Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 2290
Barcode 953702
CHAMBER ACTION
Senate House
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1 Comm: WD .
04/25/2006 01:54 PM .
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11 The Committee on General Government Appropriations (Baker)
12 recommended the following amendment:
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14 Senate Amendment (with title amendment)
15 Delete everything after the enacting clause
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17 and insert:
18 Section 1. Section 409.9102, Florida Statutes, as
19 created by section 2 of chapter 2005-252, Laws of Florida, is
20 reenacted and amended to read:
21 (Substantial rewording of section. See
22 s. 409.9102, F.S., for present text.)
23 409.9102 Florida Long-Term Care Partnership
24 Program.--The Agency for Health Care Administration, in
25 consultation with the Office of Insurance Regulation and the
26 Department of Children and Family Services, is directed to
27 establish the Florida Long-Term Care Partnership Program, in
28 compliance with the requirements of s. 1917(b) of the Social
29 Security Act, as amended.
30 (1) The program shall:
31 (a) Provide incentives for an individual to obtain or
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 2290
Barcode 953702
1 maintain insurance to cover the cost of long-term care.
2 (b) Provide a mechanism for an individual to qualify
3 for coverage of the costs of long-term care needs under
4 Medicaid without first being required to substantially exhaust
5 his or her assets, including a provision for the disregard of
6 any assets in an amount equal to the insurance benefit
7 payments that are made to or on behalf of an individual who is
8 a beneficiary under the Florida Long-Term Care Partnership
9 Program.
10 (c) Alleviate the financial burden on the state's
11 medical assistance program by encouraging the pursuit of
12 private initiatives.
13 (2) The Agency for Health Care Administration, in
14 consultation with the Office of Insurance Regulation and the
15 Department of Children and Family Services, shall create
16 standards for long-term care partnership plan information
17 distributed to individuals through insurance companies
18 offering approved partnership policies.
19 (3) The Agency for Health Care Administration is
20 authorized to amend the Medicaid state plan and adopt rules
21 pursuant to ss. 120.536(1) and 120.54 to implement this
22 section.
23 (4) The Department of Children and Family Services,
24 when determining eligibility for Medicaid long-term care
25 services for an individual who is the beneficiary of an
26 approved long-term care partnership policy, shall reduce the
27 total countable assets of the individual by an amount equal to
28 the insurance benefit payments that are made to or on behalf
29 of the individual. The department is authorized to adopt rules
30 pursuant to ss. 120.536(1) and 120.54 to implement this
31 subsection.
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 2290
Barcode 953702
1 Section 2. Section 627.94075, Florida Statutes, is
2 created to read:
3 627.94075 Florida Long-Term Care Partnership
4 Program.--
5 (1) The office, in consultation with the Agency for
6 Health Care Administration and the Department of Children and
7 Family Services, is directed to develop standards for the
8 designation of eligible long-term care policies to be issued
9 in accordance with the Florida Long-Term Care Partnership
10 Program as described in s. 409.9102 and a form or forms that
11 shall be used by insurers to assist insureds and the program
12 in making a determination of eligible policies. Insurers, upon
13 request of the office, shall provide information necessary to
14 determine the number of eligible policies, the amount of
15 benefits paid, and the types and kinds of products offered in
16 order to monitor the implementation of the program.
17 (2) The commission may adopt rules pursuant to ss.
18 120.536(1) and 120.54 to implement applicable provisions of
19 the Long-Term Care Partnership Program, establish standards
20 for the determination of whether a policy is eligible for the
21 program, establish the proper reporting of benefits paid under
22 partnership-eligible insurance policies, adopt standardized
23 forms to be used by insurers to provide information to
24 insureds and the program regarding the eligibility of the
25 insurer's long-term care policy as a qualifying or
26 nonqualifying policy with the program, and adopt forms to be
27 filed by insurers to report information requested by the
28 office in connection with the program.
29 Section 3. Sections 1 and 2 of chapter 2005-252, Laws
30 of Florida, are repealed.
31 Section 4. Section 4 of chapter 2005-252, Laws of
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 2290
Barcode 953702
1 Florida, is amended to read:
2 Section 4. This act shall take effect upon becoming a
3 law, except that the amendments to section 409.905, Florida
4 Statutes, and the newly created section 409.9102, Florida
5 Statutes, provided in this act shall take effect contingent
6 upon amendment to section 1917(b)(1)(c) of the Social Security
7 Act by the United States Congress to delete the "May 14,
8 1993," deadline for approval by states of long-term care
9 partnership plans.
10 Section 5. Section 627.94076, Florida Statutes, is
11 created to read:
12 627.94076 Time limit on certain
13 defenses.--Notwithstanding the provisions of s. 627.607, each
14 long-term care insurance policy shall provide that the policy
15 shall be incontestable after the policy has been in force
16 during the lifetime of the insured for a period of 2 years
17 from the date of issuance of the policy, except for nonpayment
18 of premiums.
19 Section 6. Section 627.9403, Florida Statutes, is
20 amended to read:
21 627.9403 Scope.--The provisions of this part shall
22 apply to long-term care insurance policies delivered or issued
23 for delivery in this state, and to policies delivered or
24 issued for delivery outside this state to the extent provided
25 in s. 627.9406, by an insurer, a fraternal benefit society as
26 defined in s. 632.601, a health maintenance organization as
27 defined in s. 641.19, a prepaid health clinic as defined in s.
28 641.402, or a multiple-employer welfare arrangement as defined
29 in s. 624.437. A policy which is advertised, marketed, or
30 offered as a long-term care policy and as a Medicare
31 supplement policy shall meet the requirements of this part and
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Florida Senate - 2006 COMMITTEE AMENDMENT
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1 the requirements of ss. 627.671-627.675 and, to the extent of
2 a conflict, be subject to the requirement that is more
3 favorable to the policyholder or certificateholder. The
4 provisions of this part shall not apply to a continuing care
5 contract issued pursuant to chapter 651 and shall not apply to
6 guaranteed renewable policies issued prior to October 1, 1988.
7 Any limited benefit policy that limits coverage to care in a
8 nursing home or to one or more lower levels of care required
9 or authorized to be provided by this part or by commission
10 rule is a type of long-term care insurance policy that must
11 meet all requirements of this part that apply to long-term
12 care insurance policies, except ss. 627.9407(3)(c), (9),
13 (10)(f), and (12) and 627.94073(2). If the limited benefit
14 policy does not provide coverage for care in a nursing home,
15 but does provide coverage for one or more lower levels of
16 care, the policy shall also be exempt from the requirements of
17 s. 627.9407(3)(d).
18 Section 7. Subsections (1) and (7) of section
19 627.9404, Florida Statutes, are amended to read:
20 627.9404 Definitions.--For the purposes of this part:
21 (1) "Long-term care insurance policy" means any
22 insurance policy or rider advertised, marketed, offered, or
23 designed to provide coverage on an expense-incurred,
24 indemnity, prepaid, or other basis for one or more necessary
25 or medically necessary diagnostic, preventive, therapeutic,
26 curing, treating, mitigating, rehabilitative, maintenance, or
27 personal care services provided in a setting other than an
28 acute care unit of a hospital. Long-term care insurance shall
29 not include any insurance policy which is offered primarily to
30 provide basic Medicare supplement coverage, basic hospital
31 expense coverage, basic medical-surgical expense coverage,
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Florida Senate - 2006 COMMITTEE AMENDMENT
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1 hospital confinement indemnity coverage, major medical expense
2 coverage, disability income protection coverage, accident only
3 coverage, specified disease or specified accident coverage, or
4 limited benefit health insurance coverage not otherwise
5 defined as long-term care insurance.
6 (7) "Limited benefit policy" means any long-term care
7 insurance policy that limits coverage to care in a nursing
8 home or to one or more lower levels of care required or
9 authorized to be provided by this part or by commission rule.
10 Section 8. Subsections (3) and (7) of section
11 627.9407, Florida Statutes, are amended to read:
12 627.9407 Disclosure, advertising, and performance
13 standards for long-term care insurance.--
14 (3) RESTRICTIONS.--A long-term care insurance policy
15 may not:
16 (a) Be canceled, nonrenewed, or otherwise terminated
17 on the grounds of the age or the deterioration of the mental
18 or physical health of the insured individual or
19 certificateholder; however, the office may authorize
20 nonrenewal for an insurer on a statewide basis on terms and
21 conditions determined to be necessary by the office to protect
22 the interests of the insureds, if the insurer demonstrates
23 that renewal will jeopardize the insurer's solvency or that
24 substantial and unexpected loss experience cannot reasonably
25 be mitigated or remedied.
26 (b) Contain a provision establishing a new waiting
27 period in the event existing coverage is converted to or
28 replaced by a new or other form within the same insurer or any
29 affiliated insurer, except with respect to an increase in
30 benefits voluntarily selected by the insured individual or
31 group policyholder.
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 2290
Barcode 953702
1 (c) Restrict its coverage to care only in a nursing
2 home licensed pursuant to part II of chapter 400 or provide
3 significantly more coverage for such care than coverage for
4 lower levels of care. The commission shall adopt rules
5 defining what constitutes significantly more coverage in
6 nursing homes licensed pursuant to part II of chapter 400 than
7 for lower levels of care.
8 (d) Provide coverage for less than 24 consecutive
9 months for nursing home care for each covered person.
10 (d)(e) Contain an elimination period in excess of 180
11 days. As used in this paragraph, the term "elimination period"
12 means the number of days at the beginning of a period of
13 confinement for which no benefits are payable.
14 (7) RATE STRUCTURE.--
15 (a) A long-term care insurance policy may not be
16 issued if the premiums to be charged are calculated to
17 increase based solely on the age of the insured.
18 (b) Any long-term care insurance policy or certificate
19 issued or renewed, at the option of the policyholder or
20 certificateholder, shall make available to the insured the
21 contingent benefit upon lapse as provided in the Long-Term
22 Care Insurance Model Regulation adopted by the National
23 Association of Insurance Commissioners in the second quarter
24 of the year 2000.
25 (c) Any premium increase for existing insureds shall
26 not result in a premium charged the insureds which would
27 exceed the premium charged to a newly issued insurance policy,
28 except to reflect benefit differences. If the insurer is not
29 currently issuing new coverage, the new business rate shall be
30 as published by the office at the rate representing the new
31 business rate of insurers representing 80 percent of the
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Florida Senate - 2006 COMMITTEE AMENDMENT
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1 carriers currently issuing policies with similar coverage as
2 determined by the prior calendar year earned premium.
3 (d) Compliance with the pooling provisions of s.
4 627.410(6)(e)3. shall be determined by pooling the experience
5 of all affiliated insurers.
6 Section 9. Subsection (3) of section 641.2018, Florida
7 Statutes, is amended to read:
8 641.2018 Limited coverage for home health care
9 authorized.--
10 (3) Any contract that limits coverage to home health
11 care benefits as provided in this section must also meet all
12 of the requirements of ss. 627.9403-627.9408 of the Long-Term
13 Care Insurance Act, except s. 627.9407(3)(c), (d), and (9).
14 Section 10. For fiscal year 2006-2007, the sum of
15 $72,500 is appropriated from the Insurance Regulatory Trust
16 Fund to the Office of Insurance Regulation for the purpose of
17 paying the salary and other administrative expenses for one
18 full-time equivalent position to implement the provisions of
19 this act.
20 Section 11. This act shall apply to long-term care
21 insurance policies issued or renewed on or after July 1, 2006.
22 For any long-term care insurance policy issued prior to July
23 1, 2006, the provisions of section 1 of this act shall apply
24 to such policy only upon renewal of such policy on or after
25 July 1, 2008, and the policies shall so provide by endorsement
26 to the policy.
27 Section 12. This act shall take effect July 1, 2006.
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30 ================ T I T L E A M E N D M E N T ===============
31 And the title is amended as follows:
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Florida Senate - 2006 COMMITTEE AMENDMENT
Bill No. SB 2290
Barcode 953702
1 Delete everything before the enacting clause
2
3 and insert:
4 A bill to be entitled
5 An act relating to long-term care insurance;
6 reenacting and amending s. 409.9102, F.S.;
7 directing the Agency for Health Care
8 Administration, in consultation with the Office
9 of Insurance Regulation and the Department of
10 Children and Family Services, to amend the
11 Medicaid state plan that established the
12 Florida Long-Term Care Partnership Program for
13 purposes of compliance with provisions of the
14 Social Security Act; providing duties of the
15 program; requiring consultation with the Office
16 of Insurance Regulation and the Department of
17 Children and Family Services for the creation
18 of standards for certain information; providing
19 rulemaking authority to the agency for
20 implementation of s. 409.9102, F.S.; providing
21 rulemaking authority to the department
22 regarding determination of eligibility for
23 certain services; creating s. 627.94075, F.S.;
24 requiring the office, in consultation with the
25 agency and the department, to develop standards
26 for designation of eligible long-term care
27 policies and related forms; providing
28 rulemaking authority to the Financial Services
29 Commission for the implementation of the
30 Long-Term Care Partnership Program; repealing
31 ss. 1 and 2 of ch. 2005-252, Laws of Florida,
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Florida Senate - 2006 COMMITTEE AMENDMENT
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1 to delete conflicting provisions relating to
2 determining eligibility for nursing and
3 rehabilitative services and establishing a
4 Long-Term Care Partnership Program which were
5 contingent upon amendment to the Social
6 Security Act; amending s. 4 of ch. 2005-252,
7 Laws of Florida, to delete a contingency in an
8 effective date; creating s. 627.94076, F.S.;
9 requiring long-term care insurance policies to
10 provide for policy incontestability after a
11 certain time; providing an exception; amending
12 s. 627.9403, F.S.; specifying that certain
13 limited benefit policies are a type of
14 long-term care insurance policy; deleting an
15 exemption from a minimum time period coverage
16 requirement for certain limited benefit
17 policies; amending s. 627.9404, F.S.; revising
18 certain definitions; amending s. 627.9407,
19 F.S.; revising certain restrictions on
20 long-term care insurance policies; providing
21 additional rate structure requirements for
22 long-term care insurance policies; amending s.
23 641.2018, F.S.; correcting a cross-reference;
24 providing an appropriation; providing
25 application; providing an effective date.
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