I 

111TH CONGRESS 

2D SESSION H. R. 5890 

To amend the Internal Revenue Code of 1986 and title XIX of the Social 

Security Act to reform the provision of long-term care insurance. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 28, 2010 

Mr. DOGGETT (for himself, Ms. SCHAKOWSKY, Mr. BLUMENAUER, Mr. 

MCDERMOTT, and Ms. EDDIE BERNICE JOHNSON of Texas) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committee on Ways and Means, for 

a period to be subsequently determined by the Speaker, in each case for 

consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend the Internal Revenue Code of 1986 and title 

XIX of the Social Security Act to reform the provision 

of long-term care insurance. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Long-Term Care Insurance Reform Act of 2010’’. 

6 (b) TABLE OF CONTENTS.—The table of contents of 

7 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

TITLE I—NATIONAL MARKET SURVEY; MODEL DISCLOSURES AND 

DEFINITIONS; LTC INSURANCE COMPARE 

Sec. 101. NAIC National Market Survey. 

Sec. 102. Model disclosure form. 

Sec. 103. LTC Insurance Compare. 

TITLE II—IMPROVED STATE CONSUMER PROTECTIONS FOR 

QUALIFIED LONG-TERM CARE INSURANCE CONTRACTS AND 

MEDICAID PARTNERSHIP POLICIES 

Sec. 201. Application of Medicaid partnership required model provisions to all 

tax-qualified long-term care insurance contracts. 

Sec. 202. Streamlined process for applying new or updated model provisions. 

TITLE III—IMPROVED CONSUMER PROTECTIONS FOR MEDICAID 

PARTNERSHIP POLICIES 

Sec. 301. Biennial reports on impact of Medicaid long-term care insurance 

partnerships. 

Sec. 302. Additional consumer protections for Medicaid partnerships. 

Sec. 303. Report to Congress regarding need for minimum annual compound 

inflation protection. 

TITLE IV—PRESERVATION OF STATE AUTHORITY 

Sec. 401. Preservation of State authority. 

1 TITLE I—NATIONAL MARKET 

2 SURVEY; MODEL DISCLO3 SURES AND DEFINITIONS; 

4 LTC INSURANCE COMPARE 

5 SEC. 101. NAIC NATIONAL MARKET SURVEY. 

6 (a) IN GENERAL.—The Secretary shall request the 

7 NAIC to conduct reviews of the national and State-specific 

8 markets for long-term care insurance policies and to sub9 mit reports to the Secretary on the results of such reviews 

10 every 5 years. 

11 (b) CONTENT.—The Secretary shall request that the 

12 reviews include, with respect to the period occurring since 

13 any prior review, analysis of the following: 


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1 (1) Information on key market parameters, in2 cluding the number of carriers offering long-term 

3 care insurance, and the scope of coverage offered 

4 under those policies (such as policies offering nurs5 ing-home only benefits, policies offering comprehen6 sive coverage, cash plans, and reimbursement plans, 

7 and hybrid products in which long-term care benefits 

8 are present). 

9 (2) The number of complaints received and re10 solved, including benefit denials. 

11 (3) The number of policies that have lapsed. 

12 (4) The number of agents trained and whether 

13 the training included competency tests. 

14 (5) The number of policyholders exhausting 

15 benefits. 

16 (6) The number of premium rate increases filed 

17 by carriers on a policy basis with the States, includ18 ing the ranges of the increases approved for or fi19 nally used. 

20 (7) The number of policyholders affected by any 

21 premium rate increases. 

22 (8) Requests for exceptions to State permitted 

23 accounting practices, as defined by the NAIC. 

24 (c) TIMING FOR REVIEWS AND REPORTS.—The Sec25 retary shall request the NAIC to— 


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1 (1) complete the initial market review under 

2 this section not later than 2 years after the date of 

3 enactment of this Act; 

4 (2) submit a report to the Secretary on the re5 sults of the initial review not later than December 

6 31, 2011; and 

7 (3) complete each subsequent review and sub8 mit each subsequent report not later than December 

9 31 of the fifth succeeding year. 

10 The Secretary shall make available to the public the re11 ports submitted by the NAIC under this subsection. 

12 (d) CONSULTATION REQUIRED.—The Secretary shall 

13 request the NAIC to consult with State insurance commis14 sioners, appropriate Federal agencies, issuers of long-term 

15 care insurance, States with experience in long-term care 

16 insurance partnership plans, other States, representatives 

17 of consumer groups, consumers of long-term care insur18 ance policies, and such other stakeholders as the Secretary 

19 or the NAIC determine appropriate, to conduct the market 

20 reviews requested under this section. 

21 (e) DEFINITIONS.—In this section and section 102: 

22 (1) LONG-TERM CARE INSURANCE POLICY.— 

23 The term ‘‘long-term care insurance policy’’— 

24 (A) means— 


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1 (i) a qualified long-term care insur2 ance contract (as defined in section 

3 7702B(b) of the Internal Revenue Code of 

4 1986); and 

5 (ii) a qualified long-term care insur6 ance contract that covers an insured who is 

7 a resident of a State with a qualified State 

8 long-term care insurance partnership 

9 under clause (iii) of section 1917(b)(1)(C) 

10 of the Social Security Act (42 U.S.C. 

11 1396p(b)(1)(C)) or a long-term care insur12 ance policy offered in connection with a 

13 State plan amendment described in clause 

14 (iv) of such section; and 

15 (B) includes any other insurance policy or 

16 rider described in the definition of ‘‘long-term 

17 care insurance’’ in section 4 of the model Act 

18 promulgated by the National Association of In19 surance Commissioners (as adopted December 

20 2006). 

21 (2) NAIC.—The term ‘‘NAIC’’ means the Na22 tional Association of Insurance Commissioners. 

23 (3) SECRETARY.—The term ‘‘Secretary’’ means 

24 the Secretary of Health and Human Services. 


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1 SEC. 102. MODEL DISCLOSURE FORM. 

2 (a) NAIC STUDY AND REPORT ON STATE DISCLO3 SURE REQUIREMENTS FOR LONG-TERM CARE INSUR4 ANCE.— 

5 (1) IN GENERAL.—The Secretary shall request 

6 the NAIC to carry out the activities described in 

7 paragraph (2) and issue the report described in 

8 paragraph (3). 

9 (2) REVIEW AND DEVELOPMENT OF PROPOSED

10 MODEL DISCLOSURE REQUIREMENTS.—The activities 

11 described in this paragraph are the following: 

12 (A) MODEL ACT AND REGULATION DISCLO13 SURE REQUIREMENTS.—Review and describe 

14 disclosure requirements for long-term care in15 surance policies under the Model Act and regu16 lation. 

17 (B) STATE LAW DISCLOSURE REQUIRE18 MENTS.—Review and describe disclosure re19 quirements for long-term care insurance policies 

20 under State laws, including as part of such de21 scription an analysis of the effectiveness of the 

22 various existing disclosures. 

23 (C) LONG-TERM CARE SERVICES.—Review 

24 and describe differences in long-term care serv25 ices, including with respect to providers of such 

26 services and the settings in which such services 


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1 are provided among States and develop stand2 ardized definitions for long-term care services. 

3 (D) IDENTIFICATION OF KEY ISSUES FOR

4 DEVELOPMENT OF MODEL DISCLOSURE MAR5 KETING FORM.—Identify and describe key 

6 issues to consider in the development of a pro7 posed form for marketing long-term care insur8 ance policies. 

9 (3) REPORT.—The report described in this 

10 paragraph is an NAIC White Paper that is issued 

11 not later than 12 months after the date of enact12 ment of this Act and contains the results of the re13 views conducted under paragraph (2) and the de14 scriptions required under that paragraph. 

15 (b) NAIC WORKING GROUP TO DEVELOP MODEL

16 DISCLOSURE FORM FOR LONG-TERM CARE INSUR17 ANCE.— 

18 (1) IN GENERAL.—The Secretary shall request 

19 the NAIC to establish, not later than 60 days after 

20 the date on which the NAIC White Paper described 

21 in subsection (a)(3) is issued and in consultation 

22 with the Secretary and the Secretary of the Treas23 ury, a Working Group to develop a model disclosure 

24 form for marketing long-term care insurance poli25 cies. 


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1 (2) WORKING GROUP MEMBERS.—The Working 

2 Group established under paragraph (1) shall be com3 posed of the following: 

4 (A) Representatives from State Depart5 ments of Health (or the most appropriate State 

6 agencies with responsibility for oversight of the 

7 provision of long-term care). 

8 (B) Representatives of long-term care pro9 viders and facilities. 

10 (C) Consumer advocates. 

11 (D) Representatives of issuers of long-term 

12 care insurance policies. 

13 (E) Representatives of the NAIC or State 

14 insurance commissioners. 

15 (F) Other experts in long-term care and 

16 long-term care insurance policies selected by the 

17 Secretary and Secretary of the Treasury or the 

18 NAIC. 

19 (3) REQUIREMENTS FOR DEVELOPMENT OF

20 FORM.— 

21 (A) CONSIDERATIONS.—In developing the 

22 model form, the Working Group shall consider 

23 the following: 


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1 (i) Variations among providers, serv2 ices, and facilities in the long-term care 

3 and long-term care insurance markets. 

4 (ii) The results of the reviews and the 

5 descriptions included in the NAIC White 

6 Paper issued under subsection (a)(3). 

7 (iii) Such other information and fac8 tors as the Working Group determines ap9 propriate. 

10 (B) MINIMUM STANDARDS.—The Working 

11 Group shall ensure that the model has— 

12 (i) minimum standard definitions for 

13 coverage of the various types of services 

14 and benefits provided under long-term care 

15 insurance policies; 

16 (ii) minimum standard language for 

17 use by issuers of such policies, and for 

18 agents selling such policies, in explaining 

19 the services and benefits covered under the 

20 policies and restrictions on the services and 

21 benefits; 

22 (iii) minimum standard format, color 

23 and type size for disclosure documents; 

24 and 


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1 (iv) such other minimum standards as 

2 the Working Group determines appro3 priate. 

4 (4) DEADLINE FOR DEVELOPMENT.—The 

5 Working Group shall issue a proposed model disclo6 sure form for marketing long-term care insurance 

7 policies not later than 1 year after the date on which 

8 the Working Group is established. 

9 (5) ADOPTION AND INCORPORATION INTO

10 MODEL ACT AND REGULATION.—The Secretary shall 

11 request the NAIC to amend the Model Act and regu12 lation to incorporate the use of the proposed model 

13 disclosure form issued by the Working Group, not 

14 later than 1 year after the date on which the Work15 ing Group issues the form. 

16 (c) REQUIRED USE OF MODEL DISCLOSURE FORM

17 IN MARKETING LONG-TERM CARE INSURANCE POLI18 CIES.— 

19 (1) APPLICATION TO TAX-QUALIFIED AND MED20 ICAID PARTNERSHIP POLICIES.—Not later than 1 

21 year after the date on which the Working Group 

22 issues the proposed model disclosure form for mar23 keting long-term care insurance policies under sub24 section (b): 


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1 (A) TAX-QUALIFIED POLICIES.—The Sec2 retary of the Treasury shall promulgate a regu3 lation requiring, not later than 1 year after the 

4 date on which the regulation is final, any issuer 

5 of a qualified long-term care insurance contract 

6 (as defined in section 7702B(b) of the Internal 

7 Revenue Code of 1986) to use the proposed 

8 model disclosure form for marketing such con9 tracts, to the extent such disclosure is not in10 consistent with State law. 

11 (B) MEDICAID PARTNERSHIP POLICIES.— 

12 The Secretary shall promulgate a regulation re13 quiring, not later than 1 year after the date on 

14 which the regulation is final, any issuer that 

15 markets a qualified long-term care insurance 

16 contract intended to cover an insured who is a 

17 resident of a State with a qualified State long18 term care insurance partnership under clause 

19 (iii) of section 1917(b)(1)(C) of the Social Se20 curity Act (42 U.S.C. 1396p(b)(1)(C)) or a 

21 long-term care insurance policy offered in con22 nection with a State plan amendment described 

23 in clause (iv) of such section to use the pro24 posed model disclosure form for marketing such 

25 contracts. 


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1 (2) APPLICATION TO ALL OTHER LONG-TERM

2 CARE INSURANCE POLICIES.—Not later than 18 

3 months, or the earliest date on which an amendment 

4 could be enacted for those States with legislatures 

5 which meet only every other year, after the date on 

6 which the NAIC adopts an amended Model Act and 

7 regulation to require the use of the proposed model 

8 disclosure form issued by the Working Group under 

9 subsection (b), each State shall require by statute or 

10 regulation any issuer of a long-term care insurance 

11 policy to use the proposed model disclosure form 

12 when marketing such a policy in the State. 

13 SEC. 103. LTC INSURANCE COMPARE. 

14 (a) IN GENERAL.—Section 6021(d) of the Deficit Re15 duction Act of 2005 (42 U.S.C. 1396p note) is amended— 

16 (1) in paragraph (2)— 

17 (A) in subparagraph (A)— 

18 (i) in clause (ii), by striking ‘‘and’’ at 

19 the end; 

20 (ii) in clause (iii), by striking the pe21 riod at the end and inserting ‘‘; and’’; and 

22 (iii) by adding at the end the fol23 lowing: 

24 ‘‘(iv) establish an Internet directory of 

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1 surance, to be known as ‘LTC Insurance 

2 Compare’, that shall include the following: 

3 ‘‘(I) Comparison tools to assist 

4 consumers in evaluating long-term 

5 care insurance policies (as defined in 

6 subparagraph (D)) with different ben7 efits and features and that allow con8 sumers to compare the price, long9 term premium stability, and carrier fi10 nancial strength of such policies. 

11 ‘‘(II) State-specific information 

12 about the long-term care insurance 

13 policies marketed in a State, including 

14 the following: 

15 ‘‘(aa) Whether a State has 

16 promulgated rate stability provi17 sions or has rate stability proce18 dures in place, and how the 

19 standards or procedures work. 

20 ‘‘(bb) The rating history for 

21 at least the most recent pre22 ceding 5 years for issuers selling 

23 long-term care insurance policies 

24 in the State. 


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1 ‘‘(cc) An appropriate sam2 pling of the policy forms mar3 keted in the State. 

4 ‘‘(III) Links to State information 

5 regarding long-term care under State 

6 Medicaid programs (which may be 

7 provided, as appropriate, through 

8 Internet linkages to the Web sites of 

9 State Medicaid programs) that in10 cludes the following: 

11 ‘‘(aa) The medical assistance 

12 provided under each State’s Med13 icaid program for nursing facility 

14 services and other long-term care 

15 services (including any functional 

16 criteria imposed for receipt of 

17 such services, as reported in ac18 cordance with section 

19 1902(a)(28)(D) of the Social Se20 curity Act) and any differences 

21 from benefits and services offered 

22 under long-term care insurance 

23 policies in the State and the cri24 teria for triggering receipt of 

25 such benefits and services. 


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1 ‘‘(bb) If the State has a 

2 qualified State long-term care in3 surance partnership under clause 

4 (iii) of section 1917(b)(1)(C) of 

5 the Social Security Act (or is ex6 empt from the application of 

7 clause (i) of such section because 

8 of the application of clauses (ii) 

9 and (iv) of such section), infor10 mation regarding how and when 

11 an individual with a partnership 

12 long-term care insurance policy 

13 who is receiving benefits under 

14 the policy should apply for med15 ical assistance for nursing facility 

16 services or other long-term care 

17 services under the State Medicaid 

18 program and information regard19 ing about how Medicaid asset 

20 protection is accumulated over 

21 time.’’; and 

22 (B) by adding at the end the following: 

23 ‘‘(C) CURRENT INFORMATION.—The Sec24 retary of Health and Human Services shall en25 sure that, to the greatest extent practicable, the 


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1 information maintained in the National Clear2 inghouse for Long-Term Care Information, in3 cluding the information required for LTC In4 surance Compare, is the most recent informa5 tion available. 

6 ‘‘(D) LONG-TERM CARE INSURANCE POL7 ICY DEFINED.—In subparagraph (A)(iv), the 

8 term ‘long-term care insurance policy’ means a 

9 qualified long-term care insurance contract (as 

10 defined in section 7702B(b) of the Internal 

11 Revenue Code of 1986), a qualified long-term 

12 care insurance contract that covers an insured 

13 who is a resident of a State with a qualified 

14 State long-term care insurance partnership 

15 under clause (iii) of section 1917(b)(1)(C) of 

16 the Social Security Act (42 U.S.C. 

17 1396p(b)(1)(C)) or a long-term care insurance 

18 policy offered in connection with a State plan 

19 amendment described in clause (iv) of such sec20 tion, and includes any other insurance policy or 

21 rider described in the definition of ‘long-term 

22 care insurance’ in section 4 of the model Act 

23 promulgated by the National Association of In24 surance Commissioners (as adopted December 

25 2006).’’; 


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1 (2) by redesignating paragraph (3) as para2 graph (4); and 

3 (3) by inserting after paragraph (2) the fol4 lowing: 

5 ‘‘(3) CONSULTATION ON LTC INSURANCE COM6 PARE.—The Secretary of Health and Human Serv7 ices shall consult with the National Association of 

8 Insurance Commissioners and other entities and 

9 stakeholders in designing and implementing the 

10 LTC Insurance Compare required under paragraph 

11 (2)(A)(iv).’’. 

12 (b) MEDICAID STATE PLAN REQUIREMENT TO SUB13 MIT NURSING FACILITY SERVICES FUNCTIONAL CRI14 TERIA DATA.—Section 1902(a)(28) of the Social Security 

15 Act (42 U.S.C. 1396a(a)(28)) is amended— 

16 (1) in subparagraph (C), by striking ‘‘and’’ 

17 after the semicolon; 

18 (2) in subparagraph (D)(iii), by adding ‘‘and’’ 

19 after the semicolon; and 

20 (3) by inserting after subparagraph (D)(iii), the 

21 following new subparagraph: 

22 ‘‘(E) for the annual submission of data re23 lating to functional criteria for the receipt of 

24 nursing facility services under the plan (in such 


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1 form and manner as the Secretary shall speci2 fy);’’. 

3 (c) EFFECTIVE DATE.— 

4 (1) IN GENERAL.—Except as provided in para5 graph (2), the amendments made by this section 

6 take effect on the date of enactment of this Act. 

7 (2) EXTENSION OF EFFECTIVE DATE FOR

8 STATE LAW AMENDMENT.—In the case of a State 

9 plan under title XIX of the Social Security Act (42 

10 U.S.C. 1396 et seq.) which the Secretary of Health 

11 and Human Services determines requires State legis12 lation or State regulation in order for the plan to 

13 meet the additional requirements imposed by the 

14 amendments made by subsection (b), the State plan 

15 shall not be regarded as failing to comply with the 

16 requirements of such title solely on the basis of its 

17 failure to meet these additional requirements before 

18 the first day of the first calendar quarter beginning 

19 after the close of the first regular session of the 

20 State legislature that begins after the date of enact21 ment of this Act. For purposes of the previous sen22 tence, in the case of a State that has a 2-year legis23 lative session, each year of the session is considered 

24 to be a separate regular session of the State legisla25 ture. 


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1 TITLE II—IMPROVED STATE 

2 CONSUMER PROTECTIONS 

3 FOR QUALIFIED LONG-TERM 

4 CARE INSURANCE CON5 TRACTS AND MEDICAID PART6 NERSHIP POLICIES 

7 SEC. 201. APPLICATION OF MEDICAID PARTNERSHIP RE8 QUIRED MODEL PROVISIONS TO ALL TAX9 QUALIFIED LONG-TERM CARE INSURANCE 

10 CONTRACTS. 

11 (a) IN GENERAL.—Section 7702B(g)(1) of the Inter12 nal Revenue Code of 1986 (relating to consumer protec13 tion provisions) is amended— 

14 (1) in subparagraph (A), by inserting ‘‘(but 

15 only to the extent such requirements do not conflict 

16 with requirements applicable under subparagraph 

17 (B)),’’ after ‘‘paragraph (2)’’, 

18 (2) by redesignating subparagraphs (B) and 

19 (C) as subparagraphs (C) and (D), respectively, and 

20 (3) by inserting after subparagraph (A), the fol21 lowing new subparagraph: 

22 ‘‘(B) the requirements of the model regula23 tion and model Act described in section 

24 1917(b)(5) of the Social Security Act,’’. 


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1 (b) EFFECTIVE DATE.—The amendments made by 

2 subsection (a) shall apply to contracts issued on or after 

3 the date that is 1 year after the date of enactment of this 

4 Act. 

5 SEC. 202. STREAMLINED PROCESS FOR APPLYING NEW OR 

6 UPDATED MODEL PROVISIONS. 

7 (a) SECRETARIAL REVIEW.— 

8 (1) TAX-QUALIFIED POLICIES.— 

9 (A) 2000 AND 2006 MODEL PROVISIONS.— 

10 Not later than 12 months after the date of en11 actment of this Act, the Secretary of the Treas12 ury, in consultation with the Secretary of 

13 Health and Human Services, shall review the 

14 model provisions specified in subsection (c)(1) 

15 for purposes of determining whether updating 

16 any such provisions for a provision specified in 

17 section 7702B(g)(2) of the Internal Revenue 

18 Code of 1986, or the inclusion of any such pro19 visions in such section, for purposes of an in20 surance contract qualifying for treatment as a 

21 qualified long-term care insurance contract 

22 under such Code, would improve consumer pro23 tections for insured individuals under such con24 tracts. 


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1 (B) SUBSEQUENT MODEL PROVISIONS.— 

2 Not later than 12 months after model provi3 sions described in paragraph (2) or (3) of sub4 section (c) are adopted by the National Associa5 tion of Insurance Commissioners, the Secretary 

6 of the Treasury, in consultation with the Sec7 retary of Health and Human Services, shall re8 view the model provisions to determine whether 

9 the application of such provisions to an insur10 ance contract for purposes of qualifying for 

11 treatment as a qualified long-term care insur12 ance contract under section 7702B(g)(2) of the 

13 Internal Revenue Code of 1986, would improve 

14 consumer protections for insured individuals 

15 under such contracts. 

16 (2) MEDICAID PARTNERSHIP POLICIES.— 

17 (A) SUBSEQUENT MODEL PROVISIONS.— 

18 Not later than 12 months after model provi19 sions described in paragraph (2) or (3) of sub20 section (c) are adopted by the National Associa21 tion of Insurance Commissioners, the Secretary 

22 of Health and Human Services, in consultation 

23 with the Secretary of the Treasury, shall review 

24 the model provisions to determine whether the 

25 application of such provisions to an insurance 


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1 contract for purposes of satisfying the require2 ments for participation in a qualified State 

3 long-term care insurance partnership under sec4 tion 1917(b)(1)(C)(iii) of such Act (42 U.S.C. 

5 1396p(b)(1)(C)(iii)) would improve consumer 

6 protections for insured individuals under such 

7 contracts. 

8 (B) REVIEW OF OTHER PARTNERSHIP RE9 QUIREMENTS.—The Secretary of Health and 

10 Human Services, in consultation with the Sec11 retary of the Treasury, shall review clauses (iii) 

12 and (iv) of section 1917(b)(1)(C) for purposes 

13 of determining whether the requirements speci14 fied in such clauses should be modified to pro15 vide improved consumer protections or, as ap16 propriate, to resolve any conflicts with the ap17 plication of the 2006 model provisions under 

18 paragraph (5) of section 1917(b) (as amended 

19 by section 302(a)) or with the application of 

20 any model provisions that the Secretary deter21 mines should apply to an insurance contract as 

22 a result of a review required under subpara23 graph (A). 

24 (b) EXPEDITED RULEMAKING.— 


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1 (1) TAX-QUALIFIED POLICIES.—Subject to 

2 paragraph (3), if the Secretary of the Treasury de3 termines that any model provisions reviewed under 

4 subsection (a)(1) should apply for purposes of an in5 surance contract qualifying for treatment as a quali6 fied long-term care insurance contract under the In7 ternal Revenue Code of 1986, the Secretary shall 

8 promulgate an interim final rule applying such pro9 visions for such purposes not later than 3 months 

10 after making such determination. 

11 (2) MEDICAID PARTNERSHIP POLICIES.—Sub12 ject to paragraph (3), if the Secretary of Health and 

13 Human Services determines that any model provi14 sions or requirements reviewed under subsection 

15 (a)(2) should apply for purposes of an insurance 

16 contract satisfying the requirements for participation 

17 in a qualified State long-term care insurance part18 nership under clauses (iii) and (iv) of section 

19 1917(b)(1)(C) of such Act (42 U.S.C. 

20 1396p(b)(1)(C)), the Secretary shall promulgate an 

21 interim final rule applying such provisions for such 

22 purposes not later than 3 months after making such 

23 determination. 

24 (3) CONSULTATION REQUIRED.—The Secretary 

25 of the Treasury and the Secretary of Health and 


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1 Human Services, respectively, shall consult with the 

2 National Association of Insurance Commissioners 

3 and the entities and stakeholders specified in section 

4 101(d) regarding the extent to which it is appro5 priate to apply the model provisions described in 

6 paragraph (1) or (2) (as applicable) to insurance 

7 contracts described in such paragraphs through pro8 mulgation of an interim final rule. If, after such 

9 consultation— 

10 (A) the Secretary of the Treasury deter11 mines it would be appropriate to promulgate an 

12 interim final rule, the Secretary of the Treasury 

13 shall use notice and comment rulemaking to 

14 promulgate a rule applying such provisions to 

15 insurance contracts described in paragraph (1); 

16 and 

17 (B) the Secretary of Health and Human 

18 Services determines it would be appropriate to 

19 promulgate an interim final rule, the Secretary 

20 of Health and Human Services shall use notice 

21 and comment rulemaking to promulgate a rule 

22 applying such provisions to insurance contracts 

23 described in paragraph (2). 

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1 ing in paragraphs (1), (2), or (3) shall be construed 

2 as affecting the application of the sections 801 

3 through 808 of title 5, United States Code (com4 monly known as the ‘‘Congressional Review Act’’) to 

5 any interim final rule issued in accordance with such 

6 paragraphs. 

7 (5) TECHNICAL AMENDMENT ELIMINATING

8 PRIOR REVIEW STANDARD MADE OBSOLETE.—Sec9 tion 1917(b)(5) of the Social Security Act (42 

10 U.S.C. 1396p(b)(5)) is amended by striking sub11 paragraph (C). 

12 (c) MODEL PROVISIONS.—In this section, the term 

13 ‘‘model provisions’’ means— 

14 (1) each provision of the long-term care insur15 ance model regulation, and the long-term care insur16 ance model Act, respectively, promulgated by the 

17 National Association of Insurance Commissioners 

18 (as adopted as of October 2000 and as of December 

19 2006); 

20 (2) each provision of the model language relat21 ing to marketing disclosures and definitions devel22 oped under section 102(b)(1); and 

23 (3) each provision of any long-term care insur24 ance model regulation, or the long-term care insur25 ance model Act, respectively, promulgated by the 


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1 National Association of Insurance Commissioners 

2 and adopted after December 2006. 

3 TITLE III—IMPROVED CON4 SUMER PROTECTIONS FOR 

5 MEDICAID PARTNERSHIP 

6 POLICIES 

7 SEC. 301. BIENNIAL REPORTS ON IMPACT OF MEDICAID 

8 LONG-TERM CARE INSURANCE PARTNER9 SHIPS. 

10 Section 6021(c) of the Deficit Reduction Act of 2005 

11 (42 U.S.C. 1396p note) is amended to read as follows: 

12 ‘‘(c) BIENNIAL REPORTS.— 

13 ‘‘(1) IN GENERAL.—Not later than January 1, 

14 2011, and biennially thereafter, the Secretary of 

15 Health and Human Services (in this subsection re16 ferred to as the ‘Secretary’) shall issue a report to 

17 States and Congress on the long-term care insurance 

18 partnerships established in accordance with section 

19 1917(b)(1)(C)(ii) of the Social Security Act (42 

20 U.S.C. 1396p(b)(1)(C)(ii)). Each report shall in21 clude (with respect to the period the report address22 es) the following information, nationally and on a 

23 State-specific basis: 

24 ‘‘(A) Analyses of the extent to which such 

25 partnerships improve access of individuals to afVerDate Mar 15 2010 16:33 Jul 29, 2010 Jkt 089200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\H5890.IH H5890

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1 fordable long-term care services and benefits 

2 and the impact of such partnerships on Federal 

3 and State expenditures on long-term care under 

4 the Medicare and Medicaid programs. 

5 ‘‘(B) Analyses of the impact of such part6 nerships on consumer decisionmaking with re7 spect to purchasing, accessing, and retaining 

8 coverage under long-term care insurance poli9 cies (as defined in subsection (d)(2)(D)), in10 cluding a description of the benefits and serv11 ices offered under such policies, the average 

12 premiums for coverage under such policies, the 

13 number of policies sold and at what ages, the 

14 number of policies retained and for how long, 

15 the number of policies for which coverage was 

16 exhausted, the number of insured individuals 

17 who were determined eligible for medical assist18 ance under the State Medicaid program, and 

19 the number of insured individuals who were de20 termined ineligible for medical assistance under 

21 the State plan and the reason for such deter22 minations. 

23 ‘‘(2) DATA.—The reports by issuers of partner24 ship long-term care insurance policies required under 

25 section 1917(b)(1)(C)(iii)(VI) of the Social Security 


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1 Act shall include such data as the Secretary shall 

2 specify in order to conduct the analyses required 

3 under paragraph (1). 

4 ‘‘(3) PUBLIC AVAILABILITY.—The Secretary 

5 shall make each report issued under this subsection 

6 publicly available through the LTC Insurance Com7 pare Web site required under subsection (d). 

8 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in 

9 this section shall be construed as requiring the Sec10 retary to conduct an independent review of each 

11 long-term care insurance policy offered under or in 

12 connection with such a partnership.’’. 

13 SEC. 302. ADDITIONAL CONSUMER PROTECTIONS FOR MED14 ICAID PARTNERSHIPS. 

15 (a) APPLICATION OF 2006 MODEL PROVISIONS.— 

16 (1) UPDATING OF 2000 REQUIREMENTS.— 

17 (A) IN GENERAL.—Section 

18 1917(b)(5)(B)(i) of the Social Security Act (42 

19 U.S.C. 1396p(b)(5)(B)(i)) is amended by strik20 ing ‘‘October 2000’’ and inserting ‘‘December 

21 2006’’. 

22 (B) CONFORMING AMENDMENTS.— 

23 (i) Subclause (XVII) of such section is 

24 amended by striking ‘‘section 26’’ and in25 serting ‘‘section 28’’. 


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1 (ii) Subclause (XVIII) of such section 

2 is amended by striking ‘‘section 29’’ and 

3 inserting ‘‘section 31’’. 

4 (iii) Subclause (XIX) of such section 

5 is amended by striking ‘‘section 30’’ and 

6 inserting ‘‘section 32’’. 

7 (2) APPLICATION TO GRANDFATHERED PART8 NERSHIPS.—Section 1917(b)(1)(C)(iv) of such Act 

9 (42 U.S.C. 1396p(b)(1)(C)(iv)) is amended by in10 serting ‘‘, and the State satisfies the requirements of 

11 paragraph (5)’’ after ‘‘2005’’. 

12 (b) APPLICATION OF PRODUCER TRAINING MODEL

13 ACT REQUIREMENTS.—Section 1917(b)(1)(C) of such Act 

14 (42 U.S.C. 1396p(b)(1)(C)) is amended— 

15 (1) in clause (iii)(V), by inserting ‘‘and satisfies 

16 the producer training requirements specified in sec17 tion 9 of the model Act specified in paragraph (5)’’ 

18 after ‘‘coverage of long-term care’’; and 

19 (2) in clause (iv), as amended by subsection 

20 (a)(2), by inserting ‘‘clause (iii)(V) and’’ before 

21 ‘‘paragraph (5)’’. 

22 (c) APPLICATION OF ADDITIONAL REQUIREMENTS

23 FOR ALL PARTNERSHIPS.—Section 1917(b) of the Social 

24 Security Act (42 U.S.C. 1396p(b)) is amended— 

25 (1) in paragraph (1)(C)— 


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1 (A) in clause (iii)— 

2 (i) by inserting after subclause (VII) 

3 the following new subclause: 

4 ‘‘(VIII) The State satisfies the re5 quirements of paragraph (6).’’; and 

6 (ii) in the flush sentence at the end, 

7 by striking ‘‘paragraph (5)’’ and inserting 

8 ‘‘paragraphs (5) and (6)’’; and 

9 (B) in clause (iv), as amended by sub10 sections (a)(2) and (b)(2), by striking ‘‘para11 graph (5)’’ and inserting ‘‘paragraphs (5) and 

12 (6)’’; and 

13 (2) by adding at the end the following new 

14 paragraph: 

15 ‘‘(6) For purposes of clauses (iii)(VIII) and (iv) of 

16 paragraph (1)(C), the requirements of this paragraph are 

17 the following: 

18 ‘‘(A) The State requires issuers of long-term 

19 care insurance policies to— 

20 ‘‘(i) use marketing materials filed with the 

21 State for purposes of the partnership in all 

22 sales and marketing activities conducted or sup23 ported by the issuers in the State with respect 

24 to any long-term care insurance policies mar25 keted by the issuer in the State; 


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1 ‘‘(ii) provide such materials to all agents 

2 selling long-term care insurance policies in the 

3 State; 

4 ‘‘(iii) ensure that agent training and edu5 cation courses conducted or supported by the 

6 issuers incorporate discussion of such mar7 keting materials; and 

8 ‘‘(iv) make such materials available to any 

9 consumer upon request, and to make such ma10 terials available to all prospective purchasers of 

11 a policy offered under a qualified State long12 term care insurance partnership before submis13 sion of an application for coverage under that 

14 policy. 

15 ‘‘(B) The State requires issuers of long-term 

16 care insurance policies sold in the State to require 

17 agents to use any inflation protection comparison 

18 form developed by the National Association of Insur19 ance Commissioners when selling the policies in the 

20 State. 

21 ‘‘(C) The State requires issuers of long-term 

22 care insurance policies sold in the State to comply 

23 with the provisions of section 8 of the model Act 

24 specified in paragraph (5) relating to contingent 

25 nonforfeiture benefits. 


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1 ‘‘(D) The State enacts legislation, not later 

2 than January 1, 2012, that establishes rating stand3 ards for all issuers of long-term care insurance poli4 cies sold in the State that result in rates over the 

5 life of the policy that are no less protective of con6 sumers than those produced by the premium rate 

7 schedule increase standards specified in section 20 

8 of the model regulation specified in paragraph (5), 

9 unless the State has more stringent procedures or 

10 requirements. 

11 ‘‘(E) The State develops and updates marketing 

12 materials filed with the State whenever changes are 

13 made under the State plan that relate to eligibility 

14 for medical assistance for nursing facility services or 

15 other long-term care services or the amount, dura16 tion, or scope of medical assistance for nursing facil17 ity services or other long-term care services, and also 

18 provides to individuals at the time of application for 

19 medical assistance under the State plan, or under a 

20 waiver of the plan materials that describe in clear, 

21 simple language the terms of eligibility, the benefits 

22 and services provided as such assistance, and rules 

23 relating to adjustment or recovery from the estate of 

24 an individual who receives such assistance. Such ma25 terials shall include a clear disclosure that medical 


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1 assistance is not guaranteed to partnership policy2 holders who exhaust or use benefits under a partner3 ship policy, and that Federal changes to the pro4 gram under this title or State changes to the State 

5 plan may affect an individual’s eligibility for, or re6 ceipt of, such assistance. 

7 ‘‘(F) The State— 

8 ‘‘(i) through the State Medicaid agency 

9 under section 1902(a)(5) and in consultation 

10 with the State insurance department, develops 

11 materials explaining how the benefits and rules 

12 of long-term care policies offered by issuers par13 ticipating in the partnership interact with the 

14 benefits and rules under the State plan under 

15 this title; 

16 ‘‘(ii) requires agents to use such materials 

17 when selling or otherwise discussing how long18 term care policies offered by issuers partici19 pating in the partnership work with potential 

20 purchasers and to provide the materials to any 

21 such purchasers upon request; 

22 ‘‘(iii) informs holders of such policies of 

23 any changes in eligibility requirements and cov24 ered services under the State plan under this 

25 title and of any changes in estate recovery rules 


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1 under the State plan as soon as practicable 

2 after such changes are made at the time and at 

3 the time of application for medical assistance; 

4 and 

5 ‘‘(iv) agrees to honor the asset protections 

6 of any such policy that were provided under the 

7 policy when purchased, regardless of whether 

8 the State subsequently terminates a partnership 

9 program under the State plan. 

10 The materials under clause (i) shall include informa11 tion on how benefits under a State plan under this 

12 title may not be available based on an individual’s 

13 moving to a State that is identified as not offering 

14 partnership reciprocity (and, to the extent prac15 ticable, the identify of those States), based an indi16 vidual’s home value exceeding the applicable limits 

17 as modified by the State (and, to the extent prac18 ticable, the limits applicable in different States), or 

19 based on an individual’s income exceeding the appli20 cable limits (and, to the extent practicable, informa21 tion on current average long-term care costs and on 

22 applied income requirements for different States). 

23 ‘‘(G) The State Medicaid agency under section 

24 1902(a)(5) and the State insurance department 

25 enter into a memorandum of understanding to— 


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1 ‘‘(i) inform consumers about long-term 

2 care policies offered by issuers participating in 

3 the partnership, the amount, duration, or scope 

4 of medical assistance for nursing facility serv5 ices and other long-term care services offered 

6 under the State plan, consumer protections, and 

7 any other issues such agency and department 

8 determine appropriate through such means as 

9 the State determines appropriate; and 

10 ‘‘(ii) jointly facilitate coordination in eligi11 bility determinations for medical assistance 

12 under the State plan and the provision of bene13 fits or other services under such policies and 

14 medical assistance provided under the State 

15 plan that includes— 

16 ‘‘(I) the number of policyholders ap17 plying for medical assistance under the 

18 State plan; and 

19 ‘‘(II) the number of policyholders 

20 deemed eligible (and, if applicable, ineli21 gible) for such assistance. 

22 ‘‘(H) Subject to subparagraph (I), the State en23 ters into agreements with other States that have es24 tablished qualified State long-term care insurance 

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1 vide reciprocity for policyholders under such partner2 ships, including providing guaranteed asset protec3 tion to all individuals covered under a policy offered 

4 under a qualified State long-term care insurance 

5 partnership who bought such a policy in the State 

6 or in another State with such a partnership and 

7 with which the State has a reciprocity agreement. 

8 ‘‘(I)(i) In the case of a State described in para9 graph (1)(C)(iv) (in this subparagraph referred to as 

10 a ‘grandfathered partnership State’) — 

11 ‘‘(I) the grandfathered partnership State 

12 may, in lieu of entering into agreements that 

13 satisfy subparagraph (I), enter into individual 

14 reciprocity agreements with other States that 

15 have established qualified State long-term care 

16 insurance partnerships; and 

17 ‘‘(II) if the grandfathered partnership 

18 State has not, as of January 1, 2013, entered 

19 into a reciprocity agreement with each State 

20 that has a qualified State long-term care insur21 ance partnership, the grandfathered partnership 

22 State shall enter into and comply with a reci23 procity agreement developed by the Secretary in 

24 accordance with clause (ii) for each partnership 

25 State that the grandfathered State does not 


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1 have a reciprocity agreement with and, with re2 spect to each such State, for so long as the 

3 grandfathered partnership State does not have 

4 an individual reciprocity agreement with that 

5 State. 

6 ‘‘(ii) In developing a reciprocity agreement for 

7 purposes of clause (i)(II), the Secretary shall take 

8 into account— 

9 ‘‘(I) the difference in consumer protections 

10 under the partnership program of the grand11 fathered partnership State and the other part12 nership State that will be covered by the agree13 ment, and, to the greatest extent possible, pre14 serve the more protective requirements; and 

15 ‘‘(II) the impact the reciprocity agreement 

16 will have on expenditures under the State plan 

17 under this title (including under any waivers of 

18 such plan) of each such State and, to the great19 est extent possible, minimize any negative im20 pact on such expenditures and States.’’. 

21 (d) EFFECTIVE DATE.— 

22 (1) IN GENERAL.—Except as provided in para23 graph (2), the amendments made by this section 

24 take effect on the date that is 1 year after the date 

25 of enactment of this Act. 


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1 (2) EXTENSION OF EFFECTIVE DATE FOR

2 STATE LAW AMENDMENT.—In the case of a State 

3 plan under title XIX of the Social Security Act (42 

4 U.S.C. 1396 et seq.) which the Secretary of Health 

5 and Human Services determines requires State legis6 lation in order for the plan to meet the additional 

7 requirements imposed by the amendments made by 

8 this section, the State plan shall not be regarded as 

9 failing to comply with the requirements of such title 

10 solely on the basis of its failure to meet these addi11 tional requirements before the first day of the first 

12 calendar quarter beginning after the close of the 

13 first regular session of the State legislature that be14 gins after the date of enactment of this Act. For 

15 purposes of the previous sentence, in the case of a 

16 State that has a 2-year legislative session, each year 

17 of the session is considered to be a separate regular 

18 session of the State legislature. 

19 SEC. 303. REPORT TO CONGRESS REGARDING NEED FOR 

20 MINIMUM ANNUAL COMPOUND INFLATION 

21 PROTECTION. 

22 Not later than 18 months after the date of enactment 

23 of this Act, the Secretary of Health and Human Services 

24 (in this section referred to as the ‘‘Secretary’’) shall sub25 mit a report to Congress that includes the Secretary’s recVerDate Mar 15 2010 16:33 Jul 29, 2010 Jkt 089200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H5890.IH H5890

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1 ommendation regarding whether legislative or other ad2 ministrative action should be taken to require all long3 term care insurance policies sold after a date determined 

4 by the Secretary in connection with a qualified State long5 term care insurance partnership under clause (iii) of sec6 tion 1917(b)(1)(C) of the Social Security Act (42 U.S.C. 

7 1396p(b)(1)(C)) or a long-term care insurance policy of8 fered in connection with a State plan amendment de9 scribed in clause (iv) of such section, provide a minimum 

10 level of annual compound inflation protection, and if so, 

11 whether such requirements should be imposed on a basis 

12 related to the age of the policyholder at the time of pur13 chase. The Secretary shall include in the report informa14 tion on the various levels of inflation protection available 

15 under such long-term care insurance partnerships and the 

16 methodologies used by issuers of such policies to calculate 

17 and present various inflation protection options under 

18 such policies, including policies with a future purchase op19 tion feature. 

20 TITLE IV—PRESERVATION OF 

21 STATE AUTHORITY 

22 SEC. 401. PRESERVATION OF STATE AUTHORITY. 

23 Nothing in this Act, any amendments made by this 

24 Act, or any rules promulgated to carry out this Act or 

25 such amendments, shall be construed to limit the authority 


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1 of a State to enact, adopt, promulgate, and enforce any 

2 law, rule, regulation, or other measure with respect to 

3 long-term care insurance that is in addition to, or more 

4 stringent than, requirements established under this Act 

5 and the amendments made by this Act. 

Æ 


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