Health care coverage: autism.

Senator Valladares frames a policy package that ties autism service delivery to a new licensing framework and telehealth standards, while extending consumer protections and transparency requirements across health plans. The centerpiece is a shift of core definitions for autism services into a new chapter of the Business and Professions Code, establishing a formal category of “qualified autism service providers” and related professionals, and linking telehealth delivery to explicit consent and professional standards. The measure also sets out parallel requirements for behavioral health treatment under medical and disability coverage, subject to the policy context described below.

A key mechanism is a redefined telehealth regime: health care and disability plans may use telehealth to deliver care, but providers must inform patients about telehealth before services begin and obtain consent that is documented. The bill preserves in-person options and requires that patient confidentiality and applicable professional standards apply to telehealth interactions. It also specifies that telehealth terminology includes asynchronous store-and-forward communication and distant-site providers, with alignment to existing practice authorities and confidentiality rules.

The bill creates a formal “Qualified Autism Service Provider” framework, defining two tiers of personnel who design, supervise, or deliver autism-related behavioral health treatment, and a corresponding “Qualified Autism Service Professional” and “Qualified Autism Service Paraprofessional.” Qualifications include national certification for some roles or state licensure in applicable health professions with supervision and treatment-plan requirements. Training standards are anchored in established California regulations and welfare codes, and providers must be employed by a qualifying autism service provider entity and operate under a treatment plan reviewed at regular intervals.

On coverage and access, the measure requires comprehensive mental health and substance use disorder benefits to be provided under the same terms as other medical conditions, including a broad definition of medically necessary treatment and protections against short-term-only limits. When in-network access is not available within geographic or timely-access standards, plans must arrange medically necessary out-of-network services with cost-sharing at in-network levels. The bill also imposes extensive provider-directory obligations: plans must publish and maintain online and printed directories with contract-status data, searchability, network tier information, languages spoken, contact details, affiliated provider groups, facilities, and rights-to-report inaccuracies; directories must be updated on a defined cadence, include a reporting mechanism for inaccuracies, and, for providers not accepting new patients, require timely notice to enrollees. Plans may delay payments for verified directory information under narrowly drawn conditions, with notice and documentation requirements, and penalties may apply for inaccuracies that affect access to care. A central-directory or central-utility framework could be established, with plans retaining responsibility for accuracy and with timelines pegged to overarching standards; if a central utility is designated, specific operational safeguards apply. The bill also introduces accuracy benchmarks—percentile-based targets for directory accuracy over several years—and requires annual verification and public posting of verification results.

The proposal situates these provisions in a broader policy context, including interdependencies with companion measures that would modify directory standards and related definitions. Several key changes would become operative only if related bills are enacted and align in time, reflecting a coordinated legislative package. Taken together, the changes aim to clarify provider qualifications for autism services, expand telehealth use with patient consent and safeguards, strengthen mental health coverage parity, and tighten directory accuracy and transparency to support enrollees, providers, and plans alike.