Special Education and Regional Center Blog
Helping Parents Navigate the Special Education, the Regional Center, and IHSS program.
California state law, AB 107, was passed in June 2017 effecting Regional Center clients under three years old (Early Start). The new law clarifies that for Early Start clients that the Regional Center must pay for needed therapy if the child’s health insurance will not cover the therapy, and if the therapy is identified in the child’s individualized family service plan (“IFSP”).
The background of this law is that Regional Centers are the payor of last resort. Meaning if there are any other agencies available to pay for a service, families must use the other agencies. If there are no other agencies to pay, then the Regional Center must pay.
The issue comes up when Early Start children need therapies. The Regional Center requires families to utilize their private health insurance first. However, sometimes when families attempt to have health insurance pay for these services they are not successful because of lack of provider network, contracting rules, waitlist, time conflicts, etc. The new law states that if insurance will not pay for the therapies or services, Regional Center must provide that the therapy or service is in the child’s Individual Family Service Plan (“IFSP”).
The new law also highlights the need for strategic planning for IFSP meetings. Families to make sure all the child’s services or therapies are identified in the Individual Family Service Plan (“IFSP”), regardless of who is paying for the service or therapy.
If you need help planning for your Individual Family Service Plan (“IFSP”) or help with getting Regional Center to pay for a service or therapy, contact me.
As you might have heard, generally the regional center is the “payer of last resort.” That means that if there is any other “payer” available parents/clients are required to ask that payer to pay first before the regional center will pay for the service or support. Other payers might include health insurance (both private and Medi-Cal), the school district, or other governmental agencies.
For instance, a parent might ask the regional center to pay for speech therapy. Often the regional center will say no because the child’s health insurance will pay for the speech therapy. The problem is that when using health insurance might have a copay or deductible.
The good news is that regional center will pay copays, coinsurance and/or deductibles. (Welfare and Institutions Code Sec. 4659.1(a))
For minors, the Lanterman Act provides that the regional center must pay for copays, deductibles or coinsurance if:
1. If the services is included in the child’s individual program plan (IPP) or individual family services plan (IFSP) and the service is needed to ensure that your child receives the service. Note, you might need to request an IEE or IFSP meeting if the service (e.g. speech therapy) is not in the IPP or IFSP.
2. The child is covered by health insurance policy under his parent or guardian.
3. The family’s annual gross income is at or below 400 percent of the federal poverty level. You can check whether your family’s annual gross income is at or below 400 percent of the federal poverty level here: https://aspe.hhs.gov/poverty-research. (Look on the index for the family size and multiply the poverty guideline by 4.)
4. There is no other third party responsible for the cost. What if the regional center says no to your request to pay for copay or deductible.
For the regional center to pay for the copay or deductible, you should first review your IPP (or IFSP) to see if the service is included in the IPP (or IFSP). If not, you should make a request to your service coordinator to hold an IPP (or IFSP) meeting to add the service and request that the regional center pay the copay or deductible. If the service is included, either request an IPP (or IFSP) meeting to be held to make the request to have the regional center pay for the copay or deductible, or make a written request to your service coordinator to pay for the copay or deductible.
If you request that the regional center to pay for a copay or deductible (or any other service or support), the regional center has 15 days to decide about whether or not to authorize that service. The regional center then has 5 days to send you a notice of action if they are denying your request. After you have received the notice of action denying the paying of copays you have 30 days to request a Fair Hearing.
Feel free to contact me if you have any questions about regional center paying for copays or any other services.