SENATE BILL 1040

47th legislature - STATE OF NEW MEXICO - first session, 2005

INTRODUCED BY

Carroll H. Leavell

AN ACT

RELATING TO LONG-TERM CARE INSURANCE; ALLOWING THE MEDICAL ASSISTANCE DIVISION OF THE HUMAN SERVICES DEPARTMENT AND THE INSURANCE DIVISION OF THE PUBLIC REGULATION COMMISSION TO ESTABLISH A LONG-TERM CARE INSURANCE PARTNERSHIP PROGRAM.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     Section 1. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] LONG-TERM CARE INSURANCE PARTNERSHIP PROGRAM.--The medical assistance division of the department:

          A. shall provide medicaid coverage under a long-term program that allows asset disregard and protection to a person receiving long-term care services;

          B. shall promulgate rules, in consultation with the superintendent of insurance, to allow for asset disregard and protection of persons that purchase a policy under a long-term partnership program pursuant to the provisions of this 2005 act; provided that the department shall count insurance benefits paid under the policy toward asset disregard to the extent the payments are for covered services under the long-term care partnership program policy;

          C. shall coordinate with the insurance division of the public regulation commission to provide information to the general public and counseling services to individuals planning for long-term care needs;

          D. shall submit a request to the federal department of health and human services for a waiver, if needed, and amendments to the state medicaid plan to allow for asset disregard and protection of persons that purchase a policy under a long-term care insurance partnership program pursuant to this 2005 act; and

          E. may enter into reciprocal agreements with other states to extend asset disregard to residents of the state that purchase long-term care policies in another state that has a substantially similar asset disregard program."

     Section 2. A new section of the Long-Term Care Insurance Law is enacted to read:

     "[NEW MATERIAL] LONG-TERM CARE INSURANCE PARTNERSHIP PROGRAM.--The insurance division:

          A. shall promulgate rules, in consultation with the secretary of human services, that provide minimum standards for a policy under the long-term care insurance partnership program pursuant to Section 1 of this 2005 act, which standards shall include:

                (1) a residential health care facility benefit;

                (2) a home care benefit with personal care, nursing care, adult health care and respite care services;

                (3) year-round coverage;

                (4) an option for coverage equivalent to a two-year maximum benefit duration;

                (5) arrangements through the insurance plan for case management, including preauthorized assessment and referral programs, utilization controls and use of approved providers;

                (6) an inflation-protection benefit;

                (7) consumer and public information;

                (8) record keeping and explanation of benefits reports on insurance payments that count toward the asset disregard; and

                (9) management information and reports necessary to document the extent of asset protection offered and to evaluate the long-term care partnership program's effectiveness;

          B. may establish permissible payments under a long-term care partnership program policy; provided, however, that a policy shall not contain an exclusion for preexisting conditions that exceeds six months; and

          C. may enter into reciprocal agreements with other states to extend asset disregard to residents of the state that purchase long-term care policies in another state that has a substantially similar asset disregard program."

     Section 3. EFFECTIVE DATE.--The effective date of the provisions of this act is sixty days after the date of repeal of the restrictions to asset protection contained in the federal Omnibus Budget Reconciliation Act of 1993.

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