Bill Text: CA SB163 | 2013-2014 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Developmental services: health insurance payments.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2014-02-03 - Returned to Secretary of Senate pursuant to Joint Rule 56. [SB163 Detail]

Download: California-2013-SB163-Amended.html

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BILL NUMBER: SB 163	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 8, 2013

INTRODUCED BY   Senator  Rubio   Hueso 

                        FEBRUARY 1, 2013

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



	LEGISLATIVE COUNSEL'S DIGEST


   SB 163, as amended,  Rubio   Hueso  .
 Health care coverage: regional center responsibilities.
  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.  
   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.  
   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..  
   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.

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


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 4659.1 is added to the 
 Welfare and Institutions Code   , 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
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.  
  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.