Bill Text: CA AB2299 | 2013-2014 | Regular Session | Amended
Bill Title: Developmental services: health insurance copayments, coinsurance, and deductibles.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2014-08-14 - In committee: Held under submission. [AB2299 Detail]
Download: California-2013-AB2299-Amended.html
BILL NUMBER: AB 2299 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 4, 2014
AMENDED IN ASSEMBLY MAY 23, 2014
AMENDED IN ASSEMBLY MAY 6, 2014
AMENDED IN ASSEMBLY MARCH 28, 2014
INTRODUCED BY Assembly Member Nazarian
FEBRUARY 21, 2014
An act to amend Section Sections 4519.6
and 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 copayments. copayments,
coinsurance, and deductibles.
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. The
Existing law provides that the 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.
Existing
Existing law authorizes a regional center to pay any
applicable copayment or coinsurance copayme
nt, coinsurance, or deductible 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. Existing law prohibits a regional
center from paying health care service plan or health insurance
policy deductibles.
This bill would instead authorize a regional
center, without regard to the family's or consumer's annual gross
income, center to pay any applicable
copayment or coinsurance copayment, coinsurance, or
deductible for a service or support required by a consumer's
individual program plan if the support or service
or support 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 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 doe
s not exceed 400% of the federal poverty level .
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.
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.
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.
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.
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.
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.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 4519.6 of the
Welfare and Institutions Code is amended to read:
4519.6. (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.
(b) 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. The
department shall annually report data collected pursuant to this
subdivision to the Legislature for purpose s 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.
(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.
(2) A report submitted pursuant to subdivision (b) shall be
submitted in compliance with Section 9795 of the Government Code.
SEC. 2. 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, 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 adjusted 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 or guardian'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, coinsurance, or
deductible associated with the service or support for which the
consumer person with a health care service
plan or health insurance policy is responsible if both of the
following conditions are met:
(1) The consumer person with a
health care service plan or health insurance policy has an
annual adjusted 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 family's or consumer's
family or person with a health care service plan or
health insurance policy has an annual adjusted gross income
that exceeds 400 percent of the federal poverty level
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 parents or person demonstrate one or
more of the following:
(1) The service or support is necessary to maintain the child at
home or the adult consumer in the least restrictive setting.
(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.
(1)
(3) The existence of a financial hardship or
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.
(2)
(4) 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)
(5) 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 the family's his or her
adjusted gross annual income for purposes of this section
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.
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.
(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.).
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.).
