SECTIONS 22000-22010

22000.  The California Partnership for Long-Term Care Program ishereby established.22001.  The purpose of the program is to link private long-term careinsurance and health care service plan contracts that coverlong-term care with the In-Home Supportive Services program (Article7 (commencing with Section 12300) of Chapter 3 of Part 3 of Division9) and Medi-Cal, and to provide specified in-home supportive servicesbenefits and specified Medi-Cal benefits to the purchasers ofapproved and certified insurance policies and health care serviceplan contracts who qualify under the special provisions of thisdivision.22002.  The State Department of Health Services shall seek anyfederal waivers and approvals necessary to accomplish the purposes ofthis division.22003.  (a) Individuals who participate in the program and haveresources above the eligibility levels for receipt of medicalassistance under Title XIX of the Social Security Act (Subchapter XIX(commencing with Section 1396) of Chapter 7 of Title 42 of theUnited States Code) shall be eligible to receive those in-homesupportive services benefits specified by the State Department ofSocial Services, and those Medi-Cal benefits specified by the StateDepartment of Health Services, for which they would otherwise beeligible, if, prior to becoming eligible for benefits, they havepurchased a long-term care insurance policy or a health care serviceplan contract covering long-term care that has been certified by theState Department of Health Services pursuant to this division. (b) Individuals may purchase approved and certified long-term careinsurance policies or health care service plan contracts which coverlong-term care services in amounts equal to the resources they wishto protect, so long as the amount of insurance purchased exceeds theminimum level set by the State Department of Health Services pursuantto Section 22009. (c) The resource protection provided by this division shall beeffective only for long-term care policies, and health care serviceplan contracts that cover long-term care services, when the policy orcontract is delivered, issued for delivery, or renewed on July 1,1993 and thereafter.22004.  Notwithstanding other provisions of law, the resources, tothe extent described in subdivision (c), of an individual whopurchases an approved and certified long-term care insurance policyor health care service plan contract which covers long-term careservices shall not be considered by: (a) The State Department of Health Services in determining: (1) Medi-Cal eligibility. (2) The amount of any Medi-Cal payment. (3) The amount of any subsequent recovery by the state of paymentsmade for medical services. (b) The State Department of Social Services in determining: (1) Eligibility for in-home supportive services provided pursuantto Article 7 (commencing with Section 12300) of Chapter 3 of Division9. (2) The amount of any payment for in-home supportive services. (c) The resources not to be considered as provided by this sectionshall be equal to, or in some proportion set by the State Departmentof Health Services or State Department of Social Services that isless than equal to, the amount of long-term care insurance paymentsor benefits made as described in Section 22006.22005.  The State Department of Health Services shall only certify along-term care insurance policy or a health care service plancontract that meets the Medi-Cal asset protection requirements.22005.1.  (a) The State Department of Health Services shall onlycertify a long-term care insurance policy that substantially meetsthe requirements of Chapter 2.6 (commencing with Section 10230) ofPart 2 of Division 2 of the Insurance Code, except the requirementsof Sections 10232.1, 10232.2, 10232.25, 10232.8, 10232.9, and10232.92 of the Insurance Code, and that provides all of the itemsspecified in subdivision (b). The State Department of Health Servicesshall only certify a health care service plan contract that has beenapproved by the Department of Corporations pursuant to Chapter 2.2(commencing with Section 1340) of Division 2 of the Health and SafetyCode as providing substantially equivalent coverage to that requiredby Chapter 2.6 (commencing with Section 10230) of Part 2 of Division2 of the Insurance Code, and that provides all of the itemsspecified in subdivision (b). Policies issued by organizationssubject to the Insurance Code and regulated by the Department ofInsurance shall also be approved by the Department of Insurance. (b) Only policies and contracts that provide all of the followingitems shall be certified by the department: (1) Individual assessment and case management by a coordinatingentity designated and approved by the department. (2) Levels and durations of benefits that meet minimum standardsset by the State Department of Health Services pursuant to Section22009. (3) Protection against loss of benefits due to inflation. (4) A periodic record issued to the insured including anexplanation of insurance payments or benefits paid that count towardMedi-Cal asset protection under this division. (5) Compliance with any other requirements imposed by regulationsadopted by the State Department of Health Services or the StateDepartment of Social Services and consistent with the purposes ofthis division.22005.2.  Each organization issuing policies certified by the StateDepartment of Health Services under this division shall each yearcontribute to a fund to be used for common educational and marketingexpenses for reaching the target population designated by theCalifornia Partnership for Long-Term Care. The amount of eachparticipating issuer's required annual contribution shall bedetermined by the department and shall not be less than twentythousand dollars ($20,000).22006.  The State Department of Health Services, in determiningeligibility for Medi-Cal, and the State Department of SocialServices, in determining eligibility for in-home supportive services,shall exclude resources up to, or equal to, the amount of insurancepayments or benefits paid by approved and certified long-term careinsurance policies or health care service plan contracts which coverlong-term care services to the extent that the benefits paid are forall of the following: (a) In-home supportive services benefits specified in regulationsadopted by the State Department of Social Services pursuant toSection 22009, or those services that Medi-Cal approves or benefitsthat Medi-Cal provides as specified in regulations adopted by theState Department of Health Services pursuant to Section 22009. (b) Services delivered to insured individuals in a communitysetting as part of an individual assessment and case managementprogram provided by coordinating entities designated and approved bythe State Department of Health Services. (c) Services the insured individual receives after meeting thedisability criteria for eligibility for long-term care benefitsestablished by the State Department of Health Services.22007.  The program shall be designed so that the estimatedaggregate state expenditures for long-term care services forindividuals participating in the program do not exceed the aggregateexpenditures that would be made for these services under the Medi-Calprogram in effect prior to the implementation of this program.22008.  Advice and counseling may be provided by the HealthInsurance Counseling and Advocacy program within the CaliforniaDepartment of Aging to individuals interested in purchasing long-termcare insurance or health care service plan contracts that coverlong-term care services approved and certified pursuant to thisdivision.22008.5.  Individuals who participate in the program shall remaineligible for those in-home supportive services benefits and thoseMedi-Cal benefits for which they are eligible under the program forthe life of the purchaser of the policy or contract, as long as thepurchaser maintains his or her insurance policy or health careservice plan contract in force, or otherwise qualifies for continuedbenefits in accordance with regulations promulgated by thedepartments.22009.  (a) The State Department of Health Services shall adoptregulations to implement this division, including, but not limitedto, regulations which establish: (1) The population and age groups that are eligible to participatein the program. (2) The minimum level of long-term care insurance or long-termcare coverage included in health care service plan contracts thatmust be purchased to meet the requirement of subdivision (b) ofSection 22003. (3) The amount and types of services that a long-term careinsurance policy or health care service plan contract which includeslong-term care services must cover to meet the requirements of thisdivision. (4) Which coordinating entities are designated and approved todeliver individual assessment and case management services toindividuals in a community setting, as required by subdivision (b) ofSection 22006. (5) The disability criteria for eligibility for long-term carebenefits as required by subdivision (c) of Section 22006. (6) The specific eligibility requirements for receipt of theMedi-Cal benefits provided for by the program, and those Medi-Calbenefits for which participants in the program shall be eligible. (b) The State Department of Social Services shall also adoptregulations to implement this division, including, but not limitedto, regulations that establish: (1) The specific eligibility requirements for in-home supportiveservices benefits. (2) Those in-home supportive services benefits for whichparticipants in the program shall be eligible. (c) The State Department of Health Services and the StateDepartment of Social Services shall also jointly adopt regulationsthat provide for the following: (1) Continuation of benefits pursuant to Section 22008.5. (2) The protection of a participant's resources pursuant toSection 22004, and the ratio of resources to long-term care benefitpayments as described in subdivision (c) of Section 22004. (d) The departments shall adopt emergency regulations pursuant toChapter 3.5 (commencing with Section 11340) of Part 1 of Division 3of Title 2 of the Government Code to implement this division. Theadoption of regulations pursuant to this section in order toimplement this division shall be deemed to be an emergency andnecessary for the immediate preservation of the public peace, health,or safety. Notwithstanding Chapter 3.5 (commencing with Section 11340) ofPart 1 of Division 3 of Title 2 of the Government Code, emergencyregulations adopted pursuant to this section shall not be subject tothe review and approval of the Office of Administrative Law. Theregulations shall become effective immediately upon filing with theSecretary of State. The regulations shall not remain in effect morethan 120 days unless the adopting agency complies with all of theprovisions of Chapter 3.5 (commencing with Section 11340) as requiredby subdivision (c) of Section 11346.1 of the Government Code.22010.  (a) In implementing this division, the State Department ofHealth Services may contract, on a bid or nonbid basis, with anyqualified individual, organization, or entity for services needed toimplement the project, and may negotiate contracts, on a nonbidbasis, with long-term care insurers, health care service plans, orboth, for the provision of coverage for long-term care services thatwill meet the certification requirements set forth in Section 22005.1and the other requirements of this division. (b) In order to achieve maximum cost savings, the Legislaturedeclares that an expedited process for issuing contracts pursuant tothis division is necessary. Therefore, contracts entered into on anonbid basis pursuant to this section shall be exempt from therequirements of Chapter 1 (commencing with Section 10100) and Chapter2 (commencing with Section 10290) of Part 2 of Division 2 of thePublic Contract Code.