Minnesota Session Laws - 1990, Regular Session

  

                         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 medically prescribed 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 medically prescribed 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.  [MEDICALLY PRESCRIBED LONG-TERM CARE.] "Medically 
Prescribed 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's diagnosis 
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 
nursing standards 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 
medically prescribed long-term care in nursing facilities and at 
least the medically prescribed 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 medically prescribed 
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.