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
begin delete shift administrative responsibilities for the program to the California Department of Aging, and
wouldend delete 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 health care service plan contract or 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
9have 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
begin delete California Department of Agingend delete pursuant to this division.
P3 1(b) Individuals may purchase approved and certified long-term
2care insurance policies or health care service plan contracts which
3cover long-term care services in amounts equal to the resources
4they wish to protect, so long as the amount of insurance purchased
5exceeds the minimum level set by the
begin delete California Department of pursuant to
8(c) The resource protection provided by this division shall be
9effective only for long-term care policies, and health care service
10plan contracts that cover long-term care services, when the policy
11or contract is delivered, issued for delivery, or renewed on July 1,
121993, and thereafter.
Section 22004 of the Welfare and Institutions Code is
14amended to read:
Notwithstanding other provisions of law, the resources,
16to the extent described in subdivision (c), of an individual who
17purchases an approved and certified long-term care insurance
18 policy or health care service plan contract which covers long-term
19care services shall not be considered by:
20(a) The State Department of Health Care Services in
22(1) Medi-Cal eligibility.
23(2) The amount of any Medi-Cal payment.
24(3) The amount of any subsequent recovery by the state of
25payments made for medical services.
26(b) The State Department of Social Services in determining:
27(1) Eligibility for in-home supportive services provided pursuant
28to Article 7 (commencing with Section 12300) of Chapter 3 of
30(2) The amount of any payment for in-home supportive services.
31(c) The resources not to be considered as provided by this
32section shall be equal to, or in some proportion set by the State
33Department of Health Care Services or State Department of Social
34Services that is less than equal to, the amount of long-term care
35insurance payments or benefits made as described in Section 22006.
Section 22005 of the Welfare and Institutions Code is
37amended to read:
begin delete California Department of Agingend delete shall only certify a long-term care
P4 1insurance policy or a health care service plan contract that meets
2the Medi-Cal asset protection requirements.
Section 22005.1 of the Welfare and Institutions Code
4 is amended to read:
begin delete California Department of Agingend delete shall only certify a long-term
7care insurance policy that substantially meets the requirements of
8Chapter 2.6 (commencing with Section 10230) of Part 2 of Division
92 of the Insurance Code, except the requirements of Sections
1010232.1, 10232.2, 10232.8, 10232.9, and 10232.92 of the Insurance
11Code, and that provides all of the items specified in subdivision
begin delete California Department of Agingend delete shall only certify a health care service plan
14contract that has been approved by the Department of Managed
15Health Care pursuant to Chapter 2.2 (commencing with Section
161340) of Division 2 of the Health and Safety Code as providing
17substantially equivalent coverage to that required by Chapter 2.6
18(commencing with Section 10230) of Part 2 of Division 2 of the
19Insurance Code, and that provides all of the items specified in
20subdivision (b). Policies issued by organizations subject to the
21Insurance Code and regulated by the Department of Insurance
22shall also be approved by the Department of Insurance.
23(b) Only policies and contracts that provide all of the following
24items shall be certified by the department:
25(1) Individual assessment and case management by a
26coordinating entity designated and approved by the department.
27(2) Levels and durations of benefits that meet minimum
28standards set by the
begin delete California Department of Agingend delete pursuant to Section 22009.
30(3) Protection against loss of benefits due to inflation. An
31applicant shall be offered, at the time of purchase, the following
33(A) One option no less favorable than that required by Sections
3458050 and 58059 of Title 22 of the California Code of Regulations,
35as those sections existed on January 1, 2015.
36(B) One lower cost option, consistent with the requirements of
37the federal Deficit Reduction Act of 2005 (Public Law 109-171).
2(4) A periodic record issued to the insured including an
3explanation of insurance payments or benefits paid that count
4toward Medi-Cal asset protection under this division.
5(5) Compliance with any other requirements imposed by
6regulations adopted by the State Department of Health Care
begin delete Services, the California Department of Aging,end delete
or the State
8Department of Social Services and consistent with the purposes
9of this division.
Section 22005.2 of the Welfare and Institutions Code
11 is amended to read:
Each organization issuing policies certified by the
begin delete California Department of Agingend delete under this division shall each year contribute to a fund to
15be used for common educational and marketing expenses for
16reaching the target population designated by the California
17Partnership for Long-Term
begin delete Care.end delete The amount of
18each participating issuer’s required annual contribution shall be
19determined by the department and shall not be less than twenty
20thousand dollars ($20,000).
Section 22005.3 is added to the Welfare and
22Institutions Code, to read:
The insurer or producer shall, at the time of
24application, provide to the individual a graph that illustrates the
25difference in premium rates and policy benefits payable in
26accordance with the inflation protection provisions described in
Section 22006 of the Welfare and Institutions Code is
29amended to read:
The State Department of Health Care Services, in
31determining eligibility for Medi-Cal, and the State Department of
32Social Services, in determining eligibility for in-home supportive
33services, shall exclude resources up to, or equal to, the amount of
34insurance payments or benefits paid by approved and certified
35long-term care insurance policies or health care service plan
36contracts which cover long-term care services to the extent that
37the benefits paid are for all of the following:
38(a) In-home supportive services benefits specified in regulations
39adopted by the State Department of Social Services pursuant to
40Section 22009, or those services that Medi-Cal approves or benefits
P6 1that Medi-Cal provides as specified in regulations adopted by the
2State Department of Health Care Services pursuant to Section
4(b) Services delivered to insured individuals at home or in a
5community setting as part of an individual assessment and case
6management program provided by coordinating entities designated
7and approved by the
begin delete California Department of Aging.end delete
9(c) Services the insured individual receives after meeting the
10disability criteria for eligibility for long-term care benefits
11established by the State Department of Health Care Services.
Section 22009 of the Welfare and Institutions Code is
13amended to read:
begin delete California Department of Agingend delete shall adopt regulations to
16implement this division, including, but not limited to, regulations
18(1) The population and age groups that are eligible to participate
19in the program.
20(2) The minimum level of long-term care insurance or long-term
21care coverage included in health care service plan contracts that
22must be purchased to meet the requirement of subdivision (b) of
24(3) (A) The amount and types of services that a long-term care
25insurance policy or health care service plan contract that includes
26long-term care services must cover to meet the requirements of
27this division. The types of policies or plans shall include nursing
28and residential care facility coverage only, home care and
29community-based care coverage only, and comprehensive
31(B) Policies that provide only home care benefits shall include
32coverage for electronic or other devices intended to assist in
33monitoring the health and safety of an insured.
34(4) Which coordinating entities are designated and approved to
35deliver individual assessment and case management services to
36individuals at home or in a community setting, as required by
37subdivision (b) of Section 22006.
38(b) The State Department of Health Care Services shall also
39adopt regulations to implement this division, including, but not
40limited to, regulations that establish:
P7 1(1) The disability criteria for eligibility for long-term care
2benefits as required by subdivision (c) of Section 22006.
3(2) The specific eligibility requirements for receipt of the
4Medi-Cal benefits provided for by the program, and those Medi-Cal
5benefits for which participants in the program shall be eligible.
6(c) The State Department of Social Services shall also
7regulations to implement this division, including, but not limited
8to, regulations that establish:
9(1) The specific eligibility requirements for in-home supportive
11(2) Those in-home supportive services benefits for which
12participants in the program shall be eligible.
13(d) The State Department of Health Care Services and the State
14Department of Social Services shall also jointly adopt regulations
15that provide for the following:
16(1) Continuation of benefits pursuant to Section 22008.5.
17(2) The protection of a participant’s resources pursuant to
18Section 22004, and the ratio of resources to long-term care benefit
19payments as described in subdivision (c) of Section 22004.
20(e) (1) The departments shall adopt emergency regulations
21pursuant to Chapter 3.5 (commencing with Section 11340) of Part
221 of Division 3 of Title 2 of the Government Code to implement
23this division. The adoption of regulations pursuant to this section
24in order to implement this division shall be deemed to be an
25emergency and necessary for the immediate preservation of the
26public peace, health, or safety.
27(2) Notwithstanding Chapter 3.5 (commencing with Section
2811340) of Part 1 of Division 3 of Title 2 of the Government Code,
29emergency regulations adopted pursuant to this section shall not
30be subject to the review and approval of the Office of
31Administrative Law. The regulations shall become effective
32immediately upon filing with the Secretary of State. The regulations
33shall not remain in effect more than 120 days unless the adopting
34agency complies with all of the provisions of Chapter 3.5
35(commencing with Section 11340) as required by subdivision (c)
36of Section 11346.1 of the Government Code.
Section 22010 of the Welfare and Institutions Code
38 is amended to read:
(a) In implementing this division, the
begin delete California
40Department of Agingend delete
P8 1 may contract, on a bid or nonbid basis, with any qualified
2individual, organization, or entity for services needed to implement
3the project, and may negotiate contracts, on a nonbid basis, with
4long-term care insurers, health care service plans, or both, for the
5provision of coverage for long-term care services that will meet
6the certification requirements set forth in Section 22005.1 and the
7other requirements of this division.
8(b) In order to achieve maximum cost savings, the Legislature
9declares that an expedited process for issuing contracts pursuant
10to this division is necessary. Therefore, contracts entered into on
11a nonbid basis pursuant to this section shall be exempt from the
12requirements of Chapter 1 (commencing with Section 10100) and
13Chapter 2 (commencing with Section 10290) of Part 2 of Division
142 of the Public Contract Code.