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BILL AS INTRODUCED 2007-2008

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S.343

Introduced by   Senator Cummings of Washington District

Referred to Committee on

Date:

Subject:  Health; health insurance; long-term care partnership; Medicaid

Statement of purpose:  This bill proposes to enable Vermont's participation in the partnership for long-term care program.

AN ACT RELATING TO THE 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 a manner agreed to by the commissioner of banking, insurance, securities, and health care administration, shall establish by rule on or before January 1, 2009 the Vermont partnership for long-term care program.

(b)  The 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:

(1)  is 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

(2)  meets 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.

(c)(1)  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.

(2)  The department of banking, insurance, securities, and health care administration shall 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 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 satisfies 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. § 1936p(b)(5), or satisfies such additional components as the commissioner of banking, insurance, securities, and health care administration determines to be beneficial to consumers; and

(E)  the policy includes inflation protection for purchasers aged 61 to 76 and compound annual inflation protection for purchasers under age 61.

(3)  The department of banking, insurance, securities, and health care administration shall 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.

(4)  The rules shall require any producer who sells long-term care policies to 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 of banking, insurance, securities, and health care administration; the office of Vermont health access; and the department of disabilities, aging, and independent living shall 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 shall ensure that this information is incorporated into the producer training program.

(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 the 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 imposition of liens pursuant to the requirements of the Medicaid program; provided, however, that 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 July 1, 2008, the secretary of human services or his or her designee, in a manner agreed to by the commissioner of banking, insurance, securities, and health care administration, shall submit an application to the Centers for Medicare and Medicaid Services seeking approval of an amendment to the state Medicaid plan pursuant to 42 U.S.C. § 430.12 specifying that an amount equal to the benefits paid by certified long-term care insurance partnership policies shall be disregarded in Medicaid eligibility determinations and exempted from estate recovery.

Sec. 3.  EFFECTIVE DATE

This act shall take effect upon passage.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us