Amended in Senate August 4, 2014

Amended in Assembly May 23, 2014

Amended in Assembly May 6, 2014

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 to amend begin delete Section end delete begin insert Sections 4519.6 and end insert 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 begin delete copayments. end delete begin insert copayments, coinsurance, and deductibles. 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. begin delete The end delete begin insert Existing law provides that the end insert 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 delete Existing end delete

begin insert Existing end insert law authorizes a regional center to pay any applicable begin delete copayment or coinsurance end delete begin insert copayment, coinsurance, or deductible end insert 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. begin delete Existing law prohibits a regional center from paying health care service plan or health insurance policy deductibles. end delete

This bill would begin insert instead end insert authorize a regional begin delete center, without regard to the family’s or consumer’s annual gross income, end delete begin insert center end insert to pay any applicable begin delete copayment or coinsurance end delete begin insert copayment, coinsurance, or deductible end insert for a service or support required by a consumer’s individual program plan if the begin delete support or end delete service begin insert or support end insert is paid for by the health care service plan or health insurance policy of the consumer or his or her parent, guardian, or caregiver begin insert and, among other things, the family or the person with a health care service plan or health insurance policy, as applicable, has an annual adjusted gross income that does not exceed 400% of the federal poverty level end insert . begin delete 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. end delete

begin insert

Existing law, notwithstanding the provisions described above, authorizes a regional care center to pay an applicable copayment, coinsurance, or deductible if the annual gross income of the family or consumer, as applicable, exceeds 400% 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 that a specified circumstance applies.

end insert begin insert

This bill would instead authorize a regional care center to pay an applicable copayment, coinsurance, or deductible if the family or person with a health care service plan or health insurance policy has an adjusted gross annual income that exceeds 400% of the federal poverty level and the parents or person demonstrates that a specified circumstance applies, including, among other things, that the service or support is necessary to successfully maintain the child at home or the adult consumer in the least restrictive setting and that the payment will maintain third-party liability for the cost of the service or support, as specified, or otherwise limit financial liability to the state.

end insert begin insert

Existing law requires a parent, guardian, or caregiver of a consumer or an adult consumer to self-certify the family’s gross annual income to the regional center for purposes of these provisions by providing specified financial documents.

end insert begin insert

This bill would prohibit any additional financial documentation beyond that which establishes adjusted gross annual income from being required of a parent, guardian, or caregiver of a consumer or adult consumer, except as specified.

end insert begin insert

Existing law requires the department and the regional centers to annually collaborate to determine the most appropriate methods to collect and compile meaningful data in a uniform manner related to the payment of copayments, coinsurance, and deductibles by each regional center, as specified.

end insert begin insert

This bill would require the department to annually report data collected pursuant to these provisions to the Legislature for purposes of examining the feasibility and costs associated with removing the income requirements described above.

end insert

Vote: majority. Appropriation: no. Fiscal committee: yes. 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 4519.6 of the end insert begin insert Welfare and Institutions
Code end insert begin insert is amended to read: end insert

4519.6.  

begin insert

(a) It is the intent of the Legislature to maintain full
access to services provided through an individual program plan
pursuant to this division or through an individualized family service
plan pursuant to the California Early Intervention Services Act
(Title 14 (commencing with Section 95000) of the Government
Code) and to not limit the access of children and adults to services
determined to be a part of an individual program plan or
individualized family service plan based on the payment of
copayments, coinsurance, or deductibles.

end insert

begin insert (b) end insert begin insert   end insert The department and the regional centers shall annually
collaborate to determine the most appropriate methods to collect
and compile meaningful data in a uniform manner, as specified in
Section 4519.5, related to the payment of copayments, coinsurance,
and deductibles by each regional center. begin insert The department shall
annually report data collected pursuant to this subdivision to the
Legislature for purposes of examining the feasibility and costs
associated with removing the income requirements established in
Section 4659.1 during the 2015-16 fiscal year and thereafter. end insert

begin insert

(c) (1) The requirement for submitting a report imposed under
subdivision (b) is inoperative on January 1, 2019, pursuant to
Section 10231.5 of the Government Code.

end insert begin insert

(2) A report submitted pursuant to subdivision (b) shall be
submitted in compliance with Section 9795 of the Government
Code.

end insert

begin insert

begin insert SEC. 2. 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 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, coinsurance, or
deductible associated with the service or support for which the
parent, guardian, or caregiver is responsible if all 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 begin insert adjusted end insert gross income that does
not exceed 400 percent of the federal poverty level.

(3) 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 begin insert or guardian’s end insert 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, coinsurance, or
deductible associated with the service or support for which the
begin delete consumer end delete begin insert person with a health care service plan or health
insurance policy end insert is responsible if both of the following conditions
are met:

(1) The begin delete consumer end delete begin insert person with end insert begin insert a health care service plan or
health insurance policy end insert has an annual begin insert adjusted end insert 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, coinsurance, or 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 begin delete family’s or consumer’s end delete
begin insert family or person with a health care service plan or health
insurance policy has an annual adjusted gross end insert income begin insert that end insert exceeds
400 percent of the federal poverty begin insert level end insert begin delete level, the service or support
is necessary to successfully maintain the child at home or the adult
consumer in the least-restrictive setting, end delete and the begin delete parents or
consumer end delete begin insert parents or person end insert demonstrate one or more of the
following:

begin insert

(1) The service or support is necessary to maintain the child at
home or the adult consumer in the least restrictive setting.

end insert begin insert

(2) The payment will maintain third-party 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), or will
otherwise limit financial liability to the state.

end insert begin delete

(1)

end delete

begin insert (3) end insert  The existence of begin insert a financial hardship or end insert 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, coinsurance, or deductible.

begin delete

(2)

end delete

begin insert (4) end insert  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.

begin delete

(3)

end delete

begin insert (5) end insert  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 begin delete the family’s end delete begin insert his or her adjusted end insert gross annual
income begin insert for purposes of this section end insert 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. begin insert Additional financial
documentation shall not be required unless an exemption is
requested pursuant to subdivision (c). If an exemption is requested,
only documentation necessary to support that request shall be
required to be provided. end insert

(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, coinsurance, or deductibles.

(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) 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.  

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 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) 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 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 subdivision (e), a regional center may pay
a 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 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 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) 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.

(e) Except as provided in subdivision (c), regional centers shall
not pay health care service plan or health insurance policy
deductibles.

(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.).

end delete