‘‘(D) The State enacts legislation, not later 
than January 1, 2012, 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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srobinson on DSKHWCL6B1PROD with BILLS
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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