Amended in Senate April 8, 2013

Senate Bill No. 163

Introduced by Senator begin delete Rubio end delete begin insert Hueso end insert

February 1, 2013

An act begin insert to add Section 4659.1 to the Welfare and Institutions Code, end insert relating to begin delete health end delete begin insert developmental services end insert .

LEGISLATIVE COUNSEL’S DIGEST

SB 163, as amended, begin delete Rubio end delete   begin insert Hueso end insert . begin delete Health care coverage: regional center responsibilities. end delete begin insert Developmental services: health insurance payments. end insert

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Under existing law, the Lanterman Developmental Disabilities Services Act, the State Department of Developmental Services is authorized to contract with regional centers to provide services and supports to individuals with developmental disabilities, including, but not limited to, autism. The services and supports to be provided to a regional center consumer are contained in an individual program plan (IPP) or individualized family services plan (IFSP) developed in accordance with prescribed requirements.

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Existing law provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and provides for the regulation of health insurers by the Department of Insurance. Existing law requires those health care service plan contracts and health insurance policies, except as specified, to provide coverage for behavioral health treatment, as defined, for pervasive developmental disorder or autism. Existing law provides, however, that no benefits are required to be provided that exceed the essential health benefits that will be required under specified federal law.

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This bill would declare the intent of the Legislature to enact legislation that would provide clarification for the implementation of those provisions of law with regards to fiscal responsibilities of regional centers that provide services and supports to individuals with developmental disabilities..

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This bill would require a regional center to pay any applicable copayment, coinsurance, and deductible imposed by a health insurance policy or health care service plan for a service or support required by a consumer’s IPP or IFSP, as specified. This bill would prohibit a regional center from imposing on the consumer or his or her family a share of cost for, or income requirements relating to, those payments, and from seeking reimbursement for those payments. This bill would require a regional center to establish appropriate application and documentation forms to implement those provisions.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

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begin insert Section 4659.1 is added to the end insert begin insert Welfare and
Institutions Code end insert begin insert , to read: end insert

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begin insert 4659.1. end insert   

(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 consumer’s or his or her parents’ private health insurance
policy or health care service plan, the regional center shall pay
any applicable copayment, coinsurance, or deductible associated
with the service or support for which the consumer and his or her
family are responsible.

(b) The regional center shall not impose on the consumer or
his or her family a share of cost for, or income requirements
relating to, payments made pursuant to subdivision (a), and shall
not seek reimbursement for any payments made pursuant to
subdivision (a).

(c) The regional center may pay the family or provide direct
reimbursement to the provider, or to the health insurer or health
care service plan, for the payments required under subdivision
(a).

(d) A consumer and his or her family shall provide appropriate
documentation to affirm that the payments required under
subdivision (a) are for services that have been established under
the consumer’s individual program plan or individualized family
service plan.

(e) The regional center shall establish appropriate application
and documentation forms to implement this section.

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SECTION 1.  

It is the intent of the Legislature to enact
legislation that would provide clarification for the implementation
of Senate Bill 946 of the 2011-12 Regular Session with regard to
fiscal responsibilities of regional centers.

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