[Federal Register Volume 73, Number 244 (Thursday, December 18, 2008)]
[Rules and Regulations]
[Pages 76960-76969]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E8-28388]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

45 CFR Part 144

[ASPE:LTCI-F]
RIN 0991-AB44


State Long-Term Care Partnership Program: Reporting Requirements 
for Insurers

AGENCY: Office of the Assistant Secretary for Planning and Evaluation 
(OASPE), HHS.

ACTION: Final rule.

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SUMMARY: This final rule sets forth reporting requirements for private 
insurers that issue qualified long-term care insurance policies in 
States participating in the State Long-Term Care Partnership Program 
established under the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-
171). Section 6021 of the DRA requires that the Secretary of Health and 
Human Services (the Secretary) specify a set of reporting requirements 
and collect data from insurers on qualified long-term care insurance 
policies issued under the program and the subsequent use of the 
benefits under these policies. Under a State Long-Term Care Partnership 
Program, an amount equal to the benefits received under the long-term 
care insurance policy is disregarded in determining the assets of an 
individual for purposes of Medicaid eligibility and estate recovery.

DATES: Effective Date: This final rule is effective on April 17, 2009.

ADDRESSES: Electronic Access: This Federal Register document is also 
available from the Federal Register online database through GPO Access, 
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password required).

FOR FURTHER INFORMATION, CONTACT: Hunter McKay, (202) 205-8999.

SUPPLEMENTARY INFORMATION:

I. Issuance of a Proposed Rule

    On May 23, 2008 (73 FR 30030), the Department of Health and Human 
Services (the Department) published in the Federal Register a proposed 
rule with a 60-day comment period that described the reporting 
requirements that we proposed to require of all insurers that issue 
qualified long-term care insurance policies under the State Long-Term 
Care Partnership Program. We received three timely pieces of 
correspondence in response to the proposed rule. Each piece of 
correspondence addressed multiple issues relating to the provisions of 
the proposed rule. We summarize these public comments and present the 
Department's responses to them under the applicable subject-area 
headings below. In addition, we have posted, for reviewers' 
convenience, all of the public comments received on the following Web 
site: http://www.regulations.gov.

II. Scope of the Proposed Rule and This Final Rule

    The proposed rule and this final rule describe the reporting 
requirements that the Department is requiring of all insurers that 
issue long-term care insurance policies under a State Long-Term Care 
Partnership Program for a State with as Medicaid State plan amendment 
approved after May 14, 1993. We point out that neither the proposed 
rule nor this final rule requires participating insurers to report data 
from States with a Partnership Medicaid State plan amendment approved 
as of May 14, 1993. In addition to the promulgation of the proposed 
rule and this final rule, the Department anticipates taking other 
actions to further the implementation of the Long-Term Care Partnership 
Program. One such action is publication of a separate Federal Register 
notice containing Partnership State Reciprocity Standards. These 
standards outline an agreement whereby States can provide Medicaid 
asset disregards for

[[Page 76961]]

Partnership policies purchased in other States.
    Comment: One commenter suggested that language be added in the 
final rule to make clear that insurers are not required by the 
regulation to report Partnership data to the Department for States with 
a Partnership Medicaid State plan amendment approved as of May 14, 
1993.
    Response: We have added language above and in other applicable 
sections of this final rule, as the commenter suggested, to make clear 
the nonapplicability of the reporting requirements for submission of 
Partnership data by insurers in States with a Partnership Medicaid 
State plan amendment approved as of May 14, 1993.

III. Background

A. Historical Overview of State Long-Term Care Partnership Programs

1. Initial Development of Programs
    In the late 1980's, a number of State Medicaid programs began to 
work with private insurance companies to create a bridge between 
Medicaid and insurance for long-term care. The goal of these 
collaborations was to create private insurance policies that were more 
affordable and provide better financial protection to consumers against 
large liabilities for long-term care costs than the policies generally 
available at that time. The result of these collaborations was the 
establishment of the State Long-Term Care Partnership Program that 
provided for expanded access to Medicaid by allowing applicants who use 
long-term care insurance policies to have higher assets and still be 
eligible for Medicaid, as long as they meet all other Medicaid 
eligibility criteria. The first four States that implemented 
Partnership programs, in 1993 (California, Connecticut, Indiana, New 
York), used two different methods for determining the amount of assets 
a participant was allowed to keep. Three States allowed participants to 
keep an amount equivalent to the amount paid by the insurance policy on 
his or her behalf (known as the ``dollar-for-dollar approach''). The 
other State required the purchase of a more comprehensive policy and, 
in exchange, allowed participants to keep all of their assets (known as 
the ``total assets approach''). Over time, one State combined these 
models to create a hybrid approach in which participants purchasing and 
using a policy that would cover fewer than 4 years of benefits would be 
allowed to keep one dollar for every dollar of paid benefits and those 
participants purchasing and using a policy that would cover 4 or more 
years of benefits would be allowed to keep all of their assets. These 
State partnership programs provided an incentive for insurers to offer 
affordable, high-quality benefits and for consumers to protect 
themselves against the high cost of long-term care through the purchase 
of insurance policies that can be used in conjunction with benefits 
provided under Medicaid.
    As part of the implementation process, each of the four States that 
initially implemented Partnership programs in 1993 outlined a set of 
data reporting requirements for participating insurers. The data that 
were to be collected were intended to allow each State to monitor 
program activities and evaluate the impact of the Partnership Program 
on Medicaid long-term care expenditures. The insurers who participated 
in these partnerships recommended, as part of the design of the data 
collection requirements, that the participating States use a unified 
set of reporting requirements to streamline the reporting burden on the 
participating insurers. The participating insurers believed that if 
each State designed its own reporting requirements, the administrative 
costs for the program would be prohibitive. The four States agreed with 
the participating insurers and adopted a uniform set of reporting 
criteria.
    The four initial States launched their Partnership programs using 
existing State authority through amendments to their State Medicaid 
plans (Partnership Medicaid State plan amendments). Each State 
requested a change in the treatment of assets in the Medicaid financial 
eligibility test. No other Federal authority was necessary at that time 
to operate the programs.
    Comment: One commenter suggested that language be added to the 
Background section of the final rule to make clear that consumers who 
take advantage of the Partnership Program must also meet all other 
Medicaid eligibility requirements. Two commenters suggested that the 
discussion of the amount of asset protection offered under the original 
Partnership Programs be expanded in the final rule to reflect the 
differences between the ``dollar-for-dollar model'' and the ``total 
assets model.''
    Response: We have added language above in this final rule, as the 
commenters suggested, to specify that consumers who take advantage of 
the Partnership Program must also meet all other Medicaid eligibility 
requirements and to explain the differences between the ``dollar-for-
dollar model'' and the ``total assets model.''
    Comment: One commenter suggested that language indicating that the 
regulations do not require insurers to report Partnership data to the 
Department for States with a Partnership Medicaid State plan amendment 
approved as of May 14, 1993, be added to the section of the final rule 
discussing the agreement reached by the original four States pertaining 
to a unified data reporting structure.
    Response: The section in which the commenter is requesting a change 
relates to the history of the Partnership programs and is not an 
appropriate place to discuss the scope of the new regulations. However, 
we have incorporated the language in section II. (Scope) of this final 
rule, as well as in other applicable sections, to address the 
nonapplicability of the reporting requirements for Partnership data for 
States with a Partnership Medicaid State plan amendment approved as of 
May 14, 1993.
2. Omnibus Budget Reconciliation Act of 1993
    The Omnibus Budget Reconciliation Act of 1993 (OBRA 1993), Public 
Law 103-66, contained language that changed the conditions under which 
Medicaid State plan amendments relating to asset disregards for private 
long-term care insurance could be approved. OBRA 1993 allowed 
California, Connecticut, Indiana, and New York, as well as Iowa and 
Massachusetts, to continue their initial Long-Term Care Partnership 
Programs. However, OBRA 1993 specified a set of requirements for any 
additional States that chose to operate a Partnership Program. Any 
State, other than the initial four partnership States, that sought a 
Medicaid State plan amendment on or after May 14, 1993, was required to 
abide by the following additional conditions:
a. Estate Recovery
    States establishing Long-Term Care Partnership Programs on or after 
May 14, 1993, were required to recover from the estates of Medicaid 
recipients in States with partnership agreements expenses incurred for 
the provision of long-term health care under Medicaid. Assets that were 
disregarded in the initial financial eligibility process were also 
exempt from estate recovery in the initial four States with Partnership 
Programs. States establishing new Partnership Programs were only 
allowed to disregard assets in the initial eligibility process but not 
in the estate recovery process. After a Medicaid recipient who had a 
long-term care insurance policy issued under a State

[[Page 76962]]

Long-Term Partnership Program died, the State was required to recover 
an amount equivalent to what Medicaid spent on his or her behalf from 
the deceased recipient's estate, including any protected assets under 
the State Long-Term Care Partnership Program.
b. No Waiver of Estate Recovery
    States establishing Long-Term Care Partnership Programs on or after 
May 14, 1993, were precluded from waiving the estate recovery 
requirement for Medicaid recipients who had obtained long-term care 
insurance policies under a State Long-Term Care Partnership Program.
c. Expanded Definition of Estate
    States establishing Long-Term Care Partnership Program on or after 
May 14, 1993, were also required to use a specific definition of 
``estate'' for recovery purposes when recovery of Medicaid expenditures 
was against the estates of Medicaid recipients who had obtained long-
term care insurance policies issued under a State Long-Term Care 
Partnership Program. This definition was more expansive than the 
definition that was generally used by States.
    While OBRA 1993 did not forbid additional States from attempting to 
establish new Long-Term Care Partnership Programs under the new 
conditions, the impact was essentially the same as a ban. A few States 
tried unsuccessfully to launch partnership programs under the new 
conditions. Other interested States passed enabling legislation with 
contingency language that allowed the State to proceed if the OBRA 1993 
partnership provisions were repealed. No subsequent Federal legislation 
related to the Long-Term Care Partnership Programs was enacted until 
the Deficit Reduction Act of 2005 (DRA) Public Law 109-171. As 
discussed in detail under section II.A.3. of this proposed rule and 
under section III.A.3. of this final rule, the DRA included provisions 
that allow States to offer specific asset disregards for Medicaid 
eligibility purposes under a new set of conditions.
3. Deficit Reduction Act of 2005
    Section 6021(a)(1) of the DRA amended section 1917(b)(1)(C)(i) of 
the Act and added new sections 1917(b)1)(C)(iii) through (vi) to the 
Act that provide for an expansion of the State Long-Term Care Insurance 
Partnership Program through a new set of conditions. These conditions 
pertain to States with Partnership Medicaid State plan amendments 
approved after May 14, 1993. Under this provision, States may establish 
``qualified State long-term care insurance partnerships'', defined in 
the Act as an approved Medicaid State plan amendment under Title XIX of 
the Act that provides for the disregard of any assets or resources in 
an amount equal to the insurance benefit payments that are made to or 
on behalf of an individual who is a beneficiary under a long-term care 
insurance policy if certain requirements specified in sections 
1917(b)(1)(C)(iii)(I) through (VII) of the Act are met. In other words, 
States establishing new Partnership programs must offer a dollar of 
asset disregard for every dollar paid out under a long-term care 
insurance policy issued under that State's long-term care partnership 
program.
    Section 1917(b)(1)(C)(iii)(II) of the Act provides that the 
insurance policy must be a qualified long-term care insurance policy as 
defined in section 7702B(b) of the Internal Revenue Code of 1986, that 
is issued not earlier than the effective date of the State plan 
amendment. (If an individual has an existing long-term care insurance 
policy that does not qualify as a qualified partnership policy due to 
the issue date of the policy, and that policy is exchanged for another 
policy, the State insurance commissioner or other State authority must 
determine the issue date for the policy that is received in exchange. 
Under this provision, a long-term care insurance policy includes a 
certificate issued under a group insurance contract.)
    Among other requirements specified in the statute for qualified 
long-term care insurance partnerships--
     The long-term care insurance policy must (1) be issued to 
an insured individual who is a resident of the State in which coverage 
first became effective under the policy (sections 1917(b)(1)(C)(iii)(I) 
of the Act); (2) be certified by the State insurance commissioner or 
other appropriate authority that the policy meets specific provisions 
of the National Association of Insurance Commissioners (NAIC) October 
2000 Model Regulation and Model Act (sections 1917(b)(1)(C)(iii)(III) 
and 1917(b)(5)(B) of the Act); and (3) include certain protections 
against inflation on an annual basis (section 1917(b)(1)(C)(iii)(IV) of 
the Act).
     The State Medicaid agency must provide information and 
technical assistance to the State insurance department on the insurance 
department's role of assuring that any individual who sells a long-term 
care insurance policy under the partnership receives training and 
demonstrates evidence of an understanding of such policies and how they 
relate to other public and private coverage of long-term care (section 
1917(b)(1)(C)(iii)(V) of the Act).
     Issuers of long-term care insurance policies under a State 
qualified long-term care insurance partnership must provide regular 
reports to the Secretary, in accordance with regulations of the 
Secretary, that include notification regarding when benefits provided 
under the policy have been paid and the amount of such benefits paid, 
notification regarding when the policy otherwise terminates, and such 
other information as the Secretary determines may be appropriate to the 
administration of State long-term care insurance partnerships (section 
1917(b)(1)(C)(iii)(VI) of the Act). Section 1917(b)(1)(C )(v) of the 
Act provides that the regulations required under section 
1917(b)(1)(C)(iii)(VI) of the Act shall be promulgated after 
consultation with the NAIC, issuers of long-term care insurance 
policies, States with experience with long-term care insurance 
partnership plans, other States, and representatives of consumers of 
long-term care insurance policies, and shall specify the type and 
format of the data to be reported and the frequency with which such 
reports are to be made. In addition, the Secretary, as appropriate, 
shall provide copies of the reports provided in accordance with that 
clause to the State involved.
     The State may not impose any requirement affecting the 
terms of benefits of a policy under the partnership program unless the 
State imposes such requirement on long-term care insurance policies 
without regard to whether the policy is covered under the partnership 
or is offered in connection with such a partnership (section 
1917(b)(1)(C)(iii)(VII) of the Act).
    Section 1917(b)(1)(C)(iv) of the Act provides that a State that had 
a State plan amendment approved as of May 14, 1993, satisfies the 
requirements of the statute under clause (II) and may continue 
operating as originally implemented if the Secretary determines that 
the State Medicaid plan amendment provides for consumer protection 
standards that are no less stringent than the consumer protection 
standards that applied under such a State plan amendment as of December 
31, 2005.
    Comment: One commenter requested that the language that describes 
the impact of the DRA of 2005 be modified in the final rule to clearly 
indicate that the conditions set forth in sections 6021(a) through (c) 
of the DRA of 2005 pertain only to States with Partnership

[[Page 76963]]

Medicaid State plan amendments approved after May 14, 1993. One 
commenter suggested that the description of the ``grandfathered'' 
States also make clear that the regulations do not pertain to States 
with a Partnership Medicaid State plan amendment approved as of May 14, 
1993.
    Response: We have added language above and in other applicable 
sections in this final rule, to make these clarifications, as suggested 
by the commenters.

B. Implementing Regulations

    Currently, there are no Federal regulations directly related to 
State operation of State Long-Term Care Partnership Programs. In 2006, 
the Department provided guidance to States, through a letter to 
Medicaid Directors, on the implementation of State long-term care 
partnership programs under the DRA. In areas in which the program 
coordinates benefits with Medicaid coverage of long-term care, the 
existing Medicaid regulations at 42 CFR Chapter IV, Subchapter C, are 
applicable. In 2006, States were provided with guidance on the 
implementation of State Long-Term Care Partnership Programs under the 
DRA of 2005.
    To implement section 1917(b)(1)(C)(iii)(VI) and 1917(b)(1)(C)(v) of 
the Act, as directed by the statute, in the May 23, 2008 proposed rule 
(73 FR 30033), we proposed to set forth in regulations the requirements 
for reporting information and data on qualified long-term care 
insurance policies issued under State Long-Term Care Partnership 
Programs under an approved State plan amendment. In this final rule, we 
are adopting the regulations as final with some technical changes, as 
discussed below.

C. States Currently Operating Long-Term Care Partnership Programs

    California, Connecticut, Indiana, Iowa, Massachusetts, and New York 
had approved State Long-Term Partnership Programs under an approved 
State plan amendment as of May 14, 1993. They were ``grandfathered'' as 
satisfying the statutorily imposed requirements when, pursuant to 
section 1917(b)(1)(C)(iv) of the Act, the Secretary determined that the 
State plan amendments of these States provide protection no less 
stringent than that applied under their State plan amendments as of 
December 31, 2005.
    At the time we issued the proposed rule, we stated that, as of 
December 2007, seven other States offered State Long-Term Care 
Partnership policies for sale under the DRA provisions: Florida, Idaho, 
Kansas, Minnesota, Nebraska, South Dakota, and Virginia. Nine States 
had approved State plan amendments for qualified State Long-Term Care 
Partnership Programs although policies had not yet been issued pursuant 
to those programs: Colorado, Florida, Georgia, Iowa, Minnesota, 
Missouri, North Dakota, Nevada, Ohio, and Oregon. Four States had 
submitted State plan amendments for which approval is pending: Arizona, 
New Hampshire, Oklahoma, and Pennsylvania. Ten other States were in the 
process of developing Partnership Programs: Illinois, Maine, Maryland, 
Michigan, Montana, New Jersey, Rhode Island, Texas, Vermont, and 
Wisconsin.
    As of August 2008, Partnership policies are still for sale in the 
four States that first implemented a Partnership program, as well as in 
13 additional States. Nine States have approved Medicaid State plan 
amendments, although policies are not yet for sale. Three other States 
have Medicaid State plan amendments pending approval from the Centers 
for Medicare and Medicaid, HHS.

IV. Provisions of the Proposed Rule and This Final Rule

A. Legislative Authority

    As stated earlier, the DRA of 2005 requires insurers participating 
in State long-term care partnership programs to provide regular reports 
to the Secretary in a manner in accordance with regulations of the 
Secretary. The reports must include notification regarding when 
benefits provided under the policy have been paid and the amount of the 
benefits paid, notification regarding when the policy otherwise 
terminates, and any other information as the Secretary determines may 
be appropriate to the administration of State long-term care insurance 
partnerships. Section 1917(b)(1)(C )(v) of the Act provides that the 
regulations required under section 1917(b)(1)(C)(iii)(VI) of the Act 
must be promulgated after consultation with the NAIC, issuers of long-
term care insurance policies, States with experience with long-term 
care insurance partnership plans, other States, and representatives of 
consumers of long-term care insurance policies, and must specify the 
type and format of the data to be reported and the frequency with which 
the reports are to be made. In addition, the Secretary, as appropriate, 
must provide copies of the reports provided in accordance with that 
clause to the State involved.

B. Collaboration With States, Insurers, Insurance Regulators, and 
Consumers in the Development of Reporting Requirements

    In accordance with section 1917(b)(1)(C)(v) of the Act, as added by 
the DRA of 2005, as we discussed in the proposed rule, we have 
consulted with numerous stakeholders in the development of the 
reporting requirements presented in this rule. In addition to one-on-
one consultations with stakeholders representing States, insurers, 
consumers, and regulators, we have established a Technical Expert Panel 
to provide a forum for the exchange of ideas, perspectives, and 
expertise regarding the specification of individual data items. The 
Technical Expert Panel consists of approximately 25 members 
representing insurers, States, consumer organizations, the NAIC, the 
Federal Government, and the policy research community. The panel 
members were selected in January 2007, from responses to invitations 
sent by HHS along with an initial draft of the reporting requirements. 
We held numerous meetings and teleconferences with the panel members to 
discuss and further develop the draft reporting requirements and to 
obtain further input on partnership implementation. The reporting 
requirements presented in the proposed rule and finalized in this final 
rule represent the product of this ongoing stakeholder input process. 
We plan to continue ongoing work with the Technical Expert Panel.

C. Incorporation of Reporting Requirements in the Code of Federal 
Regulations

    In the proposed rule, the Department proposed to establish under 
Title 45, Part 144 of the Code of Federal Regulations a new Subpart B 
to incorporate the requirements for the reporting of data by insurers 
on qualified long-term care insurance policies issued under State Long-
Term Care Partnership Programs that are established under an approved 
Medicaid State plan amendment. Specifically--
    Proposed Sec.  144.200, which contained the basis for the 
regulations.
    Proposed Sec.  144.202, which included the definitions used 
throughout the subpart.
    Proposed Sec.  144.204, which specified the applicability of the 
regulations under the subpart.
    Proposed Sec.  144.206, which specified the requirements for 
reporting of long-term care partnership program data and the frequency 
with which insurers must report the data.

[[Page 76964]]

    Proposed Sec.  144.208, which specified the deadlines for 
submission of reports.
    Proposed Sec.  144.210, which specified the format and manner in 
which the data are to be reported.
    Proposed Sec.  144.212, which specified the confidentiality of 
information requirements that will be applied.
    Proposed Sec.  144.214, which specified the action that the 
Secretary will take if an insurer fails to report the required data by 
the specified deadlines.
    Under proposed Sec.  144.202, Definitions, we included the 
following definitions:
    Partnership qualified policy refers to a qualified long-term 
insurance policy issued under a qualified State long-term care 
insurance partnership.
    Qualified long-term insurance care policy means an insurance policy 
that has been determined by a State insurance commissioner to meet the 
requirements of sections 1917(b)(1)(C)(iii)(I) through (IV) and 
1917(b)(5) of the Act. It includes a certificate issued under a group 
insurance contract.
    Qualified State long-term care insurance partnership means an 
approved Medicaid State plan amendment that provides for the disregard 
of any assets or resources in an amount equal to the insurance benefit 
payments that are made to or on behalf of an individual who is a 
beneficiary under a long-term care insurance policy that has been 
determined by a state insurance commissioner to meet the requirements 
of section 1917(b)(1)(C)(iii) of the Act [incorrectly cited in the 
proposed rule as section 1917(b)(a)(C)(iii)]. It includes any Medicaid 
State plan amendment approved as of May 14, 1993 [incorrectly stated in 
the proposed rule as May 4, 1993], that meets the requirements of 
section 1917(b)(1)(C)(iii) of the Act and for which the Secretary 
determined that the State plan amendments provides for consumer 
protection standards that are no less stringent than the consumer 
protection standards that applied under the State plan amendment as of 
December 31, 2005.
    Comment: The commenter suggested that the word ``care'' be inserted 
into the definition of ``Partnership qualified policy.'' One commenter 
pointed out that we had reversed the order of two words and therefore 
incorrectly labeled the definition of ``qualified long-term care 
insurance policy'' as ``qualified long-term insurance care policy''
    Response: We agree with the first commenter's suggestion and have 
revised the definition of ``Partnership qualified policy'' in this 
final rule to refer to a qualified long-term care insurance policy 
issued under a qualified State long-term care insurance partnership. We 
thank the commenter for bringing to our attention the inadvertent 
mislabeling of the definition of ``qualified long-term care insurance 
policy'' and have made the correction in this final rule.
    Comment: One commenter suggested that the definition of a 
``Qualified State long-term care insurance partnership'' be modified to 
clarify that the regulations do not require insurers to report 
Partnership data to the Department for States with a Partnership 
Medicaid State plan amendment approved as of May 14, 1993.
    Response: In response to the commenter's suggestions, we have 
revised the proposed definition for ``Qualified State long-term care 
insurance partnership'', by removing the last sentence of the 
definition, to clarify that the regulations do not require insurers to 
report Partnership data to the Department for States with a Partnership 
Medicaid State plan amendment approved as of May 14, 1993.
    After consideration of the public comments received, we are 
adopting as final proposed Sec. Sec.  144.200, 144.202, and 144.204, 
with the following modifications. We have revised the definition of 
``Partnership qualified policy'' by adding the word ``care'' in the 
definition. We have corrected the inadvertent mislabeling of the 
definition of ``Qualified long-term care insurance policy.'' We have 
revised the definition of ``Qualified State long-term care 
partnership'' by removing the last sentence of the proposed definition.
    Each of the additional proposed regulatory requirements is 
discussed in detail in the sections below.

D. Specific Reporting Requirements

    As discussed in the proposed rule, in consultation with 
stakeholders and the Technical Expert Panel, we developed requirements 
for insurers for reporting data under the State Long-Term Care 
Partnership Program under two categories: (1) Registry data; and (2) 
claims data (proposed Sec.  144.206).
    We proposed that these two categories would require the submission 
of data in four distinct file types. Generally, participating long-term 
care insurers will report under only two of these files. For all four 
file types, as we proposed, we are requiring insurers to report on only 
those insured individuals, policyholders, and claimants who have active 
qualified long-term care insurance partnership policies or 
certificates. The reporting requirements will not apply to insurance 
policies or certificates that are not partnership qualified.
    Insurer reporting specifications are detailed in an HHS document 
entitled ``State Long-Term Care Partnership Insurer Reporting 
Requirements'' which we expect will be available via the Internet at 
the Web site at: http://aspe.hhs.gov/daltcp/reports/2008/PartRepReq.pdf 
no later than October 1, 2008. (We noted in the proposed rule that we 
expected that this document would be available by June 1, 2008. 
However, the release date has been delayed.) We are in the process of 
developing an integrated database through which insurers will submit 
these data. As we proposed, we are requiring that data be submitted 
through a secure Web site that meets all current Health Insurance 
Portability and Accountability Act requirements for security of 
personal health information.
1. Registry Data
    In the proposed rule (73 FR 30034), we proposed to require insurers 
to report data, on a semiannual basis, on all insured individuals who 
have been issued qualified long-term care insurance policies or 
certificates under qualified State Long-Term Care Partnership Programs; 
that is, for the 6-month reporting periods of January 1 through June 30 
and July 1 through December 31 of each year (proposed Sec.  
144.206(b)(1)(ii)). We proposed that the reports must include data on 
qualified long-term care insurance partnership policies sold on either 
an individual basis or a group basis, as long as individual-level data 
are available to the insurer. Under proposed Sec.  144.206(b)(1)(iii), 
these data would include, but are not limited to, the following:
     Current identifying information on each insured 
individual.
     The name of the insurance company and the issuing State.
     The effective date and terms of coverage under the policy.
     The coverage period and benefits.
     The annual premium.
     Other information as specified by the Secretary in ``State 
Long-Term Care Insurance Partnership Insurer Reporting Requirements.''
    Comment: One commenter pointed out that we used different 
terminology in the proposed rule to describe the instruction document 
we would issue for reporting data.
    Response: We thank the commenter for bringing this inconsistency to 
our attention. In the proposed rule, we inconsistently used the term 
``Reporting

[[Page 76965]]

Instructions'' when referring to the title of this document; rather, we 
should have used ``Reporting Requirements.'' Throughout this final 
rule, we have standardized references to the document containing the 
detail instructions for insurers on how to report data to the 
Department under the title ``State Long-Term Care Partnership Insurer 
Reporting Requirements.''
    After consideration of the public comments received, we are 
adopting as final our proposed Sec.  144.206 with one technical change 
to the title of the instruction document, as discussed above.
2. Claims Data
    In the proposed rule, we proposed to require insurers to report 
data, for each quarter of the calendar year, on all benefit claims paid 
for all insured individuals who have been issued qualified long-term 
care insurance policies or certificates (individual policies or under 
group coverage plans) under qualified State Long-Term Care Partnership 
Programs (proposed Sec.  144.206(b)(2)). Under proposed Sec.  
144.206(b)(2)(ii), these data would include, but are not limited to, 
the following:
     Current identifying information on the insured individual.
     The type and cash amount of the benefits paid during the 
reporting period and lifetime to date.
     Remaining lifetime benefits.
     Other information as specified by the Secretary in ``State 
Long-Term Care Insurance Partnership Insurer Reporting Requirements.''
    We did not receive any public comments on this section other than 
the notification that we had used different titles for the instruction 
document discussed above. Therefore, we are adopting as final the 
proposed provisions of Sec.  144.206 with the technical change noted 
above.
3. Frequency of Reports and Deadlines for Submission
    In the proposed rule, we proposed to require insurers to submit 
data for different reporting periods, depending upon the file type.
    We proposed to require insurers to submit the required registry 
data to the Secretary on a semiannual basis; that is, for the 6-month 
reporting period of January 1 through June 30 and July 1 through 
December 31 of each year under proposed Sec.  144.206(b)(1)(ii). The 
proposed deadline for submittal of registry data reports was 30 days 
after the end of the reporting period (proposed Sec.  144.208(b)).
    Comment: One commenter stated that the discussion of frequency of 
reports in the preamble of the proposed rule failed to list the 
frequency of the reports on insurance claims.
    Response: The commenter is correct. Even though we specified the 
frequency of the reports on insurance claims data in the regulation 
text under proposed Sec.  144.208(c), we did not include a detailed 
discussion in the preamble. The description of the submission of the 
claims data along with a reference to the detailed documentation of the 
reporting requirements is as follows:
    We are requiring insurers to submit the required claims data to the 
Secretary on a quarterly basis; that is, for the 3-month reporting 
period of January 1 through March 30, April 1 through June 30, July 1 
through September 30, and, October 1 through December 31 of each year 
under Sec.  144.206(b)(2)(i). The deadline for submittal of claims data 
reports is 30 days after the end of the reporting period (Sec.  
144.208(c)). Detailed reporting instructions can be found on the 
Internet at the Web site: http://aspe.hhs.gov/daltcp/reports/2008/PartRepReq.pdf.
    After consideration of the public comments received, we are 
adopting as final proposed Sec. Sec.  144.208(b) and (c) without 
modification.
4. Transition Provision
    For insurers who have issued or exchanged a qualified Partnership 
policy prior to the effective date of the final regulations we issue, 
we proposed a transition provision under Sec.  144.208(a). We proposed 
that the first reports required for these insurers would be the reports 
that pertain to the reporting period that begins no more than 120 days 
after the effective date of the final regulations.
    We did not receive any public comments on the proposed Sec.  
144.208(a). Therefore, we are adopting it as final without modification 
in this final rule.
5. Format and Manner of Reporting Data
    In the proposed rule, we proposed to require that insurers submit 
the required data in the format and manner specified by the Secretary 
in the HHS-issued insurer reporting specifications document, ``State 
Long-Term Care Insurance Partnership Insurer Reporting Requirements'' 
(proposed Sec.  144.210). As we mentioned earlier, we are in the 
process of developing an integrated database that would be accessible 
through a secure Web site, and we plan to issue instructions as to how 
insurers will access and input the required data into the HHS reporting 
system.
    We did not receive any public comments on the proposed Sec.  
144.210. Therefore, we are adopting it as final without modification in 
this final rule.
6. Use of Submitted Reports
    As we discussed in the proposed rule, the overall purpose of the 
data is twofold: First, to be used in efforts to monitor program 
performance at both the State and Federal level; and second, to provide 
data for a longer term evaluation of the effectiveness of the 
Partnership Program. The Department and the States participating in the 
State Long-Term Care Partnership Program will use the information 
provided by insurers in compliance with the reporting requirements for 
analytical studies and for program monitoring. The data provided by 
insurers will reflect the combined experience of all State Long-Term 
Care Partnership Programs in terms of policies sold and benefits used. 
We plan to use the data to produce reports for Congress and other 
interested stakeholders on the implementation of the State Long-Term 
Care Partnership Program. In addition, we plan to use the data to 
generate individual State-level reports that will be used by the States 
to track the implementation of the Partnership Program at the State 
level. The Department may also use the data to examine public policy 
issues related to long-term care insurance in general as opportunities 
arise.
    HHS does not intend to use the data to determine asset disregard 
levels for individuals who participate in the State Long-Term Care 
Partnership Program and eventually apply for Medicaid coverage. We will 
not collect data on ``point in time'' information regarding the amount 
of insurance benefits used by claimants, nor exact information on when 
private insurance benefits may be exhausted, which clearly would depend 
upon how claimants use benefits to purchase long-term care services. 
The computation of asset disregard levels and the determination of 
Medicaid eligibility coverage are matters that will be dealt with among 
the insurer, the insured individual, and the State Medicaid eligibility 
office. We expect that when insured individuals exhaust their insurance 
coverage (or otherwise become eligible for Medicaid prior to the 
exhaustion of benefits), insurers will provide them with documentation 
of their participation in the State Long-Term Care Partnership Program 
and of the amount of benefits that the insured received. This 
documentation will become part of the entire documentation provided by 
the insured individual at the time he or she applies for Medicaid.

[[Page 76966]]

The Medicaid eligibility office will then determine, based upon the 
documentation provided by the applicant, the asset disregard level that 
will be applied.
    It is possible that State Medicaid programs may wish to access the 
collected data for monitoring purposes, to help them anticipate the 
number of insured individuals who may become eligible for Medicaid 
asset disregards over a projected time period. For example, through 
reports provided to each State from the integrated database, States 
would know how many partnership policyholders are ``in claim'' during 
any 3-month reporting period. States would also know, approximately, to 
what extent policyholders who are in claim have utilized the insurance 
benefits for which they are eligible and the amount of benefits 
remaining under their policy maximums. However, once an insured 
individual uses his or her insurance benefits under the policy, his or 
her eligibility for Medicaid will still depend upon the amount of 
available assets he or she retains, relative to his or her asset 
disregard, as well as other Medicaid eligibility criteria. For example, 
an insured individual may be eligible for an asset disregard of 
$150,000, but still retains $250,000 in countable assets. In this case, 
he or she would have to spend down $100,000 of his or her available 
assets before applying for Medicaid coverage. Thus, in general terms, 
States will be able to use the data to project future applications for 
Medicaid (and their potential budgetary impacts) but, at the individual 
level, the specific financial circumstances of each insured individual 
would determine his or her eligibility for Medicaid coverage.
    Comment: One commenter suggested that the Department consider a 
broader use of the data to investigate a number of issues related to 
long-term care insurance in general as well as issues related to the 
Partnership Program.
    Response: The Department will explore using the Partnership data to 
examine other issues related to long-term care insurance, to the extent 
possible. We have modified the preamble discussion above to indicate 
this.
    Comment: One commenter suggested that the language included in this 
section of the preamble of the proposed rule could imply that 
participants must exhaust their benefits before they can take advantage 
of the Partnership Program.
    Response: The commenter is correct in asserting that exhaustion of 
benefits is not required by the DRA of 2005. Participants may apply for 
a Medicaid asset disregard before they have exhausted their insurance 
benefits. We have modified the preamble language in this final rule to 
reflect the possibility that someone may apply for Medicaid and seek an 
asset disregard before they have exhausted their insurance benefits.

E. Additional State-Mandated Reporting Requirements

    The DRA of 2005 explicitly states that there is nothing in the 
statute that prohibits States from imposing additional reporting 
requirements on insurers participating in the Long-Term Care 
Partnership Program, beyond the Federal reporting requirements that we 
proposed in the proposed rule and are finalizing in this final rule. 
This regulation does not require insurers to report Partnership data to 
the Department for States with a Partnership Medicaid State plan 
amendment as May 14, 1993. However, we believe that the information 
that will be made available to the Secretary and to the States 
participating in the Long-Term Care Partnership Program through these 
mandated reporting requirements will be sufficient to meet the policy 
analysis and program monitoring needs of the States. We, as well as the 
stakeholders participating in the development of these reporting 
requirements, attempted to achieve a proper balance between the 
legitimate needs of the Federal Government and State governments to 
monitor the implementation and operation of the State Long-Term Care 
Partnership Program, and the desire not to impose undue cost burdens on 
participating insurers, to the point where they may consider it not 
economically beneficial to participate in the Partnership Program.
    Comment: One commenter suggested that the discussion of State-
mandated reporting in the final rule be revised to clarify that nothing 
in the regulation prohibits any State (including grandfathered States) 
from requiring data from participating Partnership insurers. The 
commenter further suggested that the section describe the motivations 
of States for requiring State-specific data. The commenter also 
suggested that all references to costs of data collection on the part 
of insurers be deleted. The commenter stated that the costs of 
reporting are ``often minimal or nonexistent.''
    Response: We are not modifying the language in this section as the 
commenter suggested. The balance between the Government's need for data 
and the cost burden on participating insurers is, in our view, a real 
issue, especially given the varying size of different participating 
States. Finding a balance between the need for data and the cost burden 
was part of the charge given to the stakeholder group mandated by the 
DRA. We believe the discussion of the costs of data collection in this 
section is appropriate and that its presence does not diminish States' 
ability to negotiate for State-specific data.

F. Confidentiality of Information

    In the proposed rule, we proposed to provide in the regulations 
that the data collected and reported under the requirements of the 
regulations would be subject to the confidentiality of information 
requirements specified in regulations under 42 CFR Part 401, Subpart B, 
and 45 CFR Part 5, Subpart F and any other applicable confidentiality 
statute or regulation (proposed Sec.  144.212).
    We did not receive any public comments on this section. Therefore, 
we are adopting as final the proposed Sec.  144.212 without 
modification in this final rule.

G. Actions for Noncompliance With Reporting Requirements

    In the proposed rule, we proposed under Sec.  144.214 that if an 
insurer of a qualified long-term care insurance policy does not submit 
the required reports by the due dates specified in the new subpart B of 
45 CFR Part 144, the Secretary notifies the appropriate State insurance 
commissioner within 45 days after the deadline for submission of the 
information and data specified in Sec.  144.208.
    We did not receive any comments on this proposed section. 
Therefore, we are adopting as final the proposed Sec.  144.214 without 
modification.

H. Provision of Reports to Partnership States

    Section 1917(b)(1)(C)(v) of the Act provides that the Secretary, as 
appropriate, must provide copies of the reports provided by insurers to 
the State involved. We plan to make reports containing the reported 
data available to States in a timely and efficient manner.

V. Collection of Information Requirements

    The Department of Health and Human Services has determined that 
this notice of proposed rulemaking contains information collections 
that are subject to review by the Office of Management and Budget (OMB) 
under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501-3520). 
In compliance with the requirement of section 3506(c)(2)(A) of the PRA 
, the Office of the Secretary

[[Page 76967]]

(OS), Department of Health and Human Services, published in the May 23, 
2008, proposed rule the following summary of a proposed information 
collection request for public comment. Interested persons were invited 
to send comments regarding the burden estimate or any other aspect of 
the collection of information, including any of the following subjects: 
(1) The necessity and utility of the proposed information collection 
for the proper performance of the agency's functions; (2) the accuracy 
of the estimated burden; (3) ways to enhance the quality, utility, and 
clarity of the information to be collected; and (4) the use of 
automated collection techniques or other forms of information 
technology to minimize the information collection burden.
    Individuals were given the opportunity to request and obtain copies 
of the supporting statement and any related forms for the proposed 
paperwork collections described below. Written comments and 
recommendations for the proposed information collections were due 
within 60 days of publication of the proposed rule.
    Further, the Department acknowledges that this regulation is 
covered under the Privacy Act and that this collection of data 
constitutes a System of Records. The Department is publishing elsewhere 
in this issue of the Federal Register a System of Records Notice for 
this collection of data.
    Title: Partnership for Long Term Care Data Set.
    Description: This information collected under the final rule is 
intended for insurers participating in the State Long-Term Care 
Partnership Program as authorized by the DRA of 2005. Insurers will 
provide data in the prescribed format to the Department on Partnership 
certified long-term care insurance policies for partnership 
participants in states with Partnership Medicaid state plan amendments 
approved after May 14, 1993. The requirements include the identity of 
the policy holder, the type of coverage purchased, and the amount of 
insurance benefits used. Data from this submission will be provided to 
State Medicaid agencies to assist in determining the amount of asset 
protection earned by program participants.
    Comment: One commenter brought to our attention two technical 
errors in the narrative portion of the instruction document and another 
error in the detailed data element specifications.
    Response: We have made the appropriate changes to the instruction 
document, which is now listed as Version 1.1. This instruction document 
is available on the Web site at: http://aspe.hhs.gov/daltcp/reports/2008/PartRepReg.pdf.
    It is estimated that insurers participating in the Partnership 
Program will be able to provide the necessary reports from data 
currently within their insurance operations systems. Fulfilling the 
reporting requirements will require that they write programs to extract 
the data in the manner specified by the Department. There are no costs 
to the respondents, other than their time.

                                                   Estimated Annualized Burden Hours and Burden Costs
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                     Number of      Average  response
                 CFR Section                        Type of respondent            Number of        responses per     per  respondent      Total burden
                                                                                 respondents        respondents         (in hours)           hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
45 CFR 144.206..............................  Insurers......................                30                  6              45/60                135
--------------------------------------------------------------------------------------------------------------------------------------------------------

    We indicated that public comments addressed as a result of the 
notice in the proposed rule would be taken into account in the formal 
OMB request for clearance for this data collection. The new information 
collection provisions in this final rule have been approved by OMB 
under OMB control number 0990-0333, effective through December 31, 
2011.

VI. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impacts of this final rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review) 
and the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 
96-354), section 1102(b) of the Social Security Act, the Unfunded 
Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.

B. Executive Order 12866

    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year).
    While we have determined that this final rule is not economically 
significant, it is, however, a significant regulatory action. We 
estimate that the aggregate cost to participating private insurers of 
implementing the reporting requirements in this final rule will be 
approximately $1.5 million.

C. Regulatory Flexibility Act (RFA)

    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and government agencies. 
Most insurance companies are not considered to be small entities 
because they generally have revenues of more than $29 million in any 1 
year. (For details, see the Small Business Administration's final rule 
that sets forth size standards for industries at 65 FR 69432, November 
17, 2000.) For purposes of the RFA, all insurance companies are not 
considered to be small entities. Individuals and States are not 
included in the definition of a small entity. However, we solicited 
comments on our estimates and analysis of the impact on insurers of the 
proposed rule.
    There are approximately 100 insurance companies located nationwide 
that issue long-term care insurance policies. We expect that, of these 
100 companies, approximately 30 insurance companies will participate in 
qualified State Long-Term Care Partnership Programs. Currently, there 
are 15 to 20 companies operating in States that are selling or have 
issued qualified long-term care insurance policies under the State 
Long-Term Care Partnership Programs. As of December 2007, approximately 
300,000 policies have been sold. We believe this represents 
approximately 80 percent of the policies that might be sold when the 
Partnership Programs are established nationwide. We anticipate that the 
number of insurance companies selling qualified long-term care 
insurance

[[Page 76968]]

partnership policies might increase by about 10 as more States obtain 
approved State plan amendments to operate State Long-Term Care 
Partnership Programs.
    As we stated earlier, insurers participating in the original four 
Partnership Programs have been reporting data on policies sold and 
benefits used in the program for more than a decade. The reporting 
requirements in this final rule were designed to take advantage of data 
already available in insurer data sets. Insurers will not be asked to 
collect new data, but simply to recode existing data into a common 
format for submission to the Secretary. It is estimated that 
participating insurers will have to make a one-time investment to 
produce the computer programs necessary to compile the reports. Should 
the reporting requirement change in the future, there will also be a 
cost to make the necessary changes. We are estimating that the 
programming will require 400 hours of labor on average (this number 
will vary widely by company depending on the type of systems used) to 
create the necessary changes. We also estimate an average cost per hour 
of programming time of $125. The cost per company is estimated at 
$50,000 and the total estimate for all companies is estimated at $1.5 
million.
    Subsequently, there will be a much smaller investment to run the 
quarterly and semi-annually reports. The data submissions were designed 
to be primarily snapshots of data elements in the insurers' files with 
very little tabulation or summary reporting. We note that all of the 
currently participating insurers participated in the development of the 
reporting requirements in this final rule and have given their 
consensus to the requirements.

D. Small Rural Hospitals

    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis for any proposed rule (and subsequent final 
rule) that may have a significant impact on the operations of a 
substantial number of small rural hospitals. This analysis must conform 
to the provisions of section 603 of the RFA. This final rule does not 
affect small rural hospitals.

E. Unfunded Mandates

    Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 
104-4) also requires that agencies assess anticipated costs and 
benefits before issuing any rule whose mandates require spending in any 
1 year of $100 million in 1995 dollars, updated annually for inflation. 
That threshold level is currently approximately $120 million. This 
final rule will not mandate any requirements for State, local, or 
tribal governments. However, it will affect private sector costs to 
insurance companies who sell qualified long-term care insurance 
partnership policies. We note that participation by insurers in the 
Partnership Program is voluntary. We have also determined that the 
costs of reporting the required data are not significant.

F. Federalism

    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a proposed rule (and subsequent 
final rule) that imposes substantial direct requirement costs on State 
and local governments, preempts State law, or otherwise has Federalism 
implications. As stated above, this final rule will not have a 
substantial effect on State and local governments.

List of Subjects in 45 CFR Part 144

    Health care, Health insurance, Reporting and recordkeeping.


0
For the reasons stated in the preamble of this final rule, we are 
amending 45 CFR Subtitle A, Subchapter B, Part 144 as set forth below:

Subchapter B--Requirements Relating to Health Care Access

PART 144--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE

0
1. The authority citation for Part 144 is revised to read as follows:

    Authority: Secs. 2701 through 2763, 2791, and 2792 of the Public 
Health Service Act (42 U.S.C. 300gg through 300gg-63, 300gg-91, 
300gg-92 as amended by HIPAA (Pub. L. 104-191, 110 Stat. 1936), MHPA 
(Pub. L. 104-204, 110 Stat. 2944, as amended by Pub. L. 107-116, 115 
Stat. 2177), NMHPA (Pub. L. 104-204, 110 Stat. 2935), WHCRA (Pub. L. 
105-227, 112 Stat. 2681-436)) and section 103(c)(4) of HIPAA; and 
secs. 1102 and 1917(b)(1)(C)(iii)(VI) of the Social Security Act (42 
U.S.C. 1302 and 1396p(b)(1)(C)(iii)(VI)).


0
2. A new Subpart B is added to read as follows:
Subpart B--Qualified State Long-Term Care Insurance Partnerships: 
Reporting Requirements for Insurers
Sec.
144.200 Basis.
144.202 Definitions.
144.204 Applicability of regulations.
144.206 Reporting requirements.
144.208 Deadlines for submission of reports.
144.210 Form and manner of reports.
144.212 Confidentiality of information.
144.214 Notifications of noncompliance with reporting requirements.

Subpart B--Qualified State Long-Term Care Insurance Partnerships: 
Reporting Requirements for Insurers


Sec.  144.200  Basis.

    This subpart implements--
    (a) Section 1917(b)(1)(C) (iii)(VI) of the Social Security Act, 
(Act) which requires the issuer of a long-term care insurance policy 
issued under a qualified State long-term care insurance partnership to 
provide specified regular reports to the Secretary.
    (b) Section 1917(b)(1)(C)(v) of the Act, which specifies that the 
regulations of the Secretary under section 1917(b)(1)(C)(iii)(VI) of 
the Act shall be promulgated after consultation with the National 
Association of Insurance Commissioners, issuers of long-term care 
insurance policies, States with experience with long-term care 
insurance partnership plans, other States, and representatives of 
consumers of long-term care insurance policies, and shall specify the 
type and format of the data to be reported and the frequency with which 
such reports are to be made. This section of the statute also provides 
that the Secretary provide copies of the reports to the States 
involved.


Sec.  144.202  Definitions.

    As used in this Subpart--
    Partnership qualified policy refers to a qualified long-term care 
insurance policy issued under a qualified State long-term care 
insurance partnership.
    Qualified long-term care insurance policy means an insurance policy 
that has been determined by a State insurance commissioner to meet the 
requirements of sections 1917(b)(1)(C)(iii)(I) through (IV) and 
1917(b)(5) of the Act. It includes a certificate issued under a group 
insurance contract.
    Qualified State long-term care insurance partnership means an 
approved Medicaid State plan amendment that provides for the disregard 
of any assets or resources in an amount equal to the insurance benefit 
payments that are made to or on behalf of an individual who is a 
beneficiary under a long-term care insurance policy that has been 
determined by a State insurance commissioner to meet the requirements 
of section 1917(b)(1)(C)(iii) of the Act.


Sec.  144.204  Applicability of regulations.

    The regulations contained in this subpart for reporting data apply 
only to those insurers that have issued qualified

[[Page 76969]]

long-term care insurance policies to individuals under a qualified 
State long-term care insurance partnership. They do not apply to the 
reporting of data by insurers for States with a Medicaid State plan 
amendment that established a long-term care partnership on or before 
May 14, 1993.


Sec.  144.206  Reporting requirements.

    (a) General requirement. Any insurer that sells a qualified long-
term care insurance policy under a qualified State long-term care 
insurance partnership must submit, in accordance with the requirements 
of this section, data on insured individuals, policyholders, and 
claimants who have active partnership qualified policies or 
certificates for a reporting period.
    (b) Specific requirements. Insurers of qualified long-term care 
insurance policies must submit the following data to the Secretary by 
the deadlines specified in paragraph (c) of this section:
    (1) Registry of active individual and group partnership qualified 
policies or certificates. (i) Insurers must submit data on--
    (A) Any insured individual who held an active partnership qualified 
policy or certificate at any point during a reporting period, even if 
the policy or certificate was subsequently cancelled, lost partnership 
qualified status, or otherwise terminated during the reporting period; 
and
    (B) All active group long-term care partnership qualified insurance 
policies, even if the identity of the individual policy/certificate 
holder is unavailable.
    (ii) The data required under paragraph (b)(1)(i) of this section 
must cover a 6-month reporting period of January through June 30 or 
July 1 through December 31 of each year; and
    (iii) The data must include, but are not limited to--
    (A) Current identifying information on the insured individual;
    (B) The name of the insurance company and issuing State;
    (C) The effective date and terms of coverage under the policy.
    (D) The annual premium.
    (E) The coverage period.
    (F) Other information, as specified by the Secretary in ``State 
Long-Term Care Partnership Insurer Reporting Requirements.''
    (2) Claims paid under partnership qualified policies or 
certificates. Insurers must submit data on all partnership qualified 
policies or certificates for which the insurer paid at least one claim 
during the reporting period. This includes data for employer-paid core 
plans and buy-up plans without individual insured data. The data must--
    (i) Cover a quarterly reporting period of 3 months;
    (ii) Include, but are not limited to--
    (A) Current identifying information on the insured individual;
    (B) The type and cash amount of the benefits paid during the 
reporting period and lifetime to date;
    (C) Remaining lifetime benefits;
    (D) Other information, as specified by the Secretary in ``State 
Long-Term Care Partnership Insurer Reporting Requirements.''


Sec.  144.208  Deadlines for submission of reports.

    (a) Transition provision for insurers who have issued or exchanged 
a qualified partnership policy prior to the effective date of these 
regulations.
    The first reports required for these insurers will be the reports 
that pertain to the reporting period that begins no more than 120 days 
after the effective date of the final regulations.
    (b) All reports on the registry of qualified long-term care 
insurance policies issued to individuals or individuals under group 
coverage specified in Sec.  144.206(b)(1)(ii) must be submitted within 
30 days of the end of the 6-month reporting period.
    (c) All reports on the claims paid under qualified long-term care 
insurance policies issued to individual and individuals under group 
coverage specified in Sec.  144.206(b)(2)(i) must be submitted within 
30 days of the end of the 3-month quarterly reporting period.


Sec.  144.210  Form and manner of reports.

    All reports specified in Sec.  144.206 must be submitted in the 
form and manner specified by the Secretary.


Sec.  144.212  Confidentiality of information.

    Data collected and reported under the requirements of this subpart 
are subject to the confidentiality of information requirements 
specified in regulations under 42 CFR Part 401, Subpart B, and 45 CFR 
Part 5, Subpart F.


Sec.  144.214  Notifications of noncompliance with reporting 
requirements.

    If an insurer of a qualified long-term care insurance policy does 
not submit the required reports by the due dates specified in this 
subpart, the Secretary notifies the appropriate State insurance 
commissioner within 45 days after the deadline for submission of the 
information and data specified in Sec.  144.208.

    Dated: August 15, 2008.
Mary M. McGeein,
Principal Deputy Assistant Secretary for Planning and Evaluation.
    Dated: August 21, 2008.
Michael O. Leavitt,
Secretary.

    Editorial Note: This document was received in the Office of the 
Federal Register on November 24, 2008.
[FR Doc. E8-28388 Filed 12-17-08; 8:45 am]
BILLING CODE 4154-05-P