Potential sweeping landmark health care insurance reform legislation was introduced Tuesday by Senate President Pro Tem Darrell Steinberg that would require health managed care plans and health insurance plans to provide as a covered benefit behavioral health treatment for persons with autism spectrum disorders. The legislation would take effect, if passed by the Legislature before it adjourns for the year on September 9th and signed by the Governor on or before October 9th, on January 1, 2012.
The bill, which Steinberg said he was committed to see passed before the Legislature adjourns for the year on September 9th, will likely meet fierce opposition from health managed care plans and strong support from advocates for children and adults with autism spectrum disorders and their families. Health plans who have opposed previous efforts, have said that behavioral health treatments for persons with autism are more appropriately provided by school districts and other entities.
SB 770 would require or mandate coverage of behavioral health treatment, such as Applied Behavioral Analysis (ABA) and other intensive early intervention therapy, for thousands of people with autism spectrum disorders. The bill also defines the scope of these treatments and eliminates what Steinberg says are “unwarranted restrictions” on those who are qualified to provide the treatment.
“Parents of autistic children shouldn’t have to spend their days and sleepless nights battling with insurance companies because of a lack of clarity regarding this highly effective therapy. ABA [Applied Behavioral Analysis] has long been considered medically necessary and has proven remarkably effective for a majority of families,” Steinberg said.
Advocates in favor the legislation and previous efforts in AB 171, say the new requirement would achieve significant major cost savings to the State general fund that they estimate could run as high as over $200 million because private health plans would be required to provide those services and pay for it – a contention that health plan advocates strongly disagree with.
Families of children with autism and other advocates have fought with various health plans and the Department of Managed Health Care and other agencies for years on the issue of providing critically needed behavioral health treatments for their children.
The position of Governor Brown on the issue and the bill is not known yet – but will become crucial in the coming weeks if the bill passes the Legislature.
Bill Scheduled For Hearing in Assembly Appropriations Committee August 24th – Intense Opposition from Health Plans Expected
- The legislation was amended August 16th into SB 770, a bill that previously focused on marine protected areas and Indian tribes, and will be heard in the Assembly Appropriations Committee on August 24th according to Steinberg’s office.
- More amendments to the bill are likely, according to Steinberg’s office.
SB 770 Similar to Previous AB 171 by Assemblymember Beall
- SB 770 as amended August 16 now focuses on the same issues covered by AB 171 by Assemblymember Jim Beall, Jr. (Democrat – San Jose), which was held in Assembly Appropriations Committee in May and who is now a co-author of SB 770.
- The bill also covers the same overall issue addressed by Steinberg’s SB 166, which was held in Senate Health Committee earlier this year . That bill however did not contain the new requirements on health plans that are in SB 770 – and AB 171
- Sponsors of the bill include Autism Speaks, Alliance of California Autism Organizations, Special Needs Network, and The Help Group.
Key Provisions of SB 770
- Every health care service plan contract issued,amended, or renewed on or after January 1, 2012, that provides hospital, medical, or surgical coverage pursuant to Section 1374.72 shall provide coverage for behavioral health treatment for pervasive developmental disorder or autism. The coverage shall be provided in the same manner and shall be subject to the same requirements as provided in Section 1374.72.
- Notwithstanding any other provision of law, unlicensed or uncertified staff may implement services if the qualified autism service provider ensures that each staff person implementing services pursuant to this section has adequate training and the qualified autism service provider supervises these staff persons.
- “Behavioral health treatment” means professional services and treatment programs, including, but not limited to, applied behavior analysis and other intervention programs, such as Pivotal Response Therapy and Early Start Denver Model, that meet all of the criteria in the bill (SB 770).
Action By Steinberg Comes After Settlement With Managed Care Plans With Department of Managed Health Care
The action by Steinberg comes weeks after the announcement by the Department of Managed Health Care of a settlement with two managed health care plans regarding coverage for children with autism, which many advocates called a “sham,” and that the agreement created a situation that would result in a significant loss of access to those services because it would require that those Applied Behavioral Analysis providers be licensed – a requirement that does not exist under current federal or state laws.
Steinberg was critical of the limitations of the agreement saying that “The recent agreement added urgency to clarify who is authorized to perform treatment. We need a more expansive network which includes those who are expertly trained and on the cutting edge of ABA [Applied Behavioral Analysis] therapy so parents don’t have to jump through bureaucratic hoops to get children the services they need.”
SB 770 expands the list of qualified autism providers to include any licensed or nationally certified professional, or any provider of these services approved as a vendor by one of California’s 21 non-profit regional centers which contract with the Department of Developmental Services to provide or coordinate services and supports for individuals with developmental disabilities.
Marty Omoto is Executive Director of the California Disability Community Action Network, a non-partisan link to thousands of Californians with developmental and other disabilities, people with traumatic brain injuries, the blind, the deaf, their families, community organizations and providers, direct care, homecare and other workers, and other advocates to provide information on state and local public policy issues.