Bill Text: CA SB1384 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: California Partnership for Long-Term Care Program.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2016-09-22 - Chaptered by Secretary of State. Chapter 487, Statutes of 2016. [SB1384 Detail]

Download: California-2015-SB1384-Amended.html

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BILL NUMBER: SB 1384	AMENDED
	BILL TEXT

	AMENDED IN SENATE  APRIL 26, 2016
	AMENDED IN SENATE  MARCH 29, 2016

INTRODUCED BY   Senator Liu

                        FEBRUARY 19, 2016

   An act to amend Sections 22002, 22003, 22004, 22005, 22005.1,
22005.2, 22006, 22009, and 22010  of   of, and
to add Section 22005.3 to,  the Welfare and Institutions Code,
relating to long-term care.



	LEGISLATIVE COUNSEL'S DIGEST


   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 
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 1.  Section 22002 of the Welfare and Institutions Code is
amended to read:
   22002.  The State Department of Health Care Services shall seek
any federal waivers and approvals necessary to accomplish the
purposes of this division.
  SEC. 2.  Section 22003 of the Welfare and Institutions Code is
amended to read:
   22003.  (a) Individuals who participate in the program and have
resources above the eligibility levels for receipt of medical
assistance under Title XIX of the Social Security Act (Subchapter XIX
(commencing with Section 1396) of Chapter 7 of Title 42 of the
United States Code) shall be eligible to receive those in-home
supportive services benefits specified by the State Department of
Social Services, and those Medi-Cal benefits specified by the State
Department of Health Care Services, for which they would otherwise be
eligible, if, prior to becoming eligible for benefits, they have
purchased a long-term care insurance policy or a health care service
plan contract covering long-term care that has been certified by the
California Department of Aging pursuant to this division.
   (b) Individuals may purchase approved and certified long-term care
insurance policies or health care service plan contracts which cover
long-term care services in amounts equal to the resources they wish
to protect, so long as the amount of insurance purchased exceeds the
minimum level set by the California Department of Aging pursuant to
Section 22009.
   (c) The resource protection provided by this division shall be
effective only for long-term care policies, and health care service
plan contracts that cover long-term care services, when the policy or
contract is delivered, issued for delivery, or renewed on July 1,
1993, and thereafter.
  SEC. 3.  Section 22004 of the Welfare and Institutions Code is
amended to read:
   22004.  Notwithstanding other provisions of law, the resources, to
the extent described in subdivision (c), of an individual who
purchases an approved and certified long-term care insurance policy
or health care service plan contract which covers long-term care
services shall not be considered by:
   (a) The State Department of Health Care Services in determining:
   (1) Medi-Cal eligibility.
   (2) The amount of any Medi-Cal payment.
   (3) The amount of any subsequent recovery by the state of payments
made for medical services.
   (b) The State Department of Social Services in determining:
   (1) Eligibility for in-home supportive services provided pursuant
to Article 7 (commencing with Section 12300) of Chapter 3 of Division
9.
   (2) The amount of any payment for in-home supportive services.
   (c) The resources not to be considered as provided by this section
shall be equal to, or in some proportion set by the State Department
of Health Care Services or State Department of Social Services that
is less than equal to, the amount of long-term care insurance
payments or benefits made as described in Section 22006.
  SEC. 4.  Section 22005 of the Welfare and Institutions Code is
amended to read:
   22005.  The California Department of Aging shall only certify a
long-term care insurance policy or a health care service plan
contract that meets the Medi-Cal asset protection requirements.
  SEC. 5.  Section 22005.1 of the Welfare and Institutions Code is
amended to read:
   22005.1.  (a) The California Department of Aging shall only
certify a long-term care insurance policy that substantially meets
the requirements of Chapter 2.6 (commencing with Section 10230) of
Part 2 of Division 2 of the Insurance Code, except the requirements
of Sections 10232.1, 10232.2, 10232.8, 10232.9, and 10232.92 of the
Insurance Code, and that provides all of the items specified in
subdivision (b). The California Department of Aging shall only
certify a health care service plan contract that has been approved by
the Department of Managed Health Care pursuant to Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code as providing substantially equivalent coverage to that required
by Chapter 2.6 (commencing with Section 10230) of Part 2 of Division
2 of the Insurance Code, and that provides all of the items
specified in subdivision (b). Policies issued by organizations
subject to the Insurance Code and regulated by the Department of
Insurance shall also be approved by the Department of Insurance.
   (b) Only policies and contracts that provide all of the following
items shall be certified by the department:
   (1) Individual assessment and case management by a coordinating
entity designated and approved by the department.
   (2) Levels and durations of benefits that meet minimum standards
set by the California Department of Aging pursuant to Section 22009.
   (3)  (A)   Protection against
loss of benefits due to  inflation, which shall include both
of the following:   inflation. An applicant shall be
offered, at the time of purchase, the following options: 

   (i) One option no less favorable than that required by Section
10237.1 of the Insurance Code.  
   (A) One option no less favorable than that required by Sections
58050 and 58059 of Title 22 of the California Code of Regulations, as
those sections existed on January 1, 2015.  
   (ii) 
    (B)  One lower cost option, consistent with the
requirements of the federal Deficit Reduction Act of 2005 (Public Law
109-171). 
   (B) The insurer or producer shall, at the time of application,
provide to the consumer an illustration comparing the premium rate
and benefits of each option over time. 
   (4) A periodic record issued to the insured including an
explanation of insurance payments or benefits paid that count toward
Medi-Cal asset protection under this division.
   (5) Compliance with any other requirements imposed by regulations
adopted by the State Department of Health Care Services, the
California Department of Aging, or the State Department of Social
Services and consistent with the purposes of this division.
  SEC. 6.  Section 22005.2 of the Welfare and Institutions Code is
amended to read:
   22005.2.  Each organization issuing policies certified by the
California Department of Aging under this division shall each year
contribute to a fund to be used for common educational and marketing
expenses for reaching the target population designated by the
California Partnership for Long-Term Care. The amount of each
participating issuer's required annual contribution shall be
determined by the department and shall not be less than twenty
thousand dollars ($20,000).
   SEC. 7.    Section 22005.3 is added to the  
Welfare and Institutions Code   , to read:  
   22005.3.  The insurer or producer shall, at the time of
application, provide to the individual a graph that illustrates the
difference in premium rates and policy benefits payable in accordance
with the inflation protection provisions described in Section
22005.1. 
   SEC. 7.  SEC. 8.   Section 22006 of the
Welfare and Institutions Code is amended to read:
   22006.  The State Department of Health Care Services, in
determining eligibility for Medi-Cal, and the State Department of
Social Services, in determining eligibility for in-home supportive
services, shall exclude resources up to, or equal to, the amount of
insurance payments or benefits paid by approved and certified
long-term care insurance policies or health care service plan
contracts which cover long-term care services to the extent that the
benefits paid are for all of the following:
   (a) In-home supportive services benefits specified in regulations
adopted by the State Department of Social Services pursuant to
Section 22009, or those services that Medi-Cal approves or benefits
that Medi-Cal provides as specified in regulations adopted by the
State Department of Health Care Services pursuant to Section 22009.
   (b) Services delivered to insured individuals at home or in a
community setting as part of an individual assessment and case
management program provided by coordinating entities designated and
approved by the California Department of Aging.
   (c) Services the insured individual receives after meeting the
disability criteria for eligibility for long-term care benefits
established by the State Department of Health Care Services.
   SEC. 8.   SEC. 9.   Section 22009 of the
Welfare and Institutions Code is amended to read:
   22009.  (a) The California Department of Aging shall adopt
regulations to implement this division, including, but not limited
to, regulations that establish:
   (1) The population and age groups that are eligible to participate
in the program.
   (2) The minimum level of long-term care insurance or long-term
care coverage included in health care service plan contracts that
must be purchased to meet the requirement of subdivision (b) of
Section 22003.
   (3) (A) The amount and types of services that a long-term care
insurance policy or health care service plan contract that includes
long-term care services must cover to meet the requirements of this
division. The types of policies or plans shall include nursing and
residential care facility coverage only, home care and
community-based care coverage only, and comprehensive coverage.
   (B) Policies that provide only home care benefits shall include
coverage for electronic or other devices intended to assist in
monitoring the health and safety of an insured.
   (4) Which coordinating entities are designated and approved to
deliver individual assessment and case management services to
individuals at home or in a community setting, as required by
subdivision (b) of Section 22006.
   (b) The State Department of Health Care Services shall also adopt
regulations to implement this division, including, but not limited
to, regulations that establish:
   (1) The disability criteria for eligibility for long-term care
benefits as required by subdivision (c) of Section 22006.
   (2) The specific eligibility requirements for receipt of the
Medi-Cal benefits provided for by the program, and those Medi-Cal
benefits for which participants in the program shall be eligible.
   (c) The State Department of Social Services shall also adopt
regulations to implement this division, including, but not limited
to, regulations that establish:
   (1) The specific eligibility requirements for in-home supportive
services benefits.
   (2) Those in-home supportive services benefits for which
participants in the program shall be eligible.
   (d) The State Department of Health Care Services and the State
Department of Social Services shall also jointly adopt regulations
that provide for the following:
   (1) Continuation of benefits pursuant to Section 22008.5.
   (2) The protection of a participant's resources pursuant to
Section 22004, and the ratio of resources to long-term care benefit
payments as described in subdivision (c) of Section 22004.
   (e) (1) The departments shall adopt emergency regulations pursuant
to Chapter 3.5 (commencing with Section 11340) of Part 1 of Division
3 of Title 2 of the Government Code to implement this division. The
adoption of regulations pursuant to this section in order to
implement this division shall be deemed to be an emergency and
necessary for the immediate preservation of the public peace, health,
or safety.
   (2) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, emergency
regulations adopted pursuant to this section shall not be subject to
the review and approval of the Office of Administrative Law. The
regulations shall become effective immediately upon filing with the
Secretary of State. The regulations shall not remain in effect more
than 120 days unless the adopting agency complies with all of the
provisions of Chapter 3.5 (commencing with Section 11340) as required
by subdivision (c) of Section 11346.1 of the Government Code.
   SEC. 9.   SEC. 10.   Section 22010 of
the Welfare and Institutions Code is amended to read:
   22010.  (a) In implementing this division, the California
Department of Aging may contract, on a bid or nonbid basis, with any
qualified individual, organization, or entity for services needed to
implement the project, and may negotiate contracts, on a nonbid
basis, with long-term care insurers, health care service plans, or
both, for the provision of coverage for long-term care services that
will meet the certification requirements set forth in Section 22005.1
and the other requirements of this division.
   (b) In order to achieve maximum cost savings, the Legislature
declares that an expedited process for issuing contracts pursuant to
this division is necessary. Therefore, contracts entered into on a
nonbid basis pursuant to this section shall be exempt from the
requirements of Chapter 1 (commencing with Section 10100) and Chapter
2 (commencing with Section 10290) of Part 2 of Division 2 of the
Public Contract Code.