SB 1384, as amended, Liu. California Partnership for Long-Term Care Program.
Existing law establishes the California Partnership for Long-Term Care Program 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 Medi-Cal and to provide Medi-Cal 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 provides criteria for certification of a long-term care insurance policy, including a requirement that it provide protection against loss of benefits due to inflation.
This bill would shift administrative responsibilities for the program to the California Department of Aging, and would require 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 nursing and residential care facility coverage only, home care and community-based care coverage only, or comprehensive coverage. The bill would also require that a long-term care insurance policy, as a condition of certification, include specified protections against loss of benefits due to inflation.
Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.
The people of the State of California do enact as follows:
Section 22002 of the Welfare and Institutions
2Code is amended to read:
The State Department of Health Care Services shall
4seek any federal waivers and approvals necessary to accomplish
5the purposes of this division.
Section 22003 of the Welfare and Institutions Code is
7amended to read:
(a) Individuals who participate in the program and
9 have resources above the eligibility levels for receipt of medical
10assistance under Title XIX of the Social Security Act (Subchapter
11XIX (commencing with Section 1396) of Chapter 7 of Title 42 of
12the United States Code) shall be eligible to receive those in-home
13supportive services benefits specified by the State Department of
14Social Services, and those Medi-Cal benefits specified by the State
15Department of Health Care Services, for which they would
16otherwise be eligible, if, prior to becoming eligible for benefits,
17they have purchased a long-term care insurance policy or a health
18care service plan contract covering long-term care that has been
19certified by the California Department of Aging pursuant to this
21(b) Individuals may purchase approved and certified long-term
22care insurance policies or health care service plan contracts which
23cover long-term care services in amounts equal to the resources
24they wish to protect, so long as the amount of insurance purchased
25exceeds the minimum level set by the California Department of
26Aging pursuant to Section 22009.
27(c) The resource protection provided by this division shall be
28effective only for long-term care policies, and health care service
29plan contracts that cover long-term care services, when the policy
30or contract is delivered, issued for delivery, or renewed on July 1,
311993, and thereafter.
Section 22004 of the Welfare and Institutions Code is
2amended to read:
Notwithstanding other provisions of law, the resources,
4to the extent described in subdivision (c), of an individual who
5purchases an approved and certified long-term care insurance
6policy or health care service plan contract which covers long-term
7care services shall not be considered by:
8(a) The State Department of Health Care Services in
10(1) Medi-Cal eligibility.
11(2) The amount of any Medi-Cal payment.
12(3) The amount of any subsequent recovery by the state of
13payments made for medical services.
14(b) The State Department of Social Services in determining:
15(1) Eligibility for in-home supportive services provided pursuant
16to Article 7 (commencing with Section 12300) of Chapter 3 of
18(2) The amount of any payment for in-home supportive services.
19(c) The resources not to be considered as provided by this
20section shall be equal to, or in some proportion set by the State
21Department of Health Care Services or State Department of Social
22Services that is less than equal to, the amount of long-term care
23insurance payments or benefits made as described in Section 22006.
Section 22005 of the Welfare and Institutions Code is
25amended to read:
The California Department of Aging shall only certify
27a long-term care insurance policy or a health care service plan
28contract that meets the Medi-Cal asset protection requirements.
Section 22005.1 of the Welfare and Institutions Code
30 is amended to read:
(a) The California Department of Aging shall only
32certify a long-term care insurance policy that substantially meets
33the requirements of Chapter 2.6 (commencing with Section 10230)
34of Part 2 of Division 2 of the Insurance Code, except the
35requirements of Sections 10232.1, 10232.2, 10232.8, 10232.9, and
3610232.92 of the Insurance Code, and that provides all of the items
37specified in subdivision (b). The California Department of Aging
38shall only certify a health care service plan contract that has been
39approved by the Department of Managed Health Care pursuant to
40Chapter 2.2 (commencing with Section 1340) of Division 2 of the
P4 1Health and Safety Code as providing substantially equivalent
2coverage to that required by Chapter 2.6 (commencing with Section
310230) of Part 2 of Division 2 of the Insurance Code, and that
4provides all of the items specified in subdivision (b). Policies issued
5by organizations subject to the Insurance Code and regulated by
6the Department of Insurance shall also be approved by the
7Department of Insurance.
8(b) Only policies and contracts that provide all of the following
9items shall be certified by the department:
10(1) Individual assessment and case management by a
11coordinating entity designated and approved by the department.
12(2) Levels and durations of benefits that meet minimum
13standards set by the California Department of Aging pursuant to
begin delete(A)end delete begin delete end deleteProtection
against loss of benefits due to begin delete inflation, which
16shall include both of the following:end delete
18(i) One option no less favorable than that required by Section
1910237.1 of the Insurance Code.
24 One lower cost option, consistent with the requirements of
25the federal Deficit Reduction Act of 2005 (Public Law 109-171).
26(B) The insurer or producer shall, at the time of application,
27provide to the consumer an illustration comparing the premium
28rate and benefits of each option over time.
29(4) A periodic record issued to the insured including an
30explanation of insurance payments or benefits paid that count
31toward Medi-Cal asset protection under this division.
32(5) Compliance with any other requirements
33regulations adopted by the State Department of Health Care
34Services, the California Department of Aging, or the State
35Department of Social Services and consistent with the purposes
36of this division.
Section 22005.2 of the Welfare and Institutions Code
38 is amended to read:
Each organization issuing policies certified by the
40California Department of Aging under this division shall each year
P5 1contribute to a fund to be used for common educational and
2marketing expenses for reaching the target population designated
3by the California Partnership for Long-Term Care. The amount of
4each participating issuer’s required annual contribution shall be
5determined by the department and shall not be less than twenty
6thousand dollars ($20,000).
Section 22006 of the Welfare and Institutions Code is
16amended to read:
The State Department of Health Care Services, in
18determining eligibility for Medi-Cal, and the State Department of
19Social Services, in determining eligibility for in-home supportive
20services, shall exclude resources up to, or equal to, the amount of
21insurance payments or benefits paid by approved and certified
22long-term care insurance policies or health care service plan
23contracts which cover long-term care services to the extent that
24the benefits paid are for all of the following:
25(a) In-home supportive services benefits specified in regulations
26adopted by the State Department of Social Services pursuant to
27Section 22009, or those services that Medi-Cal approves or benefits
28that Medi-Cal provides as specified in regulations adopted by the
29State Department of Health Care Services pursuant to Section
31(b) Services delivered to insured individuals at home or in a
32community setting as part of an individual assessment and case
33management program provided by coordinating entities designated
34and approved by the California Department of Aging.
35(c) Services the insured individual receives after meeting the
36disability criteria for eligibility for long-term care benefits
37established by the State Department of Health Care Services.
Section 22009 of the Welfare and Institutions Code is
40amended to read:
(a) The California Department of Aging shall adopt
2regulations to implement this division, including, but not limited
3to, regulations that establish:
4(1) The population and age groups that are eligible to participate
5in the program.
6(2) The minimum level of long-term care insurance or long-term
7care coverage included in health care service plan contracts that
8must be purchased to meet the requirement of subdivision (b) of
10(3) (A) The amount and types of services that a long-term care
11insurance policy or health care service plan contract that includes
12long-term care services must cover to meet the requirements of
13this division. The types of policies or plans shall include nursing
14and residential care facility coverage only, home care and
15community-based care coverage only, and comprehensive
17(B) Policies that provide only home care benefits shall include
18coverage for electronic or other devices intended to assist in
19monitoring the health and safety of an insured.
20(4) Which coordinating entities are designated and approved to
21deliver individual assessment and case management services to
22individuals at home or in a community setting, as required by
23subdivision (b) of Section 22006.
24(b) The State Department of Health Care Services shall also
25adopt regulations to implement this division, including, but not
26limited to, regulations that establish:
27(1) The disability criteria for eligibility for long-term care
28benefits as required by subdivision (c) of Section 22006.
29(2) The specific eligibility requirements for receipt of the
30Medi-Cal benefits provided for by the program, and those Medi-Cal
31benefits for which participants in the program shall be eligible.
32(c) The State Department of Social Services shall also adopt
33regulations to implement this division, including, but not limited
34to, regulations that establish:
35(1) The specific eligibility requirements for in-home supportive
37(2) Those in-home supportive services benefits for which
38participants in the program shall be eligible.
P7 1(d) The State Department of Health Care Services and the State
2Department of Social Services shall also jointly adopt regulations
3that provide for the following:
4(1) Continuation of benefits pursuant to Section 22008.5.
5(2) The protection of a participant’s resources pursuant to
6Section 22004, and the ratio of resources to long-term care benefit
7payments as described in subdivision (c) of Section 22004.
8(e) (1) The departments shall adopt emergency regulations
9pursuant to Chapter 3.5 (commencing with Section 11340) of Part
101 of Division 3 of Title 2 of the Government Code to implement
11this division. The adoption of regulations pursuant to this section
12in order to implement this division shall be deemed to be an
13emergency and necessary for the immediate preservation of the
14public peace, health, or safety.
15(2) Notwithstanding Chapter 3.5 (commencing with Section
1611340) of Part 1 of Division 3 of Title 2 of the Government Code,
17emergency regulations adopted pursuant to this section shall not
18be subject to the review and approval of the Office of
19Administrative Law. The regulations shall become effective
20immediately upon filing with the Secretary of State. The regulations
21shall not remain in effect more than 120 days unless the adopting
22agency complies with all of the provisions of Chapter 3.5
23(commencing with Section 11340) as required by subdivision (c)
24of Section 11346.1 of the Government Code.
Section 22010 of the Welfare and Institutions Code
27 is amended to read:
(a) In implementing this division, the California
29Department of Aging may contract, on a bid or nonbid basis, with
30any qualified individual, organization, or entity for services needed
31to implement the project, and may negotiate contracts, on a nonbid
32basis, with long-term care insurers, health care service plans, or
33both, for the provision of coverage for long-term care services that
34will meet the certification requirements set forth in Section 22005.1
35and the other requirements of this division.
36(b) In order to achieve maximum cost savings, the Legislature
37declares that an expedited process for issuing contracts pursuant
38to this division is necessary. Therefore, contracts entered into on
39a nonbid basis pursuant to this section shall be exempt from the
40requirements of Chapter 1 (commencing with Section 10100) and
P8 1Chapter 2 (commencing with Section 10290) of Part 2 of Division
22 of the Public Contract Code.