Bill Text

PDF |Add To My Favorites |Track Bill | print page

SB-1248 California Partnership for Long-Term Care Program.(2017-2018)

SHARE THIS:share this bill in Facebookshare this bill in Twitter
Date Published: 04/30/2018 02:00 PM
SB1248:v97#DOCUMENT

Amended  IN  Senate  April 30, 2018
Amended  IN  Senate  April 02, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 1248


Introduced by Senators Gaines and Glazer

February 15, 2018


An act to amend Section Sections 10232.1 and 10232.81 of the Insurance Code, and to amend Sections 22005.1 and 22009 of the Welfare and Institutions Code, relating to long-term care.


LEGISLATIVE COUNSEL'S DIGEST


SB 1248, as amended, Gaines. California Partnership for Long-Term Care Program.
Existing law establishes the California Partnership for Long-Term Care Program, which is administered by the State Department of Health Care Services. The purpose of the program is to link private long-term care insurance and health care service plan contracts that cover long-term care with the In-Home Supportive Services (IHSS) program and the Medi-Cal program, and to provide IHSS and Medi-Cal program benefits to certain individuals who have income and resources above the eligibility levels for receipt of medical assistance, but who have purchased certified private long-term care insurance policies. Existing law prescribes specified criteria for certification of a long-term care insurance policy under the program, including a requirement that the policy provide levels and durations of benefits that meet minimum standards set by the department.
Existing law requires a policy, certificate, or rider in which benefits are limited to the provision of all care settings, except nursing facility care, and that is offered under the California Partnership for Long-Term Care Program to be called a home care and community-based services policy, certificate, or rider. A long-term care policy, certificate, or rider that purports to provide benefits of home and community-based services under the California Partnership for Long-Term Care Program is required to provide specified minimum services, including assisted living facility services and residential care facility services. Existing law includes minimum policy definitions of those facilities. Existing law also requires the department to adopt regulations requiring that a long-term care insurance policy or health care service plan contract that includes long-term care services include, among other specified coverage categories, home care and community-based care coverage only.
This bill would require a policy, certificate, or rider as described above to instead be called a home care, community-based services, and residential care facility only policy, certificate, or rider. The bill would delete assisted living facility services from the list of required minimum services to be provided, and clarify that those required minimum services include care in a residential care facility, and delete the policy definitions. The bill also would make conforming name changes.
This bill would require an insurer to offer an applicant, at the time of purchase, purchase of a long-term care insurance policy, a lifetime maximum benefit that, at the time of purchase, is equivalent in dollars to at least 365 times 70% of the average daily private pay rate for a nursing facility. The bill would also authorize an insurer to offer an applicant at least one lower cost option that provides a per diem benefit of at least $100 per day for a nursing facility, a residential care facility, or home- home care and community-based services, if the policy provides a lifetime maximum benefit of not less than $73,000.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 10232.1 of the Insurance Code is amended to read:

10232.1.
 (a) Every policy that is intended to be a qualified long-term care insurance contract as provided by Public Law 104-191 shall be identified as such by prominently displaying and printing on page one of the policy form and the outline of coverage and in the application the following words: “This contract for long-term care insurance is intended to be a federally qualified long-term care insurance contract and may qualify you for federal and state tax benefits.” Every policy that is not intended to be a qualified long-term care insurance contract as provided by Public Law 104-191 shall be identified as such by prominently displaying and printing on page one of the policy form and the outline of coverage and in the application the following words: “This contract for long-term care insurance is not intended to be a federally qualified long-term care insurance contract.”
(b) Any policy or certificate in which benefits are limited to the provision of institutional care shall be called a “nursing facility and residential care facility only” policy or certificate and the words “Nursing Facility and Residential Care Facility Only” shall be prominently displayed on page one of the form and the outline of coverage. The commissioner may approve alternative wording if it is more descriptive of the benefits.
(c) Any policy or certificate in which benefits are limited to the provision of home care services, including community-based services, shall be called a “home care only” policy or certificate and the words “Home Care Only” shall be prominently displayed on page one of the form and the outline of coverage. The commissioner may approve alternative wording if it is more descriptive of the benefits.
(d) Any policy, certificate, or rider in which benefits are limited to the provision of all care settings, except nursing facility care, and that is offered under the California Partnership for Long-Term Care Program established by Section 22000 of the Welfare and Institutions Code shall be called a home and care, community-based services services, and residential care facility only policy, certificate, or rider and the words “Home and “Home Care, Community-Based Services Services, and Residential Care Facility Only” shall be prominently displayed on the first page of the form and the outline of coverage. The commissioner may approve an alternative version of those words if the alternative version is more descriptive of the benefits provided.
(e) Only those policies or certificates providing benefits for both institutional care and home care may be called “comprehensive long-term care” insurance.

SEC. 2.

 Section 10232.81 of the Insurance Code is amended to read:

10232.81.
 (a)Every long-term care policy, certificate, or rider that purports to provide benefits of home and care, community-based services services, and residential care facility services under the California Partnership for Long-Term Care Program established by Section 22000 of the Welfare and Institutions Code shall provide at least the following:

(1)Residential care facility.

(2)Assisted living facility.

(a) Care in residential care facility.

(3)

(b) Home health care.

(4)

(c) Adult day care.

(5)

(d) Personal care.

(6)

(e) Homemaker services.

(7)

(f) Hospice services.

(8)

(g) Respite care.

(b)For purposes of this section, policy definitions of the benefits described in subdivision (a) may be no more restrictive than the following:

(1)“Residential care facility” means a facility that is licensed as a residential care facility for the elderly or a residential care facility as defined in the Health and Safety Code. Outside California, an eligible provider is a facility that meets licensure standards applicable to the facility, if any, and is engaged primarily in providing ongoing care and related services sufficient to support needs resulting from impairment in activities of daily living or impairment in cognitive ability and which also provides care and services on a 24-hour basis, has a trained and ready-to-respond employee on duty in the facility at all times to provide care and services, provides three meals per day and accommodates special dietary needs, has agreements to ensure that residents receive the medical care services of a physician or nurse in case of emergency, and has appropriate methods and procedures to provide necessary assistance to residents in the management of prescribed medications.

(2)“Assisted living facility” means a facility licensed as an assisted living facility as defined in the Health and Safety Code. Outside California, an eligible provider is a facility that meets licensure standards applicable to the facility, if any, and is engaged primarily in providing food and shelter and providing personal care services, or in administering medication by a person licensed or otherwise authorized to administer the medication.

SECTION 1.SEC. 3.

 Section 22005.1 of the Welfare and Institutions Code is amended to read:

22005.1.
 (a) The State Department of Health Care Services shall only certify a long-term care insurance policy that substantially meets the requirements of Chapter 2.6 (commencing with Section 10231) of Part 2 of Division 2 of the Insurance Code, except the requirements of Sections 10232.1, 10232.2, 10232.8, 10232.9, and 10232.92 of the Insurance Code, and that provides all of the items specified in subdivision (b). The State Department of Health Care Services shall only certify a health care service plan contract that has been approved by the Department of Managed Health Care pursuant to Chapter 2.2 (commencing with Section 1340) of Division 2 of the Health and Safety Code as providing substantially equivalent coverage to that required by Chapter 2.6 (commencing with Section 10231) of Part 2 of Division 2 of the Insurance Code, and that provides all of the items specified in subdivision (b). Policies issued by organizations subject to the Insurance Code and regulated by the Department of Insurance shall also be approved by the Department of Insurance.
(b) Only policies and contracts that provide all of the following items shall be certified by the department:
(1) Individual assessment and case management by a coordinating entity designated and approved by the department.
(2) Levels and durations of benefits that meet minimum standards set by the department pursuant to Section 22009.
(A) An applicant shall be offered, at the time of purchase, a lifetime maximum benefit that, at the time of purchase, is equivalent in dollars to at least 365 times 70 percent of the average daily private pay rate for a nursing facility.
(B) Notwithstanding any other law, and in In addition to subparagraph (A), an applicant may be offered at least one lower cost option that provides a per diem benefit of at least one hundred dollars ($100) per day for a nursing facility, residential care facility, or home- home care and community-based services, if the policy provides a lifetime maximum benefit of not less than seventy-three thousand dollars ($73,000).
(3) Protection against loss of benefits due to inflation. An applicant shall be offered, at the time of purchase, the following options:
(A) One option that provides, at a minimum, protection against inflation that automatically increases benefit levels by 5 percent each year over the previous year, up to an age specified by the program.
(B) At least one lower cost option.
(4) A periodic record issued to the insured including an explanation of insurance payments or benefits paid that count toward Medi-Cal asset protection under this division.
(5) Compliance with any other requirements imposed by regulations adopted by the State Department of Health Care Services or the State Department of Social Services and consistent with the purposes of this division.

SEC. 4.

 Section 22009 of the Welfare and Institutions Code is amended to read:

22009.
 (a) The State Department of Health Care Services shall adopt regulations to implement this division, including, but not limited to, regulations that establish:
(1) The population and age groups that are eligible to participate in the program.
(2) The minimum level of long-term care insurance or long-term care coverage included in health care service plan contracts that must be purchased to meet the requirement of subdivision (b) of Section 22003.
(3) (A)  The amount and types of services that a long-term care insurance policy or health care service plan contract that includes long-term care services must cover to meet the requirements of this division. The types of policies or plans shall include nursing and residential care facility coverage only, home care and care, community-based care services, and residential care facility coverage only, and comprehensive coverage.
(B) Policies that provide only home care benefits shall include coverage for electronic or other devices intended to assist in monitoring the health and safety of an insured.
(4) Which coordinating entities are designated and approved to deliver individual assessment and case management services to individuals at home or in a community setting, as required by subdivision (b) of Section 22006.
(b) The State Department of Health Care Services shall also adopt regulations to implement this division, including, but not limited to, regulations that establish:
(1) The disability criteria for eligibility for long-term care benefits as required by subdivision (c) of Section 22006.
(2) The specific eligibility requirements for receipt of the Medi-Cal benefits provided for by the program, and those Medi-Cal benefits for which participants in the program shall be eligible.
(c) The State Department of Social Services shall also adopt regulations to implement this division, including, but not limited to, regulations that establish:
(1) The specific eligibility requirements for in-home supportive services benefits.
(2) Those in-home supportive services benefits for which participants in the program shall be eligible.
(d) The State Department of Health Care Services and the State Department of Social Services shall also jointly adopt regulations that provide for the following:
(1) Continuation of benefits pursuant to Section 22008.5.
(2) The protection of a participant’s resources pursuant to Section 22004, and the ratio of resources to long-term care benefit payments as described in subdivision (c) of Section 22004.
(e) (1) The departments shall adopt emergency regulations pursuant to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code to implement this division. The adoption of regulations pursuant to this section in order to implement this division shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health, or safety.
(2) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, emergency regulations adopted pursuant to this section shall not be subject to the review and approval of the Office of Administrative Law. The regulations shall become effective immediately upon filing with the Secretary of State. The regulations shall not remain in effect more than 120 days unless the adopting agency complies with all of the provisions of Chapter 3.5 (commencing with Section 11340) as required by subdivision (c) of Section 11346.1 of the Government Code.