Text: SF02162 Text: SF02164 Text: SF02100 - SF02199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. NEW SECTION. 249J.1 DEFINITIONS. 1 2 As used in this chapter, unless the context otherwise 1 3 requires: 1 4 1. "Health maintenance organization" means health 1 5 maintenance organization as defined in section 514B.1. 1 6 2. "Long-term care facility" includes, but is not limited 1 7 to, a facility licensed under chapter 135C or an assisted 1 8 living program certified under chapter 231C. 1 9 3. "Qualified long-term care insurance policy" means a 1 10 qualified long-term care insurance contract as defined in 1 11 section 7702B(b) of the Internal Revenue Code that is issued 1 12 by an insurer or other person who complies with section 1 13 249J.5. 1 14 4. "Qualified long-term care services" means qualified 1 15 long-term care services as defined in section 7702B(c) of the 1 16 Internal Revenue Code. 1 17 Sec. 2. NEW SECTION. 249J.2 ESTABLISHMENT AND 1 18 ADMINISTRATION OF THE PROGRAM. 1 19 1. The Iowa long-term care asset disregard incentive 1 20 program is established to do the following: 1 21 a. Provide incentives for individuals to insure against 1 22 the costs of providing for their long-term care needs. 1 23 b. Provide a mechanism for individuals to qualify for 1 24 coverage of the costs of their long-term care needs under the 1 25 medical assistance program without first being required to 1 26 substantially exhaust all their resources. 1 27 c. Assist in developing methods for increasing access to 1 28 and the affordability of long-term care insurance. 1 29 d. Provide counseling to individuals in understanding 1 30 their long-term care insurance options. 1 31 e. Alleviate the financial burden on the state's medical 1 32 assistance program by encouraging the pursuit of private 1 33 initiatives. 1 34 2. The insurance division of the department of commerce 1 35 shall administer the program in cooperation with the division 2 1 responsible for medical services within the department of 2 2 human services. 2 3 Sec. 3. NEW SECTION. 249J.3 INFORMATION ABOUT THE 2 4 PROGRAM AVAILABILITY OF ASSISTANCE. 2 5 1. The insurance division shall develop and coordinate a 2 6 plan to provide counseling as described in section 249J.2. 2 7 2. The insurance division shall make available to any 2 8 individual interested in participating in the Iowa long-term 2 9 care asset disregard incentive program information concerning 2 10 all of the following: 2 11 a. The Iowa long-term care asset disregard incentive 2 12 program. 2 13 b. Qualified long-term care insurance policies. 2 14 c. Medicare supplement insurance policies. 2 15 d. Parts A and B coverage under the Medicare program 2 16 pursuant to 42 U.S.C. } 1395 et seq. 2 17 e. Health maintenance organizations that contract with the 2 18 Medicare program. 2 19 f. The medical assistance program. 2 20 3. If an individual elects to pursue any of the options 2 21 about which information is provided under subsection 2, the 2 22 insurance division shall assist the individual. 2 23 Sec. 4. NEW SECTION. 249J.4 ELIGIBILITY. 2 24 An individual who meets either of the following criteria is 2 25 eligible for assistance under the medical assistance program 2 26 using the asset disregard provisions pursuant to section 2 27 249J.6: 2 28 1. Is the beneficiary of a qualified long-term care 2 29 insurance policy approved by the insurance division. 2 30 2. Is enrolled in a health maintenance organization that 2 31 both provides qualified long-term care services and provides a 2 32 qualified long-term care insurance policy. 2 33 Sec. 5. NEW SECTION. 249J.5 INSURER REQUIREMENTS. 2 34 1. An insurer or other person who wishes to issue a 2 35 qualified long-term care insurance policy meeting the 3 1 requirements of this chapter shall, at a minimum, offer to 3 2 each policyholder or prospective policyholder a policy that 3 3 provides both of the following: 3 4 a. Facility coverage, including but not limited to long- 3 5 term care facility coverage. 3 6 b. Nonfacility coverage, including but not limited to home 3 7 and community care coverage. 3 8 2. An insurer or other person who complies with subsection 3 9 1 may also elect to offer a qualified long-term care insurance 3 10 policy that provides only facility coverage. 3 11 Sec. 6. NEW SECTION. 249J.6 ASSET DISREGARD ADJUSTMENT. 3 12 1. As used in this section, "asset disregard" means any of 3 13 the following: 3 14 a. A one dollar increase in the amount of assets an 3 15 individual who purchases a qualified long-term care insurance 3 16 policy and meets the requirements of section 249J.4 may retain 3 17 under section 249A.34 for each one dollar of benefit paid out 3 18 under the individual's qualified long-term care insurance 3 19 policy for qualified long-term care services if the policy 3 20 provides benefits at the time of initial purchase of at least 3 21 one hundred thousand dollars if purchased on or before January 3 22 1, 2004, and includes a provision under which the total 3 23 benefit increases by at least five percent per year, 3 24 compounded annually beginning January 1, 2005, for individuals 3 25 up to seventy-two years of age. 3 26 b. The total assets an individual owns and may retain 3 27 under section 249A.34 and still qualify for benefits under 3 28 chapter 249A at the time the individual applies for benefits 3 29 if the individual meets all of the following criteria: 3 30 (1) Is the beneficiary of a qualified long-term care 3 31 insurance policy that provides benefits at the time of initial 3 32 purchase of at least one hundred forty thousand dollars if 3 33 purchased on or before January 1, 1998, and includes a 3 34 provision under which the total benefit increases by at least 3 35 five percent per year, compounded annually, beginning January 4 1 1, 1999, for individuals up to seventy-two years of age. 4 2 (2) Meets the requirements of section 249J.4. 4 3 (3) Has exhausted the benefits of the qualified long-term 4 4 care insurance policy. 4 5 2. When the division responsible for medical services 4 6 within the department of human services determines whether an 4 7 individual is eligible for medical services under chapter 4 8 249A, the division shall make an asset disregard adjustment 4 9 for any individual who meets the requirements of section 4 10 249J.4. The asset disregard shall be available after benefits 4 11 of the qualified long-term care insurance policy have been 4 12 applied to the cost of qualified long-term care services as 4 13 required under this chapter. 4 14 Sec. 7. NEW SECTION. 249J.7 APPLICATION OF ASSET 4 15 DISREGARD TO DETERMINATION OF INDIVIDUAL'S ASSETS. 4 16 A public program administered by the state that provides 4 17 long-term care services and bases eligibility upon the amount 4 18 of the individual's assets shall apply the asset disregard 4 19 under section 249J.6 in determining the amount of the 4 20 individual's assets. 4 21 Sec. 8. NEW SECTION. 249J.8 DISCONTINUATION OF PROGRAM. 4 22 1. If the Iowa long-term care asset disregard incentive 4 23 program is discontinued, an individual who is covered by a 4 24 qualified long-term care insurance policy prior to the date 4 25 the program is discontinued is eligible to continue to receive 4 26 an asset disregard as defined under section 249J.6. 4 27 2. An individual who is covered by a long-term care 4 28 insurance policy under the long-term care asset preservation 4 29 program established pursuant to chapter 249G, Code 2003, on or 4 30 before June 30, 2004, is eligible to continue to receive the 4 31 asset adjustment as defined under that chapter. 4 32 3. The insurance division shall adopt rules to provide an 4 33 asset disregard to individuals who are covered by a long-term 4 34 care insurance policy prior to July 1, 2004, consistent with 4 35 the Iowa long-term care program asset disregard. 5 1 Sec. 9. NEW SECTION. 249J.9 RECIPROCAL AGREEMENTS TO 5 2 EXTEND ASSET DISREGARD. 5 3 The division responsible for medical services within the 5 4 department of human services may enter into reciprocal 5 5 agreements with other states to extend the asset disregard 5 6 under section 249J.6 to Iowa residents who had purchased or 5 7 were covered by qualified long-term care insurance policies in 5 8 other states. 5 9 Sec. 10. NEW SECTION. 249J.10 RULES. 5 10 The department of human services and the insurance division 5 11 may adopt rules pursuant to chapter 17A as necessary to 5 12 administer this chapter. The insurance division shall consult 5 13 with representatives of the insurance industry in adopting 5 14 such rules. This delegation of rulemaking authority shall be 5 15 construed narrowly. 5 16 Sec. 11. NEW SECTION. 249A.34 PURCHASE OF QUALIFIED 5 17 LONG-TERM CARE INSURANCE POLICY COMPUTATION UNDER MEDICAL 5 18 ASSISTANCE PROGRAM. 5 19 A computation for the purposes of determining eligibility 5 20 under this chapter concerning an individual who has purchased 5 21 a qualified long-term care insurance policy under chapter 249J 5 22 shall include consideration of the asset disregard provided in 5 23 section 249J.6. 5 24 Sec. 12. Chapter 249G, Code 2003, is repealed. 5 25 Sec. 13. MEDICAID STATE PLAN. 5 26 1. The department shall amend the medical assistance state 5 27 plan to provide that all amounts paid for qualified long-term 5 28 care services under a qualified long-term care insurance 5 29 policy shall be considered in determining the amount of the 5 30 asset disregard. 5 31 2. The department shall amend the medical assistance state 5 32 plan to extend nursing home coverage using the special 5 33 institutional income rule to the medically needy directly 5 34 without the requirement of establishing a qualifying income 5 35 trust. 6 1 Sec. 14. CONTINGENT EFFECTIVE DATE IOWA LONG-TERM CARE 6 2 ASSET DISREGARD INCENTIVE PROGRAM. The Iowa long-term care 6 3 asset disregard incentive program established in this Act 6 4 shall take effect only if funding is specifically appropriated 6 5 to the insurance division for that purpose. The insurance 6 6 division shall notify the Code editor if such an appropriation 6 7 is made. 6 8 EXPLANATION 6 9 This bill establishes an Iowa long-term care asset 6 10 disregard incentive program to provide incentives for 6 11 individuals to insure against the costs of their long-term 6 12 care needs, provide a mechanism for individuals to qualify for 6 13 coverage of the costs of their long-term care needs under the 6 14 medical assistance program without first being required to 6 15 substantially exhaust all their resources, to increase access 6 16 to and the affordability of long-term care insurance, to 6 17 provide counseling to individuals in understanding their long- 6 18 term care insurance options, and to alleviate the financial 6 19 burden on the state's medical assistance program by 6 20 encouraging the pursuit of private initiatives. The bill 6 21 directs the division responsible for medical services within 6 22 the department of human services and the insurance division of 6 23 the department of commerce to administer the program. 6 24 The bill directs the insurance division to provide certain 6 25 information to individuals interested in participating in the 6 26 Iowa long-term care asset disregard incentive program, and 6 27 provides that an individual is eligible to participate in the 6 28 program if the individual is either the beneficiary of a 6 29 qualified long-term care insurance policy approved by the 6 30 insurance division or is enrolled in a health maintenance 6 31 organization that both provides qualified long-term care 6 32 services and provides a qualified long-term care insurance 6 33 policy. 6 34 The bill encourages insurers who issue qualified long-term 6 35 care policies to offer, at a minimum, a policy that provides 7 1 both facility coverage and nonfacility coverage, including but 7 2 not limited to home and community care coverage. 7 3 Under the bill, an individual who purchases or is covered 7 4 by a qualified long-term care insurance policy would be 7 5 allowed an asset disregard under the medical assistance 7 6 program. The asset disregard is either a $1 increase in the 7 7 amount of assets the individual may retain under the medical 7 8 assistance program for each $1 of benefit paid out under the 7 9 individual's qualified long-term care insurance policy for 7 10 qualified long-term care services if the benefit is at least 7 11 $100,000 if purchased on or before January 1, 2004, and the 7 12 total benefit increases by at least 5 percent compounded 7 13 annually beginning January 1, 2005, for individuals up to 7 14 seventy-two years of age, or a disregard of the total assets 7 15 the individual owns and may retain and still be eligible under 7 16 the medical assistance program if the individual is the 7 17 beneficiary of a qualified long-term care insurance policy 7 18 with a benefit of at least $140,000 if purchased on or before 7 19 January 1, 1998, with a total benefit that increases by at 7 20 least 5 percent compounded annually beginning January 1, 1999, 7 21 for individuals up to 72 years of age, is otherwise eligible 7 22 and has exhausted the benefits of the policy. 7 23 The bill provides that if the Iowa long-term care asset 7 24 disregard incentive program is discontinued, an individual who 7 25 purchased or is covered under a qualified long-term care 7 26 insurance policy prior to the date the program is discontinued 7 27 is eligible to continue to receive an asset disregard under 7 28 the bill. The bill allows an individual participating in the 7 29 asset preservation program existing on June 30, 2004, to 7 30 continue to receive that asset adjustment and directs the 7 31 department to adopt rules to allow an individual who purchased 7 32 long-term care insurance prior to July 1, 2004, to receive an 7 33 asset disregard incentive prior to July 1, 2004. The bill 7 34 allows for reciprocal agreements to extend the asset disregard 7 35 program and the division of insurance to Iowa residents who 8 1 have purchased or are covered under qualified long-term care 8 2 insurance policies in other states. 8 3 The bill authorizes the department of human services and 8 4 the insurance division to adopt rules to administer this new 8 5 Code chapter but this authority is to be construed narrowly. 8 6 The insurance division is directed to consult with 8 7 representatives of the insurance industry in adopting such 8 8 rules. 8 9 The bill directs the department of human services to amend 8 10 the medical assistance state plan to allow for disregard of 8 11 all amounts paid out under a qualified long-term care 8 12 insurance policy and to allow for extension of nursing home 8 13 coverage using the special institutional income rule to the 8 14 medically needy directly without requiring the establishment 8 15 of a qualifying income trust. 8 16 The bill repeals Code chapter 249G, the current long-term 8 17 care asset preservation program. 8 18 The bill provides that the long-term care asset disregard 8 19 incentive program takes effect only if funds are specifically 8 20 appropriated to the insurance division for that purpose. 8 21 LSB 6099SS 80 8 22 pf/pj/5.3
Text: SF02162 Text: SF02164 Text: SF02100 - SF02199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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