HB 947

1
A bill to be entitled
2An act relating to long-term care coverage; reenacting and
3amending s. 409.9102, F.S.; directing the Agency for
4Health Care Administration, in consultation with the
5Office of Insurance Regulation and the Department of
6Children and Family Services, to amend the Medicaid state
7plan that established the Florida Long-Term Care
8Partnership Program for purposes of compliance with
9provisions of the Social Security Act; establishing a
10qualified state Long-Term Care Insurance Partnership
11Program in Florida; providing duties of the program;
12requiring consultation with the Office of Insurance
13Regulation and the Department of Children and Family
14Services for the creation of standards for certain
15information; providing rulemaking authority to the agency
16for implementation of s. 409.9102, F.S.; providing
17rulemaking authority to the department regarding
18determination of eligibility for certain services;
19creating s. 627.94075, F.S.; providing rulemaking
20authority to the Financial Services Commission for the
21implementation of a qualified state Long-Term Care
22Insurance Partnership Program in Florida; repealing ss. 1
23and 2 of ch. 2005-252, Laws of Florida, to delete
24conflicting provisions relating to the determination of
25eligibility for nursing and rehabilitative services and
26the establishment of the Florida Long-Term Care
27Partnership Program that were contingent upon amendment to
28the Social Security Act; amending s. 4 of ch. 2005-252,
29Laws of Florida, to delete a contingency in an effective
30date; requiring the Office of Program Policy Analysis and
31Government Accountability to submit a report on the
32implementation of a qualified state Long-Term Care
33Insurance Partnership Program in Florida to the Governor
34and Legislature; creating s. 627.94076, F.S.; requiring
35long-term care insurance policies to provide
36incontestability after a certain time period; providing an
37exception; amending s. 627.9403, F.S.; specifying that
38certain limited benefit policies are a type of long-term
39care insurance policy; deleting an exemption from a
40minimum time period coverage requirement for certain
41limited benefit policies; amending s. 627.9404, F.S.;
42revising definitions; amending s. 627.9407, F.S.; revising
43certain restrictions on long-term care insurance policies;
44providing additional rate structure requirements for long-
45term care insurance policies; amending s. 641.2018, F.S.;
46correcting a cross-reference; providing application;
47providing an effective date.
48
49Be It Enacted by the Legislature of the State of Florida:
50
51     Section 1.  Section 409.9102, Florida Statutes, as created
52by section 2 of chapter 2005-252, Laws of Florida, is reenacted
53and amended to read:
54(Substantial rewording of section. See
55s. 409.9102, F.S., for present text.)
56     409.9102  A qualified state Long-Term Care Insurance
57Partnership Program in Florida.--The Agency for Health Care
58Administration, in consultation with the Office of Insurance
59Regulation and the Department of Children and Family Services,
60is directed to establish a qualified state Long-Term Care
61Insurance Partnership Program in Florida, in compliance with the
62requirements of s. 1917(b) of the Social Security Act, as
63amended.
64     (1)  The program shall:
65     (a)  Provide incentives for an individual to obtain or
66maintain insurance to cover the cost of long-term care.
67     (b)  Provide a mechanism to qualify for coverage of the
68costs of long-term care needs under Medicaid without first being
69required to substantially exhaust his or her assets, including a
70provision for the disregard of any assets in an amount equal to
71the insurance benefit payments that are made to or on behalf of
72an individual who is a beneficiary under the program.
73     (c)  Alleviate the financial burden on the state's medical
74assistance program by encouraging the pursuit of private
75initiatives.
76     (2)  The Agency for Health Care Administration, in
77consultation with the Office of Insurance Regulation and the
78Department of Children and Family Services, and in accordance
79with federal guidelines, shall create standards for long-term
80care partnership program information distributed to individuals
81through insurance companies offering approved long-term care
82partnership program policies.
83     (3)  The Agency for Health Care Administration is
84authorized to amend the Medicaid state plan and adopt rules
85pursuant to ss. 120.536(1) and 120.54 to implement this section.
86     (4)  The Department of Children and Family Services, when
87determining eligibility for Medicaid long-term care services for
88an individual who is the beneficiary of an approved long-term
89care partnership program policy, shall reduce the total
90countable assets of the individual by an amount equal to the
91insurance benefit payments that are made to or on behalf of the
92individual. The department is authorized to adopt rules pursuant
93to ss. 120.536(1) and 120.54 to implement this subsection.
94     Section 2.  Section 627.94075, Florida Statutes, is created
95to read:
96     627.94075  A qualified state Long-Term Care Insurance
97Partnership Program in Florida.--The commission may adopt rules
98pursuant to ss. 120.536(1) and 120.54 to implement applicable
99provisions of a qualified state Long-Term Care Insurance
100Partnership Program in Florida in accordance with the
101requirements of s. 1917(b) of the Social Security Act, as
102amended, any applicable federal guidelines, and any rules
103necessary to ensure program compliance by insurers as provided
104in s. 409.9102.
105     Section 3.  Sections 1 and 2 of chapter 2005-252, Laws of
106Florida, are repealed.
107     Section 4.  Section 4 of chapter 2005-252, Laws of Florida,
108is amended to read:
109     Section 4.  This act shall take effect upon becoming a law,
110except that the amendments to section 409.905, Florida Statutes,
111and the newly created section 409.9102, Florida Statutes,
112provided in this act shall take effect contingent upon amendment
113to section 1917(b)(1)(c) of the Social Security Act by the
114United States Congress to delete the "May 14, 1993," deadline
115for approval by states of long-term care partnership plans.
116     Section 5.  The Office of Program Policy Analysis and
117Government Accountability is directed to prepare a report on the
118implementation of a qualified state Long-Term Care Insurance
119Partnership Program in Florida. The report shall include data on
120the number and value of policies sold and the geographic areas
121in which the policies were purchased, a demographic description
122of the policyholders, and other information necessary to
123evaluate the program. The report shall be provided to the
124Governor, the President of the Senate, and the Speaker of the
125House of Representatives by January 31, 2009.
126     Section 6.  Section 627.94076, Florida Statutes, is created
127to read:
128     627.94076  Time limit on certain defenses.--Notwithstanding
129the provisions of s. 627.607, each long-term care insurance
130policy shall provide that the policy shall be incontestable
131after it has been in force during the lifetime of the insured
132for a period of 2 years after its date of issue except for
133nonpayment of premiums.
134     Section 7.  Section 627.9403, Florida Statutes, is amended
135to read:
136     627.9403  Scope.--The provisions of this part shall apply
137to long-term care insurance policies delivered or issued for
138delivery in this state, and to policies delivered or issued for
139delivery outside this state to the extent provided in s.
140627.9406, by an insurer, a fraternal benefit society as defined
141in s. 632.601, a health maintenance organization as defined in
142s. 641.19, a prepaid health clinic as defined in s. 641.402, or
143a multiple-employer welfare arrangement as defined in s.
144624.437. A policy which is advertised, marketed, or offered as a
145long-term care policy and as a Medicare supplement policy shall
146meet the requirements of this part and the requirements of ss.
147627.671-627.675 and, to the extent of a conflict, be subject to
148the requirement that is more favorable to the policyholder or
149certificateholder. The provisions of this part shall not apply
150to a continuing care contract issued pursuant to chapter 651 and
151shall not apply to guaranteed renewable policies issued prior to
152October 1, 1988. Any limited benefit policy that limits coverage
153to care in a nursing home or to one or more lower levels of care
154required or authorized to be provided by this part or by
155commission rule is a type of long-term care insurance policy
156that must meet all requirements of this part that apply to long-
157term care insurance policies, except ss. 627.9407(3)(c), (9),
158(10)(f), and (12) and 627.94073(2). If the limited benefit
159policy does not provide coverage for care in a nursing home, but
160does provide coverage for one or more lower levels of care, the
161policy shall also be exempt from the requirements of s.
162627.9407(3)(d).
163     Section 8.  Subsections (1) and (7) of section 627.9404,
164Florida Statutes, are amended to read:
165     627.9404  Definitions.--For the purposes of this part:
166     (1)  "Long-term care insurance policy" means any insurance
167policy or rider advertised, marketed, offered, or designed to
168provide coverage on an expense-incurred, indemnity, prepaid, or
169other basis for one or more necessary or medically necessary
170diagnostic, preventive, therapeutic, curing, treating,
171mitigating, rehabilitative, maintenance, or personal care
172services provided in a setting other than an acute care unit of
173a hospital. Long-term care insurance shall not include any
174insurance policy which is offered primarily to provide basic
175Medicare supplement coverage, basic hospital expense coverage,
176basic medical-surgical expense coverage, hospital confinement
177indemnity coverage, major medical expense coverage, disability
178income protection coverage, accident only coverage, specified
179disease or specified accident coverage, or limited benefit
180health insurance coverage not otherwise defined as long-term
181care insurance.
182     (7)  "Limited benefit policy" means any long-term care
183insurance policy that limits coverage to care in a nursing home
184or to one or more lower levels of care required or authorized to
185be provided by this part or by commission rule.
186     Section 9.  Subsections (3) and (7) of section 627.9407,
187Florida Statutes, are amended to read:
188     627.9407  Disclosure, advertising, and performance
189standards for long-term care insurance.--
190     (3)  RESTRICTIONS.--A long-term care insurance policy may
191not:
192     (a)  Be canceled, nonrenewed, or otherwise terminated on
193the grounds of the age or the deterioration of the mental or
194physical health of the insured individual or certificateholder;
195however, the office may authorize nonrenewal for an insurer on a
196statewide basis on terms and conditions determined to be
197necessary by the office to protect the interests of the
198insureds, if the insurer demonstrates that renewal will
199jeopardize the insurer's solvency or that substantial and
200unexpected loss experience cannot reasonably be mitigated or
201remedied.
202     (b)  Contain a provision establishing a new waiting period
203in the event existing coverage is converted to or replaced by a
204new or other form within the same insurer or any affiliated
205insurer, except with respect to an increase in benefits
206voluntarily selected by the insured individual or group
207policyholder.
208     (c)  Restrict its coverage to care only in a nursing home
209licensed pursuant to part II of chapter 400 or provide
210significantly more coverage for such care than coverage for
211lower levels of care. The commission shall adopt rules defining
212what constitutes significantly more coverage in nursing homes
213licensed pursuant to part II of chapter 400 than for lower
214levels of care.
215     (d)  Provide coverage for less than 24 consecutive months
216for nursing home care for each covered person.
217     (d)(e)  Contain an elimination period in excess of 180
218days. As used in this paragraph, the term "elimination period"
219means the number of days at the beginning of a period of
220confinement for which no benefits are payable.
221     (7)  RATE STRUCTURE.--
222     (a)  A long-term care insurance policy may not be issued if
223the premiums to be charged are calculated to increase based
224solely on the age of the insured.
225     (b)  Any long-term care insurance policy or certificate
226issued or renewed, at the option of the policyholder or
227certificateholder, shall make available to the insured the
228contingent benefit upon lapse as provided in the Long-Term Care
229Insurance Model Regulation adopted by the National Association
230of Insurance Commissioners in the second quarter of the year
2312000.
232     (c)  Any premium increase for existing insureds shall not
233result in a premium charged to the insureds that would exceed
234the premium charged on a newly issued insurance policy, except
235to reflect benefit differences. If the insurer is not currently
236issuing new coverage, the new business rate shall be as
237published by the office at the rate representing the new
238business rate of insurers representing 80 percent of the
239carriers currently issuing policies with similar coverage as
240determined by the prior calendar year earned premium.
241     (d)  Compliance with the pooling provisions of s.
242627.410(6)(e)3. shall be determined by pooling the experience of
243all affiliated insurers.
244     Section 10.  Subsection (3) of section 641.2018, Florida
245Statutes, is amended to read:
246     641.2018  Limited coverage for home health care
247authorized.--
248     (3)  Any contract that limits coverage to home health care
249benefits as provided in this section must also meet all of the
250requirements of ss. 627.9403-627.9408 of the Long-Term Care
251Insurance Act, except s. 627.9407(3)(c), (d), and (9).
252     Section 11.  This act shall apply to long-term care
253insurance policies issued or renewed on or after July 1, 2006.
254For any long-term care insurance policy issued prior to July 1,
2552006, the provisions of section 6 shall apply to such policy
256only upon renewal of such policy on or after July 1, 2008, and
257the policy shall so provide by endorsement to the policy.
258     Section 12.  This act shall take effect upon becoming a
259law.


CODING: Words stricken are deletions; words underlined are additions.