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Friday, September 9, 2011

California Mandate Update

As mentioned before, Darrell Steinberg, the president pro tem of the California State Senate, is making a push for mandate legislation. (During the summer, he held a hearing on the issue. (Video here and here.) SB 946 passed the State Assembly Appropriations Committee yesterday by a vote of 12-5. The committee's bill analysis explains how it differs from other legislation:
SB 166 (Steinberg) and SB 770 (Steinberg) are similar to SB 946. They both require health plans and insurers to cover behavioral intervention therapy as a treatment for autism. SB 166 was held in the Senate Health Committee and SB 770 is
pending on the Suspense File of this committee.

As compared to SB 770, key changes included in SB 946 include:

1) SB 946 provides more specificity about who can prescribe and provide behavioral treatment services.
2) SB 946 further specifies that "behavioral health treatment" means services and treatment programs that "develop or restore, to the maximum extent practicable, the functioning of an individual with PDD/A."
3) SB 946 specifies certain requirements with respect to treatment plans and autism service providers who prescribe the plans.
4) The coverage mandate in SB 946 is only operative from July 1, 2012 until January 1, 2014 and is repealed as of January 1, 2015, and does not require coverage beyond EHBs as of the date that EHBs are defined by the federal government.
5) SB 946 explicitly allows, notwithstanding any other provision of law, carriers to use case management, network provides, utilization review techniques, prior
authorization, co-payments, or other cost-sharing.
6) SB 946 exempts plans offered through the Healthy Families Program and CalPERS from the coverage mandate.
7) SB 946 requires the DMHC to convene an Autism Advisory Task Force to make recommendations regarding behavioral health treatment that is medically necessary for the treatment of autism and licensure requirements for autism service providers.

AB 171 (Beall) is similar to, though slightly more expansive than, SB 166, SB 770, and SB 946. AB 171 requires health insurance plans and health care service plans to provide coverage for screening, diagnosis, and treatment services associated with autism spectrum disorders (ASDs), and defines certain types of services that must be covered to treat ASDs. AB 171 is pending on the Suspense File of this committee.

AB 1205 (Berryhill) requires the Board of Behavioral Sciences (BBS) to license behavioral analysts (BA) and assistant BAs. AB 1205 was held on the Suspense File of this committee.