BILL NUMBER: AB 2299	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  MAY 23, 2014
	AMENDED IN ASSEMBLY  MAY 6, 2014
	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: 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  delete the prohibition against payment of
deductibles and would require   authorize  a
regional center, without regard to the family's or consumer's annual
gross income, to pay any applicable copayment  , 
 or  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.  The bill would also authorize a regional
center to pay a deductible associated with those plans or policies
if the service or support is necessary to successfully maintain the
child at home or the adult consumer in the least-restrictive setting
and specified conditions relating to the financial need of the
parent, caregiver, or consumer are satisfied. 
   Vote: majority. Appropriation: no. Fiscal committee: 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's
parent, guardian, or caregiver, 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 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 health care service plan or health insurance policy.

   (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 
 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)   subdivision (e) 
, a regional center may pay a  copayment or coinsurance
  deductible  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   deductible  .
   (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) 
    (d)  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 
    (e)   Except as provided in subdivision  
(c), regional  centers shall not pay health care service plan or
health insurance policy deductibles. 
   (h) 
    (f)  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.    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
shall pay any applicable copayment, coinsurance, or deductible
associated with the service or support for which the consumer or the
parent, guardian, or caregiver is responsible if both of the
following conditions are met:
   (1) The consumer is covered by his or her own health care service
plan or health insurance policy, or that of his or her parent,
guardian, or caregiver.
   (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) 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 purchasing the service or
support, a regional center may directly purchase the service or
support in lieu of paying the copayment, coinsurance, or deductible
payment.
   (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.).