1.Short
title; table of contents
(a)This Act may be cited
as the Confidence in Long-Term Care
Insurance Act of 2009
.
(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 disclosures and definitions.
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.
<enum>I</enum><header>National Market
Survey; Model Disclosures and Definitions; LTC Insurance Compare</header>
<section id="id82820DF995964F9AAF89B111F5A8E66C"><enum>101.</enum><header>NAIC National
Market Survey</header>
<subsection id="idDC2AAEB9A6D44423854BB0C539527B7B"><enum>(a)</enum><header>In
general</header><text>The Secretary shall request the NAIC to conduct biennial
reviews of the national and State-specific markets for long-term care insurance
policies and to submit biennial reports to the Secretary on the results of such
reviews.</text>
</subsection><subsection id="id4DC0DBEF5EEB40C99FDA2B3B341270DE"><enum>(b)</enum><header>Content</header><text>The
Secretary shall request that the biennial reviews include, with respect to the
period occurring since any prior review, analysis of the following:</text>
<paragraph id="idE83C8E7664594C438A6A559D71D460B4"><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, and hybrid products in which long-term care benefits are
present).</text>
</paragraph><paragraph id="idB8A3EC28E1CA42C38C039F75BBB32B0A"><enum>(2)</enum><text>The number of
complaints received and resolved, including benefit denials.</text>
</paragraph><paragraph id="id021C1966C5504E29848FBEF5ADB789F8"><enum>(3)</enum><text>The number of
policies that are cancelled (including because of having lapsed or not being
renewed) and reasons for such cancellations.</text>
</paragraph><paragraph id="id9B318993DDE84B93AA919A96D18E797E"><enum>(4)</enum><text>The number of
agents trained and the content of that training, including a description of
agent training standards, the extent to which competency tests are included in
such standards, and the pass and fail rates associated with such tests.</text>
</paragraph><paragraph id="id888C019BDB8D41AA94DDAD1ED7DAECFD"><enum>(5)</enum><text>The number of
policyholders exhausting benefits.</text>
</paragraph><paragraph id="id6C945F092C9A41EA9138CD7C88293D96"><enum>(6)</enum><text>Premium rate
increases sought by carriers and the range of the amount of the increase
sought.</text>
</paragraph><paragraph id="idB649D4AC8A8F46C4828E73C0657FEC4A"><enum>(7)</enum><text>Premium rate
increases that were approved and the range of the amount of increase.</text>
</paragraph><paragraph id="idEF844B0EA20A4F9AA0627E4D93E659A5"><enum>(8)</enum><text>The number of
policyholders affected by any approved premium rate increases.</text>
</paragraph><paragraph id="idFF71C6A1B1434D72AA2E40E7174C7CF9"><enum>(9)</enum><text>Requests for
exceptions to State reserving or capital requirements.</text>
</paragraph></subsection><subsection id="idFAEFF86FFE9447D7A68C4D74436C292F"><enum>(c)</enum><header>Timing for
biennial review and report</header><text>The Secretary shall request the NAIC
to—</text>
<paragraph id="idD86BD16B76734C049D77000E86D4956C"><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="id69EF50CAC6724AF098ECAD85E4A8A92C"><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="id5722C05F05C941C88F22595F00899BD6"><enum>(3)</enum><text>complete each
subsequent biennial review and submit each subsequent biennial report not later
than December 31 of each second succeeding year.</text>
</paragraph></subsection><subsection commented="no" display-inline="no-display-inline" id="id1F7406CB813546F5BD1F604B8D74BBBB"><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="id110B6650E7E64322856BD63404775157"><enum>(e)</enum><header>Definitions</header><text display-inline="yes-display-inline">In this section and section 102:</text>
<paragraph id="idAF98D0B24802437583D27FB6C7BBB442"><enum>(1)</enum><header>Long-term care
insurance policy</header><text>The term <term>long-term care insurance
policy</term>—</text>
<subparagraph id="idB7B08473947746618C0FDE7BB113C118"><enum>(A)</enum><text>means—</text>
<clause id="id7A32BF0FD9D2441DAE3EFFECCCEB2B27"><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="id6A7BCB6BD13F446FA7D8FE676C219739"><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="idD11CB2C7FC1748DF8DFD7BC02BD1DBEE"><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="id0B4BFE1DFA6444D68DD383B58C88066D"><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="id667AA05EC5FF4555A61B32953D9CAE6D"><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="id1E8123D82A414BD4BFA3450750005ABE"><enum>102.</enum><header>Model
Disclosures and Definitions</header>
<subsection id="id21CF20579C4F4029AC965704DBDB0C82"><enum>(a)</enum><header>In
general</header><text>The Secretary shall request the NAIC, in consultation
with State health agencies as appropriate, to carry out the activities
described in subsection (b).</text>
</subsection><subsection id="id6454B09A42AF4888AA2D97AD1F83E9A4"><enum>(b)</enum><header>Activities
described</header><text>The activities described in this subsection are the
following:</text>
<paragraph id="idC96E08225D28495E8AEBC2F1DA353446"><enum>(1)</enum><header>Develop model
disclosures and definitions for marketing of policies</header><text>To develop
model language for marketing of long-term care insurance policies (including,
as appropriate, language specific to qualified long-term care insurance
contracts, partnership long-term care insurance policies, and such other
contracts for coverage of long-term care services or benefits as the NAIC
determines appropriate), that includes the following:</text>
<subparagraph id="idF8D397838FEC4E90BBD9A933EDF6E3AB"><enum>(A)</enum><header>Consistent
definitions</header><text>Consistent definitions for coverage of the various
types of services and benefits provided under such policies, including
institutional services, residential services with varying levels of assistance,
such as assisted living, home care services, adult day services, and other
types of home and community-based care (as appropriate to describe the range of
services and benefits offered under such policies in various States).</text>
</subparagraph><subparagraph id="idD35B0F6031CB4CDC825007715CFBDA88"><enum>(B)</enum><header>Consistent
explanatory language</header><text>Consistent 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>
</subparagraph><subparagraph id="idB45D18A6A97E48A0BDF95E09491C03DA"><enum>(C)</enum><header>Inflation
protection options</header><text>A form that describes different inflation
level options offered for long-term care insurance policies, including how
policies with various levels of inflation protection compare in premium costs
and benefits within 5-year time increments from 5 years through 30 years
post-purchase.</text>
</subparagraph><subparagraph id="id87710D59AF8A4297B8CA3656F19359A2"><enum>(D)</enum><header>Standardized
methodology for calculating inflation protection</header><text>Standardized
methodology for use by issuers to use to calculate inflation protection under
such policies.</text>
</subparagraph></paragraph><paragraph id="idA8AF39DDDE0945438DD1BF5A4CACA1DF"><enum>(2)</enum><header>Enforce</header><text>To
develop recommendations for enforcement of the model marketing disclosures and
definitions, including standardized language for States to adopt to prohibit
carriers from marketing policies within the State that do not meet the model
marketing disclosures and definitions or the rate stability provisions under
section 20 of the long-term care insurance model Act promulgated by the
National Association of Insurance Commissioners (as adopted as of October 2000
and as of December 2006) and any provisions of such section adopted after
December 2006.</text>
</paragraph></subsection><subsection id="id08BF8687B12042F28737170A0B5D3A8E"><enum>(c)</enum><header>Public
comment</header><text>The Secretary shall request the NAIC to allow for public
comment on the work of the NAIC in carrying out the activities described in
subsection (b).</text>
</subsection></section><section id="id9081EA47D7E0419BA0D7455BAD463498"><enum>103.</enum><header>LTC Insurance
Compare</header>
<subsection id="id24635DEE642E4B05B6762DF9B6BDF1EA"><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="id9C77FD72DD0C4F61BD4A8E8195D10DCD"><enum>(1)</enum><text display-inline="yes-display-inline">in paragraph (2)—</text>
<subparagraph id="id5DE4D5E4DAB94C77AED4695118994415"><enum>(A)</enum><text display-inline="yes-display-inline">in subparagraph (A)—</text>
<clause id="id12F2DF914E6F41C1969C17C9544CEF8E"><enum>(i)</enum><text display-inline="yes-display-inline">in clause (ii), by striking
<quote>and</quote> at the end;</text>
</clause><clause id="id3E1E7D116F1A4F9F90BD236E7D1B429C"><enum>(ii)</enum><text>in
clause (iii), by striking the period at the end and inserting <quote>;
and</quote>; and</text>
</clause><clause id="idE941F5E60DE14DDB9D482C7D52720C98"><enum>(iii)</enum><text>by adding at
the end the following:</text>
<quoted-block display-inline="no-display-inline" id="id7F73A8987C9B4E3D87316B7084BBB7C5" style="OLC">
<clause id="idF06BD116C36A4F99956862E5C21DFEB0"><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="id0E8953696AF2441EAF15BDEBC6D72F5E"><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.</text>
</subclause><subclause id="idEA5A05D65CC74F1790EC3CFD37A2CE92"><enum>(II)</enum><text>State-specific
information about the long-term care insurance policies marketed in a State,
including the following:</text>
<item id="id59DE8D7D1F004343BCBCFBB51D50649B"><enum>(aa)</enum><text>Whether a State
has promulgated rate stability provisions for all issuers of long-term care
insurance policies and how the rate stability standards work.</text>
</item><item id="id2E2A4247AE0B47D78F06E70BB3F5412F"><enum>(bb)</enum><text>The rating
history for issuers selling long-term care insurance policies in the State for
at least the most recent preceding 5 years.</text>
</item><item id="id55DE8AC0FD324C7F9E1D1FBA52283228"><enum>(cc)</enum><text>The policy
documents for each such policy marketed in the State.</text>
</item></subclause><subclause id="id2F3ABBFC69464619B0672C8C9BEA271D"><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 websites of State
Medicaid programs) that includes the following:</text>
<item id="idDA021CB183E4454BB8CF8989803104D6"><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="id23831A37BC0F4FBFA02F205B34E18655"><enum>(bb)</enum><text>If
the State has a qualified State long-term care insurance partnership under
section 1917(b)(1)(C)(iii) of the Social Security Act, 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 under such
policies.</text>
</item></subclause></clause><after-quoted-block>;
and</after-quoted-block></quoted-block>
</clause></subparagraph><subparagraph id="id7B75E167183746B7819B603955C3FED0"><enum>(B)</enum><text>by adding at the
end the following:</text>
<quoted-block display-inline="no-display-inline" id="id1990FCFE40F344D482068303BFFD0EDC" style="OLC">
<subparagraph id="idD3E1ECB9DF634F06A623B49EAAE22280"><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="id907F079F511847C486952F9117C43949"><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="id84DE67B1AD0F42E7BCFE046E0A653423"><enum>(2)</enum><text>by redesignating
paragraph (3) as paragraph (4);</text>
</paragraph><paragraph id="id9F8F3D4909A44EC7BD3D516C28BF307E"><enum>(3)</enum><text>in paragraph (4)
(as so redesignated), by inserting <quote>, and $5,000,000 for each of fiscal
years 2011 through 2013</quote> after <quote>2010</quote>; and</text>
</paragraph><paragraph id="idBD38EC0161C344AAA33835E81C827870"><enum>(4)</enum><text>by inserting
after paragraph (2) the following:</text>
<quoted-block display-inline="no-display-inline" id="id505CAF7E7B5E4B49844F333B9F66CC1C" style="OLC">
<paragraph id="idBC8E66AF65564D11A44C211E73261D80"><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 the
entities and stakeholders specified in section 101(d) of the
<short-title>Confidence in Long-Term Care Insurance Act of
2009</short-title> 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="id62E2DD74E7AE4EA180631116C0FDACAA"><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="id352D80A473D64ECDA562CC4F86EDC408"><enum>(1)</enum><text>in subparagraph
(C), by striking <quote>and</quote> after the semicolon;</text>
</paragraph><paragraph id="id4D7CEBF7FDB540F6B396E38376FFB31C"><enum>(2)</enum><text>in subparagraph
(D)(iii), by adding <quote>and</quote> after the semicolon; and</text>
</paragraph><paragraph id="id1C2413440CAF4755B56AE88830614BA6"><enum>(3)</enum><text>by inserting
after subparagraph (D)(iii), the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="id20776A7A68294E8493A603E813076519" style="OLC">
<subparagraph id="id936D1DFC085B49C197169BA0D58F0910"><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="idACD70F847F314EA58BD4EF80C5D1179A"><enum>(c)</enum><header>Effective
date</header>
<paragraph id="id08119CF331B44F18B64C504D504B5002"><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="id0AA31D3A49BA404CB4AE87544134597F"><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="id1330B09E8F7041CBAEC2F7ED0C98E3AF"><enum>201.</enum><header>Application of
Medicaid partnership required model provisions to all tax-qualified long-term
care insurance contracts</header>
<subsection id="id141EFDD354F24B6CA06555731182BE90"><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="id034A6B632B18496CB21EC3C4344EBE4C"><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="id82978A0414B6465A9C4CFFBBDD445600"><enum>(2)</enum><text>by redesignating
subparagraphs (B) and (C) as subparagraphs (C) and (D), respectively,
and</text>
</paragraph><paragraph id="idA10E9C8EF47540F89284861381FE0E5F"><enum>(3)</enum><text>by inserting
after subparagraph (A), the following new subparagraph:</text>
<quoted-block display-inline="no-display-inline" id="idE9A70F18A2F54551B366A96FC9C5CB73" style="OLC">
<subparagraph id="id7A3A4CCD1A9E4ABFA3310C87E60D484C"><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="idDB4747F4283F46E3B946C825BFD163E3"><enum>(b)</enum><header>Effective
date</header><text>The amendments made by subsection (a) shall apply to
contracts issued after the date of enactment of this Act.</text>
</subsection></section><section id="id07F65DF1FD2C4E238B564B93D54E31E1"><enum>202.</enum><header>Streamlined
Process for Applying New or Updated Model Provisions</header>
<subsection id="id98374FC060164BFF881DF5F794E937FE"><enum>(a)</enum><header>Secretarial
review</header>
<paragraph id="id7A9417FA51B1460ABE5F41A7436306A8"><enum>(1)</enum><header>Tax-qualified
policies</header>
<subparagraph id="id920581A7027541BA9D8104A31DD79301"><enum>(A)</enum><header>2000 and 2006
model provisions</header><text>Not later than 3 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="idF694C4486FAD4A96AE87DB236038F39F"><enum>(B)</enum><header>Subsequent
model provisions</header><text>Not later than 3 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="id64635CCF13D244D38AC61A9C1357DE80"><enum>(2)</enum><header>Medicaid
partnership policies</header>
<subparagraph id="id05C37769333B44EEA506CA8650C61107"><enum>(A)</enum><header>Subsequent
model provisions</header><text>Not later than 3 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="idD294304177014E5F90FA8086127D4103"><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="idAF5BABACCEA74367BE15A1F101FF1EF3"><enum>(b)</enum><header>Expedited
rulemaking</header>
<paragraph id="id91DFE6EF9D8540C3A98F7DC21B22AB42"><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="id25E09B56571D4BB6B69C6DFA210D8C03"><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 section 1917(b)(1)(C)(iii) of
such Act (42 U.S.C. 1396p(b)(1)(C)(iii)), 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="id3979AC06F4A6459188CA15E4D7C684AC"><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="id30A90BE0E6364E2D8142DCCF7A1EF2EC"><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="id75E43634415F49D4A3767ECBAA06D81A"><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="ID87f717f10a3744f9a431db2b2fccaf02"><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="idCA669CEA800947A3891B44229461759E"><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="idF885C349CE8B4383B672722093C99FB4"><enum>(c)</enum><header>Model
provisions</header><text>In this section, the term <term>model
provisions</term> means—</text>
<paragraph id="id11412D02E20946BEB5E5982F96920BAA"><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="id30461D01CDEB451887169932C6ED7082"><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="id959C9F32AF4D4EDF9E031F4B41917FD4"><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="id4B43FB42AA2D4ADCADDDE65D89395B41"><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="id5A79A654C80B43D1B5170BF594D4ACFD" style="OLC">
<subsection id="idCBF127F748284A89B292203E9FD93999"><enum>(c)</enum><header>Biennial
reports</header>
<paragraph id="idA73AB507D0FE42ECB72B59883613754B"><enum>(1)</enum><header>In
general</header><text>Not later than January 1, 2010, 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="idE9BD96C8BF5440FB92D236F4524798B2"><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="idC3FAD72BA40F49EA9D5607CED0F11BBF"><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, and the number of insured individuals who were
determined eligible for medical assistance under the State Medicaid
program.</text>
</subparagraph></paragraph><paragraph id="idF713FC2FCB164575B739D426FDD864B6"><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="idC94C815EE23449488D02ADFAEBF5F375"><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 website
required under subsection (d).</text>
</paragraph><paragraph id="idAC1EBD7BB5D244E9A62B564A1F5A462F"><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><paragraph id="id9195C56A8F534B5B87D2E7248887A299"><enum>(5)</enum><header>Appropriation</header><text>Out
of any funds in the Treasury not otherwise appropriated, there is appropriated
to the Secretary to carry out this subsection, $1,000,000 for the period of
fiscal years 2010 through
2012.</text>
</paragraph></subsection><after-quoted-block>.</after-quoted-block></quoted-block>
</section><section id="idF4515423773C4341805CE658F010F755"><enum>302.</enum><header>Additional
consumer protections for Medicaid partnerships</header>
<subsection id="id7A7459D7DB404CC4921003920B036B26"><enum>(a)</enum><header>Application of
2006 Model Provisions</header>
<paragraph id="idE854A16102D0462783F7DE51BEA26539"><enum>(1)</enum><header>Updating of
2000 requirements</header>
<subparagraph id="id8F677334689441BBAB76EE123F8D889E"><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="idA382BE8412DD4A9EB90F9A2C6C58F9E5"><enum>(B)</enum><header>Conforming
amendments</header>
<clause id="id8D87F6F5A2274C86882B6EA6BD3BDF3B"><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="idC2802C92DB56496F9BE52454273C8C7F"><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="id1A44C86E6F55402E820245F35666CBFC"><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="id4A4ADEBBF0834B06B4CFCA3C43754BF4"><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="idE540F21A4EE448829A3A9E177B81566C"><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="idC63B08A7048746E48146443360FD9231"><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="id456049C96E32492EA4765AF9164C485B"><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="idE074D3ED487546E1B4F4291E7A3CA520"><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="idDC8FBE014C3044ABA6363C38F4550388"><enum>(1)</enum><text>in paragraph
(1)(C)—</text>
<subparagraph id="idAF032957C5CB4BC2A4BB1709C9184373"><enum>(A)</enum><text>in clause
(iii)—</text>
<clause id="id78435EA379BD4004AB3AD9036B5F0ACF"><enum>(i)</enum><text>by
inserting after subclause (VII) the following new subclause:</text>
<quoted-block display-inline="no-display-inline" id="id25BF700AB8CB4CE5B0D61769CF30FFB3" style="OLC">
<subclause id="idEBB900461C4A4880BDDC1C43FF526902" 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="id4484C11C8EDA41A4B1AF9072CA2D9AD3"><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="id501238BDAFFB478AA012FF88DA1862E8"><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="idCF16FB619DE6440F8992D45759397053"><enum>(2)</enum><text>by adding at the
end the following new paragraph:</text>
<quoted-block display-inline="no-display-inline" id="idC0C9AB43A66E4C70B5774757959FFEEB" style="OLC">
<paragraph id="id95460EEB36AA41F3AB9A58B170B8A85A" 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="id2B2E125D85C0491CA1FD3038A563C384"><enum>(A)</enum><text>The State requires issuers of
long-term care insurance policies to—</text>
<clause id="id8BAF916A725A4AEA9A4D87818D4DE01E"><enum>(i)</enum><text>use marketing materials approved by
the State for purposes of the partnership verbatim 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="idD4C64C0F113A49F5AC1F880D0401DE7E"><enum>(ii)</enum><text>provide such materials to all
agents selling long-term care insurance policies in the State;</text>
</clause><clause id="id2FC5D92A566444469D86D7A6DD6304F2"><enum>(iii)</enum><text>ensure that agent training and
education courses conducted or supported by the issuers incorporate such
materials; and</text>
</clause><clause id="idF116A1EB561C4ABEAFB0E42377833C69"><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="id7373D5DDBC85477DB82B1DE50AE7D05C"><enum>(B)</enum><text>The State requires issuers of
long-term care insurance policies to require agents to use the inflation
protection comparison form developed by the National Association of Insurance
Commissioners in accordance with section 102(b)(1)(C) of the
<short-title>Confidence in Long-Term Care Insurance Act of
2009</short-title> when selling the policies in the State.</text>
</subparagraph><subparagraph id="idC54B7B8B5FFD4536A7EFC330440D5428"><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="id8EAF334CE149476CA309F06D0134E642"><enum>(D)</enum><text>The State enacts legislation, not
later than January 1, 2012, that establishes rate stability standards for all
issuers of long-term care insurance policies sold in the State that are no less
stringent than the premium rate schedule increase standards specified in
section 20 of the model regulation specified in paragraph (5).</text>
</subparagraph><subparagraph id="id55620F157C0A4556AE43A9F557BDBB01"><enum>(E)</enum><text>The State develops, updates 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 such assistance, and provides public, readily
accessible materials that describe in clear, simple language the terms of such
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 under the State plan. Such materials shall include a
clear disclosure that medical assistance is not guaranteed to partnership
policyholders who exhaust 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="idABCF301FDF3548EAA5943F5C465A2A0B"><enum>(F)</enum><text>The State—</text>
<clause id="id23941C3545654FF981066B8AD8C5D2FC"><enum>(i)</enum><text>through the State Medicaid agency
under section 1902(a)(5) and in consultation with the State insurance
department, develops written 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="id95D44940F39447BD97394E18301B70CC"><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="idC699E211CC4841E998FF65C9288911F1"><enum>(iii)</enum><text>informs holders of such policies
of any changes in eligibility requirements 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; and</text>
</clause><clause id="id14B84985DA70452AA16DFDBF00C609D4"><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></subparagraph><subparagraph id="id4ABD850AD5C64AE6BE9436D648E5557E"><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="id25C8F6B926FE443C9ACEB2520DF7159D"><enum>(i)</enum><text>inform consumers about changes in
long-term care policies offered by issuers participating in the partnership,
changes in the amount, duration, or scope of medical assistance for nursing
facility services or other long-term care services offered under the State
plan, changes in consumer protections, and any other issues such agency and
department determine appropriate; and</text>
</clause><clause id="idF58055C826C04A3A8B7212C5EABA92EB"><enum>(ii)</enum><text>jointly maintain a nonpublic
database of partnership policyholders for purposes of facilitating 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="id64B1DEACA0634A5F9686522D74F9E53B"><enum>(I)</enum><text>the number of policyholders applying for
medical assistance under the State plan; and</text>
</subclause><subclause id="idF10EBD57FDCF4CE98954866078861CF1"><enum>(II)</enum><text>the number of policyholders deemed
eligible (and, if applicable, ineligible) for such assistance.</text>
</subclause></clause></subparagraph><subparagraph id="idD4CEA21731E84EC49716C4BB21556996"><enum>(H)</enum><text>The State does not apply any limit to
the disregard, for purposes of determining the eligibility of a partnership
policyholder for medical assistance under the State plan and for purposes of
exemption from the estate recovery requirements under the plan, of benefits
provided under a partnership policy, including cash benefits provided for
long-term care services, and benefits provided under the policy after the
effective date of the policyholder's enrollment in the State plan.</text>
</subparagraph><subparagraph id="idF615DB9FDC0E4536962E3D202F2CA5AF"><enum>(I)</enum><text>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.</text>
</subparagraph><subparagraph id="id00AF6F36AA7542A3A878E5A22BB55050"><enum>(J)</enum><text>The State provides 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 at the time of purchase.</text>
</subparagraph><subparagraph id="id6C1E758C80C74C48A496DEF5288F74BD"><enum>(K)</enum><text>At the option of the State,
notwithstanding any limitation that would otherwise be imposed under subsection
(f), the State disregards any amount of the equity interest in the home of an
individual covered of policy offered under a qualified State long-term care
insurance partnership for purposes of determining the individual's eligibility
for medical assistance with respect to nursing facility services or other
long-term care
services.</text>
</subparagraph></paragraph><after-quoted-block>.</after-quoted-block></quoted-block>
</paragraph></subsection><subsection id="id350C7C5668DF4AA4B44F983A29356CD9"><enum>(d)</enum><header>Effective
date</header>
<paragraph id="idBFA91048E00447FB886C16DCD4A2F3B0"><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="id192B0D24BFF24758943FB5BA61EF27A6"><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="id37364CA503FF4AD189A094EB0D05222B"><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 <quote>Secretary</quote>)
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, at a minimum, 5 percent 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>