Existing law establishes the Family Code, which regulates subjects including, but not limited to, marriage, dissolution and legal separation, custody, domestic violence prevention, and minors.

This bill would make a technical, nonsubstantive change to the provision establishing the Family Code.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 2246 (Ramos) - Medical Practice Act: health care providers: qualified autism service paraprofessionals

Bill Summary:

AB 2246 revises the definition of “health care provider” to include a qualified autism service (QAS) paraprofessional.

Fiscal Impact:

• The Department of Developmental Services (DDS) notes potential expenditure increases for regional centers in the range of $1.5 million beginning in Fiscal Year (FY) 2024-25, $2.9 million in FY 2025-26, and $2.9 million and annual ongoing (General Fund and other funds).
• No impact to the Medical Board of California or California Department of Insurance.

Background:

SB 946 (Steinberg), Chapter 650, Statutes of 2011 began requiring health plans and health insurance policies to cover behavioral health therapy provided by a QAS provider, a QAS professional supervised by the QAS provider, or a QAS paraprofessional supervised by a QAS provider or professional.

QAS paraprofessionals are required to have a high school diploma or the equivalent, have completed 30 hours of competency-based training designed by a certified behavior analysist, and have six months experience working with developmental disabilities. Alternatively, they may have 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 have six months of experience working with persons with developmental disabilities. QAS paraprofessionals are also required to be supervised by a QAS provider or professional, provide treatment and implement services pursuant to a treatment plan developed and approved by a QAS provider, and be employed by the QAS provider or an entity or group that employs QAS providers responsible for the autism treatment plan.

Health care service plans and health insurance policies are required to cover services provided by a health care provider via telehealth in the same manner as provided for in-person services. While QAS providers and professionals deemed health care providers in statue, QAS paraprofessionals are not. Provisions implemented during the COVID-19 pandemic, Executive Order N-43-2, temporarily required health plans and insurers to cover telehealth services provided by autism service paraprofessionals but following the lifting of the state of emergency, insurers may no longer be covering telehealth services for behavioral health treatment for individuals with ASD offered by these specified providers. By expanding the definition of health care provider to include qualified autism service paraprofessionals, telehealth services provided by these providers would be required to be covered.

Proposed Law:

Includes a QAS paraprofessional to the definition of “health care provider.”

-- END --

SENATE COMMITTEE ON

BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT

Senator Angelique Ashby, Chair

2023 - 2024 Regular

Bill No: Hearing Date: June 17, 2024

Subject:

SUMMARY:

Revises the definition of “health care provider” to include a qualified autism service paraprofessional.”

Existing law:

1. Defines “qualified autism service paraprofessional” to mean an unlicensed and uncertified individual who meets all of the following criteria:
   1. Is supervised by a qualified autism service provider or qualified autism service professional at a level of clinical supervision that meets professionally recognized standards of practice.
   2. Provides treatment and implements services pursuant to a treatment plan developed and approved by the qualified autism service provider.
   3. Meets specified education and training qualification.
   4. Has adequate education, training, and experience, as certified by a qualified autism service provider or an entity or group that employs qualified autism service providers.
   5. Is employed by the qualified autism service provider or an entity or group that employs qualified autism service providers responsible for the autism treatment plan. (Health and Safety Code § 1374.73(c)(5))
2. Defines “health care provider” to mean any of the following:
   1. A person who is licensed under the Medical Practice Act or the Osteopathic Act.
   2. An associate marriage and family therapist or marriage and family therapist trainee.
   3. A qualified autism service provider or qualified autism service professional certified by a national entity, as specified.
   4. An associate clinical social worker.
   5. An associate professional clinical counselor or clinical counselor trainee. (Business and Professions Code (BPC) § 2290.5(a)(3))
3. Defines “telehealth” as the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. (BPC § 2290.5(a)(6))
4. Requires a health care provider, before the delivery of health care via telehealth, to inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. (BPC § 2290.5(b))
5. Specify that all laws and regulations governing professional responsibility, unprofessional conduct, and standards of practice that apply to a health care provider under the health care provider’s license shall apply to that health care provider while providing telehealth services. (BPC § 2290.5(g))
6. Requires a contract between a health care service plan or health insurer and a health care provider that is issued, amended, or renewed on or after January 1, 2021, to specify that the health plan or health insurer is required to provide coverage for the cost of health care services delivered through telehealth on the same basis and to the same extent that the health plan or health insurer is responsible for coverage for the same service in-person. (Health and Safety Code § 1374.14(a); Insurance Code § 10123.855)

This bill revises the definition of “health care provider” to include a qualified autism service paraprofessional certified by a national entity, as specified.

FISCAL EFFECT:

This bill is keyed fiscal by Legislative Counsel. According to the Assembly Committee on Appropriations, the bill will not result in state costs.

COMMENTS:

1. Purpose. This bill is sponsored by the Autism Business Association. According to the Author, “With an ever increasing demand for healthcare services, especially for those with autism, California’s healthcare system has been unable to keep up with the ever increasing demand. Many families across the state have faced delays for treatment and therapy due to a shortage in health care professionals qualified to provide those essential services to their loved ones with autism.

In an effort to ensure quality services were made accessible to patients throughout the state, health reform policies have shifted their focus to the delivery of care through new innovative methods. In 2019, the legislature passed AB 744 which strengthened existing telehealth laws to better ensure coverage and utilization of services made available via telecommunications. Today, telehealth has become an essential part for the delivery of healthcare. It has provided patients, who may otherwise had limited access to care, with more timely services such as diagnosis, treatments, and patient education.

In order to meet the increasing demand for autism healthcare services, qualified autism service paraprofessionals have been able to fill a gap in communities that have been historically underserved due to the severe lack of available resources for people with mental disabilities. Qualified autism service paraprofessionals are not licensed professionals, however, work alongside those who are licensed or certified and generally are also experts in their field of behavioral health. With the use of telehealth options, many of these providers have been able to serve families wherever they are needed in a more efficient and timely manner.

By including qualified autism service paraprofessionals into what is currently defined as “health care providers,” the state would encourage health insurance companies to cover these services. Coverage for qualified autism service paraprofessionals will significantly improve health outcomes for individuals suffering from autism who lack access to qualified autism service providers or qualified autism service professionals. This bill will help fill the gap that exists between the healthcare industry and families with loved ones who have autism, but more importantly, it gives families greater access and options to timely care.”

1. Background. According to the Centers for Disease Control and Prevention, nearly 1 in 36 children are diagnosed with autism spectrum disorder (ASD), which affects the way they behave, communicate, interact, and learn. While there is no cure for ASD, there are several types of treatment to support daily functioning and quality of life. These include behavioral, developmental, educational, social-relational, pharmacological, and psychological approaches as well as complementary and alternative treatments. Treatment is often provided by multiple professionals and may be provided at school, in healthcare settings, within the community, at home, or some combination of those settings.

In 2011, SB 946 (Steinberg), Chapter 650, Statutes of 2011 began requiring health plans and health insurance policies to cover behavioral health therapy provided by a qualified autism service provider, a qualified autism service professional supervised by the qualified autism service provider, or a qualified autism service paraprofessional supervised by a qualified autism service provider or professional.

Qualified autism service paraprofessionals are required to have a high school diploma or the equivalent, have completed 30 hours of competency-based training designed by a certified behavior analysist, and have six months experience working with developmental disabilities. Alternatively, they may have 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 have six months of experience working with persons with developmental disabilities. Qualified autism service paraprofessionals are also required to be supervised by a qualified autism service provider or professional, provide treatment and implement services pursuant to a treatment plan developed and approved by a qualified autism service provider, and be employed by the qualified autism service provider or an entity or group that employs qualified autism service providers responsible for the autism treatment plan.

Health care service plans and health insurance policies are required to cover services provided by a health care provider via telehealth in the same manner as provided for in-person services. While qualified autism service providers and professionals deemed health care providers in statue, qualified autism service paraprofessionals are not. Provisions implemented during the COVID-19 pandemic, Executive Order N-43-2, temporarily required health plans and insurers to cover telehealth services provided by autism service paraprofessionals but following the lifting of the state of emergency, insurers may no longer be covering telehealth services for behavioral health treatment for individuals with ASD offered by these specified providers. By expanding the definition of health care provider to include qualified autism service paraprofessionals, telehealth services provided by these providers would be required to be covered.

1. Arguments in Support. Supporters state that this bill addresses a vital need for the autism community – improving accessibility to care. It aligns with the current healthcare innovation trends and directly tackles care accessibility issues many families face, particularly those living in remote or underserved communities. The benefits of expanding telehealth options are multifaceted. It not only supports continuity of care, where interruptions could lead to regression in progress, but also empowers families to choose the treatment modalities that work best for them. This flexibility respects people's autonomy and acknowledges diverse individual needs. In addition, telehealth expansion serves to reduce travel burdens, lower the risk of exposure to infectious diseases, and potentially lower costs for providers and families alike. It is an efficient means of providing quality care without the geographic and physical limitations attached to traditional in-person services.

SUPPORT AND OPPOSITION:

Support:

Applied Behavior Consultants, INC.
Autism Behavior Services INC.
Autism Business Association
Autism Heroes
Autism Society of California
DIR/Floortime Coalition of California
Greenhouse Therapy Center

Opposition:

None received

-- END --

Date of Hearing: May 1, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2246

Author:(Ramos) – As Amended Ver:March 18, 2024

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill expands, within statute authorizing the delivery of telehealth, the definition of “health care provider” to include a qualified autism service paraprofessional (QASPP).

FISCAL EFFECT:

No state costs.

COMMENTS:

1. Purpose. The Autism Business Association is the sponsor of this bill. According to the author:

Today, we are facing a shortage of qualified personnel who can provide the critical services our children with autism depend on. Most families are struggle to find qualified professionals in their area, especially, ones who can work within their budget. It is crucial that families maintain a level of consistent care for their loved ones with autism. AB 2246 would allow paraprofessionals, experts in their field, to fill that gap. Most importantly, would allow health insurances companies to cover the services by paraprofessionals who meeting communities where there at, not just where the community can afford to be.

1. Background.

QASPPs. A QASPP must have a high school diploma or the equivalent, have completed 30 hours of competency-based training designed by a certified behavior analysist, and have six months experience working with developmental disabilities. Alternatively, they may have an Associate’s Degree in one of several disciplines, or a degree or certification related to behavior management, and six months of experience working with persons with developmental disabilities. A QASPP must be supervised by a qualified autism service provider or professional, provide treatment and implement services pursuant to a treatment plan developed and approved by a qualified autism service provider, and be employed by the qualified autism service provider or an entity or group that employs qualified autism service providers responsible for the autism treatment plan.

Telehealth Autism Services. Since January 1, 2021, AB 744 (Aguiar-Curry), Chapter 867, Statutes of 2019, has required health plans and health insurers to cover services provided by a health care provider via telehealth in the same manner as provided for in-person services. While qualified autism service providers and professionals are deemed health care providers in statute, QASPPs are not. Health plans and insurers were required by Executive Order N-43-2 to cover telehealth services provided by QASPPs during the COVID-19 pandemic. However, since the state of emergency was lifted, the author’s office reports that one of the largest national health insurance plans has stopped covering telehealth services for behavioral health treatment for individuals with ASD. By expanding the definition of health care provider to include QASPPs, this bill requires health plans and insurers to cover telehealth services provided by these providers.

1. Related Legislation.
   
   1. SB 805 (Portantino), Chapter 635, Statutes of 2023, expands the definition of qualified autism service professional to include a psychological associate, an associate marriage and family therapist, an associate clinical social worker, and an associate professional clinical counselor.
      
   2. AB 2449 (Ta) clarifies that the Qualified Applied Behavior Analysis Credentialing Board may certify a qualified autism service provider, and authorizes the certification to be accredited by the American National Standards Institute. AB 2249 is pending on the Assembly Floor.
      
2. Prior Legislation.
   
   1. SB 562 (Portantino) of 2022 would have revised the definition of qualified autism service professional and the training requirements for a QASPP, among other things. Governor Newsom vetoed SB 562, stating, in part:

[E]xpanding access to certain therapies and interventions must be grounded in evidence-based practices and be provided by qualified professionals. I encourage the author to continue discussions related to the expansion of provider types and changes to professional standards through a formal licensing scheme that includes clinical expertise and administrative oversight to address qualification standards for practitioners, to ensure equity and quality of care, and provide effective consumer protection.

• 1. AB 744 (Aguiar-Curry), Chapter 867, Statutes of 2019, adds qualified autism service provider and qualified autism service professional to the definition of health care provider and requires health care contracts to specify that a health plan or insurer is required to cover and reimburse diagnosis, consultation, or treatment delivered through telehealth on the same basis and to the same extent as in-person diagnosis, consultation, or treatment.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Marc Berman, Chair

ABPCA Bill Id:AB 2246

Author:(Ramos) – As Amended Ver:March 18, 2024

SUBJECT: Medical Practice Act: health care providers: qualified autism service paraprofessionals.

SUMMARY: Revises the definition of “health care provider” to include a qualified autism service paraprofessional.”

EXISTING LAW:

1. Defines “qualified autism service paraprofessional” to mean an unlicensed and uncertified individual who meets all of the following criteria:
   1. Is supervised by a qualified autism service provider or qualified autism service professional at a level of clinical supervision that meets professionally recognized standards of practice.
   2. Provides treatment and implements services pursuant to a treatment plan developed and approved by the qualified autism service provider.
   3. Meets specified education and training qualification.
   4. Has adequate education, training, and experience, as certified by a qualified autism service provider or an entity or group that employs qualified autism service providers.
   5. Is employed by the qualified autism service provider or an entity or group that employs qualified autism service providers responsible for the autism treatment plan.

(Health and Safety Code § 1374.73(c)(5))

1. Defines “health care provider” to mean any of the following:
   1. A person who is licensed under the Medical Practice Act or the Osteopathic Act.
   2. An associate marriage and family therapist or marriage and family therapist trainee.
   3. A qualified autism service provider or qualified autism service professional certified by a national entity, as specified.
   4. An associate clinical social worker.
   5. An associate professional clinical counselor or clinical counselor trainee.

(Business and Professions Code (BPC) § 2290.5(a)(3))

1. Defines “telehealth” to mean the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care. (BPC § 2290.5(a)(6))
2. Requires a health care provider, before the delivery of health care via telehealth, to inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. (BPC § 2290.5(b))
3. Specify that all laws and regulations governing professional responsibility, unprofessional conduct, and standards of practice that apply to a health care provider under the health care provider’s license shall apply to that health care provider while providing telehealth services. (BPC § 2290.5(g))
4. Requires a contract between a health care service plan or health insurer and a health care provider that is issued, amended, or renewed on or after January 1, 2021, to specify that the health plan or health insurer is required to provide coverage for the cost of health care services delivered through telehealth on the same basis and to the same extent that the health plan or health insurer is responsible for coverage for the same service in-person. (Health and Safety Code § 1374.14(a); Insurance Code § 10123.855)

THIS BILL:

1. Revises the definition of “health care provider” for purposes of Division 2 of the Business and Professions Code to include a qualified autism service paraprofessional certified by a national entity, as specified.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by Legislative Counsel.

COMMENTS:

Purpose. This bill is authored by the Autism Business Association. According to the author:

Today, we are facing a shortage of qualified personnel who can provide the critical services our children with autism depend on. Most families are struggle to find qualified professionals in their area, especially, ones who can work within their budget. It is crucial that families maintain a level of consistent care for their loved ones with autism. [This bill] would allow paraprofessionals, experts in their field, to fill that gap. Most importantly, would allow health insurances companies to cover the services by paraprofessionals who meeting communities where there at, not just where the community can afford to be.

Background.

According to the Centers for Disease Control and Prevention, nearly 1 in 36 children are diagnosed with autism spectrum disorder (ASD), which affects the way they behave, communicate, interact, and learn.^[1] While there is no cure for ASD, there are several types of treatment to support daily functioning and quality of life. These include behavioral, developmental, educational, social-relational, pharmacological, and psychological approaches as well as complementary and alternative treatments.^[2] Treatment is often provided by multiple professionals and may be provided at school, in healthcare settings, within the community, at home, or some combination of those settings.

In 2011, SB 946 (Steinberg), Chapter 650, Statutes of 2011 began requiring health plans and health insurance policies to cover behavioral health therapy provided by a qualified autism service provider, a qualified autism service professional supervised by the qualified autism service provider, or a qualified autism service paraprofessional supervised by a qualified autism service provider or professional.

Qualified autism service paraprofessionals are required to have a high school diploma or the equivalent, have completed 30 hours of competency-based training designed by a certified behavior analysist, and have six months experience working with developmental disabilities. Alternatively, they may have 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 have six months of experience working with persons with developmental disabilities.^[3] Qualified autism service paraprofessionals are also required to be supervised by a qualified autism service provider or professional, provide treatment and implement services pursuant to a treatment plan developed and approved by a qualified autism service provider, and be employed by the qualified autism service provider or an entity or group that employs qualified autism service providers responsible for the autism treatment plan.

Current law has, since January 1, 2021, required health care service plans and health insurance policies to cover services provided by a health care provider via telehealth in the same manner as provided for in-person services. While qualified autism service providers and professionals deemed health care providers in statue, qualified autism service paraprofessionals are not. According to the author’s office, Executive Order N-43-2 temporarily required health plans and insurers to cover telehealth services provided by autism service paraprofessionals during the COVID-19 pandemic. However, since the state of emergency was lifted, the author’s office reports that one of the largest national health insurance plans has stopped covering telehealth services for behavioral health treatment for individuals with ASD. By expanding the definition of health care provider to include qualified autism service paraprofessionals, this bill would require health plans and health insurance policies to cover telehealth services provided by these providers. The author and sponsor portend that this change will fill gaps and increase access to care for individuals with ASD, particularly for those who live in rural communities or who require services in a language other than English.

Current Related Legislation.

AB 2449 (Ta) of 2024 would clarify that the Qualified Applied Behavior Analysis Credentialing Board is also a national entity that may certify a qualified autism service provider, and would authorize the certification to be accredited by the American National Standards Institute. AB 2249 is pending in the Assembly Health Committee.

Prior Related Legislation.

SB 805 (Portantino), Chapter 635, Statutes of 2023, expanded the definition of “qualified autism service professional” to include a psychological associate, an associate marriage and family therapist, an associate clinical social worker, and an associate professional clinical counselor.

SB 562 (Portantino) of 2022 would have, as it relates to this bill, revised the definition of qualified autism service professional and the training requirements for qualified autism service paraprofessional. SB 562 was vetoed.

AB 774 (Aguiar-Curry), Chapter 867, Statutes of 2019, added qualified autism service provider and qualified autism service professional to the definition of health care provider and required health care contracts on or after January 1, 2021, to specify that the health care service plan (health plan) or insurer is required to cover and reimburse diagnosis, consultation, or treatment delivered through telehealth on the same basis and to the same extent as in-person diagnosis, consultation, or treatment.

SB 946 (Steinberg), Chapter 650, Statutes of 2011, required, in part, health plans and health insurance policies to cover behavioral health therapy for autism.

ARGUMENTS IN SUPPORT:

As the sponsor of this bill, the Autism Business Association writes in support:

[This bill] addresses a vital need for the autism community – improving accessibility to care. The provision to include qualified autism service paraprofessionals as providers who can deliver services via telehealth modalities is a progressive step. It aligns with the current healthcare innovation trends and directly tackles care accessibility issues many families face, particularly those living in remote or underserved communities. The benefits of expanding telehealth options are multifaceted. It not only supports continuity of care, where interruptions could lead to regression in progress, but also empowers families to choose the treatment modalities that work best for them. This flexibility respects people's autonomy and acknowledges diverse individual needs. In addition, telehealth expansion serves to reduce travel burdens, lower the risk of exposure to infectious diseases, and potentially lower costs for providers and families alike. It is an efficient means of providing quality care without the geographic and physical limitations attached to traditional in-person services.

ARGUMENTS IN OPPOSITION:

None on file.

REGISTERED SUPPORT:

Autism Business Association (Sponsor)

Autism Behavior Services Inc. 
Autism Heroes
Autism Society of California
DIR/Floortime Coalition of California
Greenhouse Therapy Center

REGISTERED OPPOSITION:

None on file.

Analysis Prepared by: Kaitlin Curry / B. & P. / (916) 319-3301

1. What is Autism Spectrum Disorder? | CDC ↑

2. Treatment and Intervention Services for Autism Spectrum Disorder | NCBDDD | CDC ↑

3. CCR § 54342 ↑