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SB-255 California Partnership for Long-Term Care Program.(2017-2018)

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Date Published: 03/21/2017 04:00 AM
SB255:v98#DOCUMENT

Amended  IN  Senate  March 20, 2017

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill No. 255


Introduced by Senator Mendoza

February 07, 2017


An act to amend Sections 10232.1 and 10232.81 of the Insurance Code, and to amend Section 22009 of the Welfare and Institutions Code, relating to long-term care, and declaring the urgency thereof, to take effect immediately.


LEGISLATIVE COUNSEL'S DIGEST


SB 255, as amended, Mendoza. 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 program and the Medi-Cal program and to provide 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.
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 also would 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 and various technical nonsubstantive revisions. changes.
This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2/3   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) 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.” A 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) A 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) A 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) A 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 care, community-based services, and residential care facility only policy, certificate, or rider and the words “Home Care, Community-Based 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 care, community-based 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:

(a)Residential care facility services.

(a) Care in a residential care facility.
(b) Home health care.
(c) Adult day care.
(d) Personal care.
(e) Homemaker services.
(f) Hospice services.
(g) Respite care.

SEC. 3.

 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, community-based 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.

SEC. 4.

 This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to more accurately describe long-term care policies that may be submitted for certification by the California Partnership for Long-Term Care Program in the 2017 calendar year, it is necessary for this act to take effect immediately.