I 
112TH CONGRESS 
1ST SESSION 
H. R. 63 
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 
JANUARY 5, 2011 
Mr. DOGGETT (for himself and Ms. SCHAKOWSKY) 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 sub-
sequently 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Long-Term Care Insurance Reform Act of 2011’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
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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. 
TITLE 
I—NATIONAL 
MARKET 
SURVEY; 
MODEL 
DISCLO-
SURES 
AND 
DEFINITIONS; 
LTC INSURANCE COMPARE 
SEC. 101. NAIC NATIONAL MARKET SURVEY. 
(a) IN GENERAL.—The Secretary shall request the 
NAIC to conduct reviews of the national and State-specific 
markets for long-term care insurance policies and to sub-
mit reports to the Secretary on the results of such reviews 
every 5 years. 
(b) CONTENT.—The Secretary shall request that the 
reviews include, with respect to the period occurring since 
any prior review, analysis of the following: 
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(1) Information on key market parameters, in-
cluding the number of carriers offering long-term 
care insurance, and the scope of coverage offered 
under those policies (such as policies offering nurs-
ing-home only benefits, policies offering comprehen-
sive coverage, cash plans, and reimbursement plans, 
and hybrid products in which long-term care benefits 
are present). 
(2) The number of complaints received and re-
solved, including benefit denials. 
(3) The number of policies that have lapsed. 
(4) The number of agents trained and whether 
the training included competency tests. 
(5) The number of policyholders exhausting 
benefits. 
(6) The number of premium rate increases filed 
by carriers on a policy basis with the States, includ-
ing the ranges of the increases approved for or fi-
nally used. 
(7) The number of policyholders affected by any 
premium rate increases. 
(8) Requests for exceptions to State permitted 
accounting practices, as defined by the NAIC. 
(c) TIMING FOR REVIEWS AND REPORTS.—The Sec-
retary shall request the NAIC to— 
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(1) complete the initial market review under 
this section not later than 2 years after the date of 
enactment of this Act; 
(2) submit a report to the Secretary on the re-
sults of the initial review not later than December 
31, 2012; and 
(3) complete each subsequent review and sub-
mit each subsequent report not later than December 
31 of the fifth succeeding year. 
The Secretary shall make available to the public the re-
ports submitted by the NAIC under this subsection. 
(d) CONSULTATION REQUIRED.—The Secretary shall 
request the NAIC to consult with State insurance commis-
sioners, appropriate Federal agencies, issuers of long-term 
care insurance, States with experience in long-term care 
insurance partnership plans, other States, representatives 
of consumer groups, consumers of long-term care insur-
ance policies, and such other stakeholders as the Secretary 
or the NAIC determine appropriate, to conduct the market 
reviews requested under this section. 
(e) DEFINITIONS.—In this section and section 102: 
(1) LONG-TERM
CARE
INSURANCE
POLICY.— 
The term ‘‘long-term care insurance policy’’— 
(A) means— 
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(i) a qualified long-term care insur-
ance contract (as defined in section 
7702B(b) of the Internal Revenue Code of 
1986); and 
(ii) a qualified long-term care insur-
ance contract that covers an insured who is 
a resident of a State with a qualified State 
long-term 
care 
insurance 
partnership 
under clause (iii) of section 1917(b)(1)(C) 
of the Social Security Act (42 U.S.C. 
1396p(b)(1)(C)) or a long-term care insur-
ance policy offered in connection with a 
State plan amendment described in clause 
(iv) of such section; and 
(B) includes any other insurance policy or 
rider described in the definition of ‘‘long-term 
care insurance’’ in section 4 of the model Act 
promulgated by the National Association of In-
surance Commissioners (as adopted December 
2006). 
(2) NAIC.—The term ‘‘NAIC’’ means the Na-
tional Association of Insurance Commissioners. 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
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SEC. 102. MODEL DISCLOSURE FORM. 
(a) NAIC STUDY AND REPORT ON STATE DISCLO-
SURE REQUIREMENTS
FOR LONG-TERM CARE INSUR-
ANCE.— 
(1) IN GENERAL.—The Secretary shall request 
the NAIC to carry out the activities described in 
paragraph (2) and issue the report described in 
paragraph (3). 
(2) REVIEW AND DEVELOPMENT OF PROPOSED 
MODEL DISCLOSURE REQUIREMENTS.—The activities 
described in this paragraph are the following: 
(A) MODEL ACT AND REGULATION DISCLO-
SURE
REQUIREMENTS.—Review and describe 
disclosure requirements for long-term care in-
surance policies under the Model Act and regu-
lation. 
(B) STATE
LAW
DISCLOSURE
REQUIRE-
MENTS.—Review and describe disclosure re-
quirements for long-term care insurance policies 
under State laws, including as part of such de-
scription an analysis of the effectiveness of the 
various existing disclosures. 
(C) LONG-TERM CARE SERVICES.—Review 
and describe differences in long-term care serv-
ices, including with respect to providers of such 
services and the settings in which such services 
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are provided among States and develop stand-
ardized definitions for long-term care services. 
(D) IDENTIFICATION OF KEY ISSUES FOR 
DEVELOPMENT
OF
MODEL
DISCLOSURE
MAR-
KETING
FORM.—Identify and describe key 
issues to consider in the development of a pro-
posed form for marketing long-term care insur-
ance policies. 
(3) REPORT.—The report described in this 
paragraph is an NAIC White Paper that is issued 
not later than 12 months after the date of enact-
ment of this Act and contains the results of the re-
views conducted under paragraph (2) and the de-
scriptions required under that paragraph. 
(b) NAIC WORKING GROUP TO DEVELOP MODEL 
DISCLOSURE
FORM
FOR
LONG-TERM
CARE
INSUR-
ANCE.— 
(1) IN GENERAL.—The Secretary shall request 
the NAIC to establish, not later than 60 days after 
the date on which the NAIC White Paper described 
in subsection (a)(3) is issued and in consultation 
with the Secretary and the Secretary of the Treas-
ury, a Working Group to develop a model disclosure 
form for marketing long-term care insurance poli-
cies. 
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(2) WORKING GROUP MEMBERS.—The Working 
Group established under paragraph (1) shall be com-
posed of the following: 
(A) Representatives from State Depart-
ments of Health (or the most appropriate State 
agencies with responsibility for oversight of the 
provision of long-term care). 
(B) Representatives of long-term care pro-
viders and facilities. 
(C) Consumer advocates. 
(D) Representatives of issuers of long-term 
care insurance policies. 
(E) Representatives of the NAIC or State 
insurance commissioners. 
(F) Other experts in long-term care and 
long-term care insurance policies selected by the 
Secretary and Secretary of the Treasury or the 
NAIC. 
(3) REQUIREMENTS
FOR
DEVELOPMENT
OF 
FORM.— 
(A) CONSIDERATIONS.—In developing the 
model form, the Working Group shall consider 
the following: 
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(i) Variations among providers, serv-
ices, and facilities in the long-term care 
and long-term care insurance markets. 
(ii) The results of the reviews and the 
descriptions included in the NAIC White 
Paper issued under subsection (a)(3). 
(iii) Such other information and fac-
tors as the Working Group determines ap-
propriate. 
(B) MINIMUM STANDARDS.—The Working 
Group shall ensure that the model has— 
(i) minimum standard definitions for 
coverage of the various types of services 
and benefits provided under long-term care 
insurance policies; 
(ii) minimum standard language for 
use by issuers of such policies, and for 
agents selling such policies, in explaining 
the services and benefits covered under the 
policies and restrictions on the services and 
benefits; 
(iii) minimum standard format, color 
and type size for disclosure documents; 
and 
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(iv) such other minimum standards as 
the Working Group determines appro-
priate. 
(4) 
DEADLINE
FOR
DEVELOPMENT.—The 
Working Group shall issue a proposed model disclo-
sure form for marketing long-term care insurance 
policies not later than 1 year after the date on which 
the Working Group is established. 
(5) ADOPTION
AND
INCORPORATION
INTO 
MODEL ACT AND REGULATION.—The Secretary shall 
request the NAIC to amend the Model Act and regu-
lation to incorporate the use of the proposed model 
disclosure form issued by the Working Group, not 
later than 1 year after the date on which the Work-
ing Group issues the form. 
(c) REQUIRED USE OF MODEL DISCLOSURE FORM 
IN MARKETING LONG-TERM CARE INSURANCE POLI-
CIES.— 
(1) APPLICATION TO TAX-QUALIFIED AND MED-
ICAID
PARTNERSHIP
POLICIES.—Not later than 1 
year after the date on which the Working Group 
issues the proposed model disclosure form for mar-
keting long-term care insurance policies under sub-
section (b): 
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(A) TAX-QUALIFIED POLICIES.—The Sec-
retary of the Treasury shall promulgate a regu-
lation requiring, not later than 1 year after the 
date on which the regulation is final, any issuer 
of a qualified long-term care insurance contract 
(as defined in section 7702B(b) of the Internal 
Revenue Code of 1986) to use the proposed 
model disclosure form for marketing such con-
tracts, to the extent such disclosure is not in-
consistent with State law. 
(B) MEDICAID PARTNERSHIP POLICIES.— 
The Secretary shall promulgate a regulation re-
quiring, not later than 1 year after the date on 
which the regulation is final, any issuer that 
markets a qualified long-term care insurance 
contract intended to cover an insured who is a 
resident of a State with a qualified State long- 
term care insurance partnership under clause 
(iii) of section 1917(b)(1)(C) of the Social Se-
curity Act (42 U.S.C. 1396p(b)(1)(C)) or a 
long-term care insurance policy offered in con-
nection with a State plan amendment described 
in clause (iv) of such section to use the pro-
posed model disclosure form for marketing such 
contracts. 
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(2) APPLICATION TO ALL OTHER LONG-TERM 
CARE
INSURANCE
POLICIES.—Not later than 18 
months, or the earliest date on which an amendment 
could be enacted for those States with legislatures 
which meet only every other year, after the date on 
which the NAIC adopts an amended Model Act and 
regulation to require the use of the proposed model 
disclosure form issued by the Working Group under 
subsection (b), each State shall require by statute or 
regulation any issuer of a long-term care insurance 
policy to use the proposed model disclosure form 
when marketing such a policy in the State. 
SEC. 103. LTC INSURANCE COMPARE. 
(a) IN GENERAL.—Section 6021(d) of the Deficit Re-
duction Act of 2005 (42 U.S.C. 1396p note) is amended— 
(1) in paragraph (2)— 
(A) in subparagraph (A)— 
(i) in clause (ii), by striking ‘‘and’’ at 
the end; 
(ii) in clause (iii), by striking the pe-
riod at the end and inserting ‘‘; and’’; and 
(iii) by adding at the end the fol-
lowing: 
‘‘(iv) establish an Internet directory of 
information regarding long-term care in-
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surance, to be known as ‘LTC Insurance 
Compare’, that shall include the following: 
‘‘(I) Comparison tools to assist 
consumers in evaluating long-term 
care insurance policies (as defined in 
subparagraph (D)) with different ben-
efits and features and that allow con-
sumers to compare the price, long- 
term premium stability, and carrier fi-
nancial strength of such policies. 
‘‘(II) State-specific information 
about the long-term care insurance 
policies marketed in a State, including 
the following: 
‘‘(aa) Whether a State has 
promulgated rate stability provi-
sions or has rate stability proce-
dures in place, and how the 
standards or procedures work. 
‘‘(bb) The rating history for 
at least the most recent pre-
ceding 5 years for issuers selling 
long-term care insurance policies 
in the State. 
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‘‘(cc) An appropriate sam-
pling of the policy forms mar-
keted in the State. 
‘‘(III) Links to State information 
regarding long-term care under State 
Medicaid programs (which may be 
provided, as appropriate, through 
Internet linkages to the Web sites of 
State Medicaid programs) that in-
cludes the following: 
‘‘(aa) The medical assistance 
provided under each State’s Med-
icaid program for nursing facility 
services and other long-term care 
services (including any functional 
criteria imposed for receipt of 
such services, as reported in ac-
cordance 
with 
section 
1902(a)(28)(D) of the Social Se-
curity Act) and any differences 
from benefits and services offered 
under long-term care insurance 
policies in the State and the cri-
teria for triggering receipt of 
such benefits and services. 
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‘‘(bb) If the State has a 
qualified State long-term care in-
surance partnership under clause 
(iii) of section 1917(b)(1)(C) of 
the Social Security Act (or is ex-
empt from the application of 
clause (i) of such section because 
of the application of clauses (ii) 
and (iv) of such section), infor-
mation regarding how and when 
an individual with a partnership 
long-term care insurance policy 
who is receiving benefits under 
the policy should apply for med-
ical assistance for nursing facility 
services or other long-term care 
services under the State Medicaid 
program and information regard-
ing about how Medicaid asset 
protection is accumulated over 
time.’’; and 
(B) by adding at the end the following: 
‘‘(C) CURRENT INFORMATION.—The Sec-
retary of Health and Human Services shall en-
sure that, to the greatest extent practicable, the 
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information maintained in the National Clear-
inghouse for Long-Term Care Information, in-
cluding the information required for LTC In-
surance Compare, is the most recent informa-
tion available. 
‘‘(D) LONG-TERM CARE INSURANCE POL-
ICY
DEFINED.—In subparagraph (A)(iv), the 
term ‘long-term care insurance policy’ means a 
qualified long-term care insurance contract (as 
defined in section 7702B(b) of the Internal 
Revenue Code of 1986), a qualified long-term 
care insurance contract that covers an insured 
who is a resident of a State with a qualified 
State long-term care insurance partnership 
under clause (iii) of section 1917(b)(1)(C) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396p(b)(1)(C)) or a long-term care insurance 
policy offered in connection with a State plan 
amendment described in clause (iv) of such sec-
tion, and includes any other insurance policy or 
rider described in the definition of ‘long-term 
care insurance’ in section 4 of the model Act 
promulgated by the National Association of In-
surance Commissioners (as adopted December 
2006).’’; 
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(2) by redesignating paragraph (3) as para-
graph (4); and 
(3) by inserting after paragraph (2) the fol-
lowing: 
‘‘(3) CONSULTATION ON LTC INSURANCE COM-
PARE.—The Secretary of Health and Human Serv-
ices shall consult with the National Association of 
Insurance Commissioners and other entities and 
stakeholders in designing and implementing the 
LTC Insurance Compare required under paragraph 
(2)(A)(iv).’’. 
(b) MEDICAID STATE PLAN REQUIREMENT TO SUB-
MIT NURSING FACILITY SERVICES FUNCTIONAL CRI-
TERIA DATA.—Section 1902(a)(28) of the Social Security 
Act (42 U.S.C. 1396a(a)(28)) is amended— 
(1) in subparagraph (C), by striking ‘‘and’’ 
after the semicolon; 
(2) in subparagraph (D)(iii), by adding ‘‘and’’ 
after the semicolon; and 
(3) by inserting after subparagraph (D)(iii), the 
following new subparagraph: 
‘‘(E) for the annual submission of data re-
lating to functional criteria for the receipt of 
nursing facility services under the plan (in such 
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form and manner as the Secretary shall speci-
fy);’’. 
(c) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
take effect on the date of enactment of this Act. 
(2) EXTENSION
OF
EFFECTIVE
DATE
FOR 
STATE LAW AMENDMENT.—In the case of a State 
plan under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) which the Secretary of Health 
and Human Services determines requires State legis-
lation or State regulation in order for the plan to 
meet the additional requirements imposed by the 
amendments made by subsection (b), the State plan 
shall not be regarded as failing to comply with the 
requirements of such title solely on the basis of its 
failure to meet these additional requirements before 
the first day of the first calendar quarter beginning 
after the close of the first regular session of the 
State legislature that begins after the date of enact-
ment of this Act. For purposes of the previous sen-
tence, in the case of a State that has a 2-year legis-
lative session, each year of the session is considered 
to be a separate regular session of the State legisla-
ture. 
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TITLE 
II—IMPROVED 
STATE 
CONSUMER 
PROTECTIONS 
FOR QUALIFIED LONG-TERM 
CARE 
INSURANCE 
CON-
TRACTS AND MEDICAID PART-
NERSHIP POLICIES 
SEC. 201. APPLICATION OF MEDICAID PARTNERSHIP RE-
QUIRED MODEL PROVISIONS TO ALL TAX- 
QUALIFIED LONG-TERM CARE INSURANCE 
CONTRACTS. 
(a) IN GENERAL.—Section 7702B(g)(1) of the Inter-
nal Revenue Code of 1986 (relating to consumer protec-
tion provisions) is amended— 
(1) in subparagraph (A), by inserting ‘‘(but 
only to the extent such requirements do not conflict 
with requirements applicable under subparagraph 
(B)),’’ after ‘‘paragraph (2)’’, 
(2) by redesignating subparagraphs (B) and 
(C) as subparagraphs (C) and (D), respectively, and 
(3) by inserting after subparagraph (A), the fol-
lowing new subparagraph: 
‘‘(B) the requirements of the model regula-
tion and model Act described in section 
1917(b)(5) of the Social Security Act,’’. 
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(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to contracts issued on or after 
the date that is 1 year after the date of enactment of this 
Act. 
SEC. 202. STREAMLINED PROCESS FOR APPLYING NEW OR 
UPDATED MODEL PROVISIONS. 
(a) SECRETARIAL REVIEW.— 
(1) TAX-QUALIFIED POLICIES.— 
(A) 2000 AND 2006 MODEL PROVISIONS.— 
Not later than 12 months after the date of en-
actment of this Act, the Secretary of the Treas-
ury, in consultation with the Secretary of 
Health and Human Services, shall review the 
model provisions specified in subsection (c)(1) 
for purposes of determining whether updating 
any such provisions for a provision specified in 
section 7702B(g)(2) of the Internal Revenue 
Code of 1986, or the inclusion of any such pro-
visions in such section, for purposes of an in-
surance contract qualifying for treatment as a 
qualified long-term care insurance contract 
under such Code, would improve consumer pro-
tections for insured individuals under such con-
tracts. 
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(B) SUBSEQUENT
MODEL
PROVISIONS.— 
Not later than 12 months after model provi-
sions described in paragraph (2) or (3) of sub-
section (c) are adopted by the National Associa-
tion of Insurance Commissioners, the Secretary 
of the Treasury, in consultation with the Sec-
retary of Health and Human Services, shall re-
view the model provisions to determine whether 
the application of such provisions to an insur-
ance contract for purposes of qualifying for 
treatment as a qualified long-term care insur-
ance contract under section 7702B(g)(2) of the 
Internal Revenue Code of 1986, would improve 
consumer protections for insured individuals 
under such contracts. 
(2) MEDICAID PARTNERSHIP POLICIES.— 
(A) SUBSEQUENT
MODEL
PROVISIONS.— 
Not later than 12 months after model provi-
sions described in paragraph (2) or (3) of sub-
section (c) are adopted by the National Associa-
tion of Insurance Commissioners, the Secretary 
of Health and Human Services, in consultation 
with the Secretary of the Treasury, shall review 
the model provisions to determine whether the 
application of such provisions to an insurance 
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contract for purposes of satisfying the require-
ments for participation in a qualified State 
long-term care insurance partnership under sec-
tion 1917(b)(1)(C)(iii) of such Act (42 U.S.C. 
1396p(b)(1)(C)(iii)) would improve consumer 
protections for insured individuals under such 
contracts. 
(B) REVIEW OF OTHER PARTNERSHIP RE-
QUIREMENTS.—The Secretary of Health and 
Human Services, in consultation with the Sec-
retary of the Treasury, shall review clauses (iii) 
and (iv) of section 1917(b)(1)(C) for purposes 
of determining whether the requirements speci-
fied in such clauses should be modified to pro-
vide improved consumer protections or, as ap-
propriate, to resolve any conflicts with the ap-
plication of the 2006 model provisions under 
paragraph (5) of section 1917(b) (as amended 
by section 302(a)) or with the application of 
any model provisions that the Secretary deter-
mines should apply to an insurance contract as 
a result of a review required under subpara-
graph (A). 
(b) EXPEDITED RULEMAKING.— 
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(1) 
TAX-QUALIFIED
POLICIES.—Subject 
to 
paragraph (3), if the Secretary of the Treasury de-
termines that any model provisions reviewed under 
subsection (a)(1) should apply for purposes of an in-
surance contract qualifying for treatment as a quali-
fied long-term care insurance contract under the In-
ternal Revenue Code of 1986, the Secretary shall 
promulgate an interim final rule applying such pro-
visions for such purposes not later than 3 months 
after making such determination. 
(2) MEDICAID
PARTNERSHIP
POLICIES.—Sub-
ject to paragraph (3), if the Secretary of Health and 
Human Services determines that any model provi-
sions or requirements reviewed under subsection 
(a)(2) should apply for purposes of an insurance 
contract satisfying the requirements for participation 
in a qualified State long-term care insurance part-
nership under clauses (iii) and (iv) of section 
1917(b)(1)(C) 
of 
such 
Act 
(42 
U.S.C. 
1396p(b)(1)(C)), the Secretary shall promulgate an 
interim final rule applying such provisions for such 
purposes not later than 3 months after making such 
determination. 
(3) CONSULTATION REQUIRED.—The Secretary 
of the Treasury and the Secretary of Health and 
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Human Services, respectively, shall consult with the 
National Association of Insurance Commissioners 
and the entities and stakeholders specified in section 
101(d) regarding the extent to which it is appro-
priate to apply the model provisions described in 
paragraph (1) or (2) (as applicable) to insurance 
contracts described in such paragraphs through pro-
mulgation of an interim final rule. If, after such 
consultation— 
(A) the Secretary of the Treasury deter-
mines it would be appropriate to promulgate an 
interim final rule, the Secretary of the Treasury 
shall use notice and comment rulemaking to 
promulgate a rule applying such provisions to 
insurance contracts described in paragraph (1); 
and 
(B) the Secretary of Health and Human 
Services determines it would be appropriate to 
promulgate an interim final rule, the Secretary 
of Health and Human Services shall use notice 
and comment rulemaking to promulgate a rule 
applying such provisions to insurance contracts 
described in paragraph (2). 
(4) RULE OF CONSTRUCTION RELATING TO AP-
PLICATION OF CONGRESSIONAL REVIEW ACT.—Noth-
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ing in paragraphs (1), (2), or (3) shall be construed 
as affecting the application of the sections 801 
through 808 of title 5, United States Code (com-
monly known as the ‘‘Congressional Review Act’’) to 
any interim final rule issued in accordance with such 
paragraphs. 
(5) TECHNICAL
AMENDMENT
ELIMINATING 
PRIOR REVIEW STANDARD MADE OBSOLETE.—Sec-
tion 1917(b)(5) of the Social Security Act (42 
U.S.C. 1396p(b)(5)) is amended by striking sub-
paragraph (C). 
(c) MODEL PROVISIONS.—In this section, the term 
‘‘model provisions’’ means— 
(1) each provision of the long-term care insur-
ance model regulation, and the long-term care insur-
ance model Act, respectively, promulgated by the 
National Association of Insurance Commissioners 
(as adopted as of October 2000 and as of December 
2006); 
(2) each provision of the model language relat-
ing to marketing disclosures and definitions devel-
oped under section 102(b)(1); and 
(3) each provision of any long-term care insur-
ance model regulation, or the long-term care insur-
ance model Act, respectively, promulgated by the 
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National Association of Insurance Commissioners 
and adopted after December 2006. 
TITLE 
III—IMPROVED 
CON-
SUMER 
PROTECTIONS 
FOR 
MEDICAID 
PARTNERSHIP 
POLICIES 
SEC. 301. BIENNIAL REPORTS ON IMPACT OF MEDICAID 
LONG-TERM 
CARE 
INSURANCE 
PARTNER-
SHIPS. 
Section 6021(c) of the Deficit Reduction Act of 2005 
(42 U.S.C. 1396p note) is amended to read as follows: 
‘‘(c) BIENNIAL REPORTS.— 
‘‘(1) IN GENERAL.—Not later than January 1, 
2012, and biennially thereafter, the Secretary of 
Health and Human Services (in this subsection re-
ferred to as the ‘Secretary’) shall issue a report to 
States and Congress on the long-term care insurance 
partnerships established in accordance with section 
1917(b)(1)(C)(ii) of the Social Security Act (42 
U.S.C. 1396p(b)(1)(C)(ii)). Each report shall in-
clude (with respect to the period the report address-
es) the following information, nationally and on a 
State-specific basis: 
‘‘(A) Analyses of the extent to which such 
partnerships improve access of individuals to af-
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fordable long-term care services and benefits 
and the impact of such partnerships on Federal 
and State expenditures on long-term care under 
the Medicare and Medicaid programs. 
‘‘(B) Analyses of the impact of such part-
nerships on consumer decisionmaking with re-
spect to purchasing, accessing, and retaining 
coverage under long-term care insurance poli-
cies (as defined in subsection (d)(2)(D)), in-
cluding a description of the benefits and serv-
ices offered under such policies, the average 
premiums for coverage under such policies, the 
number of policies sold and at what ages, the 
number of policies retained and for how long, 
the number of policies for which coverage was 
exhausted, the number of insured individuals 
who were determined eligible for medical assist-
ance under the State Medicaid program, and 
the number of insured individuals who were de-
termined ineligible for medical assistance under 
the State plan and the reason for such deter-
minations. 
‘‘(2) DATA.—The reports by issuers of partner-
ship long-term care insurance policies required under 
section 1917(b)(1)(C)(iii)(VI) of the Social Security 
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Act shall include such data as the Secretary shall 
specify in order to conduct the analyses required 
under paragraph (1). 
‘‘(3) PUBLIC
AVAILABILITY.—The Secretary 
shall make each report issued under this subsection 
publicly available through the LTC Insurance Com-
pare Web site required under subsection (d). 
‘‘(4) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed as requiring the Sec-
retary to conduct an independent review of each 
long-term care insurance policy offered under or in 
connection with such a partnership.’’. 
SEC. 302. ADDITIONAL CONSUMER PROTECTIONS FOR MED-
ICAID PARTNERSHIPS. 
(a) APPLICATION OF 2006 MODEL PROVISIONS.— 
(1) UPDATING OF 2000 REQUIREMENTS.— 
(A) 
IN
GENERAL.—Section 
1917(b)(5)(B)(i) of the Social Security Act (42 
U.S.C. 1396p(b)(5)(B)(i)) is amended by strik-
ing ‘‘October 2000’’ and inserting ‘‘December 
2006’’. 
(B) CONFORMING AMENDMENTS.— 
(i) Subclause (XVII) of such section is 
amended by striking ‘‘section 26’’ and in-
serting ‘‘section 28’’. 
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(ii) Subclause (XVIII) of such section 
is amended by striking ‘‘section 29’’ and 
inserting ‘‘section 31’’. 
(iii) Subclause (XIX) of such section 
is amended by striking ‘‘section 30’’ and 
inserting ‘‘section 32’’. 
(2) APPLICATION TO GRANDFATHERED PART-
NERSHIPS.—Section 1917(b)(1)(C)(iv) of such Act 
(42 U.S.C. 1396p(b)(1)(C)(iv)) is amended by in-
serting ‘‘, and the State satisfies the requirements of 
paragraph (5)’’ after ‘‘2005’’. 
(b) APPLICATION OF PRODUCER TRAINING MODEL 
ACT REQUIREMENTS.—Section 1917(b)(1)(C) of such Act 
(42 U.S.C. 1396p(b)(1)(C)) is amended— 
(1) in clause (iii)(V), by inserting ‘‘and satisfies 
the producer training requirements specified in sec-
tion 9 of the model Act specified in paragraph (5)’’ 
after ‘‘coverage of long-term care’’; and 
(2) in clause (iv), as amended by subsection 
(a)(2), by inserting ‘‘clause (iii)(V) and’’ before 
‘‘paragraph (5)’’. 
(c) APPLICATION OF ADDITIONAL REQUIREMENTS 
FOR ALL PARTNERSHIPS.—Section 1917(b) of the Social 
Security Act (42 U.S.C. 1396p(b)) is amended— 
(1) in paragraph (1)(C)— 
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(A) in clause (iii)— 
(i) by inserting after subclause (VII) 
the following new subclause: 
‘‘(VIII) The State satisfies the re-
quirements of paragraph (6).’’; and 
(ii) in the flush sentence at the end, 
by striking ‘‘paragraph (5)’’ and inserting 
‘‘paragraphs (5) and (6)’’; and 
(B) in clause (iv), as amended by sub-
sections (a)(2) and (b)(2), by striking ‘‘para-
graph (5)’’ and inserting ‘‘paragraphs (5) and 
(6)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(6) For purposes of clauses (iii)(VIII) and (iv) of 
paragraph (1)(C), the requirements of this paragraph are 
the following: 
‘‘(A) The State requires issuers of long-term 
care insurance policies to— 
‘‘(i) use marketing materials filed with the 
State for purposes of the partnership in all 
sales and marketing activities conducted or sup-
ported by the issuers in the State with respect 
to any long-term care insurance policies mar-
keted by the issuer in the State; 
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‘‘(ii) provide such materials to all agents 
selling long-term care insurance policies in the 
State; 
‘‘(iii) ensure that agent training and edu-
cation courses conducted or supported by the 
issuers incorporate discussion of such mar-
keting materials; and 
‘‘(iv) make such materials available to any 
consumer upon request, and to make such ma-
terials available to all prospective purchasers of 
a policy offered under a qualified State long- 
term care insurance partnership before submis-
sion of an application for coverage under that 
policy. 
‘‘(B) The State requires issuers of long-term 
care insurance policies sold in the State to require 
agents to use any inflation protection comparison 
form developed by the National Association of Insur-
ance Commissioners when selling the policies in the 
State. 
‘‘(C) The State requires issuers of long-term 
care insurance policies sold in the State to comply 
with the provisions of section 8 of the model Act 
specified in paragraph (5) relating to contingent 
nonforfeiture benefits. 
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‘‘(D) The State enacts legislation, not later 
than January 1, 2013, that establishes rating stand-
ards for all issuers of long-term care insurance poli-
cies sold in the State that result in rates over the 
life of the policy that are no less protective of con-
sumers than those produced by the premium rate 
schedule increase standards specified in section 20 
of the model regulation specified in paragraph (5), 
unless the State has more stringent procedures or 
requirements. 
‘‘(E) The State develops and updates marketing 
materials filed with the State whenever changes are 
made under the State plan that relate to eligibility 
for medical assistance for nursing facility services or 
other long-term care services or the amount, dura-
tion, or scope of medical assistance for nursing facil-
ity services or other long-term care services, and also 
provides to individuals at the time of application for 
medical assistance under the State plan, or under a 
waiver of the plan materials that describe in clear, 
simple language the terms of eligibility, the benefits 
and services provided as such assistance, and rules 
relating to adjustment or recovery from the estate of 
an individual who receives such assistance. Such ma-
terials shall include a clear disclosure that medical 
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assistance is not guaranteed to partnership policy-
holders who exhaust or use benefits under a partner-
ship policy, and that Federal changes to the pro-
gram under this title or State changes to the State 
plan may affect an individual’s eligibility for, or re-
ceipt of, such assistance. 
‘‘(F) The State— 
‘‘(i) through the State Medicaid agency 
under section 1902(a)(5) and in consultation 
with the State insurance department, develops 
materials explaining how the benefits and rules 
of long-term care policies offered by issuers par-
ticipating in the partnership interact with the 
benefits and rules under the State plan under 
this title; 
‘‘(ii) requires agents to use such materials 
when selling or otherwise discussing how long- 
term care policies offered by issuers partici-
pating in the partnership work with potential 
purchasers and to provide the materials to any 
such purchasers upon request; 
‘‘(iii) informs holders of such policies of 
any changes in eligibility requirements and cov-
ered services under the State plan under this 
title and of any changes in estate recovery rules 
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under the State plan as soon as practicable 
after such changes are made at the time and at 
the time of application for medical assistance; 
and 
‘‘(iv) agrees to honor the asset protections 
of any such policy that were provided under the 
policy when purchased, regardless of whether 
the State subsequently terminates a partnership 
program under the State plan. 
The materials under clause (i) shall include informa-
tion on how benefits under a State plan under this 
title may not be available based on an individual’s 
moving to a State that is identified as not offering 
partnership reciprocity (and, to the extent prac-
ticable, the identify of those States), based an indi-
vidual’s home value exceeding the applicable limits 
as modified by the State (and, to the extent prac-
ticable, the limits applicable in different States), or 
based on an individual’s income exceeding the appli-
cable limits (and, to the extent practicable, informa-
tion on current average long-term care costs and on 
applied income requirements for different States). 
‘‘(G) The State Medicaid agency under section 
1902(a)(5) and the State insurance department 
enter into a memorandum of understanding to— 
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‘‘(i) inform consumers about long-term 
care policies offered by issuers participating in 
the partnership, the amount, duration, or scope 
of medical assistance for nursing facility serv-
ices and other long-term care services offered 
under the State plan, consumer protections, and 
any other issues such agency and department 
determine appropriate through such means as 
the State determines appropriate; and 
‘‘(ii) jointly facilitate coordination in eligi-
bility determinations for medical assistance 
under the State plan and the provision of bene-
fits or other services under such policies and 
medical assistance provided under the State 
plan that includes— 
‘‘(I) the number of policyholders ap-
plying for medical assistance under the 
State plan; and 
‘‘(II) the number of policyholders 
deemed eligible (and, if applicable, ineli-
gible) for such assistance. 
‘‘(H) Subject to subparagraph (I), the State en-
ters into agreements with other States that have es-
tablished qualified State long-term care insurance 
partnerships under which such States agree to pro-
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vide reciprocity for policyholders under such partner-
ships, including providing guaranteed asset protec-
tion to all individuals covered under a policy offered 
under a qualified State long-term care insurance 
partnership who bought such a policy in the State 
or in another State with such a partnership and 
with which the State has a reciprocity agreement. 
‘‘(I)(i) In the case of a State described in para-
graph (1)(C)(iv) (in this subparagraph referred to as 
a ‘grandfathered partnership State’)— 
‘‘(I) the grandfathered partnership State 
may, in lieu of entering into agreements that 
satisfy subparagraph (I), enter into individual 
reciprocity agreements with other States that 
have established qualified State long-term care 
insurance partnerships; and 
‘‘(II) if the grandfathered partnership 
State has not, as of January 1, 2013, entered 
into a reciprocity agreement with each State 
that has a qualified State long-term care insur-
ance partnership, the grandfathered partnership 
State shall enter into and comply with a reci-
procity agreement developed by the Secretary in 
accordance with clause (ii) for each partnership 
State that the grandfathered State does not 
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have a reciprocity agreement with and, with re-
spect to each such State, for so long as the 
grandfathered partnership State does not have 
an individual reciprocity agreement with that 
State. 
‘‘(ii) In developing a reciprocity agreement for 
purposes of clause (i)(II), the Secretary shall take 
into account— 
‘‘(I) the difference in consumer protections 
under the partnership program of the grand-
fathered partnership State and the other part-
nership State that will be covered by the agree-
ment, and, to the greatest extent possible, pre-
serve the more protective requirements; and 
‘‘(II) the impact the reciprocity agreement 
will have on expenditures under the State plan 
under this title (including under any waivers of 
such plan) of each such State and, to the great-
est extent possible, minimize any negative im-
pact on such expenditures and States.’’. 
(d) EFFECTIVE DATE.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), the amendments made by this section 
take effect on the date that is 1 year after the date 
of enactment of this Act. 
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(2) EXTENSION
OF
EFFECTIVE
DATE
FOR 
STATE LAW AMENDMENT.—In the case of a State 
plan under title XIX of the Social Security Act (42 
U.S.C. 1396 et seq.) which the Secretary of Health 
and Human Services determines requires State legis-
lation in order for the plan to meet the additional 
requirements imposed by the amendments made by 
this section, the State plan shall not be regarded as 
failing to comply with the requirements of such title 
solely on the basis of its failure to meet these addi-
tional requirements before the first day of the first 
calendar quarter beginning after the close of the 
first regular session of the State legislature that be-
gins after the date of enactment of this Act. For 
purposes of the previous sentence, in the case of a 
State that has a 2-year legislative session, each year 
of the session is considered to be a separate regular 
session of the State legislature. 
SEC. 303. REPORT TO CONGRESS REGARDING NEED FOR 
MINIMUM ANNUAL COMPOUND INFLATION 
PROTECTION. 
Not later than 18 months after the date of enactment 
of this Act, the Secretary of Health and Human Services 
(in this section referred to as the ‘‘Secretary’’) shall sub-
mit a report to Congress that includes the Secretary’s rec-
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ommendation regarding whether legislative or other ad-
ministrative action should be taken to require all long- 
term care insurance policies sold after a date determined 
by the Secretary in connection with a qualified State long- 
term care insurance partnership under clause (iii) of sec-
tion 1917(b)(1)(C) of the Social Security Act (42 U.S.C. 
1396p(b)(1)(C)) or a long-term care insurance policy of-
fered in connection with a State plan amendment de-
scribed in clause (iv) of such section, provide a minimum 
level of annual compound inflation protection, and if so, 
whether such requirements should be imposed on a basis 
related to the age of the policyholder at the time of pur-
chase. The Secretary shall include in the report informa-
tion on the various levels of inflation protection available 
under such long-term care insurance partnerships and the 
methodologies used by issuers of such policies to calculate 
and present various inflation protection options under 
such policies, including policies with a future purchase op-
tion feature. 
TITLE IV—PRESERVATION OF 
STATE AUTHORITY 
SEC. 401. PRESERVATION OF STATE AUTHORITY. 
Nothing in this Act, any amendments made by this 
Act, or any rules promulgated to carry out this Act or 
such amendments, shall be construed to limit the authority 
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of a State to enact, adopt, promulgate, and enforce any 
law, rule, regulation, or other measure with respect to 
long-term care insurance that is in addition to, or more 
stringent than, requirements established under this Act 
and the amendments made by this Act. 
Æ 
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