HOUSE BILL NO. 361 "An Act relating to licensing of behavior analysts." 2:40:00 PM REPRESENTATIVE DAN SADDLER, explained the legislation. He stated that Autism was a significant and growing problem in Alaska. Statistics show that one in 110 Alaska children, about 1 percent, are born with this developmental disability, characterized by a diminished ability to communicate, social isolation, and other symptoms. While not curable, autism was treatable. Scientific, peer- reviewed studies show that early intensive treatment in the form of Applied Behavioral Analysis (ABA) offered the best opportunity to help people with autism improve their ability to function productively in society. He stated that ABA was recognized as the basis for the most effective form of treatment for autism by the U.S. Surgeon General, the National Institute of Child Health, and the American Academy of Pediatrics. One can best understand ABA as behavior modification therapy: It sought to encourage appropriate behavior by assessing and managing the relationship between the environment and the desired behavior. Forty years of research showed that nearly half of people with autism who received intensive early intervention and treatment did not require lifelong services and support, and half could achieve normal functioning after two to three years. This could mean a lifetime savings of $200,000 to $1.1 million for a person through the age of 55-years-old. One of the most important elements in successful autism treatment is having it provided by those who hold the nationally recognized credential of Board-Certified Behavioral Analyst (BCBA). To qualify as a BCBA, applicants must have a minimum of a master's degree, plus extensive training and experience requirements of up to 1500 hours of supervised practice in the field, 225 hours of graduate-level classroom work, or a year's experience teaching ABA at the university level. They must also pass the challenging BCBA certification examination. The Board-Certified Assistant Behavioral Analyst, or BCABA credential, required slightly lower standards. The state already supported the training of BCBAs through a grant to eh Center for Human Development at UAA. There were currently approximately 20 to 30 BCBAs and BCABAs in Alaska, although not all of those were currently working in the field. Under current state law, Alaskans with BCBAs could not bill health insurance companies or Medicaid for their services at a rate that reflected their high degree of training and professional skill because there were not formally licensed. He announced that BY 361 addressed that situation by providing for those holding the BCBA or BCABA credentials in Alaska to be licensed by the Division of Professional Licensing, in the DCCED. He announced that 14 other states currently provided licensing and regulated behavior analysts. The approach had the strong support of Alaska BCBAs and the national autism advocacy groups. By ensuring licensing and higher standards of practice for BCBAs and BCABAs, HB 361 would do the following: encourage more people to provide autism services in Alaska; offer higher reimbursement rates for professional providers, provide better outcomes for Alaska children with autism; save the state money by avoiding the need for costly institutional care; and improve the quality of life for hundreds of Alaskans and their families. LORRI UNUMB, EXECUTIVE DIRECTOR, AUTISM SPEAKS, SOUTH CAROLINA (via teleconference), spoke in support of the legislation. She stated that she was involved in various autism advocacy groups. She felt that the bill took in many considerations including people who were moving from other states to practice behavior analysis. She remarked that the bill outlined some exemptions for people who need not have a license, such as a family member of a person with autism. She stated that the legislation relied on the existing national board certification, which was the appropriate structure for a licensing bill. She announced that she had worked on various state's legislation that created licensure for behavior analysts. She stated that there were currently 15 state that licensed behavior analysts, and Tennessee had just passed a behavior analyst licensing bill, so there were almost 16 states that license behavior analysts. She remarked that the legislation contained disciplinary mechanisms to ensure adequate consumer protection and created a temporary license for those who had already been practicing within the state. 2:47:04 PM REBEKA EDGE, DIRECTOR, BEHAVIOR MATTERS, EAGLE RIVER (via teleconference), testified in support of the legislation. She announced that she was a parent of two children with autism. She stated that in her position as director of Behavior Matters, she had a staff of 24 that served clients Anchorage, Mat-Su, Talkeetna, Kenai, and Juneau. She felt that the legislation would allow her business to continue to work with their current families while provided a professional weight that was consistent with their training and expertise. Co-Chair Meyer wondered if the bill would pertain to other behavioral issues other than autism. Representative Saddler replied that that the legislation would pertain to other behavioral issues. He stated that the principles of applied behavioral analysis have applicability to dealing with various development disabilities like children with fetal alcohol spectrum disorder (FASD). Co-Chair Meyer wondered how many people would seek a license in behavioral analysis. Representative Saddler replied that there were approximately 25 people that would seek a license, but agreed to provide further information. Co-Chair Meyer asked if other states had a similar program. Representative Saddler responded that 16 states had instituted behavioral analysis licenses. SARA CHAMBERS, DIRECTOR, CORPORATIONS, BUSINESSES, AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE, COMMUNITY AND ECONOMIC DEVELOPMENT, introduced herself. Co-Chair Meyer wondered if she had drafted the attached fiscal note. Ms. Chambers replied that she did not draft the fiscal note, but she was familiar with it. Co-Chair Meyer remarked that the fiscal note was indeterminate. He looked at the third paragraph fiscal analysis, and saw that the financial impact to health care and Medicaid services could be significant. He asked for further explanation regarding that statement. Ms. Chambers responded that the fiscal note that he was referencing was from the Department of Health and Social Services (DHSS). She stated that DCCED supplied a fiscal impact note. 2:52:26 PM Vice-Chair Fairclough stated that there was an issue of recovering the fees for licensing in Alaska. She remarked that the fiscal note was very low from DCCED. She queried the fee estimate. Ms. Chambers responded that the fiscal note reflected the additional appropriation that was needed to implement the program, and it was not the total cost of the program. She announced that she had been working with the bill sponsor to provide additional information that would be an estimate of anticipated additional costs based on similarly situated programs. She stated that it was determined that the additional cost plus the fiscal note could result in a license that would cost around $500 to $600 per license. Vice-Chair Fairclough stressed that Alaska had faced issues of investigation, as far as the boards to use the information that DCCED provided to manage the funds. Representative Saddler replied that the fee would be significantly lower after the first year. He observed that it would be small number of licensees, so the likelihood of investigation would be substantially low. Vice-Chair Fairclough stressed that there was a flat rate of how the departments spread cost over licenses. Representative Saddler agreed that he would not argue statistics. TERI KEKLAK, DIVISION OF BEHAVIORAL HEALTH, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via teleconference), stated that the Division of Health Care Services created the DHSS fiscal note. She stated that the fiscal note was indeterminate because until licensure occurs, it was difficult for the department to estimate the utilization that might occur. She stated that DHSS required approval that the coverage would be paid to the independent practitioners under benefits. She stated that the licensees were not currently listed in the Medicaid statute as independent practitioners. She stated that there would be some analysis of the medical necessity, utilization, and determine services. 2:57:48 PM Vice-Chair Fairclough looked at page 2 of the fiscal note, and saw that it indicated 1838 under the age of 21 with a diagnosis of autism. She queried an estimate of the cost of one person receiving services. Ms. Keklak replied that DHSS could not currently estimate that cost. She stated that there needed to be a determination of the specific services that would be covered. Vice-Chair Fairclough understood that there was a wide range of services, so she asked for an estimate range of the cost of services. Ms. Keklak replied that she could not address a range of costs. DEB ETHERIDGE, MEDICAL ASSISTANT, DIVISION OF HEALTH CARE SERVICES, DEPARTMENT OF HEALTH AND SOCIAL SERVICES (via teleconference), responded to a question from Vice-Chair Fairclough. She stated that the persons who were diagnosed with autism would undergo an initial assessment that would be eligible for and need service. She remarked that, in comparison to other states, the assessment cost would be around $175. If it was estimated that 100 percent of persons under the age of 21 with a diagnosis of autism, the total health assessment cost would be around $320,000. She stated that the service cost estimate would require some eligibility determinations. HB 361 was HEARD and HELD in committee for further consideration. 3:02:12 PM AT EASE 3:09:24 PM RECONVENED