SB 163, as amended, Hueso. Developmental services: health insurance payments.
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.
This bill would require a regional center to pay any applicable copayment, coinsurance,begin delete andend deletebegin insert orend insert 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 requirebegin delete a regional centerend deletebegin insert the departmentend insert to establish appropriate application and documentation forms to implement those provisions.
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 is added to the Welfare and
2Institutions Code, 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 consumer’s or his or her parents’ private health insurance
9policy or health care service plan, the regional center shall pay any
10applicable copayment, coinsurance, or deductible associated with
11the service or support for which the consumer and his or her family
12are responsible.
13(b) The regional center shall not impose on the consumer or his
14or her family a share
of cost for, or income requirements relating
15to, payments made pursuant to subdivision (a), and shall not seek
16reimbursement for any payments made pursuant to subdivision
17(a).
18(c) The regional center may pay the family or provide direct
19reimbursement to the provider, or to the health insurer or health
20care service plan, for the payments required under subdivision (a).
21(d) A consumer and his or her family shall provide appropriate
22documentation to affirm that the payments required under
23subdivision (a) are for services that have been established under
24the consumer’s individual program plan or individualized family
25service plan.
26(e) Thebegin delete regional centerend deletebegin insert
departmentend insert shall establish appropriate
27application and documentation forms to implement this section.
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