Health Care Coverage- Pervasive Developmental Disorders or Autism (Approved on October 10, 2023)
This assembly bill was introduced by Senator Portantino on February 17, 2023. The current legislation, known as the Knox-Keene Health Care Service Plan Act of 1975, mandates the licensure and oversight of health care service plans by the Department of Managed Health Care. It also establishes penalties for deliberate violations of the act. Additionally, it outlines regulations for health insurers overseen by the Department of Insurance. The law stipulates that health care service plan contracts and health insurance policies must include coverage for behavioral health treatment related to pervasive developmental disorders or autism. This treatment encompasses specific services and programs, including those administered according to a prescribed treatment plan by either a qualified autism service provider, a qualified autism service professional, or a qualified autism service paraprofessional under specified supervision. A "qualified autism service professional" is an individual who meets defined educational and training criteria and is employed and supervised by a qualified autism service provider. Meanwhile, a "qualified autism service paraprofessional" is an unlicensed individual who meets specified qualifications, is supervised by a qualified autism service provider or professional, and is employed by the provider.
This legislation proposes broadening the eligibility criteria for a qualified autism service professional to encompass individuals such as psychological associates, associate marriage and family therapists, associate clinical social workers, or associate professional clinical counselors, subject to specific specifications. It mandates that these roles adhere to the standards set for a Behavioral Health Professional.
This legislation mandates the department to enact regulations by July 1, 2026, concerning the utilization of Behavioral Health Professionals and Behavioral Health Paraprofessionals within behavioral health treatment group practices. It further necessitates the establishment of rates, educational or experiential prerequisites, and professional supervision standards for these roles to administer behavioral intervention services, as outlined. Given that a deliberate infringement of the bill's stipulations by a health care service plan would constitute a criminal offense, it would impose a state-mandated local program. According to the California Constitution, the state is obligated to compensate local agencies and school districts for certain state-imposed expenses, with statutory provisions outlining the reimbursement process. However, this bill specifies that no reimbursement is mandated by this act for a specified rationale.