1.1                          A bill for an act 
  1.2             relating to insurance; improving insurance coverage of 
  1.3             long-term care; amending Minnesota Statutes 2002, 
  1.4             sections 61A.072, subdivision 6; 62A.315; 62A.48, by 
  1.5             adding a subdivision; 62A.49, by adding a subdivision; 
  1.6             62S.22, subdivision 1; proposing coding for new law in 
  1.7             Minnesota Statutes, chapter 62S. 
  1.8   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.9      Section 1.  Minnesota Statutes 2002, section 61A.072, 
  1.10  subdivision 6, is amended to read: 
  1.11     Subd. 6.  [ACCELERATED BENEFITS.] (a) "Accelerated 
  1.12  benefits" covered under this section are benefits payable under 
  1.13  the life insurance contract: 
  1.14     (1) to a policyholder or certificate holder, during the 
  1.15  lifetime of the insured, ~~in anticipation of death~~ upon the 
  1.16  occurrence of a specified life-threatening or catastrophic 
  1.17  condition as defined by the policy or rider; 
  1.18     (2) that reduce the death benefit otherwise payable under 
  1.19  the life insurance contract; and 
  1.20     (3) that are payable upon the occurrence of a single 
  1.21  qualifying event that results in the payment of a benefit amount 
  1.22  fixed at the time of acceleration. 
  1.23     (b) "Qualifying event" means one or more of the following: 
  1.24     (1) a medical condition that would result in a drastically 
  1.25  limited life span as specified in the contract; 
  1.26     (2) a medical condition that has required or requires 
  2.1   extraordinary medical intervention, such as, but not limited to, 
  2.2   major organ transplant or continuous artificial life support 
  2.3   without which the insured would die; ~~or~~ 
  2.4      (3) a condition that requires continuous confinement in an 
  2.5   eligible institution as defined in the contract if the insured 
  2.6   is expected to remain there for the rest of the insured's life; 
  2.7      (4) a long-term care illness or physical condition that 
  2.8   results in cognitive impairment or the inability to perform the 
  2.9   activities of daily life or the substantial and material duties 
  2.10  of any occupation; or 
  2.11     (5) other qualifying events that the commissioner approves 
  2.12  for a particular filing. 
  2.13     Sec. 2.  Minnesota Statutes 2002, section 62A.315, is 
  2.14  amended to read: 
  2.15     62A.315 [EXTENDED BASIC MEDICARE SUPPLEMENT PLAN; 
  2.16  COVERAGE.] 
  2.17     The extended basic Medicare supplement plan must have a 
  2.18  level of coverage so that it will be certified as a qualified 
  2.19  plan pursuant to section 62E.07, and will provide: 
  2.20     (1) coverage for all of the Medicare part A inpatient 
  2.21  hospital deductible and coinsurance amounts, and 100 percent of 
  2.22  all Medicare part A eligible expenses for hospitalization not 
  2.23  covered by Medicare; 
  2.24     (2) coverage for the daily copayment amount of Medicare 
  2.25  part A eligible expenses for the calendar year incurred for 
  2.26  skilled nursing facility care; 
  2.27     (3) coverage for the copayment amount of Medicare eligible 
  2.28  expenses under Medicare part B regardless of hospital 
  2.29  confinement, and the Medicare part B deductible amount; 
  2.30     (4) 80 percent of the usual and customary hospital and 
  2.31  medical expenses and supplies described in section 62E.06, 
  2.32  subdivision 1, not to exceed any charge limitation established 
  2.33  by the Medicare program or state law, the usual and customary 
  2.34  hospital and medical expenses and supplies, described in section 
  2.35  62E.06, subdivision 1, while in a foreign country, and 
  2.36  prescription drug expenses, not covered by Medicare; 
  3.1      (5) coverage for the reasonable cost of the first three 
  3.2   pints of blood, or equivalent quantities of packed red blood 
  3.3   cells as defined under federal regulations under Medicare parts 
  3.4   A and B, unless replaced in accordance with federal regulations; 
  3.5      (6) 100 percent of the cost of immunizations and routine 
  3.6   screening procedures for cancer, including mammograms and pap 
  3.7   smears; 
  3.8      (7) preventive medical care benefit:  coverage for the 
  3.9   following preventive health services: 
  3.10     (i) an annual clinical preventive medical history and 
  3.11  physical examination that may include tests and services from 
  3.12  clause (ii) and patient education to address preventive health 
  3.13  care measures; 
  3.14     (ii) any one or a combination of the following preventive 
  3.15  screening tests or preventive services, the frequency of which 
  3.16  is considered medically appropriate: 
  3.17     (A) fecal occult blood test and/or digital rectal 
  3.18  examination; 
  3.19     (B) dipstick urinalysis for hematuria, bacteriuria, and 
  3.20  proteinuria; 
  3.21     (C) pure tone (air only) hearing screening test 
  3.22  administered or ordered by a physician; 
  3.23     (D) serum cholesterol screening every five years; 
  3.24     (E) thyroid function test; 
  3.25     (F) diabetes screening; 
  3.26     (iii) any other tests or preventive measures determined 
  3.27  appropriate by the attending physician.  
  3.28     Reimbursement shall be for the actual charges up to 100 
  3.29  percent of the Medicare-approved amount for each service as if 
  3.30  Medicare were to cover the service as identified in American 
  3.31  Medical Association current procedural terminology (AMA CPT) 
  3.32  codes to a maximum of $120 annually under this benefit.  This 
  3.33  benefit shall not include payment for any procedure covered by 
  3.34  Medicare; 
  3.35     (8) at-home recovery benefit:  coverage for services to 
  3.36  provide short-term at-home assistance with activities of daily 
  4.1   living for those recovering from an illness, injury, or surgery: 
  4.2      (i) for purposes of this benefit, the following definitions 
  4.3   shall apply: 
  4.4      (A) "activities of daily living" include, but are not 
  4.5   limited to, bathing, dressing, personal hygiene, transferring, 
  4.6   eating, ambulating, assistance with drugs that are normally 
  4.7   self-administered, and changing bandages or other dressings; 
  4.8      (B) "care provider" means a duly qualified or licensed home 
  4.9   health aide/homemaker, personal care aide, or nurse provided 
  4.10  through a licensed home health care agency or referred by a 
  4.11  licensed referral agency or licensed nurses registry; 
  4.12     (C) "home" means a place used by the insured as a place of 
  4.13  residence, provided that the place would qualify as a residence 
  4.14  for home health care services covered by Medicare.  A hospital 
  4.15  or skilled nursing facility shall not be considered the 
  4.16  insured's place of residence; 
  4.17     (D) "at-home recovery visit" means the period of a visit 
  4.18  required to provide at-home recovery care, without limit on the 
  4.19  duration of the visit, except each consecutive four hours in a 
  4.20  24-hour period of services provided by a care provider is one 
  4.21  visit; 
  4.22     (ii) coverage requirements and limitations: 
  4.23     (A) at-home recovery services provided must be primarily 
  4.24  services that assist in activities of daily living; 
  4.25     (B) the insured's attending physician must certify that the 
  4.26  specific type and frequency of at-home recovery services are 
  4.27  necessary because of a condition for which a home care plan of 
  4.28  treatment was approved by Medicare; 
  4.29     (C) coverage is limited to: 
  4.30     (I) no more than the number and type of at-home recovery 
  4.31  visits certified as medically necessary by the insured's 
  4.32  attending physician.  The total number of at-home recovery 
  4.33  visits shall not exceed the number of Medicare-approved home 
  4.34  health care visits under a Medicare-approved home care plan of 
  4.35  treatment; 
  4.36     (II) the actual charges for each visit up to a maximum 
  5.1   reimbursement of ~~$40~~ $100 per visit; 
  5.2      (III) ~~$1,600~~ $4,000 per calendar year; 
  5.3      (IV) seven visits in any one week; 
  5.4      (V) care furnished on a visiting basis in the insured's 
  5.5   home; 
  5.6      (VI) services provided by a care provider as defined in 
  5.7   this section; 
  5.8      (VII) at-home recovery visits while the insured is covered 
  5.9   under the policy or certificate and not otherwise excluded; 
  5.10     (VIII) at-home recovery visits received during the period 
  5.11  the insured is receiving Medicare-approved home care services or 
  5.12  no more than eight weeks after the service date of the last 
  5.13  Medicare-approved home health care visit; 
  5.14     (iii) coverage is excluded for: 
  5.15     (A) home care visits paid for by Medicare or other 
  5.16  government programs; and 
  5.17     (B) care provided by ~~family members,~~ unpaid volunteers~~,~~ or 
  5.18  providers who are not care providers. 
  5.19     Sec. 3.  Minnesota Statutes 2002, section 62A.48, is 
  5.20  amended by adding a subdivision to read: 
  5.21     Subd. 12.  [REGULATORY FLEXIBILITY.] The commissioner may 
  5.22  upon written request issue an order to modify or suspend a 
  5.23  specific provision or provisions of sections 62A.46 to 62A.56 
  5.24  with respect to a specific long-term care insurance policy or 
  5.25  certificate upon a written finding that: 
  5.26     (1) the modification or suspension is in the best interest 
  5.27  of the insureds; 
  5.28     (2) the purpose to be achieved could not be effectively or 
  5.29  efficiently achieved without the modifications or suspension; 
  5.30  and 
  5.31     (3)(i) the modification or suspension is necessary to the 
  5.32  development of an innovative and reasonable approach for 
  5.33  insuring long-term care; 
  5.34     (ii) the policy or certificate is to be issued to residents 
  5.35  of a life care or continuing care retirement community or some 
  5.36  other residential community for the elderly and the modification 
  6.1   or suspension is reasonably related to the special needs or 
  6.2   nature of such a community; or 
  6.3      (iii) the modification or suspension is necessary to permit 
  6.4   long-term care insurance to be sold as part of, or in 
  6.5   conjunction with, another insurance product. 
  6.6      Sec. 4.  Minnesota Statutes 2002, section 62A.49, is 
  6.7   amended by adding a subdivision to read: 
  6.8      Subd. 3.  [PROHIBITED LIMITATIONS.] A long-term care 
  6.9   insurance policy or certificate shall not, if it provides 
  6.10  benefits for home health care or community care services, limit 
  6.11  or exclude benefits by: 
  6.12     (1) requiring that the insured would need care in a skilled 
  6.13  nursing facility if home health care services were not provided; 
  6.14     (2) requiring that the insured first or simultaneously 
  6.15  receive nursing or therapeutic services in a home, community, or 
  6.16  institutional setting before home health care services are 
  6.17  covered; 
  6.18     (3) limiting eligible services to services provided by a 
  6.19  registered nurse or licensed practical nurse; 
  6.20     (4) requiring that a nurse or therapist provide services 
  6.21  covered by the policy that can be provided by a home health aide 
  6.22  or other licensed or certified home care worker acting within 
  6.23  the scope of licensure or certification; 
  6.24     (5) excluding coverage for personal care services provided 
  6.25  by a home health aide; 
  6.26     (6) requiring that the provision of home health care 
  6.27  services be at a level of certification or licensure greater 
  6.28  than that required by the eligible service; 
  6.29     (7) requiring that the insured have an acute condition 
  6.30  before home health care services are covered; 
  6.31     (8) limiting benefits to services provided by 
  6.32  Medicare-certified agencies or providers; 
  6.33     (9) excluding coverage for adult day care services; or 
  6.34     (10) excluding coverage based upon location or type of 
  6.35  residence in which the home health care services would be 
  6.36  provided. 
  7.1      Sec. 5.  Minnesota Statutes 2002, section 62S.22, 
  7.2   subdivision 1, is amended to read: 
  7.3      Subdivision 1.  [PROHIBITED LIMITATIONS.] A long-term care 
  7.4   insurance policy or certificate shall not, if it provides 
  7.5   benefits for home health care or community care services, limit 
  7.6   or exclude benefits by: 
  7.7      (1) requiring that the insured would need care in a skilled 
  7.8   nursing facility if home health care services were not provided; 
  7.9      (2) requiring that the insured first or simultaneously 
  7.10  receive nursing or therapeutic services in a home, community, or 
  7.11  institutional setting before home health care services are 
  7.12  covered; 
  7.13     (3) limiting eligible services to services provided by a 
  7.14  registered nurse or licensed practical nurse; 
  7.15     (4) requiring that a nurse or therapist provide services 
  7.16  covered by the policy that can be provided by a home health aide 
  7.17  or other licensed or certified home care worker acting within 
  7.18  the scope of licensure or certification; 
  7.19     (5) excluding coverage for personal care services provided 
  7.20  by a home health aide; 
  7.21     (6) requiring that the provision of home health care 
  7.22  services be at a level of certification or licensure greater 
  7.23  than that required by the eligible service; 
  7.24     (7) requiring that the insured have an acute condition 
  7.25  before home health care services are covered; 
  7.26     (8) limiting benefits to services provided by 
  7.27  Medicare-certified agencies or providers; ~~or~~ 
  7.28     (9) excluding coverage for adult day care services; or 
  7.29     (10) excluding coverage based upon location or type of 
  7.30  residence in which the home health care services would be 
  7.31  provided. 
  7.32     Sec. 6.  [62S.34] [REGULATORY FLEXIBILITY.] 
  7.33     The commissioner may upon written request issue an order to 
  7.34  modify or suspend a specific provision or provisions of this 
  7.35  chapter with respect to a specific long-term care insurance 
  7.36  policy or certificate upon a written finding that: 
  8.1      (1) the modification or suspension is in the best interest 
  8.2   of the insureds; 
  8.3      (2) the purpose to be achieved could not be effectively or 
  8.4   efficiently achieved without the modifications or suspension; 
  8.5   and 
  8.6      (3)(i) the modification or suspension is necessary to the 
  8.7   development of an innovative and reasonable approach for 
  8.8   insuring long-term care; 
  8.9      (ii) the policy or certificate is to be issued to residents 
  8.10  of a life care or continuing care retirement community or some 
  8.11  other residential community for the elderly and the modification 
  8.12  or suspension is reasonably related to the special needs or 
  8.13  nature of such a community; or 
  8.14     (iii) the modification or suspension is necessary to permit 
  8.15  long-term care insurance to be sold as part of, or in 
  8.16  conjunction with, another insurance product. 
  8.17     Sec. 7.  [EFFECTIVE DATE.] 
  8.18     Section 1 is effective the day following final enactment 
  8.19  and applies to policies issued on or after that date.  Sections 
  8.20  2 to 6 are effective January 1, 2004, and apply to policies 
  8.21  issued on or after that date.