Amended in Assembly March 28, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 2299

Introduced by Assembly Member Nazarian

February 21, 2014

An act begin insert to amend Section 4659.1 of the Welfare and Institutions Code, end insert relating to developmental services.

LEGISLATIVE COUNSEL’S DIGEST

AB 2299, as amended, Nazarian. Developmental services: begin delete individual program plans and individualized family service plans. end delete begin insert health insurance copayments. end insert

The Lanterman Developmental Disabilities Services Act authorizes the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities. Under existing law, the regional centers purchase needed services for individuals with developmental disabilities through approved service providers or arrange for their provision through other publicly funded agencies. The services and supports to be provided to a regional center consumer are contained in an individual program plan or individualized family service plan, developed in accordance with prescribed requirements. begin insert Existing law authorizes a regional center to pay any applicable copayment or coinsurance for a service or support required by a consumer’s individual program plan if the service is paid for by the health care service plan or health insurance policy of the consumer or his or her parent, guardian, or caregiver and, among other conditions, the family or the consumer, as applicable, has an annual gross income that does not exceed 400% of the federal poverty level. Existing law prohibits a regional center from paying health care service plan or health insurance policy deductibles. end insert

This bill would begin delete declare the intent of the Legislature to enact legislation that would remove barriers that restrict access for regional center consumers to medically necessary services identified in an individual program plan or individualized family service plan. end delete begin insert delete that prohibition against payment of deductibles and would require a regional center, without regard to the family’s or consumer’s annual gross income, to pay any applicable copayment, coinsurance, or deductible for a service or support required by a consumer’s individual program plan if the support or service is paid for by the health care service plan or health insurance policy of the consumer or his or her parent, guardian, or caregiver. end insert

Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 4659.1 of the end insert begin insert Welfare and Institutions
Code end insert begin insert is amended to read: end insert

4659.1.  

(a) If a service or support provided pursuant to a
consumer’s individual program plan under this division or
individualized family service plan pursuant to the California Early
Intervention Services Act (Title 14 (commencing with Section
95000) of the Government Code) is paid for, in whole or in part,
by the health care service plan or health insurance policy of begin insert the
consumer or end insert the consumer’s parent, guardian, or caregiver, the
regional center begin delete may, when necessary to ensure that the consumer
receives the service or support, end delete begin insert shall end insert pay any applicable begin delete copayment
or coinsurance end delete begin insert copayment, coinsurance, or deductible end insert associated
with the service or support for which the begin insert consumer or the end insert parent,
guardian, or caregiver is responsible if begin delete all end delete begin insert both end insert of the following
conditions are met:

(1) The consumer is covered by his or her begin delete parent’s, guardian’s,
or caregiver’s end delete begin insert own end insert health care service plan or health insurance
policy begin insert , or that of his or her parent, guardian, or caregiver end insert .

begin delete

(2) The family has an annual gross income that does not exceed
400 percent of the federal poverty level.

end delete begin delete

(3)

end delete

begin insert ( end insert begin insert 2) end insert  There is no other third party having liability for the cost of
the service or support, as provided in subdivision (a) of Section
4659 and Article 2.6 (commencing with Section 4659.10).

begin delete

(b) If a service or support provided to a consumer 18 years of
age or older, pursuant to his or her individual program plan, is paid
for in whole or in part by the consumer’s health care service plan
or health insurance policy, the regional center may, when necessary
to ensure that the consumer receives the service or support, pay
any applicable copayment or coinsurance associated with the
service or support for which the consumer is responsible if both
of the following conditions are met:

(1) The consumer has an annual gross income that does not
exceed 400 percent of the federal poverty level.

(2) There is no other third party having liability for the cost of
the service or support, as provided in subdivision (a) of Section
4659 and Article 2.6 (commencing with Section 4659.10).

(c) Notwithstanding paragraph (2) of subdivision (a) or
paragraph (1) of subdivision (b), a regional center may pay a
copayment or coinsurance associated with the health care service
plan or health insurance policy for a service or support provided
pursuant to a consumer’s individual program plan or individualized
family service plan if the family’s or consumer’s income exceeds
400 percent of the federal poverty level, the service or support is
necessary to successfully maintain the child at home or the adult
consumer in the least-restrictive setting, and the parents or
consumer demonstrate one or more of the following:

(1) The existence of an extraordinary event that impacts the
ability of the parent, guardian, or caregiver to meet the care and
supervision needs of the child or impacts the ability of the parent,
guardian, or caregiver, or adult consumer with a health care service
plan or health insurance policy, to pay the copayment or
coinsurance.

(2) The existence of catastrophic loss that temporarily limits
the ability to pay of the parent, guardian, or caregiver, or adult
consumer with a health care service plan or health insurance policy
and creates a direct economic impact on the family or adult
consumer. For purposes of this paragraph, catastrophic loss may
include, but is not limited to, natural disasters and accidents
involving major injuries to an immediate family member.

(3) Significant unreimbursed medical costs associated with the
care of the consumer or another child who is also a regional center
consumer.

(d) The parent, guardian, or caregiver of a consumer or an adult
consumer with a health care service plan or health insurance policy
shall self-certify the family’s gross annual income to the regional
center by providing copies of W-2 Wage Earners Statements,
payroll stubs, a copy of the prior year’s state income tax return,
or other documents and proof of other income.

(e) The parent, guardian, or caregiver of a consumer or an adult
consumer with a health care service plan or health insurance policy
is responsible for notifying the regional center when a change in
income occurs that would result in a change in eligibility for
coverage of the health care service plan or health insurance policy
copayments or coinsurance.

(f) Documentation submitted pursuant to this section shall be
considered records obtained in the course of providing intake,
assessment, and services and shall be confidential pursuant to
Section 4514.

(g) Regional centers shall not pay health care service plan or
health insurance policy deductibles.

end delete begin insert

(b) Notwithstanding subdivision (a), if the cost of a copayment,
coinsurance, or deductible payment associated with a service or
support is more than the cost of directly providing the service or
support, a regional center may directly provide the service or
support in lieu of paying the copayment, coinsurance, or deductible
payment.

end insert begin delete

(h)

end delete

begin insert ( end insert begin insert c) end insert  This section shall not be implemented in a manner that is
inconsistent with the requirements of Part C of the federal
Individuals with Disabilities Education Act (20 U.S.C. Sec. 1431
et seq.).

begin delete

SECTION 1.  

It is the intent of the Legislature to enact
legislation that would remove barriers that restrict access for
regional center consumers to medically necessary services
identified in an individual program plan or individualized family
service plan.

end delete