Bill Text: CA SB166 | 2011-2012 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Health care coverage: mental illness: autism spectrum

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2012-01-31 - Returned to Secretary of Senate pursuant to Joint Rule 56. [SB166 Detail]

Download: California-2011-SB166-Amended.html

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BILL NUMBER: SB 166	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 4, 2011

INTRODUCED BY   Senator Steinberg

                        FEBRUARY 3, 2011

   An act to add Section 1374.73 to the Health and Safety Code, and
to add Section 10144.51 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 166, as amended, Steinberg. Health care coverage:  mental
illness:  autism spectrum disorders. 
   (1) Existing law provides for licensure and regulation of health
care service plans by the Department of Managed Health Care. A
willful violation of these provisions is a crime. Existing law
provides for regulation of health insurers by the Department of
Insurance. Existing law requires health care service plan contracts
and health insurance policies to provide benefits for specified
conditions, including certain mental health conditions.  
   This bill would require those health care service plan contracts
and health insurance policies to also provide coverage for behavioral
intervention therapy, as defined, for pervasive developmental
disorder or autism. The bill would, however, provide that no benefits
are required to be provided that exceed the essential health
benefits required under federal law. Because a violation of these
provisions with respect to health care service plans would be a
crime, the bill would thereby impose a state-mandated local program.
 
   (2) The California Constitution requires the state to reimburse
local agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.  
   This bill would provide that no reimbursement is required by this
act for a specified reason.  
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care. Existing law provides
for the regulation of health insurers by the Department of
Insurance. Existing law requires that health care service plan
contracts and health insurance policies provide coverage for the
diagnosis and medically necessary treatment of severe mental
illnesses, including, but not limited to, pervasive developmental
disorder or autism, under the same terms and conditions applied to
other medical conditions, as specified.  
   This bill would state the intent of the Legislature to enact
legislation that would develop standards for the diagnosis and
treatment by health care service plans and health insurers of
individuals with autism spectrum disorders. 
   Vote: majority. Appropriation: no. Fiscal committee:  no
  yes  . State-mandated local program:  no
  yes  .


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    The Legislature finds and declares all
of the following:  
   (a) During the past decade, scientific research has established
that behavioral intervention therapy can significantly improve the
cognitive function and emotional capabilities of, and reduce
self-injurious behaviors of, a significant number of individuals with
pervasive developmental disorders or autism.  
   (b) Scientists, physicians, and other autism experts now consider
that behavioral intervention therapy is an important and medically
necessary treatment for a significant number of individuals with
pervasive developmental disorder or autism.  
   (c) Controversy, uncertainty, and disparities currently exist
among some health care service plans and health insurers as to
whether behavioral intervention therapy should be a covered benefit
for pervasive developmental disorder or autism.  
   (d) It is the intent of this act to provide clarification of
existing laws requiring mental health parity and to provide for
coverage of behavioral intervention therapy with regard to pervasive
developmental disorder or autism. 
   SEC. 2.    Section 1374.73 is added to the  
Health and Safety Code   , to read:  
   1374.73.  (a) (1) 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 intervention therapy 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.
   (2) Notwithstanding paragraph (1), this section does not require
any benefits to be provided that exceed the essential health benefits
required to be provided under Section 1302(b) of the federal Patient
Protection and Affordable Care Act (Public Law 111-148), as amended
by the federal Health Care and Education Reconciliation Act of 2010
(Public Law 111-152).
   (3) This section shall not be construed as reducing any obligation
to provide services to an individual under an individualized family
service plan, an individualized program plan, a prevention program
plan, an individualized education program, or an individualized
service plan.
   (b) (1) For the purposes of this section, "behavioral intervention
therapy" shall be defined to include, but not be limited to, the
following:
   (A) The design, implementation, and evaluation of environmental
modifications, such as applied behavioral analysis, using behavioral
stimuli and consequences, to produce significant improvement in human
health functions and behaviors, including the use of direct
observation, measurement, and functional analysis of the relationship
between environment and behavior.
   (B) Professional services or treatment programs that have been
scientifically validated and have demonstrated clinical efficacy.
   (C) Professional services or treatment programs that have
measurable treatment outcomes.
   (2) For the purposes of this section, "pervasive developmental
disorder or autism" shall have the meaning as used in Section
1374.72. 
   SEC. 3.    Section 10144.51 is added to the 
 Insurance Code   , to read:  
   10144.51.  (a) (1) Every health insurance policy issued, amended,
or renewed on or after January 1, 2012, that provides hospital,
medical, or surgical coverage pursuant to Section 10144.5 shall
provide coverage for the behavioral intervention therapy 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 10144.5.
   (2) Notwithstanding paragraph (1), this section does not require
any benefits to be provided that exceed the essential health benefits
required to be provided under Section 1302(b) of the federal Patient
Protection and Affordable Care Act (Public Law 111-148), as amended
by the federal Health Care and Education Reconciliation Act of 2010
(Public Law 111-152).
   (3) This section shall not be construed as reducing any obligation
to provide services to an individual under an individualized family
service plan, an individualized program plan, a prevention program
plan, an individualized education program, or an individualized
service plan.
   (b) (1) For the purposes of this section, "behavioral intervention
therapy" shall be defined to include, but not be limited to, the
following:
   (A) The design, implementation, and evaluation of environmental
modifications, such as applied behavioral analysis, using behavioral
stimuli and consequences, to produce significant improvement in human
health functions and behaviors, including the use of direct
observation, measurement, and functional analysis of the relationship
between environment and behavior.
   (B) Professional services or treatment programs that have been
scientifically validated and have demonstrated clinical efficacy.
   (C) Professional services or treatment programs that have
measurable treatment outcomes.
   (2) For the purposes of this section, "pervasive developmental
disorder or autism" shall have the meaning as used in Section
10144.5. 
   SEC. 4.    No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution.  
  SECTION 1.    Section 1374.73 is added to the
Health and Safety Code, to read:
   1374.73.  It is the intent of the Legislature to enact legislation
that would develop standards for the diagnosis and treatment by
health care service plans of individuals with autism spectrum
disorders.  
  SEC. 2.    Section 10144.51 is added to the
Insurance Code, to read:
   10144.51.  It is the intent of the Legislature to enact
legislation that would develop standards for the diagnosis and
treatment by health insurers of individuals with autism spectrum
disorders.