H-2041.2 _______________________________________________
SUBSTITUTE HOUSE BILL 1536
_______________________________________________
State of Washington 54th Legislature 1995 Regular Session
By House Committee on Health Care (originally sponsored by Representative Dyer)
Read first time 02/27/95.
AN ACT Relating to the long-term care partnership program; and amending RCW 48.85.010, 48.85.020, 48.85.030, 48.85.040, 48.85.050, and 74.09.585.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1. RCW 48.85.010 and 1993 c 492 s 458 are each amended to read as follows:
The
department of social and health services shall ((from July 1, 1993, to July
1, 1998)), in conjunction with the office of the insurance commissioner,
coordinate a ((pilot)) long-term care insurance program entitled
the Washington long-term care partnership, whereby private insurance and
medicaid funds shall be used to finance long-term care. ((This program must
allow for the exclusion of an individual's assets, as approved by the federal
health care financing administration, in a determination of the individual's
eligibility for medicaid; the amount of any medicaid payment; or any subsequent
recovery by the state for a payment for medicaid services to the extent such
assets are protected by a long-term care insurance policy or contract governed
by chapter 48.84 RCW and meeting the criteria prescribed in this chapter.))
For individuals purchasing a long-term care insurance policy or contract
governed by chapter 48.84 RCW and meeting the criteria prescribed in this
chapter, and any other terms as specified by the office of the insurance
commissioner and the department of social and health services, this program
shall allow for the exclusion of some or all of the individual's assets in
determination of medicaid eligibility as approved by the federal health care
financing administration.
Sec. 2. RCW 48.85.020 and 1993 c 492 s 459 are each amended to read as follows:
The
department of social and health services shall seek approval ((and a waiver
of appropriate federal medicaid regulations)) from the federal health
care financing administration to allow the protection of an individual's
assets as provided in this chapter. The department shall adopt all rules
necessary to implement the Washington long-term care partnership program, which
rules shall permit the exclusion of all or some of an individual's
assets in a manner specified by the department in a determination of
medicaid eligibility to the extent that private long-term care insurance
provides payment or benefits for services ((that medicaid would approve or
cover for medicaid recipients)).
Sec. 3. RCW 48.85.030 and 1993 c 492 s 460 are each amended to read as follows:
(1) The insurance commissioner shall adopt rules defining the criteria that long-term care insurance policies must meet to satisfy the requirements of this chapter. The rules shall provide that all long-term care insurance policies purchased for the purposes of this chapter:
(a) Be guaranteed renewable;
(b)
Provide coverage for ((home and community-based services and)) nursing
home care and provide coverage for an alternative plan of care benefit as
defined by the commissioner;
(c) Provide optional coverage for home and community-based services. Such home and community-based services shall be included in the coverage unless rejected in writing by the applicant;
(d) Provide automatic inflation protection or similar coverage for any policyholder through the age of seventy-nine and made optional at age eighty to protect the policyholder from future increases in the cost of long-term care;
(((d)))
(e) Not require prior hospitalization or confinement in a nursing home
as a prerequisite to receiving long-term care benefits; and
(((e)))
(f) Contain at least a six-month grace period that permits reinstatement
of the policy or contract retroactive to the date of termination if the policy
or contract holder's nonpayment of premiums arose as a result of a cognitive
impairment suffered by the policy or contract holder as certified by a
physician.
(2) Insurers offering long-term care policies for the purposes of this chapter shall demonstrate to the satisfaction of the insurance commissioner that they:
(a) Have procedures to provide notice to each purchaser of the long-term care consumer education program;
(b) Offer case management services;
(c) Have procedures that provide for the keeping of individual policy records and procedures for the explanation of coverage and benefits identifying those payments or services available under the policy that meet the purposes of this chapter;
(d)
Agree to provide the insurance commissioner, on or before September 1 of each
year, an annual report containing ((the following)) information((:
(i)
The number of policies issued and of the policies issued, that number sorted by
issue age;
(ii)
To the extent possible, the financial circumstance of the individuals covered
by such policies;
(iii)
The total number of claims paid; and
(iv)
Of the number of claims paid, the number paid for nursing home care, for home
care services, and community-based services)) derived
from the long-term care partnership long-term care insurance uniform data set
as specified by the office of the insurance commissioner.
Sec. 4. RCW 48.85.040 and 1993 c 492 s 461 are each amended to read as follows:
The
insurance commissioner((, in conjunction with)) shall, with the
cooperation of the department of social and health services and members
of the long-term care insurance industry, ((shall)) develop a
consumer education program designed to educate consumers as to the need for
long-term care, methods for financing long-term care, the availability of
long-term care insurance, and the availability and eligibility requirements of
the asset protection program provided under this chapter.
Sec. 5. RCW 48.85.050 and 1993 c 492 s 462 are each amended to read as follows:
By January 1 of each year until 1998, the insurance commissioner, in conjunction with the department of social and health services, shall report to the legislature on the progress of the asset protection program. The report shall include:
(1) The success of the agencies in implementing the program;
(2) The number of insurers offering long-term care policies meeting the criteria for asset protection;
(3) The number, age, and financial circumstances of individuals purchasing long-term care policies meeting the criteria for asset protection;
(4) The number of individuals seeking consumer information services;
(5) The extent and type of benefits paid by insurers offering policies meeting the criteria for asset protection;
(6) Estimates of the impact of the program on present and future medicaid expenditures;
(7) The cost-effectiveness of the program; and
(8) A determination regarding the appropriateness of continuing the program.
Sec. 6. RCW 74.09.585 and 1989 c 87 s 7 are each amended to read as follows:
(1) The department shall establish standards consistent with section 1917 of the social security act in determining the period of ineligibility for medical assistance due to the transfer of resources.
(2) There shall be no penalty imposed for the transfer of assets that are excluded in a determination of the individual's eligibility for medicaid to the extent such assets are protected by the long-term care insurance policy or contract pursuant to chapter 48.85 RCW.
(3) The department may waive a period of ineligibility if the department determines that denial of eligibility would work an undue hardship.
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