76th OREGON LEGISLATIVE ASSEMBLY--2011 Regular Session
Enrolled
Senate Bill 88
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 John A. Kitzhaber
for Department of Consumer and Business Services)
CHAPTER ................
AN ACT
Relating to long term care insurance; creating new provisions;
amending ORS 414.025, 743.652, 743.653, 743.655 and 743.664;
and declaring an emergency.
Be It Enacted by the People of the State of Oregon:
SECTION 1. { + Section 2 of this 2011 Act is added to and made
a part of ORS 743.650 to 743.664. + }
SECTION 2. { + The Director of the Department of Consumer and
Business Services shall adopt by rule prompt payment requirements
for long term care insurance. The rules shall include a
definition of 'claim' and a definition of 'clean claim.' In
adopting the rules, the director shall consider the prompt
payment requirements in long term care insurance model acts
developed by the National Association of Insurance
Commissioners. + }
SECTION 3. ORS 743.652 is amended to read:
743.652. As used in ORS 743.650 to 743.664, 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) 'Benefit trigger' means a contractual provision in a
long term care insurance policy that conditions the payment of
benefits on an insured's inability to perform activities of daily
living or on an insured's cognitive impairment. For qualified
long term care insurance, the 'benefit trigger' is the
determination that an insured is a chronically ill individual, as
defined in section 7702B(c) of the Internal Revenue Code. + }
{ - (2) - } { + (3) + } '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) - } { + (4) + } '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
Enrolled Senate Bill 88 (SB 88-A) Page 1
or former employees or a combination thereof, or for members or
former members, or a combination thereof, of the labor
organizations;
(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;
(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 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 the filing, the association or
associations shall be considered to satisfy the organizational
requirements, unless the director makes a finding that the
association or associations do not satisfy those organizational
requirements; 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:
(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.
{ - (4) - } { + (5) + } '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 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 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
Enrolled Senate Bill 88 (SB 88-A) Page 2
insurance. 'Long term care insurance ' does not include any
insurance policy 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 743.664, any product
advertised, marketed or offered as long term care insurance is
subject to ORS 743.650 to 743.664.
{ - (5) - } { + (6) + } '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) - } { + (7) + } '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
(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
Enrolled Senate Bill 88 (SB 88-A) Page 3
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 4. ORS 743.653 is amended to read:
743.653. 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
{ - (3)(d) - } { + (4)(d) + }, unless this state or another
state having statutory and regulatory long term care insurance
requirements substantially similar to those adopted in this state
has made a determination that such requirements have been met.
SECTION 5. 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 { + and that include required
procedures for internal and external review of whether the
conditions of a benefit trigger have been met + }.
(b) In adopting rules { - setting standards - } under this
section, the Director { + of the Department of Consumer and
Business Services + } must give timely notice to, and shall
consider recommendations from the Director of Human Services.
(2) A long term care insurance policy 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;
(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 to provide less than 24 months' coverage.
(3)(a) A long term care insurance policy or certificate other
than a policy or certificate issued to a group described in ORS
743.652 { - (3)(a) - } { + (4)(a) + }, (b) or (c) may not use
a definition of ' preexisting condition' that is more restrictive
than the following: 'Preexisting condition' means 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.
Enrolled Senate Bill 88 (SB 88-A) Page 4
(b) A long term care insurance policy or certificate other than
a policy or certificate thereunder issued to a group described in
ORS 743.652 { - (3)(a) - } { + (4)(a) + }, (b) or (c) may not
exclude coverage for a loss or confinement that is the result of
a preexisting condition unless 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
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. 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.
(4) A long term care insurance policy 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;
(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.
(6) Individual long term care insurance 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 applicant is not
satisfied for any reason. Long term care insurance policies and
certificates must have a notice prominently printed on the first
page or attached thereto stating in substance that the 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 or certificate, other than a
certificate issued pursuant to a policy issued to a group
described in ORS 743.652 { - (3)(a) - } { + (4)(a) + }, the
applicant is not satisfied for any reason. This subsection also
Enrolled Senate Bill 88 (SB 88-A) Page 5
applies to denials of applications. Any refund must be made
within 30 days of the return or denial.
(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 that prominently direct the
attention of the recipient to the document and its purpose.
(B) The Director { + of the Department of Consumer and
Business Services + } by rule must prescribe a standard format,
including style, arrangement and overall appearance, and the
content of an outline of coverage.
(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.
(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) - } { + (4)(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 { + of
the Department of Consumer and Business Services + }.
(b) The outline of coverage 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;
(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.
(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.
(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
Enrolled Senate Bill 88 (SB 88-A) Page 6
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
{ + personal or authorized + } 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.
{ + (13) Long term care insurance policies shall include a
clear description of the process for appealing and resolving
disputes regarding whether the conditions of a benefit trigger
have been met. + }
{ - (13) - } { + (14) + } 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 743.664.
{ - (14) - } { + (15) + } Rules adopted pursuant to ORS
743.650 to 743.664 shall be in accordance with the provisions of
ORS chapter 183.
{ - (15) - } { + (16) + } This section is exempt from ORS
743A.001.
SECTION 6. ORS 743.664 is amended to read:
743.664. (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
Enrolled Senate Bill 88 (SB 88-A) Page 7
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) - } { + (4)(d) + }, other than to a continuing
care retirement community or similar entity, the offering shall
be made to each proposed certificate holder.
(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 743A.001.
SECTION 7. ORS 414.025, as amended by section 1, chapter 73,
Oregon Laws 2010, 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, aid granted under ORS 412.001 to
412.069 and 418.647 or federal Supplemental Security Income
payments.
(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 a category of aid 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
as defined in ORS 412.001 except for age and regular attendance
in school or in a course of professional or technical training.
(e)(A) Is a caretaker relative, as defined in ORS 412.001, who
cares for a child who would be a dependent child except for age
and regular attendance in school or in a course of professional
or technical training; or
(B) Is the spouse of the caretaker relative.
(f) Is under the age of 21 years and:
(A) Is in a foster family home or licensed child-caring agency
or institution and is one for whom a public agency of this state
is assuming financial responsibility, in whole or in part; or
(B) Is 18 years of age or older, is one for whom federal
financial participation is available under Title XIX or XXI of
the federal Social Security Act and who met the criteria in
subparagraph (A) of this paragraph immediately prior to the
person's 18th birthday.
(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
Enrolled Senate Bill 88 (SB 88-A) Page 8
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 as defined in ORS 412.001 who cares
for a dependent child receiving aid granted under ORS 412.001 to
412.069 and 418.647 or is the spouse of the caretaker relative.
(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 persons with mental
retardation.
(k) Is under the age of 22 years and is in a psychiatric
hospital.
(L) 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.
(m) Is a member of a family that received aid in the preceding
month under ORS 412.006 or 412.014 and became ineligible for aid
due to 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 due to increased hours of
employment or increased earnings.
(n) Is an adopted person under 21 years of age for whom a
public agency is assuming financial responsibility in whole or in
part.
(o) 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.
(p) Is an individual or member of a group who, subject to the
rules of the department, may 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.
(q) Is a pregnant woman who would be eligible for aid granted
under ORS 412.001 to 412.069 and 418.647, whether or not the
woman is eligible for cash assistance.
(r) Except as otherwise provided in this section, is a pregnant
woman or child for whom federal financial participation is
available under Title XIX or XXI 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) - }
{ + (7) + }.
(u) Is eligible for the Health Care for All Oregon Children
program established in ORS 414.231.
(3) 'Income' has the meaning given that term in ORS 411.704.
Enrolled Senate Bill 88 (SB 88-A) Page 9
(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 Oregon
Health Authority according to the standards established pursuant
to ORS 413.032, 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;
(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.
Enrolled Senate Bill 88 (SB 88-A) Page 10
(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 8. { + (1) Section 2 of this 2011 Act and the
amendments to ORS 743.652, 743.653, 743.655 and 743.664 by
sections 3 to 6 of this 2011 Act apply to long term care
insurance policies issued or renewed on or after July 1, 2012.
(2) The Director of the Department of Consumer and Business
Services may take any action necessary after the effective date
of this 2011 Act to fully implement section 2 of this 2011 Act
and the amendments to ORS 743.652, 743.653, 743.655 and 743.664
by sections 3 to 6 of this 2011 Act on July 1, 2012. + }
SECTION 9. { + This 2011 Act being necessary for the immediate
preservation of the public peace, health and safety, an emergency
is declared to exist, and this 2011 Act takes effect on its
passage. + }
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Passed by Senate March 23, 2011
.............................................................
Robert Taylor, Secretary of Senate
.............................................................
Peter Courtney, President of Senate
Passed by House May 10, 2011
.............................................................
Bruce Hanna, Speaker of House
.............................................................
Arnie Roblan, Speaker of House
Enrolled Senate Bill 88 (SB 88-A) Page 11
Received by Governor:
......M.,............., 2011
Approved:
......M.,............., 2011
.............................................................
John Kitzhaber, Governor
Filed in Office of Secretary of State:
......M.,............., 2011
.............................................................
Kate Brown, Secretary of State
Enrolled Senate Bill 88 (SB 88-A) Page 12