AB 2299, as amended, Nazarian. Developmental services: 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 deletebegin delete thatend deletebegin insert theend insert 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.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 4659.1 of the Welfare and Institutions
2Code is amended to read:
(a) If a service or support provided pursuant to a
4consumer’s individual program plan under this division or
5individualized family service plan pursuant to the California Early
6Intervention Services Act (Title 14 (commencing with Section
795000) of the Government Code) is paid for, in whole or in part,
8by the health care service plan or health insurance policy of the
9consumer or the consumer’s parent, guardian, or caregiver, the
10regional center shall pay any applicable
copayment, coinsurance,
11or deductible associated with the service or support for which the
12consumer or the parent, guardian, or caregiver is responsible if
13both of the following conditions are met:
14(1) The consumer is covered by his or her own health care
15service plan or health insurance policy, or that of his or her parent,
16guardian, or caregiver.
17(2) There is no other third party having liability for the cost of
18the service or support, as provided in subdivision (a) of Section
194659 and Article 2.6 (commencing with Section 4659.10).
20(b) Notwithstanding subdivision (a), if the cost of a copayment,
21coinsurance, or deductible payment associated with a service or
22support is more than the cost of
directlybegin delete providingend deletebegin insert purchasingend insert the
23service or support, a regional center may directlybegin delete provideend deletebegin insert purchaseend insert
24 the service or support in lieu of paying the copayment, coinsurance,
25or deductible payment.
P3 1(c) This section shall not be implemented in a manner that is
2inconsistent with the requirements of Part C of the federal
3Individuals with Disabilities Education Act (20 U.S.C. Sec. 1431
4et seq.).
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