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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