State Requirement for Providing Behavioral Health Services
Provider Type
- Physicians
- Participating Physician Groups (PPG)
All practitioners participating in the plan's network must comply with the following standards implemented on January 1, 2018, under Assembly Bill (AB) 1074 as it amended California Health and Safety Code section 1374.73 and California Insurance Code section 10144.51, when providing behavioral health treatment for pervasive developmental disorder or autism spectrum disorders (ASDs) for Health Net members.
Participating providers must ensure that qualified autism service professionals or paraprofessionals are supervised by a qualified autism service provider when providing behavioral health services and treatment for pervasive developmental disorder or ASDs. Health Net covers applied behavioral analysis (ABA) when medically necessary for Health Net members diagnosed with ASDs.
Qualified autism service providers must be certified by a national entity, such as the Behavior Analyst Certification Board, with a certification that is accredited by the National Commission for Certifying Agencies, to design, supervise and provide treatment for pervasive developmental disorder or ASDs.
Rules of participation require that participating providers only assign Health Net members to qualified autism professionals and qualified autism paraprofessionals under a treatment plan prescribed by and supervised by a qualified autism service provider. These qualified autism professionals and qualified autism paraprofessionals must meet the following minimum qualifications:
A qualified autism service professional must meet the following criteria:
- Provides behavioral health treatment, which may include clinical case management and case supervision under the direction and supervision of a qualified autism service provider.
- Is supervised by a qualified autism service provider.
- Provides treatment according to a treatment plan developed and approved by the qualified autism service provider.
- Meets the education and experience qualifications as described in Section 54342 of Title 17 of the California Code of Regulations for an Associate Behavior Analyst, Behavior Analyst, Behavior Management Assistant, Behavior Management Consultant, or Behavior Management Program.
- Has training and experience in providing services for pervasive developmental disorder or autism.
- Is employed by the qualified autism service provider or the participating physician group (PPG) that employs qualified autism service providers responsible for the autism treatment plan.
A qualified autism service paraprofessional is an unlicensed and uncertified individual who meets all of the following criteria:
- Is supervised by a qualified autism service provider or qualified autism service professional at a level of clinical supervision that meets professionally recognized standards of practice.
- Provides treatment and implements services for a treatment plan developed and approved by the qualified autism service provider.
- Meets the education and training qualifications described in Section 54342 of Title 17 of the California Code of Regulations.
- Has adequate education, training and experience, as certified by a qualified autism service provider or the PPG that employs qualified autism service providers.
- Is employed by the qualified autism service provider or an entity or group that employs qualified autism service providers responsible for the autism treatment plan.