1.Short title; table of
contents
(a)This Act may be cited
as the Long-Term Care Insurance Reform
Act of 2010
.
(b)The table of contents of this Act is as follows:
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.
<enum>I</enum><header>National Market
Survey; Model Disclosures and Definitions; LTC Insurance Compare</header>
<section id="HA9B1147BF338471191588755211C0F3C"><enum>101.</enum><header>NAIC National
Market Survey</header>
<subsection id="H86826A319E6242CF92B513C9CA7AD146"><enum>(a)</enum><header>In
general</header><text>The Secretary shall request the NAIC to conduct reviews
of the national and State-specific markets for long-term care insurance
policies and to submit reports to the Secretary on the results of such reviews
every 5 years.</text>
</subsection><subsection id="H9BA3A010D6C44B2881DF87799B85C238"><enum>(b)</enum><header>Content</header><text>The
Secretary shall request that the reviews include, with respect to the period
occurring since any prior review, analysis of the following:</text>
<paragraph id="HF196B20C6E464F58A3B4E325A43A174A"><enum>(1)</enum><text>Information on key
market parameters, including the number of carriers offering long-term care
insurance, and the scope of coverage offered under those policies (such as
policies offering nursing-home only benefits, policies offering comprehensive
coverage, cash plans, and reimbursement plans, and hybrid products in which
long-term care benefits are present).</text>
</paragraph><paragraph id="HF36275CC4E2048CD8384C834C61E57C9"><enum>(2)</enum><text>The number of
complaints received and resolved, including benefit denials.</text>
</paragraph><paragraph id="H2CDC6CAEE1764D0B86A73E830C169D67"><enum>(3)</enum><text>The number of
policies that have lapsed.</text>
</paragraph><paragraph id="H22540467B5B843BD83362C8A89B1DBEE"><enum>(4)</enum><text>The number of
agents trained and whether the training included competency tests.</text>
</paragraph><paragraph id="H5B867D7F63BB4FF5A910388BFFAE47A8"><enum>(5)</enum><text>The number of
policyholders exhausting benefits.</text>
</paragraph><paragraph id="HA373DC3B5AB849E9B929955DD11F6C71"><enum>(6)</enum><text>The number of
premium rate increases filed by carriers on a policy basis with the States,
including the ranges of the increases approved for or finally used.</text>
</paragraph><paragraph id="HC00D3FCEFC6B4E14947547245AF43A9B"><enum>(7)</enum><text>The number of
policyholders affected by any premium rate increases.</text>
</paragraph><paragraph id="H8BB391D3EDE942E29830E8B9EF32A6A1"><enum>(8)</enum><text>Requests for
exceptions to State permitted accounting practices, as defined by the
NAIC.</text>
</paragraph></subsection><subsection id="HB1C43FC83DF344BB888ECBDC4612E48E"><enum>(c)</enum><header>Timing for
reviews and reports</header><text>The Secretary shall request the NAIC
to—</text>
<paragraph id="H90ACC204C1FE494CA280CDA1C2EB2156"><enum>(1)</enum><text>complete the
initial market review under this section not later than 2 years after the date
of enactment of this Act;</text>
</paragraph><paragraph id="H5198EB17BB2E42748E2600631734BA62"><enum>(2)</enum><text>submit a report to
the Secretary on the results of the initial review not later than December 31,
2011; and</text>
</paragraph><paragraph id="H0E48DF2FC0CC4231A12EFB76996E7ACE"><enum>(3)</enum><text>complete each
subsequent review and submit each subsequent report not later than December 31
of the fifth succeeding year.</text>
</paragraph><continuation-text continuation-text-level="subsection">The
Secretary shall make available to the public the reports submitted by the NAIC
under this subsection.</continuation-text></subsection><subsection commented="no" display-inline="no-display-inline" id="H015609F977244D688954900AD0100B05"><enum>(d)</enum><header>Consultation
required</header><text>The Secretary shall request the NAIC to consult with
State insurance commissioners, 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 insurance policies, and such other stakeholders as the
Secretary or the NAIC determine appropriate, to conduct the market reviews
requested under this section.</text>
</subsection><subsection id="H908E9F8B51604005A752F80A46684AAF"><enum>(e)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section and section 102:</text>
<paragraph id="H248DD02157294D2695574BE6E345857B"><enum>(1)</enum><header>Long-term care
insurance policy</header><text>The term <term>long-term care insurance
policy</term>—</text>
<subparagraph id="HEAB18BC3172B42CEB7BAB822F53DC243"><enum>(A)</enum><text>means—</text>
<clause id="HB97BF571BDBB43809B3B267B58305883"><enum>(i)</enum><text>a
qualified long-term care insurance contract (as defined in section 7702B(b) of
the Internal Revenue Code of 1986); and</text>
</clause><clause id="HC33A9F0700184BDD8897A9D9D8674C26"><enum>(ii)</enum><text>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
section; and</text>
</clause></subparagraph><subparagraph id="H99C7B5B5418643B6AD498AD98E56903A"><enum>(B)</enum><text>includes any other
insurance policy or rider described in the definition of <term>long-term care
insurance</term> in section 4 of the model Act promulgated by the National
Association of Insurance Commissioners (as adopted December 2006).</text>
</subparagraph></paragraph><paragraph id="H178FAC25516C4F6997D95D611B92D5CB"><enum>(2)</enum><header>NAIC</header><text>The
term <term>NAIC</term> means the National Association of Insurance
Commissioners.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HE47133FB3A134225AF0E8E51371BFD9A"><enum>(3)</enum><header>Secretary</header><text>The
term <term>Secretary</term> means the Secretary of Health and Human
Services.</text>
</paragraph></subsection></section><section id="H460884ED85C74C61B388E238680853A4"><enum>102.</enum><header>Model
disclosure form</header>
<subsection id="H3C64D1D0132B492DB89368C2ADF5EDEA"><enum>(a)</enum><header>NAIC study and
report on State disclosure requirements for long-Term care insurance</header>
<paragraph id="H842B4582D4324DE6A3CE8617D374F81E"><enum>(1)</enum><header>In
general</header><text>The Secretary shall request the NAIC to carry out the
activities described in paragraph (2) and issue the report described in
paragraph (3).</text>
</paragraph><paragraph id="H227B8BD1B2014FF58C8B2719E4A63646"><enum>(2)</enum><header>Review and
development of proposed model disclosure requirements</header><text>The
activities described in this paragraph are the following:</text>
<subparagraph id="H9A114DD1DF974DE887CB43BA8594B0D5"><enum>(A)</enum><header>Model act and
regulation disclosure requirements</header><text>Review and describe disclosure
requirements for long-term care insurance policies under the Model Act and
regulation.</text>
</subparagraph><subparagraph id="H29D3C9FFA3254990852062B909C126AD"><enum>(B)</enum><header>State law
disclosure requirements</header><text>Review and describe disclosure
requirements for long-term care insurance policies under State laws, including
as part of such description an analysis of the effectiveness of the various
existing disclosures.</text>
</subparagraph><subparagraph id="H7895D6A8E84846F1BCAFE344EA3DB756"><enum>(C)</enum><header>Long-term care
services</header><text>Review and describe differences in long-term care
services, including with respect to providers of such services and the settings
in which such services are provided among States and develop standardized
definitions for long-term care services.</text>
</subparagraph><subparagraph id="H1BEE9AA3082F4687AC8BB1A1304A5359"><enum>(D)</enum><header>Identification
of key issues for development of model disclosure marketing
form</header><text>Identify and describe key issues to consider in the
development of a proposed form for marketing long-term care insurance
policies.</text>
</subparagraph></paragraph><paragraph id="H7BC03B6AF25D4CDB871119C2D229F615"><enum>(3)</enum><header>Report</header><text>The
report described in this paragraph is an NAIC White Paper that is issued not
later than 12 months after the date of enactment of this Act and contains the
results of the reviews conducted under paragraph (2) and the descriptions
required under that paragraph.</text>
</paragraph></subsection><subsection id="HD483DC6C69064F16A9FE315147C1A784"><enum>(b)</enum><header>NAIC Working
Group To develop model disclosure form for long-Term care insurance</header>
<paragraph id="HE8BB70832A7B4FB08FD7EDB31A6F8ABB"><enum>(1)</enum><header>In
general</header><text>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 Treasury, a Working Group to develop a model disclosure form
for marketing long-term care insurance policies.</text>
</paragraph><paragraph id="H134D0B490EE54542925E7E131195CFF9"><enum>(2)</enum><header>Working Group
members</header><text>The Working Group established under paragraph (1) shall
be composed of the following:</text>
<subparagraph id="H017F5C7871084DA485235F89C84530B1"><enum>(A)</enum><text>Representatives
from State Departments of Health (or the most appropriate State agencies with
responsibility for oversight of the provision of long-term care).</text>
</subparagraph><subparagraph id="HD982899FF3124A91A5E78C85A5C761AB"><enum>(B)</enum><text>Representatives of
long-term care providers and facilities.</text>
</subparagraph><subparagraph id="HFC6DBE158435444DABE5B234B6B33835"><enum>(C)</enum><text>Consumer
advocates.</text>
</subparagraph><subparagraph id="H6250B536F6324FDE9FE3D1DFFAD708C8"><enum>(D)</enum><text>Representatives of
issuers of long-term care insurance policies.</text>
</subparagraph><subparagraph id="H01137C12C19542AE902E65044620E0EA"><enum>(E)</enum><text>Representatives of
the NAIC or State insurance commissioners.</text>
</subparagraph><subparagraph id="HE4BED08B4C68435E98C001E756F493DE"><enum>(F)</enum><text>Other experts in
long-term care and long-term care insurance policies selected by the Secretary
and Secretary of the Treasury or the NAIC.</text>
</subparagraph></paragraph><paragraph id="H884991AB494345ED8448C5A2892470F0"><enum>(3)</enum><header>Requirements for
development of form</header>
<subparagraph id="H2AD180A4F85B4C66981038D6DF7D2C99"><enum>(A)</enum><header>Considerations</header><text>In
developing the model form, the Working Group shall consider the
following:</text>
<clause id="HFACEE447C6474C9480DD1670F75C3092"><enum>(i)</enum><text>Variations among
providers, services, and facilities in the long-term care and long-term care
insurance markets.</text>
</clause><clause id="H18E471C1A752420CA47A30F8BFC36B99"><enum>(ii)</enum><text>The
results of the reviews and the descriptions included in the NAIC White Paper
issued under subsection (a)(3).</text>
</clause><clause id="H8D7C6B50AD5846C7B942250E78B58DB4"><enum>(iii)</enum><text>Such other
information and factors as the Working Group determines appropriate.</text>
</clause></subparagraph><subparagraph id="H99FAABA3188C4D68A1235C14F2519FA6"><enum>(B)</enum><header>Minimum
standards</header><text>The Working Group shall ensure that the model
has—</text>
<clause id="H45703F9F766744BCBEDD42BA006B48D5"><enum>(i)</enum><text>minimum standard
definitions for coverage of the various types of services and benefits provided
under long-term care insurance policies;</text>
</clause><clause id="H27D38F4E700C4AFD9CC4B7AE371161B1"><enum>(ii)</enum><text>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;</text>
</clause><clause id="H88C193DAAA044444B626AFDDE308242A"><enum>(iii)</enum><text>minimum standard
format, color and type size for disclosure documents; and</text>
</clause><clause id="H2D7B002F60B648ADB0EB9B7BA5BBF0DF"><enum>(iv)</enum><text>such other
minimum standards as the Working Group determines appropriate.</text>
</clause></subparagraph></paragraph><paragraph id="HCEF206E461A44D379E24B7D4158E3DD0"><enum>(4)</enum><header>Deadline for
development</header><text>The Working Group shall issue a proposed model
disclosure form for marketing long-term care insurance policies not later than
1 year after the date on which the Working Group is established.</text>
</paragraph><paragraph id="H9EED2A841F914E34922E80D7045E77CB"><enum>(5)</enum><header>Adoption and
incorporation into model act and regulation</header><text>The Secretary shall
request the NAIC to amend the Model Act and regulation 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 Working Group issues the form.</text>
</paragraph></subsection><subsection id="H84D844108FE746C0B7BDEA996A71702D"><enum>(c)</enum><header>Required use of
model disclosure form in marketing long-Term care insurance policies</header>
<paragraph id="HEF0EFEDC7BFD4E7FBEDD12CB580A2FE2"><enum>(1)</enum><header>Application to
tax-qualified and medicaid partnership policies</header><text>Not later than 1
year after the date on which the Working Group issues the proposed model
disclosure form for marketing long-term care insurance policies under
subsection (b):</text>
<subparagraph id="HE7F4F91B51024143BC8BA1DFA5051182"><enum>(A)</enum><header>Tax-qualified
policies</header><text>The Secretary of the Treasury shall promulgate a
regulation 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 contracts, to the
extent such disclosure is not inconsistent with State law.</text>
</subparagraph><subparagraph id="H35540A58A6BB489387B03D85175D25C1"><enum>(B)</enum><header>Medicaid
partnership policies</header><text>The Secretary shall promulgate a regulation
requiring, 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 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 section to use the proposed model
disclosure form for marketing such contracts.</text>
</subparagraph></paragraph><paragraph commented="no" display-inline="no-display-inline" id="HBAA09EBC5FF740DC9429CEA3DCF57F52"><enum>(2)</enum><header>Application to
all other long-term care insurance policies</header><text>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.</text>
</paragraph></subsection></section><section id="H90DBEBF3FFB64F37A1361AE281AD8523"><enum>103.</enum><header>LTC Insurance
Compare</header>
<subsection id="HD86E42B32B8643E097BB922208A79F33"><enum>(a)</enum><header>In
general</header><text display-inline="yes-display-inline">Section 6021(d) of
the Deficit Reduction Act of 2005 (42 U.S.C. 1396p note) is amended—</text>
<paragraph id="H9A160AB1BAF64E35A53EFCABA9E4B35E"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (2)—</text>
<subparagraph id="HD7FC4C91A7FD403299E3287A435B8230"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (A)—</text>
<clause id="HFCEF123BEB2C4CD5AEB2E841A95E126C"><enum>(i)</enum><text display-inline="yes-display-inline">in clause (ii), by striking
<quote>and</quote> at the end;</text>
</clause><clause id="H752F27B459814FD8827826215E90CDB5"><enum>(ii)</enum><text>in
clause (iii), by striking the period at the end and inserting <quote>;
and</quote>; and</text>
</clause><clause id="H03F88D2374CB425AA42E9F1F24F9B53E"><enum>(iii)</enum><text>by
adding at the end the following:</text>
<quoted-block display-inline="no-display-inline" id="HE4EF264CA60F420D99460814F8058C21" style="OLC">
<clause id="HA500C036BFFE4D87B4DF7991CBAF683E"><enum>(iv)</enum><text>establish an
Internet directory of information regarding long-term care insurance, to be
known as <quote>LTC Insurance Compare</quote>, that shall include the
following:</text>
<subclause id="HDD755D4C8169413985AA242A5D478550"><enum>(I)</enum><text>Comparison tools
to assist consumers in evaluating long-term care insurance policies (as defined
in subparagraph (D)) with different benefits and features and that allow
consumers to compare the price, long-term premium stability, and carrier
financial strength of such policies.</text>
</subclause><subclause id="H79F12770F4BD4DD3B79551847F1C9BBE"><enum>(II)</enum><text>State-specific
information about the long-term care insurance policies marketed in a State,
including the following:</text>
<item id="HE9A934CF872047ECBD2C084937741E0D"><enum>(aa)</enum><text>Whether a State
has promulgated rate stability provisions or has rate stability procedures in
place, and how the standards or procedures work.</text>
</item><item id="H3BC34C2823F14396BB7C4E96865A67C5"><enum>(bb)</enum><text>The
rating history for at least the most recent preceding 5 years for issuers
selling long-term care insurance policies in the State.</text>
</item><item id="H0FF29C9EA9C54A5E89AD769E0A873B79"><enum>(cc)</enum><text>An
appropriate sampling of the policy forms marketed in the State.</text>
</item></subclause><subclause id="HB8E2750B328D4049B4EB21E0C7F873BE"><enum>(III)</enum><text>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 includes the following:</text>
<item id="H7B1ECCA8FEA445E7A4184A0C68A1E6B2"><enum>(aa)</enum><text>The
medical assistance provided under each State's Medicaid program for nursing
facility services and other long-term care services (including any functional
criteria imposed for receipt of such services, as reported in accordance with
section 1902(a)(28)(D) of the Social Security Act) and any differences from
benefits and services offered under long-term care insurance policies in the
State and the criteria for triggering receipt of such benefits and
services.</text>
</item><item id="H688AE5C0005C48E086069AE7152F5DDA"><enum>(bb)</enum><text>If
the State has a qualified State long-term care insurance partnership under
clause (iii) of section 1917(b)(1)(C) of the Social Security Act (or is exempt
from the application of clause (i) of such section because of the application
of clauses (ii) and (iv) of such section), information regarding how and when
an individual with a partnership long-term care insurance policy who is
receiving benefits under the policy should apply for medical assistance for
nursing facility services or other long-term care services under the State
Medicaid program and information regarding about how Medicaid asset protection
is accumulated over time.</text>
</item></subclause></clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="H1DDF7CE4611247F5B97B61908D97DBDF"><enum>(B)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="HAE5BD3DCFB3B4EA6B51FA3EED4963B80" style="OLC">
<subparagraph id="H69ADC6F68C4F4C2F959A78073053BFDC"><enum>(C)</enum><header>Current
information</header><text>The Secretary of Health and Human Services shall
ensure that, to the greatest extent practicable, the information maintained in
the National Clearinghouse for Long-Term Care Information, including the
information required for LTC Insurance Compare, is the most recent information
available.</text>
</subparagraph><subparagraph id="H9D80AFB69A9F4D8D85BA8D9231E54002"><enum>(D)</enum><header>Long-term care
insurance policy defined</header><text>In subparagraph (A)(iv), the term
<term>long-term care insurance policy</term> 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
section, and includes any other insurance policy or rider described in the
definition of <term>long-term care insurance</term> in section 4 of the model
Act promulgated by the National Association of Insurance Commissioners (as
adopted December 2006).</text>
</subparagraph><after-quoted-block>;
</after-quoted-block></quoted-block>
</subparagraph></paragraph><paragraph id="HE6856D615C8846F18B65EA65CC36B755"><enum>(2)</enum><text>by redesignating
paragraph (3) as paragraph (4); and</text>
</paragraph><paragraph id="H67BF8D9573C349E8928E851F4678AF95"><enum>(3)</enum><text>by inserting after
paragraph (2) the following:</text>
<quoted-block display-inline="no-display-inline" id="HC2F0572011B441FAB58499B762E25E31" style="OLC">
<paragraph id="H471EF1D8E76643DCBBB88FF629857903"><enum>(3)</enum><header>Consultation on
LTC Insurance Compare</header><text>The Secretary of Health and Human Services
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).</text>
</paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HDD06CEE8B2E64B11BD22601ECE124C5D"><enum>(b)</enum><header>Medicaid State
plan requirement To submit nursing facility services functional criteria
data</header><text>Section 1902(a)(28) of the Social Security Act (42 U.S.C.
1396a(a)(28)) is amended—</text>
<paragraph id="HEDC0719CFFAA441B9870B13C251C77F3"><enum>(1)</enum><text>in subparagraph
(C), by striking <quote>and</quote> after the semicolon;</text>
</paragraph><paragraph id="HFB018461A1F44FCAA0BE3D261B18FA83"><enum>(2)</enum><text>in subparagraph
(D)(iii), by adding <quote>and</quote> after the semicolon; and</text>
</paragraph><paragraph id="H75D70A1585D2466F86422D81BACDFC95"><enum>(3)</enum><text>by inserting after
subparagraph (D)(iii), the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="HB690D875757B40B0950D1BF6BB70E8D1" style="OLC">
<subparagraph id="HE0F1A7FCC93E4C98BDF5491BB6ACAA99"><enum>(E)</enum><text>for the annual
submission of data relating to functional criteria for the receipt of nursing
facility services under the plan (in such form and manner as the Secretary
shall
specify);</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="H031B31E4B73C47E49508B20F6F5B6E6E"><enum>(c)</enum><header>Effective
date</header>
<paragraph id="H10A8F308E3454EE2B164D78BE01D7A18"><enum>(1)</enum><header>In
general</header><text>Except as provided in paragraph (2), the amendments made
by this section take effect on the date of enactment of this Act.</text>
</paragraph><paragraph id="H9D8154894E874CA6A91798E00CEBDBBE"><enum>(2)</enum><header>Extension of
effective date for state law amendment</header><text>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
legislation 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
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.</text>
</paragraph></subsection></section><enum>II</enum><header>Improved State
Consumer Protections for Qualified Long-Term Care Insurance Contracts and
Medicaid Partnership Policies</header>
<section id="H8B8B3DC04CCD4DB490FA56ABD2E26EB8"><enum>201.</enum><header>Application of
Medicaid partnership required model provisions to all tax-qualified long-term
care insurance contracts</header>
<subsection id="HA717A23F3A7B48D5840246A893DD11E4"><enum>(a)</enum><header>In
general</header><text>Section 7702B(g)(1) of the Internal Revenue Code of 1986
(relating to consumer protection provisions) is amended—</text>
<paragraph id="HBAA489D0E627436BBD3E80EE1FA50703"><enum>(1)</enum><text>in subparagraph
(A), by inserting <quote>(but only to the extent such requirements do not
conflict with requirements applicable under subparagraph (B)),</quote> after
<quote>paragraph (2)</quote>,</text>
</paragraph><paragraph id="H8ADB2FC9C3DF425DB04C8EAD4C99F88F"><enum>(2)</enum><text>by redesignating
subparagraphs (B) and (C) as subparagraphs (C) and (D), respectively,
and</text>
</paragraph><paragraph id="H0E20EFCA770C4CF1A0FD94F5803D61D9"><enum>(3)</enum><text>by inserting after
subparagraph (A), the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="H68ADE2143D264E868A802D91433A9A0B" style="OLC">
<subparagraph id="H52424C973A514909A72118694E650C11"><enum>(B)</enum><text>the requirements
of the model regulation and model Act described in section 1917(b)(5) of the
Social Security
Act,</text>
</subparagraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HF69C39B9B72C494FBA38432ECEB3EDC1"><enum>(b)</enum><header>Effective
date</header><text>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.</text>
</subsection></section><section id="H7D16391CD76B4E6980CA83F7A0141379"><enum>202.</enum><header>Streamlined
process for applying new or updated model provisions</header>
<subsection id="HB9EC5BF34C0E4D68966DE7B9EC81E308"><enum>(a)</enum><header>Secretarial
review</header>
<paragraph id="HB789EDCB8D854DC4A12493805277C4C7"><enum>(1)</enum><header>Tax-qualified
policies</header>
<subparagraph id="HD0E3837527194CF698C1F6EBE8FEB35C"><enum>(A)</enum><header>2000 and 2006
model provisions</header><text>Not later than 12 months after the date of
enactment of this Act, the Secretary of the Treasury, 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 provisions in such
section, for purposes of an insurance contract qualifying for treatment as a
qualified long-term care insurance contract under such Code, would improve
consumer protections for insured individuals under such contracts.</text>
</subparagraph><subparagraph id="HF65BC4BC6D9B411E8FC534A1DB0E8648"><enum>(B)</enum><header>Subsequent model
provisions</header><text>Not later than 12 months after model provisions
described in paragraph (2) or (3) of subsection (c) are adopted by the National
Association of Insurance Commissioners, the Secretary of the Treasury, in
consultation with the Secretary of Health and Human Services, shall review the
model provisions to determine whether the application of such provisions to an
insurance contract for purposes of qualifying for treatment as a qualified
long-term care insurance contract under section 7702B(g)(2) of the Internal
Revenue Code of 1986, would improve consumer protections for insured
individuals under such contracts.</text>
</subparagraph></paragraph><paragraph id="H53492C150D02405A8E06C5E788EC262C"><enum>(2)</enum><header>Medicaid
partnership policies</header>
<subparagraph id="H76D746C7006B47578092CF41ECFB839D"><enum>(A)</enum><header>Subsequent model
provisions</header><text>Not later than 12 months after model provisions
described in paragraph (2) or (3) of subsection (c) are adopted by the National
Association 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 contract for purposes of satisfying the requirements for
participation in a qualified State long-term care insurance partnership under
section 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.</text>
</subparagraph><subparagraph id="HFEBF1183FEBE4C5E851E5D3C4C0DD754"><enum>(B)</enum><header>Review of other
partnership requirements</header><text>The Secretary of Health and Human
Services, in consultation with the Secretary of the Treasury, shall review
clauses (iii) and (iv) of section 1917(b)(1)(C) for purposes of determining
whether the requirements specified in such clauses should be modified to
provide improved consumer protections or, as appropriate, to resolve any
conflicts with the application 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 determines should apply to an insurance
contract as a result of a review required under subparagraph (A).</text>
</subparagraph></paragraph></subsection><subsection id="H9A411B88D1CD4AA1886E3CD227D46757"><enum>(b)</enum><header>Expedited
rulemaking</header>
<paragraph id="H1F55894187124CEBAA34225C8FD50357"><enum>(1)</enum><header>Tax-qualified
policies</header><text>Subject to paragraph (3), if the Secretary of the
Treasury determines that any model provisions reviewed under subsection (a)(1)
should apply for purposes of an insurance contract qualifying for treatment as
a qualified long-term care insurance contract under the Internal Revenue Code
of 1986, the Secretary shall promulgate an interim final rule applying such
provisions for such purposes not later than 3 months after making such
determination.</text>
</paragraph><paragraph id="H5080D34AE9D0437EA359AA333DCEFF34"><enum>(2)</enum><header>Medicaid
partnership policies</header><text>Subject to paragraph (3), if the Secretary
of Health and Human Services determines that any model provisions 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 partnership 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.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="H72DBAAA82E5742928A9AA35F67B5B907"><enum>(3)</enum><header>Consultation
required</header><text>The Secretary of the Treasury and the Secretary of
Health and 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 appropriate to
apply the model provisions described in paragraph (1) or (2) (as applicable) to
insurance contracts described in such paragraphs through promulgation of an
interim final rule. If, after such consultation—</text>
<subparagraph commented="no" display-inline="no-display-inline" id="HFDA5C68861024E9E915C338B97575EEC"><enum>(A)</enum><text>the Secretary of
the Treasury determines 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</text>
</subparagraph><subparagraph commented="no" display-inline="no-display-inline" id="HCBD08CCE90B84F2CB53505539AAEFB83"><enum>(B)</enum><text>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).</text>
</subparagraph></paragraph><paragraph id="HC0A05E2648D84C61837029F681672D2D"><enum>(4)</enum><header>Rule of
construction relating to application of congressional review
act</header><text>Nothing 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 (commonly known as the <quote>Congressional Review Act</quote>) to
any interim final rule issued in accordance with such paragraphs.</text>
</paragraph><paragraph id="HE970DE23E52F45528A19FBD598701317"><enum>(5)</enum><header>Technical
amendment eliminating prior review standard made obsolete</header><text>Section
1917(b)(5) of the Social Security Act (42 U.S.C. 1396p(b)(5)) is amended by
striking subparagraph (C).</text>
</paragraph></subsection><subsection id="H5D6BE68DBD494777924B10BFFD6098D0"><enum>(c)</enum><header>Model
provisions</header><text>In this section, the term <term>model
provisions</term> means—</text>
<paragraph id="H04019F310B7C445A96FF6F59CC89E72C"><enum>(1)</enum><text>each provision of
the long-term care insurance model regulation, and the long-term care insurance
model Act, respectively, promulgated by the National Association of Insurance
Commissioners (as adopted as of October 2000 and as of December 2006);</text>
</paragraph><paragraph id="HD21D3E588FEE4E07AA0AFC9188736DFB"><enum>(2)</enum><text>each provision of
the model language relating to marketing disclosures and definitions developed
under section 102(b)(1); and</text>
</paragraph><paragraph id="H0B59059A8F9A4B13BBAC60803A126C5B"><enum>(3)</enum><text>each provision of
any long-term care insurance model regulation, or the long-term care insurance
model Act, respectively, promulgated by the National Association of Insurance
Commissioners and adopted after December 2006.</text>
</paragraph></subsection></section><enum>III</enum><header>Improved
Consumer Protections for Medicaid Partnership Policies</header>
<section id="H245EB02C1D1747F18C7003BB05983D9C"><enum>301.</enum><header>Biennial
reports on impact of Medicaid long-term care insurance
partnerships</header><text display-inline="no-display-inline">Section 6021(c)
of the Deficit Reduction Act of 2005 (42 U.S.C. 1396p note) is amended to read
as follows:</text>
<quoted-block display-inline="no-display-inline" id="H8E305985019844EF85B4C60E1F902531" style="OLC">
<subsection id="H12F6CB808BCE4F748421F7358AE0FD39"><enum>(c)</enum><header>Biennial
reports</header>
<paragraph id="H846D4E7CA2B14E72A5EAB1D7E9F7121E"><enum>(1)</enum><header>In
general</header><text>Not later than January 1, 2011, and biennially
thereafter, the Secretary of Health and Human Services (in this subsection
referred to as the <term>Secretary</term>) 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 include (with respect to the period the
report addresses) the following information, nationally and on a State-specific
basis:</text>
<subparagraph id="H3C49A35F003941969640D72D3C12B276"><enum>(A)</enum><text>Analyses of the
extent to which such partnerships improve access of individuals to affordable
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.</text>
</subparagraph><subparagraph id="H4677A1593A21415DB6E052E472F89541"><enum>(B)</enum><text>Analyses of the
impact of such partnerships on consumer decisionmaking with respect to
purchasing, accessing, and retaining coverage under long-term care insurance
policies (as defined in subsection (d)(2)(D)), including a description of the
benefits and services 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 assistance under the State Medicaid program, and the
number of insured individuals who were determined ineligible for medical
assistance under the State plan and the reason for such determinations.</text>
</subparagraph></paragraph><paragraph id="H9B46410EE13547F19F8FDDB17736C43C"><enum>(2)</enum><header>Data</header><text>The
reports by issuers of partnership long-term care insurance policies required
under section 1917(b)(1)(C)(iii)(VI) of the Social Security Act shall include
such data as the Secretary shall specify in order to conduct the analyses
required under paragraph (1).</text>
</paragraph><paragraph id="HF97E9A4925FB4E0C93D0DF8A1A85B50E"><enum>(3)</enum><header>Public
availability</header><text>The Secretary shall make each report issued under
this subsection publicly available through the LTC Insurance Compare Web site
required under subsection (d).</text>
</paragraph><paragraph id="H6B27BE7614944AABADE81E2E262D4F3F"><enum>(4)</enum><header>Rule of
construction</header><text>Nothing in this section shall be construed as
requiring the Secretary to conduct an independent review of each long-term care
insurance policy offered under or in connection with such a
partnership.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="H0AF9E5A82737447B95F7D89CBC930821"><enum>302.</enum><header>Additional
consumer protections for Medicaid partnerships</header>
<subsection id="H5B852827D8984E37902869C884AFEA64"><enum>(a)</enum><header>Application of
2006 Model Provisions</header>
<paragraph id="HD597FFC79F274798B143994EB26E2EC3"><enum>(1)</enum><header>Updating of 2000
requirements</header>
<subparagraph id="H6D1BFC2FC68E4D1DA65F1E0E757AC690"><enum>(A)</enum><header>In
general</header><text>Section 1917(b)(5)(B)(i) of the Social Security Act (42
U.S.C. 1396p(b)(5)(B)(i)) is amended by striking <quote>October 2000</quote>
and inserting <quote>December 2006</quote>.</text>
</subparagraph><subparagraph id="HC1B04B785EDA40BFB990B3F70E194DF5"><enum>(B)</enum><header>Conforming
amendments</header>
<clause id="H5160EE412EBA4832BC02545E592B6501"><enum>(i)</enum><text>Subclause (XVII)
of such section is amended by striking <quote>section 26</quote> and inserting
<quote>section 28</quote>.</text>
</clause><clause id="H36D6807CFBEF43A7B92E64D04EB6284A"><enum>(ii)</enum><text>Subclause (XVIII)
of such section is amended by striking <quote>section 29</quote> and inserting
<quote>section 31</quote>.</text>
</clause><clause id="H2C0974D5A08E4CF1BFE7073E54EE2F25"><enum>(iii)</enum><text>Subclause (XIX)
of such section is amended by striking <quote>section 30</quote> and inserting
<quote>section 32</quote>.</text>
</clause></subparagraph></paragraph><paragraph id="H121341A4D1E14E50AE4FB7BFA695AC37"><enum>(2)</enum><header>Application to
grandfathered partnerships</header><text>Section 1917(b)(1)(C)(iv) of such Act
(42 U.S.C. 1396p(b)(1)(C)(iv)) is amended by inserting <quote>, and the State
satisfies the requirements of paragraph (5)</quote> after
<quote>2005</quote>.</text>
</paragraph></subsection><subsection id="H521BAD8C56764B83B18E8D7DEB2149AE"><enum>(b)</enum><header>Application of
producer training model act requirements</header><text>Section 1917(b)(1)(C) of
such Act (42 U.S.C. 1396p(b)(1)(C)) is amended—</text>
<paragraph id="HD293BBD3DD7F453685CAE421E58DCC9F"><enum>(1)</enum><text>in clause
(iii)(V), by inserting <quote>and satisfies the producer training requirements
specified in section 9 of the model Act specified in paragraph (5)</quote>
after <quote>coverage of long-term care</quote>; and</text>
</paragraph><paragraph id="H528CA9EC4668473EB467489389AE70D8"><enum>(2)</enum><text>in clause (iv), as
amended by subsection (a)(2), by inserting <quote>clause (iii)(V) and</quote>
before <quote>paragraph (5)</quote>.</text>
</paragraph></subsection><subsection id="H8E77401DC3134D3A96CC8290E378E4C4"><enum>(c)</enum><header>Application of
additional requirements for all partnerships</header><text>Section 1917(b) of
the Social Security Act (42 U.S.C. 1396p(b)) is amended—</text>
<paragraph id="HEDD498456F2E45BB999D3BF4901710CC"><enum>(1)</enum><text>in paragraph
(1)(C)—</text>
<subparagraph id="H4B36D2D2C1194880B81E3CAA1B7BBEBC"><enum>(A)</enum><text>in clause
(iii)—</text>
<clause id="H5DF85BB5853E4F3E96EFFBB3381CF1CB"><enum>(i)</enum><text>by
inserting after subclause (VII) the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="H4EDF92F5F5C5479AAD46692148757C3C" style="OLC">
<subclause id="H062E525A87A542CC91FD63FFB1AEA9FF" indent="up1"><enum>(VIII)</enum><text>The State satisfies the requirements
of paragraph (6).</text>
</subclause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause><clause id="HF5C117BB9F644C0093C9FCE4FDB50DB3"><enum>(ii)</enum><text>in
the flush sentence at the end, by striking <quote>paragraph (5)</quote> and
inserting <quote>paragraphs (5) and (6)</quote>; and</text>
</clause></subparagraph><subparagraph id="H1F3801E4B5A543AD906256426D2898C8"><enum>(B)</enum><text>in clause (iv), as
amended by subsections (a)(2) and (b)(2), by striking <quote>paragraph
(5)</quote> and inserting <quote>paragraphs (5) and (6)</quote>; and</text>
</subparagraph></paragraph><paragraph id="H81484D21682A4D43A4AB3840CEFEC3FA"><enum>(2)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="H74A1C0CD31D44E4A97082911038FC6C5" style="OLC">
<paragraph id="HF1240D86BECD49368F256D06487DAA1F" indent="up1"><enum>(6)</enum><text>For purposes of clauses (iii)(VIII)
and (iv) of paragraph (1)(C), the requirements of this paragraph are the
following:</text>
<subparagraph id="HC3C9A48269CF45E485EE971B622A21BF"><enum>(A)</enum><text>The State requires issuers of
long-term care insurance policies to—</text>
<clause id="H75010668F0704A0DB5FFB860D84CB949"><enum>(i)</enum><text>use marketing materials filed with
the State for purposes of the partnership in all sales and marketing activities
conducted or supported by the issuers in the State with respect to any
long-term care insurance policies marketed by the issuer in the State;</text>
</clause><clause id="H175012BA6DC24695B84E6D0F363DA08B"><enum>(ii)</enum><text>provide such materials to all
agents selling long-term care insurance policies in the State;</text>
</clause><clause id="HC0B14530D2BC4571B790F3E5C5A0FD1F"><enum>(iii)</enum><text>ensure that agent training and
education courses conducted or supported by the issuers incorporate discussion
of such marketing materials; and</text>
</clause><clause id="HC667F25501D04C20B72734A3CB65B0EF"><enum>(iv)</enum><text>make such materials available to
any consumer upon request, and to make such materials available to all
prospective purchasers of a policy offered under a qualified State long-term
care insurance partnership before submission of an application for coverage
under that policy.</text>
</clause></subparagraph><subparagraph id="H797FFB30B79F4E8CAC7CDE2A70526571"><enum>(B)</enum><text>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 Insurance Commissioners when selling the policies in the State.</text>
</subparagraph><subparagraph id="HD7C47E53EAB443AB8A981C66B02E7C9C"><enum>(C)</enum><text>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.</text>
</subparagraph><subparagraph id="H3D2504416CB04CF9AF9D62EBDCF3F219"><enum>(D)</enum><text>The State enacts legislation, not
later than January 1, 2012, that establishes rating standards for all issuers
of long-term care insurance policies sold in the State that result in rates
over the life of the policy that are no less protective of consumers 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.</text>
</subparagraph><subparagraph id="HFFE4DC09E62E4E9B867D3AAD791FBE0E"><enum>(E)</enum><text>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, duration, or
scope of medical assistance for nursing facility 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 materials shall include a clear disclosure that medical
assistance is not guaranteed to partnership policyholders who exhaust or use
benefits under a partnership policy, and that Federal changes to the program
under this title or State changes to the State plan may affect an individual's
eligibility for, or receipt of, such assistance.</text>
</subparagraph><subparagraph id="HB98A7BE426A64053B047FBCDA9066987"><enum>(F)</enum><text>The State—</text>
<clause id="H6C097029B15D4E2E83EF81735B38B358"><enum>(i)</enum><text>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 participating in the partnership
interact with the benefits and rules under the State plan under this
title;</text>
</clause><clause id="H5060504A3B0341D381C49DEE4B42EBDB"><enum>(ii)</enum><text>requires agents to use such
materials when selling or otherwise discussing how long-term care policies
offered by issuers participating in the partnership work with potential
purchasers and to provide the materials to any such purchasers upon
request;</text>
</clause><clause id="HB9A7CEC150654EF396ECF109B2206D2E"><enum>(iii)</enum><text>informs holders of such policies
of any changes in eligibility requirements and covered services under the State
plan under this title and of any changes in estate recovery rules 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</text>
</clause><clause id="HB20B6FCD749E40358B3730281A27CB52"><enum>(iv)</enum><text>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.</text>
</clause><continuation-text continuation-text-level="subparagraph">The
materials under clause (i) shall include information 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 practicable, the identify of those States), based an
individual’s home value exceeding the applicable limits as modified by the
State (and, to the extent practicable, the limits applicable in different
States), or based on an individual’s income exceeding the applicable limits
(and, to the extent practicable, information on current average long-term care
costs and on applied income requirements for different States).</continuation-text></subparagraph><subparagraph id="H4FB794E13A3642A0B427E812B863496F"><enum>(G)</enum><text>The State Medicaid agency under
section 1902(a)(5) and the State insurance department enter into a memorandum
of understanding to—</text>
<clause id="H3200803EC83E456AA9D457DEC724F906"><enum>(i)</enum><text>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 services 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</text>
</clause><clause id="H9ED5F76C9FF348F6AA537656915E0DBD"><enum>(ii)</enum><text>jointly facilitate coordination in
eligibility determinations for medical assistance under the State plan and the
provision of benefits or other services under such policies and medical
assistance provided under the State plan that includes—</text>
<subclause id="H0DAADE0144BF463DA0AB72F6438E1C81"><enum>(I)</enum><text>the number of policyholders applying for
medical assistance under the State plan; and</text>
</subclause><subclause id="H6C8A9723BD4D4CB9958ED4C9D8040152"><enum>(II)</enum><text>the number of policyholders deemed
eligible (and, if applicable, ineligible) for such assistance.</text>
</subclause></clause></subparagraph><subparagraph id="HC058867786A5485B9640F5C19CDAFB03"><enum>(H)</enum><text>Subject to subparagraph (I), the State
enters into agreements with other States that have established qualified State
long-term care insurance partnerships under which such States agree to provide
reciprocity for policyholders under such partnerships, including providing
guaranteed asset protection 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.</text>
</subparagraph><subparagraph id="H7DA8C05065584097B66DF3E8BEB6235C"><enum>(I)</enum><clause commented="no" display-inline="yes-display-inline" id="HBBCF1A9C1DF94E2BB1B289BF94E954AF"><enum>(i)</enum><text>In the case of a State
described in paragraph (1)(C)(iv) (in this subparagraph referred to as a
<term>grandfathered partnership State</term>) —</text>
<subclause id="HEF786F832F7A415F94966EBC170D6CD5" indent="up1"><enum>(I)</enum><text>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</text>
</subclause><subclause id="H9CF6DA66918244AC83A47C0FCED29C4D" indent="up1"><enum>(II)</enum><text>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 insurance partnership, the
grandfathered partnership State shall enter into and comply with a reciprocity
agreement developed by the Secretary in accordance with clause (ii) for each
partnership State that the grandfathered State does not have a reciprocity
agreement with and, with respect to each such State, for so long as the
grandfathered partnership State does not have an individual reciprocity
agreement with that State.</text>
</subclause></clause><clause id="H9B0008D3E5E6402A99854011B3FA0B8F" indent="up1"><enum>(ii)</enum><text>In developing a reciprocity agreement
for purposes of clause (i)(II), the Secretary shall take into account—</text>
<subclause id="HC23F325345524A9F8162776141314632"><enum>(I)</enum><text>the difference in consumer
protections under the partnership program of the grandfathered partnership
State and the other partnership State that will be covered by the agreement,
and, to the greatest extent possible, preserve the more protective
requirements; and</text>
</subclause><subclause id="H495D082110D7400FB6E77810AE450B11"><enum>(II)</enum><text>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
greatest extent possible, minimize any negative impact on such expenditures and
States.</text>
</subclause></clause></subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="HCAFE87938A2B4360A2A3C415517CB364"><enum>(d)</enum><header>Effective
date</header>
<paragraph id="HEC01C0D01B804FCBB9AEB5940578FA32"><enum>(1)</enum><header>In
general</header><text>Except as provided in paragraph (2), the amendments made
by this section take effect on the date that is 1 year after the date of
enactment of this Act.</text>
</paragraph><paragraph commented="no" display-inline="no-display-inline" id="HC78D21F70F05497A811A5119961F6F40"><enum>(2)</enum><header>Extension of
effective date for state law amendment</header><text>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
legislation 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 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 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.</text>
</paragraph></subsection></section><section id="H65A3297A7D1A47FF9E430B42137895F8"><enum>303.</enum><header>Report to
Congress regarding need for minimum annual compound inflation
protection</header><text display-inline="no-display-inline">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 <term>Secretary</term>)
shall submit a report to Congress that includes the Secretary's recommendation
regarding whether legislative or other administrative 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 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
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 purchase. The Secretary shall include in
the report information 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 option
feature.</text>
</section><enum>IV</enum><header>Preservation of
State Authority</header>
<section id="H7585CB3A3FC646E995BA192369C3505F"><enum>401.</enum><header>Preservation of
State authority</header><text display-inline="no-display-inline">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 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.</text>
</section>