| Introduced By: Senators Tavares, Goodwin, Connors, Damiani and Polisena |
| Date Introduced: February 12, 1997 |
| Referred To: Senate Committee on Health, Education and Welfare |
It is enacted by the General Assembly as follows
SECTION 1. Title 23 of the General Laws entitled "Health and Safety" is hereby amended by adding thereto the following chapter:
{ADD CHAPTER 69 ADD}
{ADD LONG-TERM CARE ADD}
{ADD 23-69-1. Short title. -- ADD} {ADD This act shall be known and may be cited as the "Rhode Island Partnership for Long-Term Care Act of 1997". ADD}
{ADD 23-69-2. Pilot program established. -- ADD} {ADD The department of
health is hereby authorized to establish and coordinate a pilot program entitled the "Rhode Island 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 assets. Notwithstanding any provision of the general or public laws 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 23-69-3 of this chapter, shall not be considered by the department of health in a determination of (1) his or her eligibility for Medicaid, (2) the amount of any Medicaid payment or (3) in any subsequent recovery by the state of a payment for medical services. ADD}{ADD 23-69-3. Department of health duties. -- ADD} {ADD The department of health shall seek appropriate amendments to its Medicaid regulations and state plan to allow protection of resources and income pursuant to section 23-69-2 of this chapter. Such protection shall be provided, to the extent approved by the federal Health Care Financing Administration, for any purchaser of a precertified long-term care policy delivered, issued for delivery or renewed from the effective date of this chapter, and shall last for the life of the purchaser. Such protection shall be provided under the Medicaid program, or its successor program. Any purchaser of a precertified long-term care policy shall be guaranteed coverage under the Medicaid program, or its successor program, to the extent the individual meets all applicable eligibility requirements for the Medicaid program, or its successor program.
The department of health shall count insurance benefit payments toward resource exclusion to the extent such payments (1) are for services paid for by a precertified long-term care policy; (2) are for the lower of the actual charge and the amount paid by the insurance company; (3) are for nursing home care, or formal services delivered to insureds in the community as part of a care plan approved by the department of health; and (4) are for services provided after the individual meets the coverage requirements for long-term care benefits established by the department of health for this program. The director of the department of health shall adopt regulations to implement the provisions of this chapter relating to determining eligibility of applicants for Medicaid and the coverage requirements for long-term care benefits. ADD}
{ADD 23-69-4. Insurance commissioner -- Duties. -- ADD} {ADD The insurance commissioner shall only precertify long-term care insurance policies which (1) alert the purchaser to the availability of consumer information and public education provided by the department of health pursuant to section 23-69-5 of this chapter; (2) offer the option of home and community-based services in addition to nursing home care; (3) in all home care plans, offer case management services delivered by a coordination, assessment and monitoring agency, licensed pursuant to the general laws, or by a home health care agency separately licensed as a coordination, assessment and monitoring agency pursuant to said chapter; (4) services shall include, but need not be limited to, the development of a comprehensive individualized assessment and care plan and, as needed, the coordination of appropriate services and the monitoring of the delivery of such services;
(5) provide for the keeping of records and an explanation of benefit reports on insurance payments which count toward Medicaid resource exclusion; and (6) provide the management information and reports necessary to document the extent of Medicaid resource protection offered and to evaluate the Rhode Island Partnership for Long-Term Care. No policy shall be precertified if it requires prior hospitalization or a prior stay in a nursing home as a condition of providing benefits. The commissioner may adopt regulations to carry out the precertification provisions of this act. ADD}
{ADD 23-69-5. Department of elderly affairs -- Duties. -- ADD} {ADD The department of elderly affairs shall establish an outreach program to educate consumers as to: (1) the need for long-term care; (2) mechanism for financing such care; (3) the availability of long-term care insurance; and (4) the asset protection provided under this act. The department of elderly affairs shall provide public information to assist individuals in choosing appropriate insurance coverage. ADD}
{ADD 23-69-6. Department of business regulation -- Duties. -- ADD} {ADD The department of business regulation shall seek the foundation funds and federal approvals necessary to carry out the purposes of this chapter. Each year, on January first, the director, or his or her designee, shall report to the general assembly on the progress of the program. Such report shall include: (1) the success in implementing the public and private partnership; (2) the number of policies precertified; (3) the number age, and financial circumstances of individuals purchasing precertified policies; (4) the number of individuals seeking consumer information services; (5) the extent and type of benefits paid under precertified policies that could count toward Medicaid resource protection; (6) estimates of impact on present and future Medicaid expenditures; (7) the cost-effectiveness of the program; and (8) a determination regarding the appropriateness of continuing the program. ADD}
SECTION 2. This act shall take effect upon passage.
* * *
This act would create a pilot program known as the Rhode Island Partnership for Long-Term Care Act of 1997, under which program an individual would be entitled to purchase a precertified long-term care insurance policy, in an amount commensurate with his or her assets. The program would be administered by the Departments of Health, Business Regulation and Elderly Affairs.
This act would take effect upon passage.
