Demystifying Senate Bill 946.

Although the bill was signed into law on October 14th, 2011 and takes effect on July 1st, 2012, we have already heard of some misconceptions that when studying the bill don’t seem to make sense. Here is what we have heard so far. We will present the myth and then cut-and-paste parts of the bill that directly address or contradict the myth or misconception.

The first myth is that MEDICAL INSURANCE SERVICES WILL REPLACE OR ALTER SCHOOL DISTRICT SERVICES. In closely reading the bill, there is no mention of the need for school services to stop or be altered in any way as a result of the commencement of services from a medical insurance provider. In fact, there is language in the bill that directly contradicts the notion that school district services will discontinue or even change as a result of services funded by medical insurance: This section shall not affect or reduce any obligation to provide services under an individualized education program, as defined in Section 56032 of the Education Code,…… (text deleted by present author), or under the Individuals with Disabilities Education Act (20 U.S.C. Sec. 1400, et seq.) and its implementing regulations (italicized text comes directly from SB 946).

The second myth is that MEDICAL INSURANCE SERVICES WILL REPLACE OR ALTER REGIONAL CENTER SERVICES. In closely reading the bill, there is no mention of the need for regional center services to stop or be altered in any way as a result of the commencement of services from a medical insurance provider. In fact, there is language in the bill that directly contradicts the notion that regional center services will discontinue or even change as a result of services funded by medical insurance: This section shall not affect or reduce any obligation to provide services under ……. (text deleted by present author), or an individualized service plan, as described in Section 5600.4 of the Welfare and Institutions Code,..……. (italicized type comes directly from SB 946).

The third myth that we have encountered thus far is that QUALIFIED PROVIDERS MUST BE LICENSED OR HAVE A LICENSED PROVIDER ON STAFF TO REVIEW ABA PROGRAMS. Again, there is no language in SB 946 that requires or states that a Qualified Provider be licensed or have a licensed person on staff. In fact, language in the bill clearly specifies that Board Certified Behavior Analysts (BCBAs) meet the criteria of Qualified Service Providers. (3) “Qualified autism service provider” means either of the following: (A) A person, entity, or group that is certified by a national entity, such as the Behavior Analyst Certification Board, that is accredited by the National Commission for Certifying Agencies, and who designs, supervises, or provides treatment for pervasive developmental disorder or autism, provided the services are within the experience and competence of the person, entity, or group that is nationally certified (italicized type comes directly from SB 946).

The fourth and final myth that we have heard to date is that MEDICAL INSURANCES COMPANIES MUST CONTRACT WITH ALL QUALIFIED SERVICE PROVIDERS. This is not correct. The bill specifically states that must maintain a network of Qualified Providers, but it allows for the medical insurance companies to choose who they wish to be engage in a contract. (4) (b) Every health care service plan subject to this section shall maintain an adequate network that includes qualified autism service providers who supervise and employ qualified autism service professionals or paraprofessionals who provide and administer behavioral health treatment. Nothing shall prevent a health care service plan from selectively contracting with providers within these requirements (italicized type comes directly from SB 946).

 

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