BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1091|
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UNFINISHED BUSINESS
Bill No: SB 1091
Author: Liu (D)
Amended: 8/18/16
Vote: 21
SENATE INSURANCE COMMITTEE: 8-0, 4/13/16
AYES: Roth, Gaines, Berryhill, Glazer, Hall, Liu, Mitchell,
Wieckowski
NO VOTE RECORDED: Hernandez
SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8
SENATE FLOOR: 37-0, 5/16/16
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hancock,
Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno,
Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Moorlach,
Morrell, Nguyen, Nielsen, Pavley, Roth, Stone, Vidak,
Wieckowski, Wolk
NO VOTE RECORDED: Hall, Pan, Runner
ASSEMBLY FLOOR: 80-0, 8/24/16 - See last page for vote
SUBJECT: Long-term care insurance
SOURCE: Author
DIGEST: This bill establishes minimum standards for alternate
plans of care as provided in long-term care insurance (LTCI)
policies and requires insurers to provide written notice when
they deny a request for treatment for an alternate plan of care.
Assembly Amendments (1) eliminate provisions establishing new
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forms of LTCI; (2) eliminate provisions requiring insurers to
report certain information regarding alternate plans of care to
the California Department of Insurance (CDI); (3) apply the
bill's provisions prospectively; and (4) add definitions and
standards that apply to alternate plans of care.
ANALYSIS:
Existing law:
1)Provides for the regulation of LTCI by CDI and prescribes
various requirements and conditions governing the delivery of
individual or group policies in the state.
2)Requires approval of policy forms and rate schedules by CDI
before the insurer may begin issuing policies based on that
form.
This bill:
1)Makes findings and declarations regarding LTCI coverage.
2)Defines "alternate plan of care" to mean means a plan of care
developed by a licensed health care practitioner that includes
a specification of long-term care services required by an
insured that are not specifically defined as covered services
under the policy.
3)Requires alternate plans of care to be freely agreed to by the
insured, insurers, and licensed health care practitioner.
4)Provides that maximum benefit available under the contract
shall not change based on an insured utilizing an alternate
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plan of care, but provides that the maximum benefit will be
reduced by the amount of any benefits paid under an alternate
plan of care.
5)Provides that coverage for services under an alternate plan of
care shall be in addition to, not in lieu of, covered services
and permits the insured to switch to covered services as a
matter of right, and back to an alternate plan of care if
there is agreement by the licensed health care practitioner
and the insurer.
6)Declares that the bill should not be construed to require an
insurer to include an alternate plan of care in its contracts.
7)Applies the terms of the bill to policies issued on or after
January 1, 2017.
8)Requires insurers to provide written notice to the insured
within 60 days if they deny a request for treatment for an
alternate plan of care.
Background
Long-term care services prescribed by an authorized licensed
professional, such as a medical doctor, are listed in a "plan of
care." Some LTCI policies contain provisions that explicitly
govern "alternate plan of care," that is a plan of care that
includes services not covered in the policy. The insurer will
pay for these services if the insurer, the insured, and the
overseeing health care professional agree to the alternate plan
of care. For example, some insurers will pay for durable
medical equipment or modifications to the home, not otherwise
covered, if the modifications allow the insured to stay in their
own home rather instead of facility care. Existing law does not
explicitly define or address alternate plans of care. This bill
codifies existing practices and requires insurers to provide a
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written explanation to the insured within 60 days once it
determines that an agreement cannot be reached.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:NoLocal: No
SUPPORT: (Verified8/24/16)
California Commission on Aging
California Health Advocates
California Long-term Care Insurance Services
OPPOSITION: (Verified8/24/16)
None received
ARGUMENTS IN SUPPORT: The California Commission on Aging
writes that models for long-term care are shifting away from
institutional care and toward less formalized, home-based care.
As more Californians live longer and require longer periods of
care, alternative plans of care will be a critical piece of the
long-term care regime.
ASSEMBLY FLOOR: 80-0, 8/24/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth
Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper,
Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim,
Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
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Prepared by:Hugh Slayden / INS. / (916) 651-4110
8/25/16 17:54:17
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