Developmental services: health insurance 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. 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 law authorizes a regional center to pay any applicable copayment, 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. This bill would instead authorize a regional center to pay any applicable copayment, coinsurance, or deductible for a service or support required by a consumer's individual program plan if the 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 does not exceed 400% of the federal poverty level. 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.