BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1091| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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 SB 1091 Page 2 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 SB 1091 Page 3 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 SB 1091 Page 4 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 SB 1091 Page 5 Prepared by:Hugh Slayden / INS. / (916) 651-4110 8/25/16 17:54:17 **** END ****