FIRST REGULAR SESSION
[PERFECTED]
HOUSE COMMITTEE SUBSTITUTE FOR
94TH GENERAL ASSEMBLY
Reported from the Special Committee on Ticket to Work February 7, 2007 with recommendation that House Committee Substitute for House Bill Nos. 40, 116 & 367 Do Pass. Referred to the Committee on Rules pursuant to Rule 25(21)(f).
Reported from the Committee on Rules February 13, 2007 with recommendation that House Committee Substitute for House Bill Nos. 40, 116 & 367 Do Pass.
Taken up for Perfection February 26, 2007. House Committee Substitute for House Bill Nos. 40, 116 & 367 ordered Perfected and printed, as amended.
D. ADAM CRUMBLISS, Chief Clerk
AN ACT
To repeal sections 135.096, 660.546, 660.547, 660.549, 660.551, 660.553, 660.555, and 660.557, RSMo, and to enact in lieu thereof seven new sections relating to long-term care insurance.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 135.096, 660.546, 660.547, 660.549, 660.551, 660.553, 660.555, and 660.557, RSMo, are repealed and seven new sections enacted in lieu thereof, to be known as sections 135.096, 208.690, 208.692, 208.694, 208.696, 208.698, and 208.699, to read as follows:
135.096. 1. In order to promote personal financial responsibility for long-term health care in this state, for all taxable years beginning after December 31, 1999, a resident individual may deduct from such individual's Missouri taxable income an amount equal to fifty percent of all nonreimbursed amounts paid by such individual for qualified long-term care insurance premiums to the extent such amounts are not included the individual's itemized deductions. For all taxable years beginning after December 31, 2006, a resident individual may deduct from each individual's Missouri taxable income an amount equal to one hundred percent of all nonreimbursed amounts paid by such individual for qualified long-term care insurance premiums to the extent such amounts are not included in the individual's itemized deductions. A married individual filing a Missouri income tax return separately from his or her spouse shall be allowed to make a deduction pursuant to this section in an amount equal to the proportion of such individual's payment of all qualified long-term care insurance premiums. The director of the department of revenue shall place a line on all Missouri individual income tax returns for the deduction created by this section.
2. For purposes of this section, "qualified long-term care insurance" means any policy which meets or exceeds the provisions of sections 376.1100 to 376.1118, RSMo, and the rules and regulations promulgated pursuant to such sections for long-term care insurance. Notwithstanding any other provision of law to the contrary, two or more insurers issuing a qualified long-term care insurance policy shall not act in concert with each other and with others with respect to any matters pertaining to the making of rates or rating systems.
208.690. 1. This act shall be known and may be cited as the "Missouri Long-term Care Partnership Program Act".
2. As used in sections 208.690 to 208.699, the following terms shall mean:
(1) "Asset disregard", the disregard of any assets or resources in an amount equal to the insurance benefit payments that are used on behalf of the individual;
(2) "Missouri Qualified Long-term Care Partnership approved policy", a long-term care insurance policy certified by the director of the department of insurance, financial institutions and professional registration as meeting the requirements of:
(a) The National Association of Insurance Commissioners' Long-term Care Insurance Model Act and Regulation as specified in 42 U.S.C. 1917(b); and
(b) The provisions of Section 6021 of the Federal Deficit Reduction Act of 2005.
(3) "State Medicaid program", the medical assistance program established in this state under Title XIX of the federal Social Security Act;
(4) "State plan amendment", a state Medicaid plan amendment to the federal Department of Health and Human Services that, in determining eligibility for state Medicaid benefits, provides for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a qualified long-term care insurance partnership policy.
208.692. 1. In accordance with Section 6021 of the Federal Deficit Reduction Act of 2005, there is established the Missouri Long-term Care Partnership Program, which shall be administered by the department of social services in conjunction with the department of insurance, financial institutions and professional registration. The program shall:
(1) Provide incentives for individuals to insure against the costs of providing for their long-term care needs;
(2) Provide a mechanism for individuals to qualify for coverage of the cost of their long-term care needs under the state Medicaid program without first being required to substantially exhaust their resources; and
(3) Alleviate the financial burden on the state's Medicaid program by encouraging the pursuit of private initiatives.
2. Upon the exhaustion of benefits or upon the diminishment of assets below the anticipated remaining benefits under a Missouri qualified long-term care partnership approved policy, certain assets of an individual, as provided in subsection 3 of this section, shall be disregarded when determining any of the following:
(1) Medicaid eligibility;
(2) The amount of any Medicaid payment; and
(3) Any subsequent recovery by the state of a payment for medical services.
3. The department of social services shall:
(1) Within one hundred eighty days of the effective date of sections 208.690 to 208.699, make application to the federal Department of Health and Human Services for a state plan amendment to establish a program that, in determining eligibility for state Medicaid benefits, provides for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a qualified long-term care insurance partnership policy; and
(2) Provide information and technical assistance to the department of insurance, financial institutions and professional registration to assure that any individual who sells a qualified long-term care insurance partnership policy receives training and demonstrates evidence of an understanding of such policies and how they relate to other public and private coverage of long-term care.
4. The department of social services shall promulgate rules to implement the provisions of sections 208.690 to 208.699. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions 43 of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2007, shall be invalid and void.
208.694. 1. An individual who is beneficiary of a Missouri qualified long-term care partnership approved policy is eligible for assistance under the state Medicaid program using asset disregard under sections 208.690 to 208.699.
2. If the Missouri long-term care partnership program is discontinued, an individual who purchased a qualified long-term care partnership approved policy prior to the date the program was discontinued shall be eligible to receive asset disregard, as provided by Title VI, Section 6021 of the Federal Deficit Reduction Act of 2005.
3. The department of social services may enter into reciprocal agreements with other states that have asset disregard provisions established under Title VI, Section 6021 of the Federal Deficit Reduction Act of 2005 in order to extend the asset disregard to Missouri residents who purchase long-term care policies in another state.
208.696. 1. The director of the department of insurance, financial institutions and professional registration shall:
(1) Develop requirements to ensure that any individual who sells a qualified long-term care insurance partnership policy receives training and demonstrates evidence of an understanding of such policies and how they relate to other public and private coverage of long-term care;
(2) Impose no requirements affecting the terms or benefits of qualified long-term care partnership policies unless the director imposes such a requirement on all long-term care policies sold in this state, without regard to whether the policy is covered under the partnership or is offered in connection with such partnership; and
(3) Develop a summary notice in clear, easily understood language for the consumer purchasing qualified long-term care insurance partnership policies on the current law pertaining to asset disregard and asset tests.
2. The director of the department of insurance, financial institutions and professional registration shall promulgate rules to carry out the provisions of this section, and on the process for certifying the qualified long-term care partnership policies. Any rule or portion of a rule, as that term is defined in section 536.010, RSMo, that is created under the authority delegated in this section shall become effective only if it complies with and is subject to all of the provisions of chapter 536, RSMo, and, if applicable, section 536.028, RSMo. This section and chapter 536, RSMo, are nonseverable and if any of the powers vested with the general assembly pursuant to chapter 536, RSMo, to review, to delay the effective date, or to disapprove and annul a rule are subsequently held unconstitutional, then the grant of rulemaking authority and any rule proposed or adopted after August 28, 2007, shall be invalid and void.
208.698. The issuers of qualified long-term care partnership policies in this state shall provide regular reports to both the Secretary of the Department of Health and Human Services in accordance with federal law and regulations and to the department of social services and the department of insurance, financial institutions and professional registration as provided in Section 6021 of the Federal Deficit Reduction Act of 2005.
208.699. Under section 23.253, RSMo, of the Missouri sunset act:
(1) The provisions of the new program authorized under sections 208.690 to 208.698 shall sunset automatically six years after the effective date of said sections unless reauthorized by an act of the general assembly; and
(2) If such program is reauthorized, the program authorized under sections 208.690 to 208.698 shall sunset automatically twelve years after the effective date of the reauthorization of sections 208.690 to 208.698; and
(3) Sections 208.690 to 208.698 shall terminate on September first of the calendar year immediately following the calendar year in which the program authorized under said sections is sunset.
[660.546. 1. The department of social services shall coordinate a program entitled the "Missouri Partnership for Long-term Care" whereby private insurance and Medicaid funds shall be combined to finance long-term care. Under such program, an individual may purchase a precertified long-term care insurance policy in an amount commensurate with his resources as defined pursuant to the Medicaid program. Notwithstanding any provision of law to the contrary, the resources of such an individual, to the extent such resources are equal to the amount of long-term care insurance benefit payments as provided in section 660.547, shall not be considered by the department of social services in a determination of:
(1) His eligibility for Medicaid;
(2) The amount of any Medicaid payment.
Any subsequent recovery of a payment for medical services by the state shall be as provided by federal law.
2. Notwithstanding any provision of law to the contrary, for purposes of recovering any medical assistance paid on behalf of an individual who was allowed an asset or resource disregard based on such long-term care insurance policy, the definition of estate shall be expanded to include any other real or personal property and other assets in which the individual has any legal title or interest at the time of death, to the extent of such interest, including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust or other arrangement.]
[660.547. The department of social services shall request appropriate waiver or waivers from the Secretary of the federal Department of Health and Human Services to permit the use of long-term care insurance for the preservation of resources pursuant to section 660.546. Such preservation shall be provided, to the extent approved by the federal Department of Health and Human Services, for any purchaser of a precertified long-term care insurance policy delivered, issued for delivery or renewed within five years after receipt of the federal approval of the waiver, and shall continue for the life of the original purchaser of the policy, provided that he maintains his obligations pursuant to the precertified long-term care insurance policy. Insurance benefit payments made on behalf of a claimant, for payment of services which would be covered under section 208.152, RSMo, shall be considered to be expenditures of resources as required under chapter 208, RSMo, for eligibility for medical assistance to the extent that such payments are:
(1) For services Medicaid approves or covers for its recipients;
(2) In an amount not in excess of the charges of the health services provider;
(3) For nursing home care, or formal services delivered to insureds in the community as part of a care plan approved by a coordination, assessment and monitoring agency licensed pursuant to chapter 198, RSMo; and
(4) For services provided after the individual meets the coverage requirements for long-term care benefits established by the department of social services for this program.
The director of the department of social services shall adopt regulations in accordance with chapter 536, RSMo, to implement the provisions of sections 660.546 to 660.557, relating to determining eligibility of applicants for Medicaid and the coverage requirements for long-term care benefits.]
[660.549. The department of social services shall establish an outreach program to educate consumers to:
(1) The mechanisms for financing long-term; and
(2) The asset protection provided under sections 660.546 to 660.557.]
[660.551. 1. The department of insurance shall precertify long-term care insurance policies which are issued by insurers who, in addition to complying with other relevant laws and regulations:
(1) Alert the purchaser to the availability of consumer information and public education provided by the division of aging and the department of insurance pursuant to sections 660.546 to 660.557;
(2) Offer the option of home- and community-based services in lieu of nursing home care;
(3) Offer automatic inflation protection or optional periodic per diem upgrades until the insured begins to receive long-term care benefits; provided, however, that such inflation protection or upgrades shall not be required of life insurance policies or riders containing accelerated long-term care benefits;
(4) Provide for the keeping of records and an explanation of benefits reports to the insured and the department of insurance on insurance payments which count toward Medicaid resource exclusion; and
(5) Provide the management information and reports necessary to document the extent of Medicaid resource protection offered and to evaluate the Missouri partnership for long-term care including, but not limited to, the information listed in section 660.553.
Included among those policies precertified under this section shall be life insurance policies which offer long-term care either by rider or integrated into the life insurance policy.
2. No policy shall be precertified pursuant to sections 660.546 to 660.557, if it requires prior hospitalization or a prior stay in a nursing home as a condition of providing benefits.
3. The department of insurance may adopt regulations to carry out the provisions of sections 660.546 to 660.557.]
[660.553. The department of insurance shall provide public information to assist individuals in choosing appropriate insurance coverage, and shall establish an outreach program to educate consumers as to:
(1) The need for long-term; and
(2) The availability of long-term care
insurance.]
[660.555. The director of the department of insurance each year, on January first shall report in writing to the department of social services the following information:
(1) The success in implementing the provisions of sections 660.546 to 660.557;
(2) The number of policies precertified pursuant to sections 660.546 to 660.557;
(3) The number of individuals filing consumer complaints with respect to precertified policies; and
(4) The extent and type of benefits paid, in the aggregate, under such policies that could count toward Medicaid resource protection.]
[660.557. The director of the department of social services shall request the federal approvals necessary to carry out the purposes of sections 660.546 to 660.557. Each year on January first, the director of the department of social services shall report in writing to the general assembly on the progress of the program. Such report will include, but not be limited to:
(1) The success in implementing the provisions of sections 660.546 to 660.557;
(2) The number of policies precertified pursuant to sections 660.546 to 660.557;
(3) The number of individuals filing consumer complaints with respect to precertified policies;
(4) The extent and type of benefits paid, in the aggregate, under such policies that could count toward Medicaid resource protection;
(5) Estimates of impact on present and future Medicaid expenditures;
(6) The cost effectiveness of the program; and
(7) A recommendation regarding the appropriateness of continuing the program.]
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