74th OREGON LEGISLATIVE ASSEMBLY--2007 Regular Session
Enrolled
Senate Bill 191
Printed pursuant to Senate Interim Rule 213.28 by order of the
President of the Senate in conformance with presession filing
rules, indicating neither advocacy nor opposition on the part
of the President (at the request of Governor Theodore R.
Kulongoski for Department of Consumer and Business Services)
CHAPTER ................
AN ACT
Relating to long term care insurance; creating new provisions;
amending ORS 411.708, 414.025, 743.650, 743.652, 743.653 and
743.655; and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 743.650 is amended to read:
743.650. (1) ORS 743.650 to 743.656 { - , 748.603 and
750.055 - } may be known and cited as the 'Long Term Care
Insurance Act. '
(2) The purpose of ORS 743.650 to 743.656 { - , 748.603 and
750.055 - } is to:
(a) Promote the public interest in long term care insurance;
(b) Promote the availability of long term care insurance
policies;
(c) Protect applicants for long term care insurance from unfair
or deceptive sales or enrollment practices;
(d) Establish standards for long term care insurance;
(e) Facilitate public understanding and comparison of long term
care insurance policies;
(f) Facilitate flexibility and innovation in the development of
long term care insurance coverage; and
(g) { - Assure - } { + Ensure + } that Oregon residents who
purchase insurance for long term care shall have access to
policies providing for a comprehensive range of benefits.
(3) The requirements of ORS 743.650 to 743.656, 748.603 and
750.055 apply to policies and certificates delivered or issued
for delivery in this state on or after December 31, 1989. ORS
743.650 to 743.656, 748.603 and 750.055 are not intended to
supersede the obligations of entities subject to ORS 743.650 to
743.656, 748.603 and 750.055 to comply with the substance of
other applicable insurance laws insofar as such laws do not
conflict with ORS 743.650 to 743.656, 748.603 and 750.055, except
that laws and rules designed and intended to apply to Medicare
supplement insurance policies shall not be applied to long term
care insurance. A policy that is not advertised, marketed or
offered as long term care insurance or nursing home insurance is
not required to meet the requirements of ORS 743.650 to 743.656,
748.603 and 750.055.
SECTION 2. ORS 743.652 is amended to read:
Enrolled Senate Bill 191 (SB 191-B) Page 1
743.652. As used in ORS 743.650 to 743.656, { - 748.603 and
750.055, - } unless the context requires otherwise:
(1) 'Applicant' means:
(a) In the case of an individual long term care insurance
policy, the person who seeks to contract for benefits; and
(b) In the case of a group long term care insurance policy, the
proposed certificate holder.
(2) 'Certificate' means any certificate issued under a group
long term care insurance policy, if the policy has been delivered
or issued for delivery in this state.
{ - (3) 'Director' means the Director of the Department of
Consumer and Business Services. - }
{ - (4) 'Elimination period' means the period at the
beginning of a disability during which no benefits are
payable. - }
{ - (5) 'Functionally necessary' or 'functionally impaired '
means a need of a person who is not able to perform independently
activities of daily living because of a physical or cognitive
impairment. - }
{ - (6) - } { + (3) + } 'Group long term care insurance'
means a long term care insurance policy that is delivered or
issued for delivery in this state and issued to:
(a) One or more employers or labor organizations, or to a trust
or to the trustees of a fund established by one or more employers
or labor organizations, or a combination thereof, for employees
or former employees or a combination thereof, or for members or
former members, or a combination thereof, of the labor
organizations; { - or - }
(b) Any professional, trade or occupational association for its
members or former or retired members, or combination thereof, if
such association:
(A) Is composed of individuals all of whom are or were actively
engaged in the same profession, trade or occupation; and
(B) Has been maintained in good faith for purposes other than
obtaining insurance; { - or - }
(c)(A) An association or a trust or the trustee of a fund
established, created or maintained for the benefit of members of
one or more associations. Prior to advertising, marketing or
offering { - such - } { + the + } policy within this state,
the association or associations, or the insurer of the
association or associations shall file evidence with the director
that the association or associations have been organized and
maintained in good faith for purposes other than that of
obtaining insurance; have been in active existence for at least
one year; and have a constitution and bylaws that provide that:
(i) The association or associations hold regular meetings not
less than annually to further purposes of the members;
(ii) Except for credit unions, the association or associations
collect dues or solicit contributions from members; and
(iii) The members have voting privileges and representation on
the governing board and committees; and
(B) Sixty days after { - such - } { + the + } filing, the
association or associations shall be considered to satisfy
{ - such - } { + the + } organizational requirements, unless
the director makes a finding that the association or associations
do not satisfy those organizational requirements; { - and - }
{ + or + }
(d) A group other than as described in paragraphs (a), (b) and
(c) of this subsection, subject to a finding by the director
that:
Enrolled Senate Bill 191 (SB 191-B) Page 2
(A) The issuance of the group policy is not contrary to the
best interest of the public;
(B) The issuance of the group policy would result in economies
of acquisition or administration; and
(C) The benefits are reasonable in relation to the premiums
charged.
{ - (7) - } { + (4) + } 'Long term care insurance' means
any insurance { + policy or rider + } advertised, marketed,
offered or designed to provide coverage for not less than 24
{ + consecutive + } months for each covered person on an expense
incurred, indemnity, prepaid or other basis; for one or more
{ - functionally - } necessary or medically necessary services,
including but not limited to nursing, diagnostic, preventive,
therapeutic, rehabilitative, maintenance or personal care
services, provided in a setting other than an acute care unit of
a hospital. 'Long term care insurance ' includes group and
individual { + annuities and life insurance + } policies or
riders { - whether - } { + that provide directly or
supplement long term care insurance. 'Long term care insurance'
also includes a policy or rider that provides for payment of
benefits based upon cognitive impairment or the loss of
functional capacity, and qualified long term care insurance
contracts. Long term care insurance may be + } issued by
insurers; fraternal benefit societies; nonprofit health, hospital
and medical service corporations; prepaid health plans; or health
maintenance organizations, health care service contractors or any
similar organization { + to the extent they are otherwise
authorized to issue life or health insurance + }. 'Long term care
insurance' { - shall - } { + does + } not include any
insurance policy { - which - } { + that + } is offered
primarily to provide basic Medicare supplement coverage, basic
hospital expense coverage, basic medical-surgical expense
coverage, hospital confinement indemnity coverage, major medical
expense coverage, disability income { + or related asset + }
protection coverage, catastrophic coverage, accident only
coverage, specified disease or specified accident coverage { +
or limited benefit health coverage + }. { + With regard to life
insurance, 'long term care insurance' does not include life
insurance policies that accelerate the death benefit specifically
for one or more of the qualifying events of terminal illness,
medical conditions requiring extraordinary medical intervention
or permanent institutional confinement, and that provide the
option of a lump-sum payment for those benefits and when neither
the benefits nor the eligibility for the benefits is conditioned
upon the receipt of long term care. Notwithstanding any other
provision of ORS 743.650 to 743.656, any product advertised,
marketed or offered as long term care insurance is subject to ORS
743.650 to 743.656. + }
{ - (8) - } { + (5) + } 'Policy' means any policy,
contract, subscriber agreement, rider or indorsement delivered or
issued for delivery in this state by an insurer; fraternal
benefit society; nonprofit health, hospital or medical service
corporation; prepaid health plan; or health maintenance
organization, health care service contractor or any similar
organization.
{ + (6) 'Qualified long term care insurance' means:
(a) The portion of a life insurance contract that provides long
term care insurance coverage by rider or as part of the contract
and that satisfies the requirements of section 7702B(b) and (e)
of the Internal Revenue Code; or
Enrolled Senate Bill 191 (SB 191-B) Page 3
(b) Individual or group long term care insurance as defined in
this section that meets all of the following requirements of
section 7702B(b) of the Internal Revenue Code:
(A) The only insurance protection provided under the contract
is coverage of qualified long term care services. A contract
shall not fail to satisfy the requirements of this subparagraph
by reason of payments being made on a per diem or other periodic
basis without regard to the expenses incurred during the period
to which the payments relate.
(B) The contract does not pay or reimburse expenses incurred
for services or items to the extent that the expenses are
reimbursable under Title XVIII of the Social Security Act, or
would be reimbursable but for the application of a deductible or
coinsurance amount. The requirements of this subparagraph do not
apply to expenses that are reimbursable under Title XVIII of the
Social Security Act only as a secondary payer. A contract does
not fail to satisfy the requirements of this subparagraph by
reason of payments being made on a per diem or other periodic
basis without regard to the expenses incurred during the period
to which the payments relate.
(C) The contract is guaranteed renewable within the meaning of
section 7702B(b)(1)(C) of the Internal Revenue Code.
(D) The contract does not provide for a cash surrender value or
other money that can be paid, assigned, pledged as collateral for
a loan, or borrowed except as provided in subparagraph (E) of
this paragraph.
(E) All refunds of premiums, and all policyholder dividends or
similar amounts, under the contract are to be applied as a
reduction in future premiums or to increase future benefits,
except that a refund on the event of death of the insured or a
complete surrender or cancellation of the contract cannot exceed
the aggregate premiums paid under the contract.
(F) The contract meets the consumer protection provisions set
forth in section 7702B(g) of the Internal Revenue Code. + }
SECTION 3. ORS 743.653 is amended to read:
743.653. { - No - } Group long term care insurance coverage
may { + not + } be offered to a resident of this state under a
group policy issued in another state to a group described in ORS
743.652 { - (6)(d) - } { + (3)(d) + }, unless { - the
other - } { + this state or another + } state { - has - }
{ + having + } statutory and regulatory long term care insurance
requirements substantially similar to those adopted in this state
{ - and the Director of the Department of Consumer and Business
Services - } has made a determination that such requirements
{ - are substantially similar - } { + have been met + }.
SECTION 4. ORS 743.655 is amended to read:
743.655. (1)(a) The Director of the Department of Consumer and
Business Services shall adopt rules that include standards for
full and fair disclosure setting forth the manner, content and
required disclosures for the sale of long term care insurance
policies, terms of renewability, initial and subsequent
conditions of eligibility, nonduplication of coverage provisions,
coverage of dependents, preexisting conditions, termination of
insurance, program for public understanding, continuation or
conversion, probationary periods, limitations, exceptions,
reductions, elimination periods, underwriting at time of
application, requirements for replacement, recurrent conditions
and definitions of terms. { - The director shall adopt rules
establishing standards for loss ratios and reserves, provided
Enrolled Senate Bill 191 (SB 191-B) Page 4
that a specific reference to long term care insurance is
contained in the rules. - }
(b) In adopting rules setting standards under this section, the
director { - shall - } { + must + } give timely notice to,
and shall consider recommendations from the Director of Human
Services.
(2) { - No - } { + A + } long term care insurance policy
{ - shall - } { + may not + }:
(a) Be canceled, nonrenewed or otherwise terminated on the
grounds of the age or the deterioration of the mental or physical
health of the insured individual or certificate holder;
(b) Contain a provision establishing a new waiting period in
the event existing coverage is converted to or replaced by a new
or other form within the same company, except with respect to an
increase in benefits voluntarily selected by the insured
individual or group policyholder;
(c) Provide coverage for skilled nursing care only or provide
significantly more coverage for skilled care in a facility than
coverage for lower levels of care { - . This evaluation of the
amount of coverage provided shall be based on aggregate days of
care covered for lower levels of care, when compared to days of
care covered for skilled care - } ;
(d) Exclude coverage for Alzheimer's disease and related
dementias;
(e) Be nonrenewed or otherwise terminated for nonpayment of
premiums until 31 days overdue and then only after notice of
nonpayment is given the policyholder prior to expiration of the
31 days { + , except as otherwise provided by rule + }; or
(f) Be sold { - after December 31, 1989, - } to provide less
than 24 months' coverage.
(3)(a) { - No - } { + A + } long term care insurance policy
or certificate other than a policy or certificate issued to a
group { - , as defined - } { + described + } in ORS 743.652
{ - (6)(a) - } { + (3)(a) + }, (b) or (c) { - , shall - }
{ + may not + } use a definition of 'preexisting condition'
{ - which - } { + that + } is more restrictive than the
following: 'Preexisting condition ' means { - the existence of
symptoms which would cause an ordinarily prudent person to seek
diagnosis, care or treatment, or - } a condition for which
medical advice or treatment was recommended by, or received from
a provider of health care services, within six months preceding
the effective date of coverage of an insured person.
(b) { - No - } { + A + } long term care insurance policy or
certificate other than a policy or certificate thereunder issued
to a group
{ - as defined - } { + described + } in ORS 743.652
{ - (6)(a) - } { + (3)(a) + }, (b) or (c) may { + not + }
exclude coverage for a loss or confinement { - which - } { +
that + } is the result of a preexisting condition unless
{ - such - } { + the + } loss or confinement begins within six
months following the effective date of coverage of an insured
person.
(c) The Director { + of the Department of Consumer and
Business Services + } may extend the limitation periods set forth
in paragraphs (a) and (b) of this subsection as to specific age
group categories or specific policy forms upon findings that the
extension is in the best interest of the public.
(d) The definition of preexisting condition does not prohibit
an insurer from using an application form designed to elicit the
complete health history of an applicant, over the 10 years
Enrolled Senate Bill 191 (SB 191-B) Page 5
immediately prior to the date of application, and, on the basis
of the answers on the application, from underwriting in
accordance with that insurer's established underwriting
standards. Unless otherwise provided in the policy or
certificate, a preexisting condition, regardless of whether it is
disclosed on the application, need not be covered until the
waiting period described in paragraph (b) of this subsection
expires. { - No - } { + A + } long term care insurance policy
or certificate may { + not + } exclude or use waivers or riders
of any kind to exclude, limit or reduce coverage or benefits for
specifically named or described preexisting diseases or physical
conditions beyond the waiting period described in paragraph (b)
of this subsection { - , unless such waiver or rider has been
specifically approved by the director - } .
(4) { - No - } { + A + } long term care insurance policy
{ - shall - } { + may not + } be delivered or issued for
delivery in this state if the policy:
(a) Conditions eligibility for any benefits on a prior
hospitalization requirement; { - or - }
(b) Conditions eligibility for benefits provided in an
institutional care setting on the receipt of a higher level of
institutional care { - . - } { + ; or
(c) Conditions eligibility for any benefits other than waiver
of premium or post-confinement, post-acute care or recuperative
benefits on a prior institutionalization requirement.
(5)(a) A long term care insurance policy containing
post-confinement, post-acute care or recuperative benefits must
clearly label in a separate paragraph of the policy or
certificate titled 'Limitations or Conditions of Eligibility for
Benefits ' all such limitations or conditions, including any
required number of days of confinement.
(b) A long term care insurance policy or rider that conditions
eligibility of noninstitutional benefits on the prior receipt of
institutional care may not require a prior institutional stay of
more than 30 days. + }
{ - (5)(a) - } { + (6) + } Individual long term care
insurance
{ - policyholders - } { + applicants + } shall have the right
to return the policy { + or certificate + } within 30 days of
its delivery and to have the premium refunded if, after
examination of the policy { + or certificate + }, the
{ - policyholder - } { + applicant + } is not satisfied for
any reason. { - Individual - } Long term care insurance
policies { - shall - } { + and certificates must + } have a
notice prominently printed on the first page { - of the
policy - } or attached thereto stating in substance that the
{ - policyholder shall have - } { + applicant has + } the
right to return the policy { + or certificate + } within 30 days
of its delivery and to have the premium refunded if, after
examination of the policy { - , the policyholder - } { + or
certificate, other than a certificate issued pursuant to a policy
issued to a group described in ORS 743.652 (3)(a), the
applicant + } is not satisfied for any reason. { + This
subsection also applies to denials of applications. Any refund
must be made within 30 days of the return or denial. + }
{ - (b) A person insured under a long term care insurance
policy or certificate issued in this state or any other state to
a group described in ORS 743.652 (6)(b), (c) or (d) shall have
the right to return the policy within 30 days of its delivery and
to have the premium refunded if, after examination, the insured
Enrolled Senate Bill 191 (SB 191-B) Page 6
person is not satisfied for any reason. Long term care insurance
policies shall have a notice prominently printed in 10 point type
on the first page or attached thereto stating in substance that
the insured person shall have the right to return the policy
within 30 days of its delivery and to have the premium refunded
if after examination the insured person is not satisfied for any
reason. - }
{ - (6)(a) - } { + (7)(a)(A) + } An outline of coverage
shall be delivered to a prospective applicant for long term care
insurance at the time of initial solicitation through means
{ - which - } { + that + } prominently direct the attention of
the recipient to the document and its purpose.
{ - (A) - } { + (B) + } The director { - shall - } { +
by rule must + } prescribe a standard format { + , + } including
style, arrangement and overall appearance { + , + } and the
content of an outline of coverage.
{ - (B) - } { + (C) + } In the case of solicitations by an
insurance producer, the insurance producer must deliver the
outline of coverage prior to the presentation of an application
or enrollment form.
{ - (C) - } { + (D) + } In the case of direct response
solicitations, the outline of coverage must be presented in
conjunction with any application or enrollment form.
{ + (E) In the case of a policy issued to a group described
in ORS 743.652 (3)(a), an outline of coverage is not required to
be delivered as long as the information described in paragraph
(b) of this subsection is contained in other materials related to
the enrollment. Upon request, these other materials must be made
available to the director. + }
(b) The outline of coverage { - shall - } { + must + }
include:
(A) A description of the principal benefits and coverage
provided in the policy;
(B) A statement of the principal exclusions, reductions and
limitations contained in the policy;
(C) A statement of the terms under which the policy or
certificate, or both, may be continued in force or discontinued,
including any reservation in the policy of a right to change
premium. Continuation or conversion provisions of group coverage
shall be specifically described;
(D) A statement that the outline of coverage is a summary only,
not a contract of insurance, and that the policy or group master
policy contains governing contractual provisions;
(E) A description of the terms under which the policy or
certificate may be returned and premium refunded; { - and - }
(F) A brief description of the relationship of cost of care and
benefits { + ; and
(G) A statement that discloses to the policyholder or
certificate holder whether the policy is intended to be qualified
long term care insurance as defined in ORS 743.652 + }.
{ - (7) - } { + (8) + } A certificate issued pursuant to a
group long term care insurance policy if the policy is delivered
or issued for delivery in this state shall include:
(a) A description of the principal benefits and coverage
provided in the policy;
(b) A statement of the principal exclusions, reductions and
limitations contained in the policy; and
(c) A statement that the group master policy determines
governing contractual provisions.
Enrolled Senate Bill 191 (SB 191-B) Page 7
{ + (9) If an application for a long term care insurance
policy or certificate is approved, the insurer must deliver the
policy or certificate to the applicant no later than 30 days
after the date of approval.
(10) At the time of policy delivery, a policy summary must be
delivered for an individual life insurance policy that provides
long term care benefits within the policy or by rider. In the
case of direct response solicitations, the insurer must deliver
the policy summary upon the applicant's request, but regardless
of request must make delivery not later than at the time of
policy delivery. In addition to complying with all applicable
requirements, the summary must also include the provisions
required in this subsection. The required provision may be
incorporated into a basic illustration or into the life insurance
policy summary if required by rule. The following provisions must
be included in the summary:
(a) An explanation of how the long term care benefit interacts
with other components of the policy, including deductions from
death benefits;
(b) An illustration of the amount of benefits, the length of
benefits and the guaranteed lifetime benefits, if any, for each
covered person;
(c) Any exclusions, reductions and limitations on benefits of
long term care;
(d) A statement that any long term care inflation protection
option required by rule is not available under the policy; and
(e) If applicable to the policy type, the following:
(A) A disclosure of the effects of exercising other rights
under the policy;
(B) A disclosure of guarantees related to long term care costs
of insurance charges; and
(C) Current and projected maximum lifetime benefits.
(11) When a long term care benefit that is funded through a
life insurance policy by an acceleration of the death benefit is
in benefit payment status, the insurer must provide a monthly
report to the policyholder. The report must include:
(a) Any long term care benefits paid out during the month;
(b) An explanation of any changes in the policy, such as death
benefits or cash values, owing to payment of long term care
benefits; and
(c) The amount of long term care benefits existing or
remaining.
(12) If a claim under a long term care insurance policy is
denied, then not later than the 60th day after the date of a
written request by the policyholder or certificate holder, or a
representative of either, the insurer must:
(a) Provide a written explanation of the reasons for the
denial; and
(b) Make available all information directly related to the
denial. + }
{ - (8) - } { + (13) + } { - No - } { + A + } policy
may { + not + }be advertised, marketed or offered as long term
care or nursing home insurance unless it complies with the
provisions of ORS 743.650 to 743.656 { - , 748.603 and
750.055 - } .
{ - (9) ORS 743.414 applies to long term care insurance
regulated under ORS 743.650 to 743.656, 748.603 and 750.055. - }
{ - (10) - } { + (14) + } Rules adopted pursuant to ORS
743.650 to 743.656 { - , 748.603 and 750.055 - } shall be in
accordance with the provisions of ORS chapter 183.
Enrolled Senate Bill 191 (SB 191-B) Page 8
{ + (15) This section is exempt from ORS 743.700. + }
SECTION 5. { + Sections 6 and 7 of this 2007 Act are added to
and made a part of ORS 743.650 to 743.656. + }
SECTION 6. { + (1) For a policy or certificate that has been
in force for less than six months, an insurer may rescind a long
term care insurance policy or certificate or deny an otherwise
valid long term care insurance claim upon a showing of a
misrepresentation that is material to the acceptance for
coverage.
(2) For a policy or certificate that has been in force for at
least six months but less than two years, an insurer may rescind
a long term care insurance policy or certificate or deny an
otherwise valid long term care insurance claim upon a showing of
a misrepresentation that is material to the acceptance for
coverage and also pertains to the condition for which benefits
are sought.
(3) After a policy or certificate has been in force for two
years, the policy or certificate is not contestable upon the
ground of misrepresentation alone. The policy or certificate may
be contested only upon a showing that the insured knowingly and
intentionally misrepresented relevant facts relating to the
insured's health.
(4) A long term care insurance policy or certificate may not be
field issued based on medical or health status. A policy or
certificate is field issued for the purposes of this subsection
if the policy or certificate is issued by an insurance producer
or a third party administrator pursuant to underwriting authority
granted to the insurance producer or third party administrator by
an insurer.
(5) If an insurer has paid benefits under the long term care
insurance policy or certificate, the insurer may not recover the
benefit payments in the event that the policy or certificate is
rescinded.
(6) This section does not apply to the remaining death benefit
of a life insurance policy in the event of the death of the
insured if the policy accelerates benefits for long term care,
but this section otherwise applies to a life insurance policy
that accelerates benefits for long term care. In the event of the
death of an insured, the remaining death benefits under the life
insurance policy are governed by ORS 743.168.
(7) This section is exempt from ORS 743.700. + }
SECTION 7. { + (1) Except as provided in subsection (2) of
this section, a long term care insurance policy may not be
delivered or issued for delivery in this state unless the
policyholder or certificate holder has been offered the option of
purchasing a policy or certificate including a nonforfeiture
benefit. The offer of a nonforfeiture benefit may be in the form
of a rider that is attached to the policy. If the policyholder or
certificate holder declines the nonforfeiture benefit, the
insurer must provide a contingent benefit upon lapse that is
available for a specified period of time following a substantial
increase in premium rates.
(2) When a group long term care insurance policy is issued, the
offer required in subsection (1) of this section must be made to
the group policyholder. However, if the policy is issued as group
long term care insurance as described in ORS 743.652 (3)(d),
other than to a continuing care retirement community or similar
entity, the offering shall be made to each proposed certificate
holder.
Enrolled Senate Bill 191 (SB 191-B) Page 9
(3) The Director of the Department of Consumer and Business
Services by rule shall specify:
(a) The type or types of nonforfeiture benefits to be offered
as part of long term care insurance policies and certificates;
(b) The standards for nonforfeiture benefits; and
(c) The standards governing contingent benefits upon lapse,
including a determination of the specified period of time during
which a contingent benefit upon lapse will be available and the
substantial premium increase that triggers a contingent benefit
upon lapse as described in subsection (1) of this section.
(4) This section is exempt from ORS 743.700. + }
SECTION 8. { + Section 9 of this 2007 Act is added to and made
a part of ORS 744.052 to 744.089. + }
SECTION 9. { + (1) An individual may not sell, solicit or
negotiate long term care insurance unless the individual is
licensed as an insurance producer for health or life insurance
and satisfies the following training requirements:
(a) The individual must complete a one-time training course of
not less than eight hours before selling, soliciting or
negotiating long term care insurance; and
(b) The individual must complete ongoing training of not less
than four hours in each 24-month period following the one-time
training course.
(2) The Director of the Department of Consumer and Business
Services may approve as continuing education courses under ORS
744.072 any courses offered to satisfy the training requirements
of this section.
(3) The training required by this section must consist of
topics related to long term care insurance, long term care
services and, if applicable, qualified state long term care
insurance partnership programs, including but not limited to:
(a) State and federal rules and requirements and the
relationship between qualified state long term care insurance
partnership programs and other public and private coverage of
long term care services, including Medicaid.
(b) Available long term care services and providers.
(c) Changes or improvements in long term care services or
providers.
(d) Alternatives to the purchase of private long term care
insurance.
(e) The effect of inflation on benefits and the importance of
inflation protection.
(f) Consumer suitability standards and guidelines.
(4) The training required by this section may not include
training that is insurer or company product specific or that
includes any sales or marketing information, materials or
training, other than those required by state or federal law.
(5) An insurer must:
(a) Obtain verification that an insurance producer receives
training required by this section before an insurance producer
sells, solicits or negotiates the insurer's long term care
insurance products.
(b) Maintain records subject to the state's record retention
requirements.
(c) Make the verification obtained under paragraph (a) of this
subsection available to the director upon request.
(6) An insurer must maintain records with respect to the
training of its insurance producers concerning the distribution
of its partnership policies that will allow the director to
provide assurance to the state Medicaid agency that insurance
Enrolled Senate Bill 191 (SB 191-B) Page 10
producers have received training on the topics described in
subsection (3)(a) of this section and that insurance producers
have demonstrated an understanding of the partnership policies
and their relationship to public and private coverage of long
term care, including Medicaid, in this state. An insurer must
make the records available to the director upon request.
(7) The satisfaction in any state of the training required by
this section is considered to satisfy the training required by
this section. + }
SECTION 9a. { + An individual who is licensed on the effective
date of this 2007 Act and is subject to the requirements of
section 9 (1) of this 2007 Act must, not later than January 31,
2008:
(1) Complete the entire one-time training course required under
section 9 (1)(a) of this 2007 Act;
(2) Satisfy qualifications equivalent to the training
requirement under section 9 (1)(a) of this 2007 Act as specified
by the Director of the Department of Consumer and Business
Services by rule; or
(3) Satisfy the training requirement under section 9 (1)(a) of
this 2007 Act in part by completing a portion of the one-time
training course and for the remainder by satisfying
qualifications specified by the director by rule. + }
SECTION 10. ORS 411.708 is amended to read:
411.708. (1) The amount of any assistance paid under ORS
411.706 is a claim against the property or interest in the
property belonging to and a part of the estate of any deceased
recipient. If the deceased recipient has no estate, the estate of
the surviving spouse of the deceased recipient, if any, shall be
charged for assistance granted under ORS 411.706 to the deceased
recipient or the surviving spouse. There shall be no adjustment
or recovery of assistance correctly paid on behalf of any
deceased recipient under ORS 411.706 except after the death of
the surviving spouse of the deceased recipient, if any, and only
at a time when the deceased recipient has no surviving child who
is under 21 years of age or who is blind or disabled. Transfers
of real or personal property by recipients of assistance without
adequate consideration are voidable and may be set aside under
ORS 411.620 (2).
(2) Except when there is a surviving spouse, or a surviving
child who is under 21 years of age or who is blind or disabled,
the amount of any assistance paid under ORS 411.706 is a claim
against the estate in any conservatorship proceedings and may be
paid pursuant to ORS 125.495.
{ + (3) A claim under this section shall exclude benefits
paid to or on behalf of a beneficiary under a policy of qualified
long term care insurance, as defined in ORS 414.025 (2)(t). + }
{ - (3) - } { + (4) + } Nothing in this section authorizes
the recovery of the amount of any assistance from the estate or
surviving spouse of a recipient to the extent that the need for
assistance resulted from a crime committed against the recipient.
SECTION 11. ORS 414.025 is amended to read:
414.025. As used in this chapter, unless the context or a
specially applicable statutory definition requires otherwise:
(1) 'Category of aid' means assistance provided by the Oregon
Supplemental Income Program, temporary assistance for needy
families granted under ORS 418.035 to 418.125 or federal
Supplemental Security Income payments.
Enrolled Senate Bill 191 (SB 191-B) Page 11
(2) 'Categorically needy' means, insofar as funds are available
for the category, a person who is a resident of this state and
who:
(a) Is receiving a category of aid.
(b) Would be eligible for, but is not receiving a category of
aid.
(c) Is in a medical facility and, if the person left such
facility, would be eligible for a category of aid.
(d) Is under the age of 21 years and would be a dependent child
under the program for temporary assistance for needy families
except for age and regular attendance in school or in a course of
professional or technical training.
(e)(A) Is a caretaker relative named in ORS 418.035 (2)(a)(C)
who cares for a dependent child who would be a dependent child
under the program for temporary assistance for needy families
except for age and regular attendance in school or in a course of
professional or technical training; or
(B) Is the spouse of such caretaker relative and fulfills the
requirements of ORS 418.035 (1).
(f) Is under the age of 21 years, is in a foster family home or
licensed child-caring agency or institution under a purchase of
care agreement and is one for whom a public agency of this state
is assuming financial responsibility, in whole or in part.
(g) Is a spouse of an individual receiving a category of aid
and who is living with the recipient of a category of aid, whose
needs and income are taken into account in determining the cash
needs of the recipient of a category of aid, and who is
determined by the Department of Human Services to be essential to
the well-being of the recipient of a category of aid.
(h) Is a caretaker relative named in ORS 418.035 (2)(a)(C) who
cares for a dependent child receiving temporary assistance for
needy families or is the spouse of such caretaker relative and
fulfills the requirements of ORS 418.035 (1).
(i) Is under the age of 21 years, is in a youth care center and
is one for whom a public agency of this state is assuming
financial responsibility, in whole or in part.
(j) Is under the age of 21 years and is in an intermediate care
facility which includes institutions for the mentally retarded;
or is under the age of 22 years and is in a psychiatric hospital.
(k) Is under the age of 21 years and is in an independent
living situation with all or part of the maintenance cost paid by
the Department of Human Services.
(L) Is a member of a family that received temporary assistance
for needy families in at least three of the six months
immediately preceding the month in which such family became
ineligible for such assistance because of increased hours of or
increased income from employment. As long as the member of the
family is employed, such families will continue to be eligible
for medical assistance for a period of at least six calendar
months beginning with the month in which such family became
ineligible for assistance because of increased hours of
employment or increased earnings.
(m) Is an adopted person under 21 years of age for whom a
public agency is assuming financial responsibility in whole or in
part.
(n) Is an individual or is a member of a group who is required
by federal law to be included in the state's medical assistance
program in order for that program to qualify for federal funds.
(o) Is an individual or member of a group who, subject to the
rules of the department and within available funds, may
Enrolled Senate Bill 191 (SB 191-B) Page 12
optionally be included in the state's medical assistance program
under federal law and regulations concerning the availability of
federal funds for the expenses of that individual or group.
(p) Is a pregnant woman who would be eligible for temporary
assistance for needy families including such aid based on the
unemployment of a parent, whether or not the woman is eligible
for cash assistance.
(q) Would be eligible for temporary assistance for needy
families pursuant to 42 U.S.C. 607 based upon the unemployment of
a parent, whether or not the state provides cash assistance.
(r) Except as otherwise provided in this section and to the
extent of available funds, is a pregnant woman or child for whom
federal financial participation is available under Title XIX of
the federal Social Security Act.
(s) Is not otherwise categorically needy and is not eligible
for care under Title XVIII of the federal Social Security Act or
is not a full-time student in a post-secondary education program
as defined by the Department of Human Services by rule, but whose
family income is less than the federal poverty level and whose
family investments and savings equal less than the investments
and savings limit established by the department by rule.
{ + (t) Would be eligible for a category of aid but for the
receipt of qualified long term care insurance benefits under a
policy or certificate issued on or after January 1, 2008. As used
in this paragraph, 'qualified long term care insurance' means a
policy or certificate of insurance as defined in ORS 743.652
(6). + }
(3) 'Income' has the meaning given that term in ORS 411.704.
(4) 'Investments and savings' means cash, securities as defined
in ORS 59.015, negotiable instruments as defined in ORS 73.0104
and such similar investments or savings as the Department of
Human Services may establish by rule that are available to the
applicant or recipient to contribute toward meeting the needs of
the applicant or recipient.
(5) 'Medical assistance' means so much of the following medical
and remedial care and services as may be prescribed by the
Department of Human Services according to the standards
established pursuant to ORS 414.065, including payments made for
services provided under an insurance or other contractual
arrangement and money paid directly to the recipient for the
purchase of medical care:
(a) Inpatient hospital services, other than services in an
institution for mental diseases;
(b) Outpatient hospital services;
(c) Other laboratory and X-ray services;
(d) Skilled nursing facility services, other than services in
an institution for mental diseases;
(e) Physicians' services, whether furnished in the office, the
patient's home, a hospital, a skilled nursing facility or
elsewhere;
(f) Medical care, or any other type of remedial care recognized
under state law, furnished by licensed practitioners within the
scope of their practice as defined by state law;
(g) Home health care services;
(h) Private duty nursing services;
(i) Clinic services;
(j) Dental services;
(k) Physical therapy and related services;
(L) Prescribed drugs, including those dispensed and
administered as provided under ORS chapter 689;
Enrolled Senate Bill 191 (SB 191-B) Page 13
(m) Dentures and prosthetic devices; and eyeglasses prescribed
by a physician skilled in diseases of the eye or by an
optometrist, whichever the individual may select;
(n) Other diagnostic, screening, preventive and rehabilitative
services;
(o) Inpatient hospital services, skilled nursing facility
services and intermediate care facility services for individuals
65 years of age or over in an institution for mental diseases;
(p) Any other medical care, and any other type of remedial care
recognized under state law;
(q) Periodic screening and diagnosis of individuals under the
age of 21 years to ascertain their physical or mental
impairments, and such health care, treatment and other measures
to correct or ameliorate impairments and chronic conditions
discovered thereby;
(r) Inpatient hospital services for individuals under 22 years
of age in an institution for mental diseases; and
(s) Hospice services.
(6) 'Medical assistance' includes any care or services for any
individual who is a patient in a medical institution or any care
or services for any individual who has attained 65 years of age
or is under 22 years of age, and who is a patient in a private or
public institution for mental diseases. 'Medical assistance '
includes 'health services' as defined in ORS 414.705. 'Medical
assistance' does not include care or services for an inmate in a
nonmedical public institution.
(7) 'Medically needy' means a person who is a resident of this
state and who is considered eligible under federal law for
medically needy assistance.
(8) 'Resources' has the meaning given that term in ORS 411.704.
For eligibility purposes, 'resources' does not include charitable
contributions raised by a community to assist with medical
expenses.
SECTION 12. { + The Department of Human Services shall submit
to the Centers for Medicare and Medicaid Services a request for
approval of a Medicaid state plan amendment that provides for a
long term care insurance partnership as defined in section
1917(b)(1)(C)(iii) of the Social Security Act. + }
SECTION 13. { + The amendments to ORS 411.708 and 414.025 by
sections 10 and 11 of this 2007 Act become operative on the day
after the date the Department of Human Services receives approval
of the Medicaid state plan amendment described in section 12 of
this 2007 Act. + }
SECTION 14. { + The Director of Human Services shall notify
Legislative Counsel upon approval of the Medicaid state plan
amendment described in section 12 of this 2007 Act. + }
SECTION 15. { + The Director of Human Services may take any
action before the operative date of the amendments to ORS 411.708
and 414.025 by sections 10 and 11 of this 2007 Act that is
necessary to enable the director to exercise, on or after the
operative date of the amendments to ORS 411.708 and 414.025 by
sections 10 and 11 of this 2007 Act, all the duties, functions
and powers conferred on the director by this 2007 Act. + }
SECTION 16. { + The Director of the Department of Consumer and
Business Services may take any action before the operative date
of sections 6, 7 and 9 of this 2007 Act and the amendments to ORS
743.650, 743.652, 743.653 and 743.655 by sections 1 to 4 of this
2007 Act that is necessary to enable the director to exercise, on
or after the operative date of sections 6, 7 and 9 of this 2007
Act and the amendments to ORS 743.650, 743.652, 743.653 and
Enrolled Senate Bill 191 (SB 191-B) Page 14
743.655 by sections 1 to 4 of this 2007 Act, all of the duties,
functions and powers conferred on the director by this 2007
Act. + }
SECTION 17. { + Sections 6, 7 and 9 of this 2007 Act and the
amendments to ORS 743.650, 743.652, 743.653 and 743.655 by
sections 1 to 4 of this 2007 Act become operative on January 1,
2008. + }
SECTION 18. { + Sections 6 and 7 of this 2007 Act and the
amendments to ORS 743.650, 743.652, 743.653 and 743.655 by
sections 1 to 4 of this 2007 Act apply to policies and
certificates delivered or issued for delivery on or after January
1, 2008. + }
SECTION 19. { + This 2007 Act being necessary for the
immediate preservation of the public peace, health and safety, an
emergency is declared to exist, and this 2007 Act takes effect on
its passage. + }
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Passed by Senate March 7, 2007
Repassed by Senate June 8, 2007
...........................................................
Secretary of Senate
...........................................................
President of Senate
Passed by House June 5, 2007
...........................................................
Speaker of House
Enrolled Senate Bill 191 (SB 191-B) Page 15
Received by Governor:
......M.,............., 2007
Approved:
......M.,............., 2007
...........................................................
Governor
Filed in Office of Secretary of State:
......M.,............., 2007
...........................................................
Secretary of State
Enrolled Senate Bill 191 (SB 191-B) Page 16