California Mandate Legislation

The California State Assembly Appropriations Committee analyzes SB 770, the insurance mandate legislation.

1)Rationale . According to the author, SB 770 provides clarity in the law by mandating that health plans and insurers cover behavioral health treatment, such as Applied Behavioral Analysis (ABA), for those with autism. The author also states the bill defines the scope of these treatments and eliminates unwarranted restrictions on those who are qualified to provide the treatment. The author contends this clarification will save struggling families from the bureaucratic hurdles many face in getting this treatment covered by health plans and insurers.

2)Mental Health Parity . Under current law, California has had partial mental health parity for specified conditions since AB 88 (Thompson), Chapter 524, Statutes of 1999. AB 88 requires treatment parity for serious mental illness (SMI) such as schizophrenia, autism, and anorexia nervosa. This bill would further specify that behavioral health treatment for pervasive developmental disorder or autism (PDD/A) must be covered.

3)Applied Behavioral Analysis . CHBRP's analysis indicates that a similar bill would result in significant increases in behavioral health treatments for PDD/A. Because the largest impact would be an increase in applied behavioral analysis (ABA) and similar services, CHBRP's analysis and this analysis focus on ABA. ABA is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors to a meaningful degree. Socially significant behaviors include reading, academics, social skills, communication, and adaptive living skills like motor skills, eating and food preparation, personal self-care, domestic skills, home and community orientation, and work skills. ABA requires intensive treatments of more than 25 hours each week and costs about $50,000 each year. Consumers complain about the refusal of health care service plans to cover ABA services. Some independent medical reviews (IMRs) of health plan coverage denials for ABA services for children diagnosed with autism have overturned the health plan's decision to deny coverage, while others have not.

4)Effectiveness of ABA . CHBRP indicates that the literature on the effectiveness of behavioral intervention therapies (BIT), of which ABA is the most popular, is difficult to synthesize since most studies compared intensive behavioral intervention therapies of differing duration and intensity or compared interventions based on different theories of behavior. Thus, most studies of intensive behavioral intervention therapy cannot determine whether BIT improves outcomes relative to no treatment; they can only determine whether some form of BIT is more effective than others. CHBRP notes that even this question is difficult to answer because the characteristics of treatments provided to both intervention and comparison groups vary widely across studies. Additionally, CHBRP states that many studies of BIT do not assess outcomes over sufficiently long periods of time to determine whether use of these therapies is associated with long-term benefits. In conclusion, CHBRP indicates there is some support that BIT, including ABA, can improve IQ and adaptive behavior as compared to other types of treatment. However, the increases in IQ were not sufficiently large to enable the children to achieve levels of intellectual and educational functioning similar to their peers without PDD/A.