[Congressional Record Volume 155, Number 82 (Wednesday, June 3, 2009)]
[Senate]
[Pages S6046-S6050]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. KOHL (for himself and Mr. Wyden):
  S. 1177. A bill to improve consumer protections for purchasers of 
long-term care insurance, and for other purposes; to the Committee on 
Finance.
  Mr. KOHL. Mr. President, I rise today to express my support for the 
Confidence in Long-Term Care Insurance Act of 2009. With America aging 
at an unprecedented rate, and with the high and rising costs of caring 
for a loved one, the financing of long-term care must be addressed if 
we are going to get health care costs under control. I am proud to be 
an original cosponsor of this bill. I wish to also thank my colleague 
Senator Wyden for his leadership on addressing the financing of long-
term care.
  We all know that long-term care is expensive. The cost of an average 
nursing home is nearly $75,000 per year. However, according to the 
Congressional Research Service, most Americans do not realize that 
neither Medicare nor Medicaid will cover these costs unless their 
household savings are nearly eliminated. States share the 
responsibility of providing Medicaid funding for long-term care with 
the federal government, and are also looking for ways to reduce their 
expenses. As of today, 43 states are in the process of launching 
``Partnership'' programs, which provide incentives to consumers who 
purchase private long-term care insurance. But in the rush to ease the 
burden of long-term care costs on state budgets, we fear that some key 
concerns are being overlooked.
  We have a duty to make sure these policies, which may span many 
decades, are financially viable. Several long-term care insurance 
providers have applied for TARP funds in recent months, raising 
questions about their solvency. In addition, many insurance companies 
have been raising their policyholders' monthly premiums, which can be 
devastating for older persons who are living on a fixed income. Many 
Americans living on modest or fixed incomes, who have held policies for 
many years, have seen premium rates double when a company encounters 
financial difficulties. For such consumers, the choices are stark and 
very limited: they can either dig deeper and pay the increased 
premiums, or let their policy lapse, leaving them with no coverage if 
they ever need care.
  Last year, I was joined by several Senate and House colleagues in 
releasing a GAO report on whether adequate consumer protections are in 
place for those who purchase long-term care insurance. The report found 
that rate increases are common throughout the industry, and that 
consumer protections are uneven. While some states have adopted 
requirements that keep rates relatively stable, some have not, leaving 
consumers unprotected.
  The Confidence in Long-Term Care Insurance Act takes several 
important steps to ensure that premiums increases are kept at a 
minimum, insurance agents receive adequate training, and that 
complaints and appeals are addressed in a timely manner. We should also 
make it easier for consumers to accurately compare policies from 
different insurance carriers, particularly with regard to what benefits 
are covered and whether the plan offers inflation protection. States 
should also have to approve materials used to market Partnership 
policies. The Confidence in Long-Term Care Insurance Act will institute 
many of these needed improvements.
  In closing, I urge my colleagues to support the Confidence in Long-
Term Care Insurance Act of 2009. It is estimated that two out of three 
Americans who reach the age of 65 will need long-term care services and 
supports at some point to assist them with day-to-day activities, and 
enable them to maintain a high-quality, independent life. Long-term 
care insurance is an appropriate product for many who wish to plan for 
a secure retirement. But we must guarantee that consumers have adequate 
information and protections, and that premiums won't skyrocket down the 
road. I thank Senator Wyden for his commitment to ensuring we address 
the important issue of long-term care financing. I look forward to 
working with my colleagues to enact the legislation we are introducing 
today.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 1177

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Confidence 
     in Long-Term Care Insurance Act of 2009''.
       (b) Table of Contents.--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.

TITLE I--NATIONAL MARKET SURVEY; MODEL DISCLOSURES AND DEFINITIONS; LTC 
                           INSURANCE COMPARE

     SEC. 101. NAIC NATIONAL MARKET SURVEY.

       (a) In General.--The Secretary shall request the NAIC to 
     conduct biennial reviews of the national and State-specific 
     markets

[[Page S6047]]

     for long-term care insurance policies and to submit biennial 
     reports to the Secretary on the results of such reviews.
       (b) Content.--The Secretary shall request that the biennial 
     reviews include, with respect to the period occurring since 
     any prior review, analysis of the following:
       (1) 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).
       (2) The number of complaints received and resolved, 
     including benefit denials.
       (3) The number of policies that are cancelled (including 
     because of having lapsed or not being renewed) and reasons 
     for such cancellations.
       (4) 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.
       (5) The number of policyholders exhausting benefits.
       (6) Premium rate increases sought by carriers and the range 
     of the amount of the increase sought.
       (7) Premium rate increases that were approved and the range 
     of the amount of increase.
       (8) The number of policyholders affected by any approved 
     premium rate increases.
       (9) Requests for exceptions to State reserving or capital 
     requirements.
       (c) Timing for Biennial Review and Report.--The Secretary 
     shall request the NAIC to--
       (1) complete the initial market review under this section 
     not later than 2 years after the date of enactment of this 
     Act;
       (2) submit a report to the Secretary on the results of the 
     initial review not later than December 31, 2011; and
       (3) complete each subsequent biennial review and submit 
     each subsequent biennial report not later than December 31 of 
     each second succeeding year.
       (d) Consultation Required.--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.
       (e) Definitions.--In this section and section 102:
       (1) Long-term care insurance policy.--The term ``long-term 
     care insurance policy''--
       (A) means--
       (i) a qualified long-term care insurance contract (as 
     defined in section 7702B(b) of the Internal Revenue Code of 
     1986); and
       (ii) 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
       (B) includes any other insurance policy or rider described 
     in the definition of ``long-term care insurance'' in section 
     4 of the model Act promulgated by the National Association of 
     Insurance Commissioners (as adopted December 2006).
       (2) NAIC.--The term ``NAIC'' means the National Association 
     of Insurance Commissioners.
       (3) Secretary.--The term ``Secretary'' means the Secretary 
     of Health and Human Services.

     SEC. 102. MODEL DISCLOSURES AND DEFINITIONS.

       (a) In General.--The Secretary shall request the NAIC, in 
     consultation with State health agencies as appropriate, to 
     carry out the activities described in subsection (b).
       (b) Activities Described.--The activities described in this 
     subsection are the following:
       (1) Develop model disclosures and definitions for marketing 
     of policies.--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:
       (A) Consistent definitions.--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).
       (B) Consistent explanatory language.--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.
       (C) Inflation protection options.--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.
       (D) Standardized methodology for calculating inflation 
     protection.--Standardized methodology for use by issuers to 
     use to calculate inflation protection under such policies.
       (2) Enforce.--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.
       (c) Public Comment.--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).

     SEC. 103. LTC INSURANCE COMPARE.

       (a) In General.--Section 6021(d) of the Deficit Reduction 
     Act of 2005 (42 U.S.C. 1396p note) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (A)--
       (i) in clause (ii), by striking ``and'' at the end;
       (ii) in clause (iii), by striking the period at the end and 
     inserting ``; and''; and
       (iii) by adding at the end the following:
       ``(iv) establish an Internet directory of information 
     regarding long-term care insurance, to be known as `LTC 
     Insurance Compare', that shall include the following:

       ``(I) Comparison tools to assist consumers in evaluating 
     long-term care insurance policies (as defined in subparagraph 
     (D)) with different benefits and features.
       ``(II) State-specific information about the long-term care 
     insurance policies marketed in a State, including the 
     following:

       ``(aa) Whether a State has promulgated rate stability 
     provisions for all issuers of long-term care insurance 
     policies and how the rate stability standards work.
       ``(bb) The rating history for issuers selling long-term 
     care insurance policies in the State for at least the most 
     recent preceding 5 years.
       ``(cc) The policy documents for each such policy marketed 
     in the State.

       ``(III) Links to State information regarding long-term care 
     under State Medicaid programs (which may be provided, as 
     appropriate, through Internet linkages to the websites of 
     State Medicaid programs) that includes the following:

       ``(aa) 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.
       ``(bb) 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.''; and
       (B) by adding at the end the following:
       ``(C) Current information.--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.
       ``(D) Long-term care insurance policy defined.--In 
     subparagraph (A)(iv), the term `long-term care insurance 
     policy' means a qualified long-term care insurance contract 
     (as defined in section 7702B(b) of the Internal Revenue Code 
     of 1986), a qualified long-term care insurance contract that 
     covers an insured who is a resident of a State with a 
     qualified State long-term care insurance partnership under 
     clause (iii) of section 1917(b)(1)(C) of the Social Security 
     Act (42 U.S.C. 1396p(b)(1)(C)) or a long-term care insurance 
     policy offered in connection with a State plan amendment 
     described in clause (iv) of such section, and includes any 
     other insurance policy or rider described in the definition 
     of `long-term care insurance' in section 4 of the model Act 
     promulgated by the National Association of Insurance 
     Commissioners (as adopted December 2006).'';
       (2) by redesignating paragraph (3) as paragraph (4)
       (3) in paragraph (4), (as so redesignated), by inserting 
     ``, and $5,000,000 for each of fiscal years 2011 through 
     2013'' after ``2010''; and
       (4) by inserting after paragraph (2) the following:
       ``(3) Consultation on ltc insurance compare.--The Secretary 
     of Health and Human Services shall consult with the National 
     Association of Insurance Commissioners and the entities and 
     stakeholders specified in

[[Page S6048]]

     section 101(d) of the Confidence in Long-Term Care Insurance 
     Act of 2009 in designing and implementing the LTC Insurance 
     Compare required under paragraph (2)(A)(iv).''.
       (b) Medicaid State Plan Requirement to Submit Nursing 
     Facility Services Functional Criteria Data.--Section 
     1902(a)(28) of the Social Security Act (42 U.S.C. 
     1396a(a)(28)) is amended--
       (1) in subparagraph (C), by striking ``and'' after the 
     semicolon;
       (2) in subparagraph (D)(iii), by adding ``and'' after the 
     semicolon; and
       (3) by inserting after subparagraph (D)(iii), the following 
     new subparagraph:
       ``(E) for the annual submission of data relating to 
     functional criteria for the receipt of nursing facility 
     services under the plan (in such form and manner as the 
     Secretary shall specify);''.
       (c) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendments made by this section take effect on the date of 
     enactment of this Act.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     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.

 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.

       (a) In General.--Section 7702B(g)(1) of the Internal 
     Revenue Code of 1986 (relating to consumer protection 
     provisions) is amended--
       (1) in subparagraph (A), by inserting ``(but only to the 
     extent such requirements do not conflict with requirements 
     applicable under subparagraph (B)),'' after ``paragraph 
     (2)'',
       (2) by redesignating subparagraphs (B) and (C) as 
     subparagraphs (C) and (D), respectively, and
       (3) by inserting after subparagraph (A), the following new 
     subparagraph:
       ``(B) the requirements of the model regulation and model 
     Act described in section 1917(b)(5) of the Social Security 
     Act,''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to contracts issued after the date of enactment 
     of this Act.

     SEC. 202. STREAMLINED PROCESS FOR APPLYING NEW OR UPDATED 
                   MODEL PROVISIONS.

       (a) Secretarial Review.--
       (1) Tax-qualified policies.--
       (A) 2000 and 2006 model provisions.--Not later than 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.
       (B) Subsequent model provisions.--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.
       (2) Medicaid partnership policies.--
       (A) Subsequent model provisions.--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.
       (B) Review of other partnership requirements.--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).
       (b) Expedited Rulemaking.--
       (1) Tax-qualified policies.--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.
       (2) Medicaid partnership policies.--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.
       (3) Consultation required.--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--
       (A) 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
       (B) the Secretary of Health and Human Services determines 
     it would be appropriate to promulgate an interim final rule, 
     the Secretary of Health and Human Services shall use notice 
     and comment rulemaking to promulgate a rule applying such 
     provisions to insurance contracts described in paragraph (2).
       (4) Rule of construction relating to application of 
     congressional review act.--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 ``Congressional Review Act'') to any 
     interim final rule issued in accordance with such paragraphs.
       (5) Technical amendment eliminating prior review standard 
     made obsolete.--Section 1917(b)(5) of the Social Security Act 
     (42 U.S.C. 1396p(b)(5)) is amended by striking subparagraph 
     (C).
       (c) Model Provisions.--In this section, the term ``model 
     provisions'' means--
       (1) 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);
       (2) each provision of the model language relating to 
     marketing disclosures and definitions developed under section 
     102(b)(1); and
       (3) 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.

   TITLE III--IMPROVED CONSUMER PROTECTIONS FOR MEDICAID PARTNERSHIP 
                                POLICIES

     SEC. 301. BIENNIAL REPORTS ON IMPACT OF MEDICAID LONG-TERM 
                   CARE INSURANCE PARTNERSHIPS.

       Section 6021(c) of the Deficit Reduction Act of 2005 (42 
     U.S.C. 1396p note) is amended to read as follows:
       ``(c) Biennial Reports.--
       ``(1) In general.--Not later than January 1, 2010, and 
     biennially thereafter, the Secretary of Health and Human 
     Services (in this subsection referred to as the `Secretary') 
     shall issue a report to States and Congress on the long-term 
     care insurance partnerships established in accordance with 
     section 1917(b)(1)(C)(ii) of the Social Security Act (42 
     U.S.C. 1396p(b)(1)(C)(ii)). Each report shall include (with 
     respect to the period the report addresses) the following 
     information, nationally and on a State-specific basis:
       ``(A) 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.
       ``(B) Analyses of the impact of such partnerships on 
     consumer decisionmaking with respect to purchasing, 
     accessing, and retaining coverage under long-term care 
     insurance

[[Page S6049]]

     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.
       ``(2) Data.--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).
       ``(3) Public availability.--The Secretary shall make each 
     report issued under this subsection publicly available 
     through the LTC Insurance Compare website required under 
     subsection (d).
       ``(4) Rule of construction.--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.
       ``(5) Appropriation.--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.''.

     SEC. 302. ADDITIONAL CONSUMER PROTECTIONS FOR MEDICAID 
                   PARTNERSHIPS.

       (a) Application of 2006 Model Provisions.--
       (1) Updating of 2000 requirements.--
       (A) In general.--Section 1917(b)(5)(B)(i) of the Social 
     Security Act (42 U.S.C. 1396p(b)(5)(B)(i)) is amended by 
     striking ``October 2000'' and inserting ``December 2006''.
       (B) Conforming amendments.--
       (i) Subclause (XVII) of such section is amended by striking 
     ``section 26'' and inserting ``section 28''.
       (ii) Subclause (XVIII) of such section is amended by 
     striking ``section 29'' and inserting ``section 31''.
       (iii) Subclause (XIX) of such section is amended by 
     striking ``section 30'' and inserting ``section 32''.
       (2) Application to grandfathered partnerships.--Section 
     1917(b)(1)(C)(iv) of such Act (42 U.S.C. 1396p(b)(1)(C)(iv)) 
     is amended by inserting ``, and the State satisfies the 
     requirements of paragraph (5)'' after ``2005''.
       (b) Application of Producer Training Model Act 
     Requirements.--Section 1917(b)(1)(C) of such Act (42 U.S.C. 
     1396p(b)(1)(C)) is amended--
       (1) in clause (iii)(V), by inserting ``and satisfies the 
     producer training requirements specified in section 9 of the 
     model Act specified in paragraph (5)'' after ``coverage of 
     long-term care''; and
       (2) in clause (iv), as amended by subsection (a)(2), by 
     inserting ``clause (iii)(V) and'' before ``paragraph (5)''.
       (c) Application of Additional Requirements for All 
     Partnerships.--Section 1917(b) of the Social Security Act (42 
     U.S.C. 1396p(b)) is amended--
       (1) in paragraph (1)(C)--
       (A) in clause (iii)--
       (i) by inserting after subclause (VII) the following new 
     subclause:
       ``(VIII) The State satisfies the requirements of paragraph 
     (6).''; and
       (ii) in the flush sentence at the end, by striking 
     ``paragraph (5)'' and inserting ``paragraphs (5) and (6)''; 
     and
       (B) in clause (iv), as amended by subsections (a)(2) and 
     (b)(2), by striking ``paragraph (5)'' and inserting 
     ``paragraphs (5) and (6)''; and
       (2) by adding at the end the following new paragraph:
       ``(6) For purposes of clauses (iii)(VIII) and (iv) of 
     paragraph (1)(C), the requirements of this paragraph are the 
     following:
       ``(A) The State requires issuers of long-term care 
     insurance policies to--
       ``(i) use marketing materials 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;
       ``(ii) provide such materials to all agents selling long-
     term care insurance policies in the State;
       ``(iii) ensure that agent training and education courses 
     conducted or supported by the issuers incorporate such 
     materials;
       ``(iv) 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.
       ``(B) 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 Confidence in Long-Term Care 
     Insurance Act of 2009 when selling the policies in the State.
       ``(C) The State requires issuers of long-term care 
     insurance policies sold in the State to comply with the 
     provisions of section 8 of the model Act specified in 
     paragraph (5) relating to contingent nonforfeiture benefits.
       ``(D) 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).
       ``(E) 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.
       ``(F) The State--
       ``(i) 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;
       ``(ii) 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;
       ``(iii) 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
       ``(iv) agrees to honor the asset protections of any such 
     policy that were provided under the policy when purchased, 
     regardless of whether the State subsequently terminates a 
     partnership program under the State plan.
       ``(G) The State Medicaid agency under section 1902(a)(5) 
     and the State insurance department enter into a memorandum of 
     understanding to--
       ``(i) 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
       ``(ii) 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--
       ``(I) the number of policyholders applying for medical 
     assistance under the State plan; and
       ``(II) the number of policyholders deemed eligible (and, if 
     applicable, ineligible) for such assistance.
       ``(H) 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.
       ``(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.
       ``(J) 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.
       ``(K) 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.''.
       (d) Effective Date.--
       (1) In general.--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.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     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

[[Page S6050]]

     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.

     SEC. 303. REPORT TO CONGRESS REGARDING NEED FOR MINIMUM 
                   ANNUAL COMPOUND INFLATION PROTECTION.

       Not later than 18 months after the date of enactment of 
     this Act, the Secretary of Health and Human Services (in this 
     section referred to as the ``Secretary'') shall 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.

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