language to be deleted (2) new language
Laws of Minnesota 1990 CHAPTER 551-H.F.No. 2474 An act relating to insurance; long-term care; modifying the definition of medically prescribed long-term care; allowing additional licensed health care providers to prepare plans of care; regulating assessments; regulating cancellations; amending Minnesota Statutes 1988, sections 62A.46, subdivisions 2, 4, 5, and 8; 62A.48, subdivision 3, and by adding a subdivision; and 62A.56; Minnesota Statutes 1989 Supplement, section 62A.48, subdivision 1. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: Section 1. Minnesota Statutes 1988, section 62A.46, subdivision 2, is amended to read: Subd. 2. [LONG-TERM CARE POLICY.] "Long-term care policy" means an individual or group policy, certificate, subscriber contract, or other evidence of coverage that provides benefits for
medicallyprescribed long-term care, including nursing facility services and home care services, pursuant to the requirements of sections 62A.46 to 62A.56. A long-term care policy must contain a designation specifying whether the policy is a long-term care policy AA or A and a caption stating that the commissioner has established two categories of long-term care insurance and the minimum standards for each. Sections 62A.46, 62A.48, and 62A.52 to 62A.56 do not apply to a long-term care policy issued to (a) an employer or employers or to the trustee of a fund established by an employer where only employees or retirees, and dependents of employees or retirees, are eligible for coverage or (b) to a labor union or similar employee organization. The associations exempted from the requirements of sections 62A.31 to 62A.44 under 62A.31, subdivision 1, clause (c) shall not be subject to the provisions of sections 62A.46 to 62A.56 until July 1, 1988. Sec. 2. Minnesota Statutes 1988, section 62A.46, subdivision 4, is amended to read: Subd. 4. [HOME CARE SERVICES.] "Home care services" means one or more of the following medicallyprescribed services for the long-term care and treatment of an insured that are provided by a home health agency in a noninstitutional setting according to a written diagnosis or assessment and plan of care: (1) nursing and related personal care services under the direction of a registered nurse, including the services of a home health aide; (2) physical therapy; (3) speech therapy; (4) respiratory therapy; (5) occupational therapy; (6) nutritional services provided by a licensed dietitian; (7) homemaker services, meal preparation, and similar nonmedical services; (8) medical social services; and (9) other similar medical services and health-related support services. Sec. 3. Minnesota Statutes 1988, section 62A.46, subdivision 5, is amended to read: Subd. 5. [ MEDICALLYPRESCRIBED LONG-TERM CARE.] " MedicallyPrescribed long-term care" means a service, type of care, or procedure that could not be omitted without adversely affecting the patient's illness or condition and is specified in a plan of care prepared by either: (1) a physician and a registered nurse and is appropriate and consistent with the physician'sdiagnosis and that could not be omitted without adversely affecting the patient's illness or condition.; or (2) a registered nurse or licensed social worker based on an assessment of the insured's ability to perform the activities of daily living and to perform basic cognitive functions appropriately. Sec. 4. Minnesota Statutes 1988, section 62A.46, subdivision 8, is amended to read: Subd. 8. [PLAN OF CARE.] "Plan of care" means a written document prepared and signed by either: (1) a physician and registered nurse that specifies medically prescribed long-term care services or treatment that are consistent with the diagnosis and are; or (2) by a registered nurse or licensed social worker that specifies prescribed long-term care services or treatment that are consistent with an assessment of the insured's ability to perform the activities of daily living and to perform basic cognitive functions appropriately. The plan of care must be prepared in accordance with accepted medical and nursingstandards of practice and must contain services or treatment that could not be omitted without adversely affecting the patient's illness or condition. Sec. 5. Minnesota Statutes 1989 Supplement, section 62A.48, subdivision 1, is amended to read: Subdivision 1. [POLICY REQUIREMENTS.] No individual or group policy, certificate, subscriber contract, or other evidence of coverage of nursing home care or other long-term care services shall be offered, issued, delivered, or renewed in this state, whether or not the policy is issued in this state, unless the policy is offered, issued, delivered, or renewed by a qualified insurer and the policy satisfies the requirements of sections 62A.46 to 62A.56. A long-term care policy must cover medicallyprescribed long-term care in nursing facilities and at least the medicallyprescribed long-term home care services in section 62A.46, subdivision 4, clauses (1) to (5), provided by a home health agency. Coverage under a long-term care policy AA must include: a maximum lifetime benefit limit of at least $100,000 for services, and nursing facility and home care coverages must not be subject to separate lifetime maximums. Coverage under a long-term care policy A must include: a maximum lifetime benefit limit of at least $50,000 for services, and nursing facility and home care coverages must not be subject to separate lifetime maximums. Prior hospitalization may not be required under a long-term care policy. Coverage under either policy designation must cover preexisting conditions during the first six months of coverage if the insured was not diagnosed or treated for the particular condition during the 90 days immediately preceding the effective date of coverage. Coverage under either policy designation may include a waiting period of up to 90 days before benefits are paid, but there must be no more than one waiting period per benefit period. No policy may exclude coverage for mental or nervous disorders which have a demonstrable organic cause, such as Alzheimer's and related dementias. No policy may require the insured to be homebound or house confined to receive home care services. The policy must include a provision that the plan will not be canceled or renewal refused except on the grounds of nonpayment of the premium, provided that the insurer may change the premium rate on a class basis on any policy anniversary date. A provision that the policyholder may elect to have the premium paid in full at age 65 by payment of a higher premium up to age 65 may be offered. A provision that the premium would be waived during any period in which benefits are being paid to the insured during confinement in a nursing facility must be included. A nongroup policyholder may return a policy within 30 days of its delivery and have the premium refunded in full, less any benefits paid under the policy, if the policyholder is not satisfied for any reason. No individual long-term care policy shall be offered or delivered in this state until the insurer has received from the insured a written designation of at least one person, in addition to the insured, who is to receive notice of cancellation of the policy for nonpayment of premium. The insured has the right to designate up to a total of three persons who are to receive the notice of cancellation, in addition to the insured. The form used for the written designation must inform the insured that designation of one person is required and that designation of up to two additional persons is optional and must provide space clearly designated for listing between one and three persons. The designation shall include each person's full name, home address, and telephone number. Each time an individual policy is renewed or continued, the insurer shall notify the insured of the right to change this written designation. The insurer may file a policy form that utilizes a plan of care prepared as provided under section 62A.46, subdivision 5, clause (1) or clause (2). Sec. 6. Minnesota Statutes 1988, section 62A.48, subdivision 3, is amended to read: Subd. 3. [EXPENSE-INCURRED COVERAGE.] If benefits are provided on an expense-incurred basis, a benefit of not less than 80 percent of covered charges for medicallyprescribed long-term care must be provided. Sec. 7. Minnesota Statutes 1988, section 62A.48, is amended by adding a subdivision to read: Subd. 8. [CANCELLATION FOR NONPAYMENT OF PREMIUM.] No individual long-term care policy shall be canceled for nonpayment of premium unless the insurer, at least 30 days before the effective date of the cancellation, has given notice to the insured and to those persons designated pursuant to section 62A.48, subdivision 1, at the address provided by the insured for purposes of receiving notice of cancellation. Sec. 8. Minnesota Statutes 1988, section 62A.56, is amended to read: 62A.56 [RULEMAKING.] Subdivision 1. [PERMISSIVE.] The commissioner may adopt rules pursuant to chapter 14 to carry out the purposes of sections 62A.46 to 62A.56. The rules may: (1) establish additional disclosure requirements for long-term care policies designed to adequately inform the prospective insured of the need and extent of coverage offered; (2) prescribe uniform policy forms in order to give the purchaser of long-term care policies a reasonable opportunity to compare the cost of insuring with various insurers; and (3) establish other reasonable minimum standards as needed to further the purposes of sections 62A.46 to 62A.56. Subd. 2. [MANDATORY.] The commissioner shall adopt rules under chapter 14 establishing general standards to ensure that assessments used in the prescribing of long-term care are reliable, valid, and clinically appropriate. Sec. 9. [APPLICATION.] Sections 1 to 8 apply to policies issued after the effective date of sections 1 to 8. For policies issued before the effective date of sections 1 to 8, the insured may exercise the right to designate additional persons under section 5 at each renewal or continuation date after August 1, 1990. The insurer shall notify the insured in writing of this right, and the right to change a written designation, each time the policy is renewed or continued beginning with the first renewal or continuation date after August 1, 1990. Presented to the governor April 26, 1990 Signed by the governor May 3, 1990, 5:30 p.m.