers

6. SB 946 (Steinberg)Actions & Requirements of the Autism Insurance Mandate “Behavioral health treatment” (BHT) means professional services and treatment programs, including applied behavior analysis and evidence-based behavior intervention programs, that develop or restore, to the maximum extent practicable, the functioning of an individual with pervasive developmental disorder or autism and that meet all of the following criteria: • The treatment is prescribed by a licensed physician or psychologist • The treatment is provided under a treatment plan prescribed by a qualified autism service provider and is administered by one of the following: • A qualified autism service provider (licensed or certified) • A qualified autism service professional (provides BHT & RC vendorized) supervised/employed ~ qualified autism service provider • Board Certified, Associate Behavior Analyst • Psychological Assistant • Associate Licensed Clinical Social Worker • Behavior Management Assistant (Bachelor’s Degree + 12 ABA units & one year’s experience) or(Bachelor’s Degree + 2 year’s experience)

7. SB 946 (Steinberg)Actions & Requirements of the Autism Insurance Mandate Qualified Autism Service Paraprofessionalshall practice: • Direct supervision of a Certified Behavior Analyst or a Behavior Management Consultant (within the same vendor group practice) • Implements instructional and environmental modifications to produce socially significant improvements in the consumer's behavior • Has a High School Diploma or the equivalent, has completed 30 hours of competency-based training designed by a certified behavior analyst, and has six months experience working with persons with developmental disabilities; or • Possesses an Associate’s Degree in either a human, social, or educational services discipline, or a degree or certification related to behavior management, from an accredited community college or educational institution, and has six months experience working with persons with developmental disabilities.

8. SB 946 (Steinberg)Actions & Requirements of the Autism Insurance Mandate The treatment plan has measurable goals over a specific timeline that is developed and approved by the qualified autism service provider for the specific patient being treated. The treatment plan shall be reviewed no less than once every six months by the qualified autism service provider and modified whenever appropriate, and shall be consistent of the following:  • Describes the patient’s behavioral health impairments to be treated. • Designs an intervention plan that includes the service type, number of hours, and parent participation needed to achieve the plan’s goal and objectives, and the frequency at which the patient’s progress is evaluated and reported. •  Provides intervention plans that utilize evidence-based practices, with demonstrated clinical efficacy in treating pervasive developmental disorder or autism. • Discontinues intensive behavioral intervention services when the treatment goals and objectives are achieved or no longer appropriate.

9. SB 946 (Steinberg)Actions & Requirements of the Autism Insurance Mandate The DMHC, in consultation with Dept. of Insurance & other organizations, shall convene an Autism Advisory Task Force and address:  • Scientifically validated Interventions that have demonstrated clinical efficacy and measurable treatment outcomes. • Patient selection, monitoring and duration of therapy. • Qualifications, training and supervision of providers. • Adequate networks of providers. • Requirements that unlicensed providers must meet in order to obtain licensure from the state. The DMHC shall submit a report of the Autism Advisory Task Force to the Governor and the Legislature by December 31, 2012, on which date the task force shall cease to exist. SB 946 “sunsets” on July 1, 2014 SB 946 does not alter the existing California Mental Health Parity Law

10. SB 946 (Steinberg)DMHC Contact information Web Site: www.dmhc.ca.gov ~ (Autism Taskforce “tab”) Phone:    1-888-466-2219 FAX:    916-255-5241 Mailing Address: California Department of Managed Health Care 980 9th Street, Suite 500 Sacramento, CA 95814-2725

11. Ensuring Fair & Equal Access to Regional Center Services for Autism Spectrum Disorders (ASD)APRIL 30, 2012AGENDA • Welcome & Opening RemarksSenator Darrell Steinberg and Members • Overview of California’s Services for Individuals with ASD • Gaps & Inequities in Regional Center Services for ASD • Regional Centers & Their Systems of Care • Moving Towards a Solution: Recommendations & Discussion • Public Comment •   Closing Comments & Adjournment http://autism.senate.ca.gov/informationalhearings

12. “Never doubt that a small group of committed people can change the world. Indeed, it is the only thing that ever has!” ~ Margaret Mead Advisory Commission on Special Education