SECTIONS 22000-22010 - California Statutes

WELFARE AND INSTITUTIONS CODE

SECTION 22000-22010

22000. The California Partnership for Long-Term Care Program is
hereby established.

22001. The purpose of the program is to link private long-term care
insurance and health care service plan contracts that cover
long-term care with the In-Home Supportive Services program (Article
7 (commencing with Section 12300) of Chapter 3 of Part 3 of Division
9) and Medi-Cal, and to provide specified in-home supportive services
benefits and specified Medi-Cal benefits to the purchasers of
approved and certified insurance policies and health care service
plan contracts who qualify under the special provisions of this
division.

22002. The State Department of Health Services shall seek any
federal waivers and approvals necessary to accomplish the purposes of
this division.

22003. (a) Individuals who participate in the program and have
resources above the eligibility levels for receipt of medical
assistance under Title XIX of the Social Security Act (Subchapter XIX
(commencing with Section 1396) of Chapter 7 of Title 42 of the
United States Code) shall be eligible to receive those in-home
supportive services benefits specified by the State Department of
Social Services, and those Medi-Cal benefits specified by the State
Department of Health Services, for which they would otherwise be
eligible, if, prior to becoming eligible for benefits, they have
purchased a long-term care insurance policy or a health care service
plan contract covering long-term care that has been certified by the
State Department of Health Services pursuant to this division.
(b) Individuals may purchase approved and certified long-term care
insurance policies or health care service plan contracts which cover
long-term care services in amounts equal to the resources they wish
to protect, so long as the amount of insurance purchased exceeds the
minimum level set by the State Department of Health Services pursuant
to Section 22009.
(c) The resource protection provided by this division shall be
effective only for long-term care policies, and health care service
plan contracts that cover long-term care services, when the policy or
contract is delivered, issued for delivery, or renewed on July 1,
1993 and thereafter.

22004. Notwithstanding other provisions of law, the resources, to
the extent described in subdivision (c), of an individual who
purchases an approved and certified long-term care insurance policy
or health care service plan contract which covers long-term care
services shall not be considered by:
(a) The State Department of Health Services in determining:
(1) Medi-Cal eligibility.
(2) The amount of any Medi-Cal payment.
(3) The amount of any subsequent recovery by the state of payments
made for medical services.
(b) The State Department of Social Services in determining:
(1) Eligibility for in-home supportive services provided pursuant
to Article 7 (commencing with Section 12300) of Chapter 3 of Division
9.
(2) The amount of any payment for in-home supportive services.
(c) The resources not to be considered as provided by this section
shall be equal to, or in some proportion set by the State Department
of Health Services or State Department of Social Services that is
less than equal to, the amount of long-term care insurance payments
or benefits made as described in Section 22006.

22005. The State Department of Health Services shall only certify a
long-term care insurance policy or a health care service plan
contract that meets the Medi-Cal asset protection requirements.

22005.1. (a) The State Department of Health Services shall only
certify a long-term care insurance policy that substantially meets
the requirements of Chapter 2.6 (commencing with Section 10230) of
Part 2 of Division 2 of the Insurance Code, except the requirements
of Sections 10232.1, 10232.2, 10232.25, 10232.8, 10232.9, and
10232.92 of the Insurance Code, and that provides all of the items
specified in subdivision (b). The State Department of Health Services
shall only certify a health care service plan contract that has been
approved by the Department of Corporations pursuant to Chapter 2.2
(commencing with Section 1340) of Division 2 of the Health and Safety
Code as providing substantially equivalent coverage to that required
by Chapter 2.6 (commencing with Section 10230) of Part 2 of Division
2 of the Insurance Code, and that provides all of the items
specified in subdivision (b). Policies issued by organizations
subject to the Insurance Code and regulated by the Department of
Insurance shall also be approved by the Department of Insurance.
(b) Only policies and contracts that provide all of the following
items shall be certified by the department:
(1) Individual assessment and case management by a coordinating
entity designated and approved by the department.
(2) Levels and durations of benefits that meet minimum standards
set by the State Department of Health Services pursuant to Section
22009.
(3) Protection against loss of benefits due to inflation.
(4) A periodic record issued to the insured including an
explanation of insurance payments or benefits paid that count toward
Medi-Cal asset protection under this division.
(5) Compliance with any other requirements imposed by regulations
adopted by the State Department of Health Services or the State
Department of Social Services and consistent with the purposes of
this division.

22005.2. Each organization issuing policies certified by the State
Department of Health Services under this division shall each year
contribute to a fund to be used for common educational and marketing
expenses for reaching the target population designated by the
California Partnership for Long-Term Care. The amount of each
participating issuer's required annual contribution shall be
determined by the department and shall not be less than twenty
thousand dollars ($20,000).

22006. The State Department of Health Services, in determining
eligibility for Medi-Cal, and the State Department of Social
Services, in determining eligibility for in-home supportive services,
shall exclude resources up to, or equal to, the amount of insurance
payments or benefits paid by approved and certified long-term care
insurance policies or health care service plan contracts which cover
long-term care services to the extent that the benefits paid are for
all of the following:
(a) In-home supportive services benefits specified in regulations
adopted by the State Department of Social Services pursuant to
Section 22009, or those services that Medi-Cal approves or benefits
that Medi-Cal provides as specified in regulations adopted by the
State Department of Health Services pursuant to Section 22009.
(b) Services delivered to insured individuals in a community
setting as part of an individual assessment and case management
program provided by coordinating entities designated and approved by
the State Department of Health Services.
(c) Services the insured individual receives after meeting the
disability criteria for eligibility for long-term care benefits
established by the State Department of Health Services.

22007. The program shall be designed so that the estimated
aggregate state expenditures for long-term care services for
individuals participating in the program do not exceed the aggregate
expenditures that would be made for these services under the Medi-Cal
program in effect prior to the implementation of this program.

22008. Advice and counseling may be provided by the Health
Insurance Counseling and Advocacy program within the California
Department of Aging to individuals interested in purchasing long-term
care insurance or health care service plan contracts that cover
long-term care services approved and certified pursuant to this
division.

22008.5. Individuals who participate in the program shall remain
eligible for those in-home supportive services benefits and those
Medi-Cal benefits for which they are eligible under the program for
the life of the purchaser of the policy or contract, as long as the
purchaser maintains his or her insurance policy or health care
service plan contract in force, or otherwise qualifies for continued
benefits in accordance with regulations promulgated by the
departments.

22009. (a) The State Department of Health Services shall adopt
regulations to implement this division, including, but not limited
to, regulations which establish:
(1) The population and age groups that are eligible to participate
in the program.
(2) The minimum level of long-term care insurance or long-term
care coverage included in health care service plan contracts that
must be purchased to meet the requirement of subdivision (b) of
Section 22003.
(3) The amount and types of services that a long-term care
insurance policy or health care service plan contract which includes
long-term care services must cover to meet the requirements of this
division.
(4) Which coordinating entities are designated and approved to
deliver individual assessment and case management services to
individuals in a community setting, as required by subdivision (b) of
Section 22006.
(5) The disability criteria for eligibility for long-term care
benefits as required by subdivision (c) of Section 22006.
(6) The specific eligibility requirements for receipt of the
Medi-Cal benefits provided for by the program, and those Medi-Cal
benefits for which participants in the program shall be eligible.
(b) The State Department of Social Services shall also adopt
regulations to implement this division, including, but not limited
to, regulations that establish:
(1) The specific eligibility requirements for in-home supportive
services benefits.
(2) Those in-home supportive services benefits for which
participants in the program shall be eligible.
(c) The State Department of Health Services and the State
Department of Social Services shall also jointly adopt regulations
that provide for the following:
(1) Continuation of benefits pursuant to Section 22008.5.
(2) The protection of a participant's resources pursuant to
Section 22004, and the ratio of resources to long-term care benefit
payments as described in subdivision (c) of Section 22004.
(d) The departments shall adopt emergency regulations pursuant to
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code to implement this division. The
adoption of regulations pursuant to this section in order to
implement this division shall be deemed to be an emergency and
necessary for the immediate preservation of the public peace, health,
or safety.
Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, emergency
regulations adopted pursuant to this section shall not be subject to
the review and approval of the Office of Administrative Law. The
regulations shall become effective immediately upon filing with the
Secretary of State. The regulations shall not remain in effect more
than 120 days unless the adopting agency complies with all of the
provisions of Chapter 3.5 (commencing with Section 11340) as required
by subdivision (c) of Section 11346.1 of the Government Code.

22010. (a) In implementing this division, the State Department of
Health Services may contract, on a bid or nonbid basis, with any
qualified individual, organization, or entity for services needed to
implement the project, and may negotiate contracts, on a nonbid
basis, with long-term care insurers, health care service plans, or
both, for the provision of coverage for long-term care services that
will meet the certification requirements set forth in Section 22005.1
and the other requirements of this division.
(b) In order to achieve maximum cost savings, the Legislature
declares that an expedited process for issuing contracts pursuant to
this division is necessary. Therefore, contracts entered into on a
nonbid basis pursuant to this section shall be exempt from the
requirements of Chapter 1 (commencing with Section 10100) and Chapter
2 (commencing with Section 10290) of Part 2 of Division 2 of the
Public Contract Code.