S.B. 667: AN ACT to renumber subchapter III of chapter 440 [precedes 440.41], subchapter IV of chapter 440 [precedes 440.51], subchapter V of chapter 440 [precedes 440.60], subchapter VI of chapter 440 [precedes 440.70], subchapter VII of chapter 440 [precedes 440.88], subchapter VIII of chapter 440 [precedes 440.90], subchapter IX of chapter 440 [precedes 440.96], subchapter X of chapter 440 [precedes 440.97], subchapter XI of chapter 440 [precedes 440.98], subchapter XII of chapter 440 [precedes 440.9805] and subchapter XIII of chapter 440 [precedes 440.99]; to amend 157.055 (2) (intro.), 441.15 (2m), 448.03 (2) (a) and 632.895 (12m) (b) 4.; and to create 440.03 (13) (b) 15m., 440.08 (2) (a) 20m., subchapter III of chapter 440 [precedes 440.310] and 632.895 (12m) (b) 3m. of the statutes; relating to: licensure and regulation of behavior analysts, insurance coverage of the services of behavior analysts for autism treatment, providing an exemption from emergency rule procedures, granting rule−making authority, and providing a penalty.
S.B. 667 was introduced on April 5, 2010 and referred to the Senate Committee on Health, Health Insurance, Privacy, Property Tax Relief, and Revenue; the public hearing held on April 14, 2010. The bill was reported with passage recommendation by the Committee on April 19, 2010, and submitted to the Senate where it passed on April 20, was messaged to the House, where it was read and concurred in on April 21. The next step is Governor Jim Doyle's signature.
"This bill provides for licensure and regulation of behavior analysts. Under the bill, no person may engage in the practice of behavior analysis unless the person has been granted a license by the Department of Regulation and Licensing (department). [definition of practice of scope of practice of behavior analysis] The bill provides that the licensure requirement may not be applied to restrict the practice of behavior analysis within the scope of practice of a licensed professional who is not a behavior analyst, if the professional does not represent that he or she is a behavior analyst. An unlicensed person who practices behavior analysis is subject to a fine up to $250, up to three months in jail, or both.
The department must grant a license to an applicant who submits an application, an initial credential, and evidence that the applicant is certified as a behavior analyst by the private organization Behavior Analyst Certification Board, Inc. (board), except that the department may not grant a license to an applicant who has been convicted of certain crimes specified in the bill.
The bill authorizes the department to promulgate rules regarding the practice of behavior analysis, including rules authorizing the issuance of temporary permits to practice behavior analysis, but any rules must be consistent with standards established by the board. The department may not promulgate rules that impose additional educational requirements; that require a behavior analyst to practice under supervision by, or in collaboration with, another health care provider; that require a behavior analyst to enter into an agreement with another health care provider; or that limit the location where a behavior analyst may practice.
Under current law, health insurance policies and self-insured governmental and school district health plans are required to cover a specified amount of intensive-level services and nonintensive-level services provided to an insured for the treatment of autism, Asperger’s syndrome, and pervasive developmental disorder not otherwise specified as long as the treatment is prescribed by a physician and provided by any of the following providers who are qualified to provide intensive-level services or nonintensive-level services:[list of current providers] The bill provides that the coverage must also apply to services provided by a behavior analyst who is licensed to practice behavior analysis by the department or by a paraprofessional working under the supervision of such a behavior analyst, if the behavior analyst or paraprofessional is qualified to provide intensive-level services or nonintensive-level services."
The intensive-level and nonintensive-level services referenced relate to the Wisconsin autism insurance reform law (§12m) coverage passed in 2009 that specifies a four year minimum of intensive services and thereafter nonintensive services. S.B. 667 is similar to the House measure, A.B. 789, however after amendment AB 789 was tabled in the House on April 20.
Wisconsin currently has an amended substitute bill that was reported on April 14, 2010 from the Assembly Committee on Insurance with a do pass recommendation sent to the Committee on Rules, and is currently listed as "made a special order of business at 11:13 A.M. on (Tuesday) April 20, 2010 persuant to Assembly Resolution 23".
ASSEMBLY BILL 789: An Act to amend 632.895 (12m) (b) 4.; and to create 632.895 (12m) (b) 3m. of the statutes; relating to: insurance coverage of the services of behavior analysts for autism treatment.
Analysis by the legislative reference bureau of the introduced bill,
"Under current law, health insurance policies and self-insured governmental and school district health plans are required to cover a specified amount of intensive-level services and nonintensive-level services provided to an insured for the treatment of autism, Asperger's syndrome, and pervasive developmental disorder not otherwise specified as long as the treatment is prescribed by a physician and provided by any of the following providers who are qualified to provide intensive-level services or nonintensive-level services: a psychiatrist; a psychologist; a social worker who is certified or licensed to practice psychotherapy; a paraprofessional working under the supervision of any of those three types of providers; a professional working under the supervision of an outpatient mental health clinic; a speech-language pathologist; or an occupational therapist.
This bill provides that the coverage must also apply to services provided by a behavior analyst, excluding an assistant behavior analyst, who is certified to practice behavior analysis by the Behavior Analyst Certification Board, Inc., or by a paraprofessional working under the supervision of such a behavior analyst, if the behavior analyst or paraprofessional is qualified to provide intensive-level services or nonintensive-level services."
The bill history shows that AB 789 was introduced on March 3, 2010, with the public hearing held March 11, 2010. An offered substitute and amendments to the substitute extends insurance coverage to Marriage and Family Therapists and Professional Counselors who meet specifications, and upgrades the certification requirement for Behavior Analysts to a licensing requirement. This license would be granted by the Wisconsin Department of Regulation and Licensing and specifies the certification of the Behavior Analyst Certification Board (BACB) (excluding Board Certified Assistant Behavior Analysts (BCaBAs)). Among the stipulations would be: prohibition of rules requiring additional coursework conditions beyond those required for BACB certification, prohibition of requiring a licensed behavior analyst to practice behavior analysis under the supervision of, or in collaboration with, another health care provider. An advisory group could be appointed to advise the Department of Regulation and Licensing on matters relating to the regulation of behavior analysts. Other prohibitions, conditions and regulation of practice are described in the full bill text and amendments.
**Clarifying note that the "Standings Bill" is HF 2531, [successor to HSB 741]. The author would like to apologize for prior typos on this bill number, which have now been corrected**
With the Iowa General Assembly rapidly winding up its business for the 2010 session, the major focus of Friday, Saturday and continuing into the upcoming week is HF 2531, the "Standings bill", which by addition of last minute amendments and additions is sometimes referred to as the "Christmas tree" or "Catch-all" bill. HF 2531 contains the state budget, corrections and changes to bills passed earlier in the session and bills that one body may have passed but never reached vote in the other.
SF 2349 A bill for an act requiring certain group health insurance plans established for employees of the state to provide coverage for autism spectrum disorders for certain persons, requiring certification of behavior specialists, and providing an applicability date. (Formerly SF 1.), which was amended to recognize Board Certified Behavior Analysts and other licensed health professionals as service providers of applied behavior analysis.
SF 2349 was unable to come to the House floor to be deliberated as a separate bill, but as of Saturday, March 27 was active as an amendment added in the Iowa Senate to the Standings Bill, with the provision recognizing BACB certificants added as an amendment to that amendment. The amended HF 2531 also contained a budget provision for implementation of the insurance reform amendments, which strongly suggested that the autism insurance clauses would be retained in the final passed HF 2531
Although this is a positive development, on Sunday March 28, 2010, Autism Votes put out an action alert that three Iowa Representatives who had previously supported the autism insurance bill were wavering on reversing their vote, which would jeopardize approval of the amendment in the House.
Any further amendment in the House will force HF 2531 back to Senate for final concurrence.
The Iowa House is currently scheduled to resume at 10:00AM CDT, and the Senate at 2:00PM CDT. Predictions for the end of the session are imprecise, with some forecasting the final vote on the Standings bill to come as early as Monday night, and others extending through the March 31, 2010 end date originally posted on the legislative calendar.
The purpose of the bill is to clarify existing statute which presumes to cover autism treatment, however claims are commonly denied. A legislative study determined that applied behavior analysis as well as speech and occupational l therapies are necessary services that should be covered, in alignment with American Academy of Pediatrics recommendations; the purpose of HB 569-FN is to clarify that requirement. In other aspects it would not change educational or existing insurance law. While other professions are explicitly identified within the bill, the applied behavior analysis provision was inferred to be under service delivery by "provided by a pervasive developmental disorder or autism service provider"; BACB certificants or other equivalent not referenced.
The Rhode Island General Assembly is entertaining two autism insurance bills - one, House Bill 7260, would define and cover applied behavior analysis as an autism treatment; the other, Senate Bill 2422, does not state either - it includes a provision to increase training and numbers of related personnel such as nurses, physical therapists, occupational therapists, and occupational therapist assistants.
House Bill No.7260 BY Palumbo, Naughton, Corvese, Jackson, Caprio D
01/28/2010 Introduced, referred to House Corporations
03/10/2010 Committee transferred to House Committee on Health, Education & Welfare
03/31/2010 Scheduled for hearing and/or consideration
03/31/2010 Committee postponed at request of sponsor
H.7260 defines applied behavior analysis, includes coverage of applied behavior analysis within "habilitative or rehabilitative care", however the delivery of applied behavior analysis is not defined nor are such as BACB certificants or of equivalent competency defined. A statement is made that an "Autism services provider" means any person, entity, or group that provides treatment.
Senate Bill No.2422 BY O`Neill E, Pinga, Cote, Raptakis, Maher
02/11/2010 Introduced, referred to Senate Health and Human Services
S. 2422 does not identify applied behavior analysis, nor does it specify it as a treatment modality. The bill does direct the state institutions of higher education to evaluate whether nursing, physical therapy, occupational therapy and occupational therapy assistant programs offer preparation for those who interact with ASD patients and families and present a plan, including financial and scholarship incentives to encourage study in these fields.
The Kentucky State Senate appears poised to pass as early as Monday, KY HB 159, a bill that would both provide coverage for applied behavior analysis for Kentucky children with autism and, in a recent version, establish a license and licensing board for Behavior Analysts. Autism Votes earlier today announced that HB 159 had passed unanimously in the Senate Licensing and Occupations Committee, and a news story followed up that the bill is on the Senate Consent Calendar,
"...The Senate Licensing and Occupations Committee approved HB 159 and placed it on the consent calendar — a spot reserved for legislation without opposition that is likely to pass with no discussion.
“We’re going to pass it,” [Senate President David] Williams said.
[Rep. Jeff] Greer said he was pleased that the bill could win final approval as early as Monday. “It’s going to change children’s lives — no doubt about it,” he said..."
The Kentucky Legislative calendar does not have specific bills posted but does show business being conducted in the Senate on Monday, March 29, 2010 commencing at 12:00 Noon EDT.
The Autism Speaks blog has put up a post in which they identify what is seen as the outcome from the passage of S. 3590 and the potential passage of H.R. 4872.
While the post is posed in general terms, there are comments related to those plans under the Employee Retirement Income Security Act of 1974 (ERISA) not being required to provide the essential benefits package requiring "behavioral health", and what they see as benefits and effects on state mandates.
Will health care reform directly benefit the autism community?
Does it apply to all insurers?
How does health care reform impact the state autism insurance reform effort?
The short version is that passage of the Federal health care reform, while projected as a positive outcome for the country as a whole, is not a universal solution to the coverage and reimbursement problems currently facing families with a child who has an autism diagnosis, and that Autism Speaks' assessment is that obtaining uniform coverage providing behavior analytic treatment for those with an autism diagnosis will require continuing advocacy and legislation at both Federal and State levels. That blog also welcomes comments and questions.
A.10372: Requires that individual accident and health insurance policies shall provide coverage for screening, diagnosis and treatment of autism spectrum disorder.
The New York legislative website shows that A. 10372 has been referred to Ways and Means.
As of March 24, 2010, both of New York's autism insurance bills, S.7000A and A.10372 have quickly and unanimously passed their respective committees, which suggests some promise for positive progress in this legislature.
A.10372: Requires that individual accident and health insurance policies shall provide coverage for screening, diagnosis and treatment of autism spectrum disorder
New York and Maine's autism insurance bills received positive legislative action on Monday, March 22, 2010 - New York's S.7000A passing in the Senate Insurance Committee, and the amended version of Maine's SP 446/LD 1198 accepted in its 2nd reading in the Maine Senate.
New York - Autism Votes has reported that amended New York's S.7000A, was passed in the Senate insurance committee on March 22, 2010. The NY legislative tracking service shows that the vote was 13-2 in favor of the bill, and that the bill has been referred to the Senate Codes Committee. The identical Assembly bill, A10372, remains in the Assembly Insurance Committee where it was referred on March 19, 2010.
With the Iowa General Assembly scheduled to adjourn by March 31, 2010 and possibly as early as March 26,
SF 2349: A bill for an act requiring certain group health insurance plans established for employees of the state to provide coverage for autism spectrum disorders for certain persons, requiring certification of behavior specialists, and providing an applicability date. (Formerly SF 1.)
History to date shows that after passage by the Senate on February 23, 2010 and transmission to the Iowa House, that the bill was amended on March 9 [H-8372], to include that
An autism service provider that provides treatment of autism spectrum disorders that includes applied behavioral analysis shall be certified as a behavior analyst by the behavior analyst certification board or shall be a health professional licensed under chapter 147.
Has been reported by the Maine Legislative website as having been reported from Committee on March 17, 2010 with a "do pass recommendation", and may be scheduled for a second reading in the Maine Senate on Monday, March 22, 2010; the Senate convenes at 10AM EDT on the 22nd. Video link
As noted in a previous blog post, the amended version of SP 446/LD 1198 retains coverage of applied behavior analysis as a rehabilitative service, but the age ceiling was reduced from 21 years to 5 years, which essentially renders the legislation an "early intervention" bill.
the neighboring state of Missouri on March 18 ALSO had its autism insurance bill SS/SB 618, pass in the Senate by a vote of 26-6. SS/SB 618 has been transmitted to the Missouri House. This vote and passage has come after a delay of some weeks after the bill was anticipated for the third reading.
A non-autism insurance bill that is of interest to practicing behavior analysts is SB 1030, introduced on March 1, 2010, which would regulate the practice of behavior analysis by a licensing provision and create an advisory body to the Missouri State Committee of Psychologists, the body who would be in charge of regulating the license. SB 1030 is currently in the Senate Financial and Governmental Organizations and Elections Committee.
SB 204 defines applied behavior analysis, includes it for coverage under the "habilitative or rehabilitative care" category, and includes among those denoted as an "Autism services provider", "practitioners with the national certification of board-certified behavioral analyst",or any person, entity, or group meeting the standards set by the Department of Health and Social Services.
Prefacing notes. - A previous blog post addressed other autism insurance bills bills previously introduced in the NY State legislature: S 385/A 2759, S 1175, A 3332, S 2366/A 6001, S 6123/A 6888-B.
The stated rationale for the drafting of S. 7000, per an Autism Votes FAQ for S. 7000 , is that S. 7000 represents an effort to consolidate into one bill the multiple pieces of legislation already on the bill docket which were granted hearing in October of 2009. With the introduction of S. 7000, while the other bills will remain on the docket, the comment in the FAQ is that none of them would be proceeding through the NY Senate. This blog has takes no position on the FAQs or the comments therein.
New York S.7000 : An Act to Amend the Insurance Law and the Public Health Law, in Relation to Coverage for the Screening, Diagnosis and Treatment of Autism Spectrum Disorder
Requires that individual accident and health insurance policies shall provide coverage for screening diagnosis and treatment of autism spectrum disorder.
Sponsored by Senator Neil Breslin (Albany Co.) Chair of the Senate Insurance Committee, Senator Thomas Duane (Manhattan) Chair of the Senate Health Committee, and Senator Charles Fuschillo, Jr. (Nassau Co.)
The bill has been referred to the Senate Insurance Committee; Autism Votes comments that a committee meeting will be held on March 22, 2010 and that a vote is projected to be taken at 11:00 am on Monday, March 22, 2010 in Room 123 in the Capitol Building
S. 7000 does not define applied behavior analysis nor are the providers or competencies addressed explicitly.
However, it does state starting on page 2,
"...Coverage for behavioral therapies required puruant to this subparagraph shall not be denied on the basis that such therapies are educational or habilitative in nature, unless such treatments are provided pursuant to an Individualized Family Service Plan [IFSP] under Section 2545 of the Public Health Law or an Individualized Education Program [IEP] under Article 89 of the Education Law. The provision of services pursuant to an Individualized Family Service Plan or an Individualized Eduation Program shall not affect coverage under the policy for sercices provided on a supplemental basis outside of an educational setting if such services are deemed medically necessary.
(C) This paragraph shall not be construed to affect any obligation to provide services to an individual under an Individualized Family Service Plan under Section 2545 of the Public Health Law of an Individualized Eduation Program under Article 89 of the Education Law.
(D) Nothing in this paragraph shall be construed to prevent a policy from providing services through a network of participating providers who shall meet certain requirements for participation, including provider credentialing..."
As previously stated, Autism Votes has posted a Frequently Asked Questions (FAQ) on S. 7000. While readers are encouraged to read the FAQ first hand, some of the comments in the document are that the clinical report and treatment guideline of the American Academy of Pediatrics, “Management of Children with Autism Spectrum Disorders” which was published in October, 2007, would serve as the standard for covered treatments until treatment guidelines would be developed by the NY Division of Health, the Office of Mental Health, and the Office of Mental Retardation and Developmental Disabilities.
**Update 2/22/10, 11:51AM PST - The history of actions for SS/SB 618 shows that it was not voted on today, but is again on the Senate calendar for a Third Reading on February 22, 2010.**
------------------------------ Missouri SS/SB 618: Requires health carriers to provide coverage for the diagnosis and treatment of autism spectrum disorders under certain conditions
**Correction 2/18/10 - SS/SB 618 did not come to a 3rd reading on 2/15/10, however it is shown on the Senate calendar for 2/18/10 at 10AM CST [blogpost]**
**Update February 16, 2010 - The Missouri House amended, perfected and passed HCS HB 1311 & 1341. The House Journal for February 16 notes a number of amendments, some of which affect the portions of the bill referring to the practice of behavior analysis; the bill as perfected and passed will be posted when available from the legislative website**
-------------------------------------
The Missouri General Assembly is currently entertaining two bills that would affect the practice and reimbursement of the practice of behavior analysis in Missouri, and the legislative website indicates that action on these could be happening as early as the beginning of this coming week,
Senate Substitute (SS)/SB.618 : Requires health carriers to provide coverage for the diagnosis and treatment of autism spectrum disorders under certain conditions.
Bill History
SS/SB. 618 provides coverage under the age of 21 for applied behavior analysis, with such payments or reimbursements shall be made to either an "autism provider", the person who is supervising an autism service provider, who is certified as a board certified behavior analyst by the Behavior Analyst Certification Board; or the entity or group for whom such supervising person works or is associated.
SS/SB. 618 defines applied behavior analysis, and includes applied behavior analysis in the coverage category of "habilitative or rehabilitative care". It specifies an "Autism service provider" as 'any person, entity, or group that provides diagnostic or treatment services for autism spectrum disorders who is licensed or certified by the state of Missouri; any person who is certified as a board certified behavior analyst by the behavior analyst certification board; or any person, if not licensed or certified, who is supervised by a person who is certified as a board certified behavioral analyst by the Behavioral Analyst Certification Board, whether such board certified behavioral analyst supervises as an individual or as an employee of or in association with an entity or group'..."
The Missouri House of Representatives reports that HCS HB 1311 & 1341 was reported favorably out of the Rules Committee on February 8, 2010 with a "do pass" recommendation and is shown on the House Bill Calendar for February 15, 2010 for "Perfection".
A significant inclusion in HCS HB 1311 & 1341 is creation of a "Behavior Analyst Advisory Board", the inclusion of a licensure provision for Licensed Behavior Analysts, Licensed Assistant Behavior Analyst, and definition of a "PDD Service Provider" as a Licensed Behavior Analyst, and "Line Therapist" as a person supervised by a Licensed Behavior Analyst.
HCS HB 1311 & 1341 defines applied behavior analysis and the practice of applied behavior analysis.
It would create a "Behavior Analyst Advisory Board...under the state committee of psychologists within the division of professional registration. Appointments to this Advisory Board would be made by the Governor upon the recommendations of the director of the division, upon the advice and consent of the senate.
The division, prior to submitting nominations, shall solicit nominees from professional associations and licensed behavior analysts or licensed assistant behavior analysts in the state.
The Behavior Analyst Advisory Board shall consist of the following seven members:
three licensed behavior analysts,
one licensed behavior analyst holding a doctoral degree,
one licensed assistant behavior analyst,
one professional member of the committee, and
one public member."
The Behavior Analyst Certification Board (BACB) is stated explicitly as a certifying entity, although there is provision for an "equivalent nationally accredited nongovernmental agency approved by the committee [of psychologists] which certifies individuals who have completed academic, examination, training, and supervision requirements in applied behavior analysis;"
Authority, duties, term of service, scope of practice and other specifics are found within the full text of HCS HB 1311 & 1341.
HB 1311 & 1341 also addresses insurance coverage for diagnosis and treatment of autism spectrum disorders; defining applied behavior analysis, including it under the category of "habilitative or rehabilitative care", defines a "PDD service provider" as a licensed behavior analyst/LBA and would authorize payment for applied behavior analysis services to a "PDD service provider".
Coverage would extend through age 21 with differential coverage for children through age 9 and a lower amount through 21.
FULL SUMMARY with description of testimony and statements by opponents and proponents.
Among those testifying for the bill were Lorri Unumb, Autism Speaks; Representative Dennis O'Brien, Pennsylvania House of Representatives; Colin Peeler, Ph.D., BCBA, Ronald Ekstrand, Jr.,John M. Guercio, Ph.D., BCBA, CBIST, Missouri Association for Behavior Analysis.
A previous post reported on Kentucky HB 159, which specified a licensing condition for behavior analysts practicing in the state, depending on the conditions specified in the bill, as Licensed Behavior Analyst or Licensed Assistant Behavior Analyst; however at the time of that post, the proposal was that regulation and licensure would be under the purview of Kentucky Board of Examiners of Psychology.
HB 159 also contains a section defining health insurance coverage for autism with differentials from ages 1-6 years and 7-21 years with applied behavior analysis and practice defined, included under the category of "habilitative and rehabilitative care". The competencies of the Behavior Analyst Certification Board are specified in HB 159 under the definitions and in meeting the licensure requirements.
On February 10, 2010, the Kentucky Legislative website reports that a substitute bill for HB 159 (HCS) passed favorably from the House Standing Committee on Local Governmentnow specifies establishment of a separate licensing board - the "Kentucky Applied Behavior Analysis Licensing Board".
HB 159 - AMENDMENTS
HCS/HM - Delete the provisions relating to regulation and licensure of applied behavior analysis for behavior disorders by the Board of Examiners of Psychology and in lieu thereof establish a new KRS Chapter 319B to create the Kentucky Applied Behavior Analysis Licensing Board including the definitions, membership, terms, per diem and authority of the board, the requirements for licensure, and the exemptions from licensure; retain the provisions containing the health mandate, but clarify that the large group mandate for individuals is for individuals through age six by providing that individuals between the ages of one and their seventh birthday shall receive the mandated benefits.
"(...)SECTION 20. A NEW SECTION OF KRS CHAPTER 319B IS CREATED TO READ AS FOLLOWS: (1) (a) There is hereby created the Kentucky Applied Behavior Analysis Licensing Board. The board shall consist of seven (7) members appointed by the Governor.
(b) The initial board members shall be appointed as follows:
1. Four (4) members shall be credentialed behavior analysts nominated by a credentialed behavior analyst practicing in the state;
2. One (1) member shall be a psychologist licensed in the state, the majority of whose practice is related to the treatment of behavior disorders, including but not limited to autism spectrum disorders. The psychologist member shall be nominated by a credentialed behavior analyst practicing in the state; and
3. Two (2) members shall be the parent of a child diagnosed with and treated for a behavior disorder, including but not limited to an autism spectrum disorder, selected from the state at large.
(c) Subsequent board members shall be appointed by the Governor as follows:
1. Four (4) members shall be licensed behavior analysts nominated by a licensed behavior analyst practicing in the state;
2. One (1) member shall be a psychologist licensed in the state, the majority of whose practice is related to the treatment of behavior disorders, including but not limited to autism spectrum disorders. The psychologist member shall be nominated by a licensed behavior analyst practicing in the state; and
3. Two (2) members shall be the parent of a child diagnosed with and treated for a behavior` disorder, including but not limited to an autism spectrum disorder, selected from the state at large.
(...)"
