5304-S2.E AMH DYER H2454.2

E2SSB 5304 - H AMD TO REV COMM AMD (H-2235.7/93) 000363 WITHDRAWN 4-8-93

By Representative Dyer

    On page 150, after line 14 of the amendment, insert the following:

    "NEW SECTION. Sec. 452.  The department of social and health services shall from July 1, 1993, to July 1, 1998, coordinate a pilot 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.

NEW SECTION. Sec. 453.  The department of social and health services shall seek approval and a waiver of appropriate federal medicaid regulations 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 an individual's assets 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.

NEW SECTION. Sec. 454.  (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;

    (c) Provide automatic inflation protection or similar coverage to protect the policyholder from future increases in the cost of long-term care;

    (d) Not require prior hospitalization or confinement in a nursing home as a prerequisite to receiving long-term care benefits; and

    (e) 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.

NEW SECTION. Sec. 455.  The insurance commissioner, in conjunction with the department of social and health services, 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.

NEW SECTION. Sec. 456.  By January 1 of each year, 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.

NEW SECTION. Sec. 457.  Sections 452 through 456 of this act shall constitute a new chapter in Title 48 RCW."

    Renumber the remaining sections consecutively and correct internal references accordingly.

EFFECT:  Establishes long-term care partnership program.  (Similar to HB 1971.)

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