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Moore, Senate colleagues adopt major long-term care reforms to help senior citizens

March 22, 2006,. Boston... Today, Senator Richard T. Moore (D-Uxbridge) and his colleagues in the Massachusetts Senate unanimously adopted several bills aimed at strengthening long-term care options for the elderly. The bills were endorsed last week by the Joint Committee on Health Care Financing which is chaired by the senior lawmaker. 

“I am pleased that the full Senate has acted quickly on the Health Care Financing Committee’s recommendation that these important bills be adopted,” Moore said. “The passage of these two bills demonstrates a strong commitment to improving long-term care for our elderly citizens and provides new incentives for younger citizens to obtain long-term care insurance.”

Moore noted that the consumer-friendly provisions contained in these two bills were also included in the Senate’s Health Care Reform plan, co-sponsored by Senator Moore and currently pending in Conference Committee. 

The first bill, Senate 2273, An Act regarding choice of long-term care setting, will allow “clinically eligible” individuals seeking admission to long-term care facilities whose income and resources are insufficient to meet the cost of their care, and who are eligible for long term care benefits, to be given the choice of care setting that is the least restrictive and most appropriate to meet their needs. In some cases this may mean in-home care as opposed to institutional care.

The bill also authorizes MassHealth (Medicaid) to provide financial assistance to those seeking a choice of care setting. Individuals must have an income eligibility of up to 300 percent of the federal benefit rate under the supplemental security income (SSI) program and assets of not less than $10,000.

Finally, the bill compels all those seeking admission to a long term care facility paid for by MassHealth to receive pre-admission counseling for long term care services, which will include an assessment of their community-based service options. Those seeking care in a long term care facility on a private pay basis may receive these services on an optional basis.

The second bill, Senate 2285, An Act to establish standards for long-term care insurance, which was co-sponsored by Senator Moore, creates two incentives to encourage the purchase of long-term care insurance by requiring the Group Insurance Commission to establish a plan for long-term care insurance for state employees and by creating a tax exemption under state tax law of up to $5,000 of the annual premiums paid for long-term care insurance policies approved for sale in the Commonwealth.

The bill also prohibits cancellation or non-renewal of an individual’s policy on the grounds of age or deterioration of the insured’s health and further prohibits coverage for skilled nursing care only. The bill also establishes a time limit on the invocation of pre-existing conditions to justify denial of coverage.

The bill also:

  • Requires a 30-day “free look” period for policy holders
  • Requires the delivery of an outline of coverage to the policy holder at the time of initial solicitation
  • Requires delivery of the policy within 30 days of approval and delivery of a policy summary with the policy
  • Requires that a monthly report to be issued to the policy holder any time a long-term care benefit, funded through a life insurance vehicle by the acceleration of the death benefit, is in benefit payment status
  • Requires a written explanation of all claim denials upon request by the policy holder, together will all information related to the denial
  • Describes the circumstances under which an insurer may rescind for misrepresentation, with a contestability period of two years, and prohibits the insurer from recovering any benefits paid before rescission
  • Requires all policies to be offered with a non-forfeiture benefit
  • Holds long term insurers and producers subject, in addition to the penalties detailed in chapter 175 and 176D, to penalties of the greater of three times the policy commission or up to $10,000 for violation of the statute

The bill now moves to the House of Representatives for consideration.

To learn more about Senator Moore’s legislation and his work in the Massachusetts Senate, log onto his web site at www.senatormoore.com.

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