BILL ANALYSIS Ó SENATE HUMAN SERVICES COMMITTEE Senator Carol Liu, Chair BILL NO: SB 764 S AUTHOR: Steinberg B VERSION: January 4, 2012 HEARING DATE: January 10, 2012 7 FISCAL: Appropriations 6 4 CONSULTANT: Sara Rogers SUBJECT Developmental Services: Autism TeleHealth Program SUMMARY Requires the Department of Developmental Services to establish the telehealth systems program for the purpose of expanding the provision of applied behavioral analysis (ABA) or intensive behavioral intervention (IBI) services by regional centers or vendors through the use of telehealth systems (THS). Requires the Department to implement vendorization codes and/or sub codes for relevant THS services and programs. ABSTRACT Current law 1.Enacts the Telehealth Advancement Act of 2011 and repeals the Telemedicine Development Act of 1996. Defines telehealth as a mode of delivering health care and public health services facilitating the diagnosis, consultation, treatment, education, care management and self-management while the patient is at an originating site and the health care provider is at a distant site. Continued--- STAFF ANALYSIS OF SENATE BILL 764 (Steinberg) Page 2 2.Enacts the Lanterman Developmental Disabilities Service Act under the Department of Developmental Services (DDS) affirming a variety of rights and responsibilities for persons with developmental disabilities, including the right to treatment and habilitation services and supports in the least restrictive environment. 3.Establishes regional centers (RC), a network of nonprofit private corporations that operate under contract with DDS to provide or direct the provision of services and supports identified in a client individual program plan. 4.Enacts the California Early Intervention Services Act of 1993 establishing a statewide system of family-centered interagency programs responsible for providing appropriate early intervention services and support to all eligible infants and toddlers and their families, also known as "Early Start." 5.Enacts, through federal law, the Early Intervention Program for Infants and Toddlers with Disabilities of 1986 under the Individuals with Disabilities Education Act (IDEA). 6.Prohibits health care service plans, health insurers, and the Medi-Cal program from requiring in-person contact to occur between a health provider and a patient before payment is made for covered services appropriately provided through telehealth, subject to the terms and conditions of plan contract or the reimbursement policies adopted by the Department of Health Care Services. This bill 1.Requires the Department of Developmental Services to establish the telehealth systems program. 2.Authorizes a provider vendorized with a regional center to provide applied behavioral analysis (ABA) services or intensive behavioral intervention (IBI) services to provide such services through telehealth systems (THS), subject to approval by a regional center. 3.Authorizes a regional center to purchase ABA or IBI STAFF ANALYSIS OF SENATE BILL 764 (Steinberg) Page 3 services through the use of THS if the provider can demonstrate that the provided services are beneficial for the consumer and are in compliance with existing ABA and IBI program requirements, privacy and confidentiality standards, state and federal requirements and federal funding participation guidelines. 4.Requires regional centers to consider the use of THS in implementation of parent training for autism related ABA or behavior intervention as part of the regional centers family support services. 5.Requires the department to implement vendorization codes or subcodes for all applicable THS services and programs. 6.States that a provider shall be responsible for all expenses and costs related to the THS. 7.Defines telehealth systems as a mode of delivering services and information that utilizes technologies to enable evaluation, consultation, and treatment of individuals and the provision of supports, self-management and other appropriate services, including synchronous and asynchronous interactions to individuals being served by regional centers regardless of the location of the providers or individuals. FISCAL IMPACT This bill has not been analyzed by a fiscal committee. BACKGROUND AND DISCUSSION Purpose of the bill According to the author, this bill is intended to enhance and promote the use of telehealth for the diagnosis and treatment of Autism Spectrum Disorders (ASD) by DDS and RCs and support the provision of services in the most competent and cost effective manner possible. The author notes that there are currently over 53,000 ASD consumers receiving services through RCs and that remote and underserved communities in particular lack sufficient access to STAFF ANALYSIS OF SENATE BILL 764 (Steinberg) Page 4 programs and providers to serve these consumers. The author states that telehealth applications have been established as highly effective in providing access to services, especially in rural and underserved communities. The author further asserts that the goals and objectives of SB 764 are consistent with the DDS ASD initiative that has emphasized the use of innovative methods and technology to promote best practices in the assessment, diagnosis, treatment, education and training for individuals with ASD and their families. The author states that, as amended, SB 764 is intended to ensure that the proposed telehealth services comply with all existing requirements of the Lanterman Act; comply with all existing privacy and confidentiality requirements and regulations; and also comply with all relevant federal and state requirements. Autism Autism is defined as a group of neural development disorders linked to atypical biology and chemistry in the brain and generally appearing within the first three years of life. Autism is further characterized by delayed, impaired or otherwise atypical verbal and social communication skills, sensitivity to sensory stimulation, atypical behaviors and body movements, and sensitivity to changes in routines. According to the Centers for Disease Control and Prevention (CDC), the average total ASD prevalence in 2006 (children born in 1998) was 9.0 per 1,000 children, translating to one in 110 children. ASD prevalence was found to be 4 to 5 times higher for boys than for girls. In 2007, the California Department of Developmental Services (DDS) reported serving 38,000 individuals with autism reflecting an annual increase of 13.4 percent since 2002, and that, of California children born during 1990-1997, more than 11,000 are enrolled with DDS to receive services for autism. Public services for children and adults with autism The Lanterman Developmental Disabilities Service Act administered by the Department of Developmental Services STAFF ANALYSIS OF SENATE BILL 764 (Steinberg) Page 5 (DDS) affirms a variety of rights and responsibilities for persons with developmental disabilities, including the right to treatment and habilitation services and supports in the least restrictive environment. Prior to enactment of the Lanterman Act the majority of children with autism were placed in state funded institutions for life at higher average and overall cost to the state. State law requires the Department of Developmental Services and Regional Centers, as their contracted local administrator, to provide a variety of services and supports necessary to prevent institutionalization and to assist families caring for their children at home. Provided services include diagnosis and eligibility assessment services as well as family support or community/independent living services in accordance with an individual program plan (IPP) or an individualized family service plan (IFSP). Regional centers are permitted to purchase Applied Behavior Analysis or Intensive Behavior Intervention services if the service provider uses evidence-based practices and the services promote positive social behaviors and help address issues with learning and social interactions. DDS additionally administers the Early Start program in California which provides a broad scope of behavioral intervention and family support services to infants and toddlers under the age of 3 who are 'developmentally delayed' or have an 'established risk' or are 'at high risk' of a developmental delay. Telehealth as a treatment modality for autism Many studies indicate that early diagnosis and intervention is critical for children with ASD, offering significant opportunities to improve quality of life for these children and their families over the short and long term. Recent studies have evaluated the effectiveness and efficiency of behavioral intervention treatments, functional communication training and functional analysis training for parents conducted through telehealth, including both synchronous (simultaneous exchange of information) and asynchronous (information exchange occurs over a period of time) modalities. These studies have demonstrated that telehealth can result in increased STAFF ANALYSIS OF SENATE BILL 764 (Steinberg) Page 6 efficiency, cost savings and comparable treatment outcomes. Related/prior legislation AB 415 (Logue), Chapter 547, Statutes of 2011 repealed the Telemedicine Development Act of 1996, changing the reference from "telemedicine" to "telehealth", revising confidentiality and privacy standards, consent requirements, and other health provider and insurance requirements for telehealth. ABx4 9, Chapter 9, Statutes of 2009-10, Fourth Extraordinary Session among other provisions, required the least costly available provider of comparable service, including transportation costs, who is able to accomplish all or parts of the consumer's IPP, consistent with the needs of the consumer and family as identified in the IPP, to be selected to deliver services to the consumer. Statutorily defined ABA and IBI treatments and established a variety of standards and restrictions for vendors providing applied behavioral analysis (ABA) services or intensive behavioral intervention services, or both. SB 1665 (M. Thompson), Chapter 864, Statutes of 1996 enacted the "Telemedicine Development Act of 1996" imposing several requirements governing the delivery of health care services through telemedicine. Prohibited health insurers from requiring face to face contact between a health care provider and patient for covered services appropriately provided through telemedicine. COMMENTS AND QUESTIONS 1.A previous Senate Health Committee analysis of an earlier version of this bill noted that a number of terms and conditions used in this bill are also defined in AB 415 (Chapter 547, 2011). Health Committee staff recommended this bill use terms that are consistent with that law. Currently, the definitions of the terms continue to differ. Staff notes that differences between ABA/IBI services in comparison to traditional medical services may necessitate some variance between the definitions; however staff recommends the author consider bringing the two definitions into closer alignment. STAFF ANALYSIS OF SENATE BILL 764 (Steinberg) Page 7 (d) For purposes of this section, "telehealth systems" meansathe mode of delivering servicesandvia informationthat utilizesand communication technologies toenablefacilitate diagnosis, evaluation, consultation,andtreatment, education, care management, supports, and self-managementand other appropriate services, including synchronous and a synchronous interactions to individuals who are within the purview and responsibility of the regional centerregardless of the location of the providers orindividualsconsumers. Telehealth includes synchronous interactions and asynchronous store and forward transfers. 2.Creation of a new program. This bill calls for the creation of the telehealth systems program; however, the substantive effect of the bill makes changes addressing the administration of existing programs. Staff recommends the author consider amending or deleting this provision. POSITIONS Support: Behavioral Intervention Association (BIA) Capitol Autism Services The Children's Partnership Oppose: None received -- END --