California Legislature—2015–16 Regular Session

Assembly Bill No. 1285

Introduced by Assembly Member Thurmond

February 27, 2015

An act to amend Section 4659 of the Welfare and Institutions Code, relating to developmental services.

LEGISLATIVE COUNSEL’S DIGEST

AB 1285, as introduced, Thurmond. Developmental services: regional centers.

Existing law, the Lanterman Developmental Disabilities Services Act, requires the State Department of Developmental Services to contract with regional centers to provide services and supports to individuals with developmental disabilities and their families, and requires regional centers to identify and pursue all possible sources of funding for consumers receiving those services.

This bill would make technical, nonsubstantive changes to those provisions.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

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

SECTION 1.  

Section 4659 of the Welfare and Institutions Code
is amended to read:

4659.  

(a) Except as otherwise provided in subdivision (b) or
(e), the regional center shall identify and pursue all possible sources
of funding for consumers receiving regional center services. These
sources shall include, but not be limited to, both of the following:

(1) Governmental or other entities or programs required to
provide or pay the cost of providing services, including Medi-Cal,
Medicare, the Civilian Health and Medical Program for Uniform
Services, school districts, and federal supplemental security income
and the state supplementary program.

(2) Private entities, to the maximum extent they are liable for
the cost of services, aid, insurance, or medical assistance to the
consumer.

(b) Any revenues collected by a regional center pursuant to this
section shall be applied against the cost of services prior to use of
regional center funds for those services. This revenue shall not
result in a reduction in the regional center’s purchase of services
budget, except as it relates to federal supplemental security income
and the state supplementary program.

(c) Effective July 1, 2009, notwithstanding any other law or
regulation, regional centers shall not purchase any service that
would otherwise be available from Medi-Cal, Medicare, the
Civilian Health and Medical Program for Uniform Services,
In-Home Support Services, California Children’s Services, private
insurance, or a health care service plan when a consumer or a begin insert end insert
begin insert consumer’s end insert family meets the criteria of this coverage but chooses
not to pursue that coverage. If, on July 1, 2009, a regional center
is purchasing that service as part of a consumer’s individual
program plan (IPP), the prohibition shall take effect on October
1, 2009.

(d) (1) Effective July 1, 2009, notwithstanding any other law
or regulation, a regional center shall not purchase medical or dental
services for a consumer three years of age or older unless the
regional center is provided with documentation of a Medi-Cal,
private insurance, or a health care service plan denial and the
regional center determines that an appeal by the consumer or begin insert the
consumer’s end insert family of the denial does not have merit. If, on July
1, 2009, a regional center is purchasing the service as part of a
consumer’s IPP, this provision shall take effect on August 1, 2009.
Regional centers may pay for medical or dental services during
the following periods:

(A) While coverage is being pursued, but before a denial is
made.

(B) Pending a final administrative decision on the administrative
appeal if the begin insert consumer’s end insert family has provided to the regional center
a verification that an administrative appeal is being pursued.

(C) Until the commencement of services by Medi-Cal, private
insurance, or a health care service plan.

(2) When necessary, the consumer or begin insert the consumer’s end insert family
may receive assistance from the regional center, the Clients’ Rights
Advocate funded by the department, or the state council in pursuing
these appeals.

(e) This section shall not impose any additional liability on the
parents of children with developmental disabilities, or to restrict
eligibility for, or deny services to, any individual who qualifies
for regional center services but is unable to pay.

(f) In order to best utilize generic resources, federally funded
programs, and private insurance programs for individuals with
developmental disabilities, the department and regional centers
shall engage in the following activities:

(1) Within existing resources, the department shall provide
training to regional centers, no less than once every two years, in
the availability and requirements of generic, federally funded and
private programs available to persons with developmental
disabilities, including, but not limited to, eligibility requirements,
the application process and covered services, and the appeal
process.

(2) Regional centers shall disseminate information and training
to all service coordinators regarding the availability and
requirements of generic, federally funded, and private insurance
programs on the local level.