BILL ANALYSIS Ó
AB 2299
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Date of Hearing: May 21, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 2299 (Nazarian) - As Amended: May 6, 2014
Policy Committee: Human
ServicesVote:6 - 0
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill deletes the income limit for a regional center payment
of consumers' coinsurance or copayments, and instead requires a
regional center to pay any copayment, coinsurance, or deductible
required under a health plan or health insurance policy that
provides coverage for services identified in his or her
Individual Program Plan (IPP) or Individualized Family Service
Plan (IFSP).
FISCAL EFFECT
1)Potential ongoing costs in the range of $10 million (GF) to
pay for additional regional center consumers' health insurance
copayments/coinsurance.
2)Potential ongoing costs in the tens of millions (GF) to pay
for regional center consumers' health insurance deductibles.
3)Ongoing administrative costs in the low millions (GF) to
manage payments to families or insurance companies and health
plans by the regional centers.
COMMENTS
1)Purpose . The author notes that since the passage of the
developmental services trailer bill in 2013, families have
been required to pay for services that used to be free to
them. The author states: "There have been several challenges
at the Office of Administrative Hearings by families who
cannot afford the co-pay or deductible. In those cases, judges
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have consistently sided with families and have required the
regional center to either pay the cost of the co-payment or
the full cost of treatment, if the family cannot afford the
deductible. This bill reverses the trailer bill policy and
reinstates the entitlement of the Lanterman Act by expressly
requiring regional centers to pay for co-payments, coinsurance
and deductibles for individuals with developmental
disabilities." This bill seeks to ensure regional center
consumers have full access to services and supports included
in their IPPs and IFSPs that are covered by health care
service plans or health insurance policies.
2)Existing Law . SB 946 (Steinberg), Chapter 650, Statutes of
2011, required health care service plans and health insurance
companies in California to begin covering behavioral health
treatment for pervasive developmental disorders or autism by
July 1, 2012. The coverage mandate resulted in savings to the
state, as regional centers were required to purchase most
behavioral health services provided for in consumers' IPPs and
IFSPs prior to passage of the mandate.
As insurers and health plans began paying for services
pursuant to SB 946 requirements, some families reported their
inability to access behavioral services approved in the
consumer's IPP or IFSP due to the out-of-pocket expenses
related to the insurance coverage. In response, most regional
centers paid copayments and deductibles on a discretionary
basis when a regional center determined that payment was
critical for a consumer to receive the necessary and approved
treatment and services.
This resulted in varied practices regarding copayments and
deductibles between regional centers, and the Department of
Developmental Services (DDS) argued that a clear statewide
policy was needed. The developmental services trailer bill in
the 2013-14 state Budget Act (AB 89, Chapter 25, Statutes of
2013) provided funding to regional centers for the payment of
copayments and coinsurance for families with incomes at or
below 400% of the federal poverty level. It did not authorize
the payment of deductibles.
During the 2013 budget discussions, DDS indicated that
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administering deductible coverage is more complex than
copayments and coinsurance because deductibles are not always
directly linked to utilization of a specific service that is
included in an IPP or IFSP and may apply to an entire family,
not just the developmental services consumer.
3)Regional Centers . The 21 regional centers throughout the state
serve over 260,000 consumers who receive services such as
residential placements, supported living services, respite
care, transportation, day treatment programs, work support
programs, and various social and therapeutic services and
activities. Approximately 1,300 consumers reside at one of
California's four Developmental Centers which provide 24-hour
habilitation and medical and social treatment services.
Services provided to people with developmental disabilities
are determined through an individual planning process.
Planning teams jointly prepare an Individual Program Plan
(IPP) based on the consumer's needs and choices. The Lanterman
Act requires that the IPP promote community integration and
maximize opportunities for each consumer to develop
relationships, be part of community life, increase control
over his or her life, and acquire increasingly positive roles
in the community.
4)Prior Legislation .
a) SB 163 (Hueso) 2013 would have required regional centers
to pay any copayment, coinsurance, or deductible required
under a health plan or health insurance policy that
provides coverage for services included in a regional
center consumer's Individual Program Plan or Individualized
Family Service Plan. The bill was held on the Senate
Appropriations Committee's Suspense File.
b) SB 946 (Steinberg) Chapter 650, Statutes of 2011,
required health care service plans and health insurance
policies to provide coverage for behavioral health
treatment for autism and related disorders.
Analysis Prepared by : Jennifer Swenson / APPR. / (916)
319-2081
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