FirstSteps for Kids CEO Matt McAlear Testifies in Sacramento

The FirstSteps Team is proud to have Matt McAlear at the helm of our company as Chief Executive Officer, while also serving as Executive Director of our state’s professional association, the California Association for Behavior Analysis (CalABA). In both capacities, McAlear is a true champion for those we serve and for all the behavior analysts and registered behavior technicians who have dedicated their professional lives to this field of work.

Throughout McAlear’s nearly two-decades of leadership at CalABA, he has repeatedly been called upon to provide legislative testimony on behalf of CalABA’s 30,000+ behavior analysts and registered behavior technicians working in both academia and applied settings throughout California. His representation and efforts in Sacramento have helped shape some of the most influential ABA legislation, benefiting individuals with autism and their families tremendously.

Most notably, McAlear played a key role in the passage of Senate Bill 946, more commonly referred to as the Autism Health Insurance Mandate. With the passage of this foundational bill, which required commercial health plans (and later Medi-Cal plans) to include ABA in their benefit packages, significantly greater numbers of autistic individuals were able to receive high quality ABA intervention, a treatment for which the American Academy of Pediatrics recommends as best practice for children diagnosed with autism. McAlear explains, “Prior to the passage of SB 946, parity in autism health care was virtually absent. With the passage SB 946, so many families who were previously unable to self-fund their children’s medically necessary ABA services finally had access to the resources they needed and could rest assured knowing that their kids’ services would be provided by well-trained and credentialed clinicians.”

Last month, on April 25th, McAlear was once again invited to return to Sacramento as one of just two expert witnesses permitted to testify in opposition to Assembly Bill 2449. AB 2449 was introduced during the 2023-2024 regular session and is aimed at amending the provider qualifications stipulated in SB 946 for insurance reimbursement.

McAlear, in collaboration with CalABA’s lobbyists, devised a comprehensive strategy and formulated key talking points designed to reveal the detrimental impacts of the proposed bill. Additionally, McAlear orchestrated messaging alignment by partnering with colleague, Marial Fernandez, from the Council of Autism Services Providers (CASP), who was invited to provide the second opposing testimonial at the hearing. Together, they also connected with members of the Assembly Health Committee to furnish contextual background and articulate opposition to the bill.

In a full circle moment, McAlear’s testimony served to emphasize the original intent of the Autism Insurance Mandate (SB 946). He summarized, “the intent [of SB 946] was not to force the hands of insurers to simply pay for any provider claiming to work with the autistic population. Rather, it was about access to quality ABA services. Services that were guided by board certified behavior analysts with both the education and clinical expertise to truly help this population and vetted by our non-profit, nationally recognized credentialing body, the BACB.”

While proponents of AB 2449 stress that its amended language, which now includes the Qualified Behavior Analyst (QBA) certification, will allow for more access to ABA, McAlear and Fernandez, along with the larger ABA professional and academic communities of both CalABA and CASP, contend that the QBA inclusion is actually more likely to threaten treatment integrity and patient care. A side-by-side analysis indeed highlights meaningful differences, including the inherent financial conflict of interest associated with the QBAs certification mechanism, a for-profit, private business.

McAlear’s and Fernandez’s testimony against AB 2449 powerfully highlighted these differences. Specifically, each of their testimonies called out additional problems associated with the QBA beyond the obvious financial implications of its private business’ desired profit margins. Specifically, the Assembly learned that unlike the BACB and other non-profit, professional associations (e.g., The Board of Behavioral Sciences, The American Psychological Association, The California Speech and Hearing Association, etc.) who typically oversee licensing or credentialing of allied health professions in accordance with best practices and case law, the Qualified Behavior Analyst (QBA) certification differs in its:

• Eligibility criteria which lack the advanced degree requirement from an accredited university.

• Coursework requirements which may be completed outside of an accredited university setting and may be developed and delivered by individuals or private companies approved solely by the private entity who owns and operates the QBA certification program.

• An absence of a pre-certification intern period or any similar requirement to complete supervised applied clinical work hours prior to certification.

• Its certification exam that is neither psychometrically validated nor developed by independent experts (who will not financially benefit from high pass rates).

• The defined scope of the QBA certification is specific to autism intervention rather than defining an actual profession. In contrast, none of the behavioral health professions regulated in the state of California considers training and examination content that is limited to or focused on a single client population to be acceptable. 

As such, McAlear firmly concluded his testimony by asserting that the “adoption of this bill would put individuals in California and their families living with autism at risk and undermine the integrity of all behavioral health professions in the state. We urge a no vote on AB 2449.”

Despite McAlear and Fernandez’s efforts and the compelling facts, the assembly members were not swayed, and the bill remains subject to further deliberation in subsequent sessions prior to advancing to the Governor’s desk for potential enactment into law. Though frustrating to have this process continuing, this is not an uncommon occurrence.

Indeed, since the passage of SB 946, McAlear and the Board of Directors at CalABA have steadfastly continued their public policy work in Sacramento, including the ongoing pursuit of licensure for behavior analysts in our state. McAlear shared, “At any one time, we have our eyes, ears, and collective votes on no fewer than 10 bills coming to the floor [state legislation], each with significant implications for consumers and/or clinicians providing ABA.”  

As behavior analysts we know all too well about competing contingencies and there are certainly quite a few evident in our state’s capitol. Fortunately, though our field is relatively small, we are a passionate one with strong leadership in both our state and professional associations. As providers we will continue to insist on the highest standards of care as the financial vs. Quality of care tug-of-war continues on. In essence, AB 2449 is yet another reminder to all of us to remain active participants in our state’s governing process. If we do not get involved, we do ourselves and those with whom we have dedicated our professional lives a disservice.

Kudos to our beloved CEO, Matt McAlear, and to the active Boards, public policy committees, and engaged members of both CalABA and CASP. FirstSteps is with you, on guard and at the ready!