BILL NUMBER: AB 2299 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 28, 2014
INTRODUCED BY Assembly Member Nazarian
FEBRUARY 21, 2014
An act to amend Section 4659.1 of the Welfare and
Institutions Code, relating to developmental services.
LEGISLATIVE COUNSEL'S DIGEST
AB 2299, as amended, Nazarian. Developmental services:
individual program plans and individualized family service plans.
health insurance copayments.
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. 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.
This bill would 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.
delete that prohibition against payment of
deductibles and woul d 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.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4659.1 of the
Welfare and Institutions Code is amended to read:
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 the
consumer or the consumer's parent, guardian, or caregiver, the
regional center may, when necessary to ensure that the
consumer receives the service or support, shall
pay any applicable copayment or coinsurance
copayment, coinsurance, or deductible associated with the
service or support for which the consumer or the parent,
guardian, or caregiver is responsible if all
both of the following conditions are met:
(1) The consumer is covered by his or her parent's,
guardian's, or caregiver's own health care
service plan or health insurance policy , or that of
his or her parent, guardian, or caregiver .
(2) The family has an annual gross income that does not exceed 400
percent of the federal poverty level.
(3)
( 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).
(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.
(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.
(h)
( c) 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.).
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.