§ 1908a. Vermont Partnership for Long-Term Care

(a) The Secretary of Human Services or his or her designee, in consultation with the Commissioner of Financial Regulation, shall establish by rule the Vermont Partnership for Long-Term Care Program.

(b) The Program shall provide Medicaid extended coverage to an individual receiving long-term care services if there is federal participation for such coverage, and if the individual:

(1) is or was covered by a long-term care insurance policy under 8 Vt. Stat. Ann. chapter 154 that provides coverage for three years of long-term care services in an amount that, in combination with other resources available to the individual, is sufficient to permit the individual to pay for the individual’s own care while the policy remains in force and that is precertified by the Department of Financial Regulation pursuant to subsection (c) of this section;

(2) meets any other requirements for approval of participation under the Program; and

(3) has exhausted coverage and benefits under the long-term care insurance policy as required by the Program.

(c)(1) The Department of Financial Regulation shall adopt rules for precertification of long-term care partnership policies and for the information needed to evaluate the Program. The Department of Financial Regulation shall consider whether all precertified policies should require:

(A) protection against loss of benefits due to inflation;

(B) coverage of individual assessment and case management;

(C) a minimum level of covered benefits, including coverage of long-term care services as defined in subsection (g) of this section;

(D) the option of a nonforfeiture benefit;

(E) a level premium;

(F) information to the purchaser about available consumer information and public education provided by the Department of Financial Regulation and the Department of Vermont Health Access; and

(G) Program information, using the uniform data set developed by other states with long-term care partnership programs, and reports necessary to document the extent of the Medicaid resource protection offered and to evaluate the partnership for long-term care.

(2) The Department of Financial Regulation shall not require all long-term care partnership insurance policies to be federally tax-qualified long-term care insurance policies.

(d) The Secretary or his or her designee may enter into reciprocal agreements with other states to extend the benefits of the Vermont Partnership for Long-Term Care Program to Vermont residents who had purchased qualified long-term care policies in other states.

(e) The Agency and the Department of Financial Regulation shall make available consumer information regarding the Long-Term Care Partnership Program. The Secretary and Commissioner may allocate responsibilities for providing consumer information between the Agency and Department.

(f) As used in this section:

(1) “Long-term care services” includes care, treatment, maintenance, and services:

(A) provided in a nursing facility;

(B) provided in a residential care home or assisted living residence;

(C) provided by a home care services agency, certified home health agency, or long-term home health care program;

(D) provided by an adult day care program;

(E) provided by a personal care provider licensed or regulated by any other State or local agency; and

(F) such other long-term care services as determined by the Secretary or his or her designee for which medical assistance is otherwise available under the Medicaid program.

(2) “Medicaid extended coverage” means eligibility for medical assistance without regard to the resource requirements of the Medicaid program and without regard to the recovery of medical assistance from the estates of individuals and the imposition of liens pursuant to the requirements of the Medicaid program; provided, however, that nothing in this section shall prevent the imposition of a lien or recovery against property of an individual on account of medical assistance incorrectly paid. Nothing in this section shall modify what medical assistance is covered by Medicaid. (Added 2003, No. 124 (Adj. Sess.), § 4; amended 2005, No. 174 (Adj. Sess.), § 98; 2009, No. 156 (Adj. Sess.), § I.50.)