|BILL AS INTRODUCED||2007-2008|
Introduced by Representative Koch of Barre Town
Subject: Health; insurance; long-term care partnership; Medicaid
Statement of purpose: This bill proposes to enable Vermont to participate in the partnership for long-term care program.
AN ACT RELATING TO LEGISLATION ENABLING THE VERMONT PARTNERSHIP FOR LONG-TERM CARE PROGRAM
It is hereby enacted by the General Assembly of the State of Vermont:
Sec. 1. 33 V.S.A. § 1908a is amended to read:
§ 1908a. VERMONT PARTNERSHIP FOR LONG-TERM CARE
(a) The secretary of human services or his or her designee, in consultation with the commissioner of banking, insurance, securities, and health care administration, shall establish by rule the Vermont partnership for long-term care program.
program shall provide Medicaid extended coverage to an individual receiving
long-term care services
if there is federal participation for such coverage,
and if the individual:
or was covered by a long-term care insurance policy issued under chapter
154 of Title 8
that provides coverage for three years of long-term care
services in an amount which, in combination with other resources available to
the individual, is sufficient to permit the individual to pay for the
individual's own care while the policy remains in force and that is
precertified by the department of banking, insurance, securities, and health
care administration pursuant to subsection (c) of this section; and
any other requirements for approval of participation under the program
; and (3) has
exhausted coverage and benefits under the long-term care insurance policy as
required by the program.
The department of banking, insurance, securities, and health care
administration shall adopt rules for precertification of long-term care
partnership policies and, for the information needed to evaluate
the partnership program, and to establish training requirements for
producers who sell long-term care policies.
(1) The department of banking, insurance, securities, and health care administration shall precertify a policy as a partnership policy only if:
(A) the policy covers an insured person who was a resident of Vermont at the time coverage first became effective under the policy;
(B) the policy meets the definition of a “qualified long-term care insurance policy” pursuant to Section 7702B(b) of the Internal Revenue Code of 1986 (as amended);
(C) the policy issue date is subsequent to the date of approval of the state plan amendment establishing the partnership program;
(D) the policy meets the specific components of the National Association of Insurance Commissioners’ long-term care insurance model act and model regulation listed in 42 U.S.C. § 1396p(b)(5);
(E) the policy includes inflation protection for purchasers age 61 to age 76 and compound annual inflation protection for purchasers under age 61;
department of banking, insurance, securities, and health care administration
consider whether all precertified policies should require: (A)
protection against loss of benefits due to inflation; (B)
coverage of individual assessment and case management; (C) a
minimum level of covered benefits, including coverage of long-term care
services as defined in subsection (g) of this section; (D)
the option of a nonforfeiture benefit; (E) a
level premium; (F)
information to the purchaser about available consumer information and public
education provided by the department of banking, insurance, securities, and
health care administration and the office of Vermont health access; and (G)
program information, using the uniform data set developed by other states with
long-term care partnership programs, and reports necessary to document the
extent of the Medicaid resource protection offered and to evaluate the
partnership for long-term care. (2)
The department of banking, insurance, securities, and health care
administration shall not require all long-term care partnership insurance
policies to be federally tax-qualified long-term care insurance policies.
not impose on partnership policies any requirements affecting policy terms and benefits that are not imposed on all other long-term care policies issued in Vermont.
(3) The rules shall require that any producer who sells long-term care policies be trained in and demonstrate understanding of the protections offered to purchasers of long-term care insurance and how the insurance relates to public and private coverage of long-term care. The commissioner and the department of disabilities, aging, and independent living will provide information concerning the partnership program and the relationship of
long-term care policies to public and private coverage of long-term care, and the department of banking, insurance, securities, and health care administration will ensure this information is incorporated into the producer training.
(d) The secretary or his or her designee may enter into reciprocal agreements with other states to extend the benefits of the Vermont partnership for long-term care program to Vermont residents who had purchased qualified long-term care policies in other states.
(e) The agency and the department of banking, insurance, securities, and health care administration shall make available consumer information regarding the long-term care partnership program. The secretary and commissioner may allocate responsibilities for providing consumer information between the agency and department.
(f) As used in this section:
(1) "Long-term care services" includes care, treatment, maintenance, and services:
(A) provided in a nursing facility;
(B) provided in a residential care home or assisted living residence;
(C) provided by a home care services agency, certified home health agency, or long-term home health care program;
(D) provided by an adult day care program;
(E) provided by a personal care provider licensed or regulated by any other state or local agency; and
(F) such other long-term care services as determined by the secretary or his or her designee for which medical assistance is otherwise available under the Medicaid program.
(2) "Medicaid extended
coverage" means eligibility for medical assistance without regard to
resource requirements of the Medicaid program resources in an amount
equal to the amount of the benefits paid under the long-term care partnership
policy and without regard to the an amount equal to the amount of
the benefits paid under the long-term care partnership policy in any recovery
of medical assistance from the estates of individuals and the any
imposition of liens pursuant to the requirements of the Medicaid program ;
provided, however, that. However, nothing in this section shall
prevent the imposition of a lien or recovery against property of an individual
on account of medical assistance incorrectly paid. Nothing in this section
shall modify what medical assistance is covered by Medicaid.
Sec. 2. State Plan Amendment
No later than February 15, 2007, the agency of human services or designee shall submit an application seeking approval of a state plan amendment that specifies that an amount equal to the benefits paid by certified long-term care insurance partnership policies will be disregarded in Medicaid eligibility determinations and exempted from estate recovery.
The Vermont General Assembly
115 State Street