[Federal Register Volume 73, Number 244 (Thursday, December 18, 2008)]
[Rules and Regulations]
[Pages 76960-76969]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: E8-28388]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
45 CFR Part 144
[ASPE:LTCI-F]
RIN 0991-AB44
State Long-Term Care Partnership Program: Reporting Requirements
for Insurers
AGENCY: Office of the Assistant Secretary for Planning and Evaluation
(OASPE), HHS.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This final rule sets forth reporting requirements for private
insurers that issue qualified long-term care insurance policies in
States participating in the State Long-Term Care Partnership Program
established under the Deficit Reduction Act of 2005 (DRA) (Pub. L. 109-
171). Section 6021 of the DRA requires that the Secretary of Health and
Human Services (the Secretary) specify a set of reporting requirements
and collect data from insurers on qualified long-term care insurance
policies issued under the program and the subsequent use of the
benefits under these policies. Under a State Long-Term Care Partnership
Program, an amount equal to the benefits received under the long-term
care insurance policy is disregarded in determining the assets of an
individual for purposes of Medicaid eligibility and estate recovery.
DATES: Effective Date: This final rule is effective on April 17, 2009.
ADDRESSES: Electronic Access: This Federal Register document is also
available from the Federal Register online database through GPO Access,
a service of the U.S. Government Printing Office. Free public access is
available on a Wide Area Information Server (WAIS) through the Internet
and via asynchronous dial-in. Internet users can access the database by
using the World Wide Web; the Superintendent of Documents' home page
address is http://www.gpoaccess.gov/, by using local WAIS client
software, or by telnet to swais.access.gpo.gov, then login as guest (no
password required). Dial-in users should use communications software
and modem to call (202) 512-1661; type swais, then login as guest (no
password required).
FOR FURTHER INFORMATION, CONTACT: Hunter McKay, (202) 205-8999.
SUPPLEMENTARY INFORMATION:
I. Issuance of a Proposed Rule
On May 23, 2008 (73 FR 30030), the Department of Health and Human
Services (the Department) published in the Federal Register a proposed
rule with a 60-day comment period that described the reporting
requirements that we proposed to require of all insurers that issue
qualified long-term care insurance policies under the State Long-Term
Care Partnership Program. We received three timely pieces of
correspondence in response to the proposed rule. Each piece of
correspondence addressed multiple issues relating to the provisions of
the proposed rule. We summarize these public comments and present the
Department's responses to them under the applicable subject-area
headings below. In addition, we have posted, for reviewers'
convenience, all of the public comments received on the following Web
site: http://www.regulations.gov.
II. Scope of the Proposed Rule and This Final Rule
The proposed rule and this final rule describe the reporting
requirements that the Department is requiring of all insurers that
issue long-term care insurance policies under a State Long-Term Care
Partnership Program for a State with as Medicaid State plan amendment
approved after May 14, 1993. We point out that neither the proposed
rule nor this final rule requires participating insurers to report data
from States with a Partnership Medicaid State plan amendment approved
as of May 14, 1993. In addition to the promulgation of the proposed
rule and this final rule, the Department anticipates taking other
actions to further the implementation of the Long-Term Care Partnership
Program. One such action is publication of a separate Federal Register
notice containing Partnership State Reciprocity Standards. These
standards outline an agreement whereby States can provide Medicaid
asset disregards for
[[Page 76961]]
Partnership policies purchased in other States.
Comment: One commenter suggested that language be added in the
final rule to make clear that insurers are not required by the
regulation to report Partnership data to the Department for States with
a Partnership Medicaid State plan amendment approved as of May 14,
1993.
Response: We have added language above and in other applicable
sections of this final rule, as the commenter suggested, to make clear
the nonapplicability of the reporting requirements for submission of
Partnership data by insurers in States with a Partnership Medicaid
State plan amendment approved as of May 14, 1993.
III. Background
A. Historical Overview of State Long-Term Care Partnership Programs
1. Initial Development of Programs
In the late 1980's, a number of State Medicaid programs began to
work with private insurance companies to create a bridge between
Medicaid and insurance for long-term care. The goal of these
collaborations was to create private insurance policies that were more
affordable and provide better financial protection to consumers against
large liabilities for long-term care costs than the policies generally
available at that time. The result of these collaborations was the
establishment of the State Long-Term Care Partnership Program that
provided for expanded access to Medicaid by allowing applicants who use
long-term care insurance policies to have higher assets and still be
eligible for Medicaid, as long as they meet all other Medicaid
eligibility criteria. The first four States that implemented
Partnership programs, in 1993 (California, Connecticut, Indiana, New
York), used two different methods for determining the amount of assets
a participant was allowed to keep. Three States allowed participants to
keep an amount equivalent to the amount paid by the insurance policy on
his or her behalf (known as the ``dollar-for-dollar approach''). The
other State required the purchase of a more comprehensive policy and,
in exchange, allowed participants to keep all of their assets (known as
the ``total assets approach''). Over time, one State combined these
models to create a hybrid approach in which participants purchasing and
using a policy that would cover fewer than 4 years of benefits would be
allowed to keep one dollar for every dollar of paid benefits and those
participants purchasing and using a policy that would cover 4 or more
years of benefits would be allowed to keep all of their assets. These
State partnership programs provided an incentive for insurers to offer
affordable, high-quality benefits and for consumers to protect
themselves against the high cost of long-term care through the purchase
of insurance policies that can be used in conjunction with benefits
provided under Medicaid.
As part of the implementation process, each of the four States that
initially implemented Partnership programs in 1993 outlined a set of
data reporting requirements for participating insurers. The data that
were to be collected were intended to allow each State to monitor
program activities and evaluate the impact of the Partnership Program
on Medicaid long-term care expenditures. The insurers who participated
in these partnerships recommended, as part of the design of the data
collection requirements, that the participating States use a unified
set of reporting requirements to streamline the reporting burden on the
participating insurers. The participating insurers believed that if
each State designed its own reporting requirements, the administrative
costs for the program would be prohibitive. The four States agreed with
the participating insurers and adopted a uniform set of reporting
criteria.
The four initial States launched their Partnership programs using
existing State authority through amendments to their State Medicaid
plans (Partnership Medicaid State plan amendments). Each State
requested a change in the treatment of assets in the Medicaid financial
eligibility test. No other Federal authority was necessary at that time
to operate the programs.
Comment: One commenter suggested that language be added to the
Background section of the final rule to make clear that consumers who
take advantage of the Partnership Program must also meet all other
Medicaid eligibility requirements. Two commenters suggested that the
discussion of the amount of asset protection offered under the original
Partnership Programs be expanded in the final rule to reflect the
differences between the ``dollar-for-dollar model'' and the ``total
assets model.''
Response: We have added language above in this final rule, as the
commenters suggested, to specify that consumers who take advantage of
the Partnership Program must also meet all other Medicaid eligibility
requirements and to explain the differences between the ``dollar-for-
dollar model'' and the ``total assets model.''
Comment: One commenter suggested that language indicating that the
regulations do not require insurers to report Partnership data to the
Department for States with a Partnership Medicaid State plan amendment
approved as of May 14, 1993, be added to the section of the final rule
discussing the agreement reached by the original four States pertaining
to a unified data reporting structure.
Response: The section in which the commenter is requesting a change
relates to the history of the Partnership programs and is not an
appropriate place to discuss the scope of the new regulations. However,
we have incorporated the language in section II. (Scope) of this final
rule, as well as in other applicable sections, to address the
nonapplicability of the reporting requirements for Partnership data for
States with a Partnership Medicaid State plan amendment approved as of
May 14, 1993.
2. Omnibus Budget Reconciliation Act of 1993
The Omnibus Budget Reconciliation Act of 1993 (OBRA 1993), Public
Law 103-66, contained language that changed the conditions under which
Medicaid State plan amendments relating to asset disregards for private
long-term care insurance could be approved. OBRA 1993 allowed
California, Connecticut, Indiana, and New York, as well as Iowa and
Massachusetts, to continue their initial Long-Term Care Partnership
Programs. However, OBRA 1993 specified a set of requirements for any
additional States that chose to operate a Partnership Program. Any
State, other than the initial four partnership States, that sought a
Medicaid State plan amendment on or after May 14, 1993, was required to
abide by the following additional conditions:
a. Estate Recovery
States establishing Long-Term Care Partnership Programs on or after
May 14, 1993, were required to recover from the estates of Medicaid
recipients in States with partnership agreements expenses incurred for
the provision of long-term health care under Medicaid. Assets that were
disregarded in the initial financial eligibility process were also
exempt from estate recovery in the initial four States with Partnership
Programs. States establishing new Partnership Programs were only
allowed to disregard assets in the initial eligibility process but not
in the estate recovery process. After a Medicaid recipient who had a
long-term care insurance policy issued under a State
[[Page 76962]]
Long-Term Partnership Program died, the State was required to recover
an amount equivalent to what Medicaid spent on his or her behalf from
the deceased recipient's estate, including any protected assets under
the State Long-Term Care Partnership Program.
b. No Waiver of Estate Recovery
States establishing Long-Term Care Partnership Programs on or after
May 14, 1993, were precluded from waiving the estate recovery
requirement for Medicaid recipients who had obtained long-term care
insurance policies under a State Long-Term Care Partnership Program.
c. Expanded Definition of Estate
States establishing Long-Term Care Partnership Program on or after
May 14, 1993, were also required to use a specific definition of
``estate'' for recovery purposes when recovery of Medicaid expenditures
was against the estates of Medicaid recipients who had obtained long-
term care insurance policies issued under a State Long-Term Care
Partnership Program. This definition was more expansive than the
definition that was generally used by States.
While OBRA 1993 did not forbid additional States from attempting to
establish new Long-Term Care Partnership Programs under the new
conditions, the impact was essentially the same as a ban. A few States
tried unsuccessfully to launch partnership programs under the new
conditions. Other interested States passed enabling legislation with
contingency language that allowed the State to proceed if the OBRA 1993
partnership provisions were repealed. No subsequent Federal legislation
related to the Long-Term Care Partnership Programs was enacted until
the Deficit Reduction Act of 2005 (DRA) Public Law 109-171. As
discussed in detail under section II.A.3. of this proposed rule and
under section III.A.3. of this final rule, the DRA included provisions
that allow States to offer specific asset disregards for Medicaid
eligibility purposes under a new set of conditions.
3. Deficit Reduction Act of 2005
Section 6021(a)(1) of the DRA amended section 1917(b)(1)(C)(i) of
the Act and added new sections 1917(b)1)(C)(iii) through (vi) to the
Act that provide for an expansion of the State Long-Term Care Insurance
Partnership Program through a new set of conditions. These conditions
pertain to States with Partnership Medicaid State plan amendments
approved after May 14, 1993. Under this provision, States may establish
``qualified State long-term care insurance partnerships'', defined in
the Act as an approved Medicaid State plan amendment under Title XIX of
the Act that provides for the disregard of any assets or resources in
an amount equal to the insurance benefit payments that are made to or
on behalf of an individual who is a beneficiary under a long-term care
insurance policy if certain requirements specified in sections
1917(b)(1)(C)(iii)(I) through (VII) of the Act are met. In other words,
States establishing new Partnership programs must offer a dollar of
asset disregard for every dollar paid out under a long-term care
insurance policy issued under that State's long-term care partnership
program.
Section 1917(b)(1)(C)(iii)(II) of the Act provides that the
insurance policy must be a qualified long-term care insurance policy as
defined in section 7702B(b) of the Internal Revenue Code of 1986, that
is issued not earlier than the effective date of the State plan
amendment. (If an individual has an existing long-term care insurance
policy that does not qualify as a qualified partnership policy due to
the issue date of the policy, and that policy is exchanged for another
policy, the State insurance commissioner or other State authority must
determine the issue date for the policy that is received in exchange.
Under this provision, a long-term care insurance policy includes a
certificate issued under a group insurance contract.)
Among other requirements specified in the statute for qualified
long-term care insurance partnerships--
The long-term care insurance policy must (1) be issued to
an insured individual who is a resident of the State in which coverage
first became effective under the policy (sections 1917(b)(1)(C)(iii)(I)
of the Act); (2) be certified by the State insurance commissioner or
other appropriate authority that the policy meets specific provisions
of the National Association of Insurance Commissioners (NAIC) October
2000 Model Regulation and Model Act (sections 1917(b)(1)(C)(iii)(III)
and 1917(b)(5)(B) of the Act); and (3) include certain protections
against inflation on an annual basis (section 1917(b)(1)(C)(iii)(IV) of
the Act).
The State Medicaid agency must provide information and
technical assistance to the State insurance department on the insurance
department's role of assuring that any individual who sells a long-term
care insurance policy under the partnership receives training and
demonstrates evidence of an understanding of such policies and how they
relate to other public and private coverage of long-term care (section
1917(b)(1)(C)(iii)(V) of the Act).
Issuers of long-term care insurance policies under a State
qualified long-term care insurance partnership must provide regular
reports to the Secretary, in accordance with regulations of the
Secretary, that include notification regarding when benefits provided
under the policy have been paid and the amount of such benefits paid,
notification regarding when the policy otherwise terminates, and such
other information as the Secretary determines may be appropriate to the
administration of State long-term care insurance partnerships (section
1917(b)(1)(C)(iii)(VI) of the Act). Section 1917(b)(1)(C )(v) of the
Act provides that the regulations required under section
1917(b)(1)(C)(iii)(VI) of the Act shall be promulgated after
consultation with the NAIC, issuers of long-term care insurance
policies, States with experience with long-term care insurance
partnership plans, other States, and representatives of consumers of
long-term care insurance policies, and shall specify the type and
format of the data to be reported and the frequency with which such
reports are to be made. In addition, the Secretary, as appropriate,
shall provide copies of the reports provided in accordance with that
clause to the State involved.
The State may not impose any requirement affecting the
terms of benefits of a policy under the partnership program unless the
State imposes such requirement on long-term care insurance policies
without regard to whether the policy is covered under the partnership
or is offered in connection with such a partnership (section
1917(b)(1)(C)(iii)(VII) of the Act).
Section 1917(b)(1)(C)(iv) of the Act provides that a State that had
a State plan amendment approved as of May 14, 1993, satisfies the
requirements of the statute under clause (II) and may continue
operating as originally implemented if the Secretary determines that
the State Medicaid plan amendment provides for consumer protection
standards that are no less stringent than the consumer protection
standards that applied under such a State plan amendment as of December
31, 2005.
Comment: One commenter requested that the language that describes
the impact of the DRA of 2005 be modified in the final rule to clearly
indicate that the conditions set forth in sections 6021(a) through (c)
of the DRA of 2005 pertain only to States with Partnership
[[Page 76963]]
Medicaid State plan amendments approved after May 14, 1993. One
commenter suggested that the description of the ``grandfathered''
States also make clear that the regulations do not pertain to States
with a Partnership Medicaid State plan amendment approved as of May 14,
1993.
Response: We have added language above and in other applicable
sections in this final rule, to make these clarifications, as suggested
by the commenters.
B. Implementing Regulations
Currently, there are no Federal regulations directly related to
State operation of State Long-Term Care Partnership Programs. In 2006,
the Department provided guidance to States, through a letter to
Medicaid Directors, on the implementation of State long-term care
partnership programs under the DRA. In areas in which the program
coordinates benefits with Medicaid coverage of long-term care, the
existing Medicaid regulations at 42 CFR Chapter IV, Subchapter C, are
applicable. In 2006, States were provided with guidance on the
implementation of State Long-Term Care Partnership Programs under the
DRA of 2005.
To implement section 1917(b)(1)(C)(iii)(VI) and 1917(b)(1)(C)(v) of
the Act, as directed by the statute, in the May 23, 2008 proposed rule
(73 FR 30033), we proposed to set forth in regulations the requirements
for reporting information and data on qualified long-term care
insurance policies issued under State Long-Term Care Partnership
Programs under an approved State plan amendment. In this final rule, we
are adopting the regulations as final with some technical changes, as
discussed below.
C. States Currently Operating Long-Term Care Partnership Programs
California, Connecticut, Indiana, Iowa, Massachusetts, and New York
had approved State Long-Term Partnership Programs under an approved
State plan amendment as of May 14, 1993. They were ``grandfathered'' as
satisfying the statutorily imposed requirements when, pursuant to
section 1917(b)(1)(C)(iv) of the Act, the Secretary determined that the
State plan amendments of these States provide protection no less
stringent than that applied under their State plan amendments as of
December 31, 2005.
At the time we issued the proposed rule, we stated that, as of
December 2007, seven other States offered State Long-Term Care
Partnership policies for sale under the DRA provisions: Florida, Idaho,
Kansas, Minnesota, Nebraska, South Dakota, and Virginia. Nine States
had approved State plan amendments for qualified State Long-Term Care
Partnership Programs although policies had not yet been issued pursuant
to those programs: Colorado, Florida, Georgia, Iowa, Minnesota,
Missouri, North Dakota, Nevada, Ohio, and Oregon. Four States had
submitted State plan amendments for which approval is pending: Arizona,
New Hampshire, Oklahoma, and Pennsylvania. Ten other States were in the
process of developing Partnership Programs: Illinois, Maine, Maryland,
Michigan, Montana, New Jersey, Rhode Island, Texas, Vermont, and
Wisconsin.
As of August 2008, Partnership policies are still for sale in the
four States that first implemented a Partnership program, as well as in
13 additional States. Nine States have approved Medicaid State plan
amendments, although policies are not yet for sale. Three other States
have Medicaid State plan amendments pending approval from the Centers
for Medicare and Medicaid, HHS.
IV. Provisions of the Proposed Rule and This Final Rule
A. Legislative Authority
As stated earlier, the DRA of 2005 requires insurers participating
in State long-term care partnership programs to provide regular reports
to the Secretary in a manner in accordance with regulations of the
Secretary. The reports must include notification regarding when
benefits provided under the policy have been paid and the amount of the
benefits paid, notification regarding when the policy otherwise
terminates, and any other information as the Secretary determines may
be appropriate to the administration of State long-term care insurance
partnerships. Section 1917(b)(1)(C )(v) of the Act provides that the
regulations required under section 1917(b)(1)(C)(iii)(VI) of the Act
must be promulgated after consultation with the NAIC, issuers of long-
term care insurance policies, States with experience with long-term
care insurance partnership plans, other States, and representatives of
consumers of long-term care insurance policies, and must specify the
type and format of the data to be reported and the frequency with which
the reports are to be made. In addition, the Secretary, as appropriate,
must provide copies of the reports provided in accordance with that
clause to the State involved.
B. Collaboration With States, Insurers, Insurance Regulators, and
Consumers in the Development of Reporting Requirements
In accordance with section 1917(b)(1)(C)(v) of the Act, as added by
the DRA of 2005, as we discussed in the proposed rule, we have
consulted with numerous stakeholders in the development of the
reporting requirements presented in this rule. In addition to one-on-
one consultations with stakeholders representing States, insurers,
consumers, and regulators, we have established a Technical Expert Panel
to provide a forum for the exchange of ideas, perspectives, and
expertise regarding the specification of individual data items. The
Technical Expert Panel consists of approximately 25 members
representing insurers, States, consumer organizations, the NAIC, the
Federal Government, and the policy research community. The panel
members were selected in January 2007, from responses to invitations
sent by HHS along with an initial draft of the reporting requirements.
We held numerous meetings and teleconferences with the panel members to
discuss and further develop the draft reporting requirements and to
obtain further input on partnership implementation. The reporting
requirements presented in the proposed rule and finalized in this final
rule represent the product of this ongoing stakeholder input process.
We plan to continue ongoing work with the Technical Expert Panel.
C. Incorporation of Reporting Requirements in the Code of Federal
Regulations
In the proposed rule, the Department proposed to establish under
Title 45, Part 144 of the Code of Federal Regulations a new Subpart B
to incorporate the requirements for the reporting of data by insurers
on qualified long-term care insurance policies issued under State Long-
Term Care Partnership Programs that are established under an approved
Medicaid State plan amendment. Specifically--
Proposed Sec. 144.200, which contained the basis for the
regulations.
Proposed Sec. 144.202, which included the definitions used
throughout the subpart.
Proposed Sec. 144.204, which specified the applicability of the
regulations under the subpart.
Proposed Sec. 144.206, which specified the requirements for
reporting of long-term care partnership program data and the frequency
with which insurers must report the data.
[[Page 76964]]
Proposed Sec. 144.208, which specified the deadlines for
submission of reports.
Proposed Sec. 144.210, which specified the format and manner in
which the data are to be reported.
Proposed Sec. 144.212, which specified the confidentiality of
information requirements that will be applied.
Proposed Sec. 144.214, which specified the action that the
Secretary will take if an insurer fails to report the required data by
the specified deadlines.
Under proposed Sec. 144.202, Definitions, we included the
following definitions:
Partnership qualified policy refers to a qualified long-term
insurance policy issued under a qualified State long-term care
insurance partnership.
Qualified long-term insurance care policy means an insurance policy
that has been determined by a State insurance commissioner to meet the
requirements of sections 1917(b)(1)(C)(iii)(I) through (IV) and
1917(b)(5) of the Act. It includes a certificate issued under a group
insurance contract.
Qualified State long-term care insurance partnership means an
approved Medicaid State plan amendment that provides for the disregard
of any assets or resources in an amount equal to the insurance benefit
payments that are made to or on behalf of an individual who is a
beneficiary under a long-term care insurance policy that has been
determined by a state insurance commissioner to meet the requirements
of section 1917(b)(1)(C)(iii) of the Act [incorrectly cited in the
proposed rule as section 1917(b)(a)(C)(iii)]. It includes any Medicaid
State plan amendment approved as of May 14, 1993 [incorrectly stated in
the proposed rule as May 4, 1993], that meets the requirements of
section 1917(b)(1)(C)(iii) of the Act and for which the Secretary
determined that the State plan amendments provides for consumer
protection standards that are no less stringent than the consumer
protection standards that applied under the State plan amendment as of
December 31, 2005.
Comment: The commenter suggested that the word ``care'' be inserted
into the definition of ``Partnership qualified policy.'' One commenter
pointed out that we had reversed the order of two words and therefore
incorrectly labeled the definition of ``qualified long-term care
insurance policy'' as ``qualified long-term insurance care policy''
Response: We agree with the first commenter's suggestion and have
revised the definition of ``Partnership qualified policy'' in this
final rule to refer to a qualified long-term care insurance policy
issued under a qualified State long-term care insurance partnership. We
thank the commenter for bringing to our attention the inadvertent
mislabeling of the definition of ``qualified long-term care insurance
policy'' and have made the correction in this final rule.
Comment: One commenter suggested that the definition of a
``Qualified State long-term care insurance partnership'' be modified to
clarify that the regulations do not require insurers to report
Partnership data to the Department for States with a Partnership
Medicaid State plan amendment approved as of May 14, 1993.
Response: In response to the commenter's suggestions, we have
revised the proposed definition for ``Qualified State long-term care
insurance partnership'', by removing the last sentence of the
definition, to clarify that the regulations do not require insurers to
report Partnership data to the Department for States with a Partnership
Medicaid State plan amendment approved as of May 14, 1993.
After consideration of the public comments received, we are
adopting as final proposed Sec. Sec. 144.200, 144.202, and 144.204,
with the following modifications. We have revised the definition of
``Partnership qualified policy'' by adding the word ``care'' in the
definition. We have corrected the inadvertent mislabeling of the
definition of ``Qualified long-term care insurance policy.'' We have
revised the definition of ``Qualified State long-term care
partnership'' by removing the last sentence of the proposed definition.
Each of the additional proposed regulatory requirements is
discussed in detail in the sections below.
D. Specific Reporting Requirements
As discussed in the proposed rule, in consultation with
stakeholders and the Technical Expert Panel, we developed requirements
for insurers for reporting data under the State Long-Term Care
Partnership Program under two categories: (1) Registry data; and (2)
claims data (proposed Sec. 144.206).
We proposed that these two categories would require the submission
of data in four distinct file types. Generally, participating long-term
care insurers will report under only two of these files. For all four
file types, as we proposed, we are requiring insurers to report on only
those insured individuals, policyholders, and claimants who have active
qualified long-term care insurance partnership policies or
certificates. The reporting requirements will not apply to insurance
policies or certificates that are not partnership qualified.
Insurer reporting specifications are detailed in an HHS document
entitled ``State Long-Term Care Partnership Insurer Reporting
Requirements'' which we expect will be available via the Internet at
the Web site at: http://aspe.hhs.gov/daltcp/reports/2008/PartRepReq.pdf
no later than October 1, 2008. (We noted in the proposed rule that we
expected that this document would be available by June 1, 2008.
However, the release date has been delayed.) We are in the process of
developing an integrated database through which insurers will submit
these data. As we proposed, we are requiring that data be submitted
through a secure Web site that meets all current Health Insurance
Portability and Accountability Act requirements for security of
personal health information.
1. Registry Data
In the proposed rule (73 FR 30034), we proposed to require insurers
to report data, on a semiannual basis, on all insured individuals who
have been issued qualified long-term care insurance policies or
certificates under qualified State Long-Term Care Partnership Programs;
that is, for the 6-month reporting periods of January 1 through June 30
and July 1 through December 31 of each year (proposed Sec.
144.206(b)(1)(ii)). We proposed that the reports must include data on
qualified long-term care insurance partnership policies sold on either
an individual basis or a group basis, as long as individual-level data
are available to the insurer. Under proposed Sec. 144.206(b)(1)(iii),
these data would include, but are not limited to, the following:
Current identifying information on each insured
individual.
The name of the insurance company and the issuing State.
The effective date and terms of coverage under the policy.
The coverage period and benefits.
The annual premium.
Other information as specified by the Secretary in ``State
Long-Term Care Insurance Partnership Insurer Reporting Requirements.''
Comment: One commenter pointed out that we used different
terminology in the proposed rule to describe the instruction document
we would issue for reporting data.
Response: We thank the commenter for bringing this inconsistency to
our attention. In the proposed rule, we inconsistently used the term
``Reporting
[[Page 76965]]
Instructions'' when referring to the title of this document; rather, we
should have used ``Reporting Requirements.'' Throughout this final
rule, we have standardized references to the document containing the
detail instructions for insurers on how to report data to the
Department under the title ``State Long-Term Care Partnership Insurer
Reporting Requirements.''
After consideration of the public comments received, we are
adopting as final our proposed Sec. 144.206 with one technical change
to the title of the instruction document, as discussed above.
2. Claims Data
In the proposed rule, we proposed to require insurers to report
data, for each quarter of the calendar year, on all benefit claims paid
for all insured individuals who have been issued qualified long-term
care insurance policies or certificates (individual policies or under
group coverage plans) under qualified State Long-Term Care Partnership
Programs (proposed Sec. 144.206(b)(2)). Under proposed Sec.
144.206(b)(2)(ii), these data would include, but are not limited to,
the following:
Current identifying information on the insured individual.
The type and cash amount of the benefits paid during the
reporting period and lifetime to date.
Remaining lifetime benefits.
Other information as specified by the Secretary in ``State
Long-Term Care Insurance Partnership Insurer Reporting Requirements.''
We did not receive any public comments on this section other than
the notification that we had used different titles for the instruction
document discussed above. Therefore, we are adopting as final the
proposed provisions of Sec. 144.206 with the technical change noted
above.
3. Frequency of Reports and Deadlines for Submission
In the proposed rule, we proposed to require insurers to submit
data for different reporting periods, depending upon the file type.
We proposed to require insurers to submit the required registry
data to the Secretary on a semiannual basis; that is, for the 6-month
reporting period of January 1 through June 30 and July 1 through
December 31 of each year under proposed Sec. 144.206(b)(1)(ii). The
proposed deadline for submittal of registry data reports was 30 days
after the end of the reporting period (proposed Sec. 144.208(b)).
Comment: One commenter stated that the discussion of frequency of
reports in the preamble of the proposed rule failed to list the
frequency of the reports on insurance claims.
Response: The commenter is correct. Even though we specified the
frequency of the reports on insurance claims data in the regulation
text under proposed Sec. 144.208(c), we did not include a detailed
discussion in the preamble. The description of the submission of the
claims data along with a reference to the detailed documentation of the
reporting requirements is as follows:
We are requiring insurers to submit the required claims data to the
Secretary on a quarterly basis; that is, for the 3-month reporting
period of January 1 through March 30, April 1 through June 30, July 1
through September 30, and, October 1 through December 31 of each year
under Sec. 144.206(b)(2)(i). The deadline for submittal of claims data
reports is 30 days after the end of the reporting period (Sec.
144.208(c)). Detailed reporting instructions can be found on the
Internet at the Web site: http://aspe.hhs.gov/daltcp/reports/2008/
PartRepReq.pdf.
After consideration of the public comments received, we are
adopting as final proposed Sec. Sec. 144.208(b) and (c) without
modification.
4. Transition Provision
For insurers who have issued or exchanged a qualified Partnership
policy prior to the effective date of the final regulations we issue,
we proposed a transition provision under Sec. 144.208(a). We proposed
that the first reports required for these insurers would be the reports
that pertain to the reporting period that begins no more than 120 days
after the effective date of the final regulations.
We did not receive any public comments on the proposed Sec.
144.208(a). Therefore, we are adopting it as final without modification
in this final rule.
5. Format and Manner of Reporting Data
In the proposed rule, we proposed to require that insurers submit
the required data in the format and manner specified by the Secretary
in the HHS-issued insurer reporting specifications document, ``State
Long-Term Care Insurance Partnership Insurer Reporting Requirements''
(proposed Sec. 144.210). As we mentioned earlier, we are in the
process of developing an integrated database that would be accessible
through a secure Web site, and we plan to issue instructions as to how
insurers will access and input the required data into the HHS reporting
system.
We did not receive any public comments on the proposed Sec.
144.210. Therefore, we are adopting it as final without modification in
this final rule.
6. Use of Submitted Reports
As we discussed in the proposed rule, the overall purpose of the
data is twofold: First, to be used in efforts to monitor program
performance at both the State and Federal level; and second, to provide
data for a longer term evaluation of the effectiveness of the
Partnership Program. The Department and the States participating in the
State Long-Term Care Partnership Program will use the information
provided by insurers in compliance with the reporting requirements for
analytical studies and for program monitoring. The data provided by
insurers will reflect the combined experience of all State Long-Term
Care Partnership Programs in terms of policies sold and benefits used.
We plan to use the data to produce reports for Congress and other
interested stakeholders on the implementation of the State Long-Term
Care Partnership Program. In addition, we plan to use the data to
generate individual State-level reports that will be used by the States
to track the implementation of the Partnership Program at the State
level. The Department may also use the data to examine public policy
issues related to long-term care insurance in general as opportunities
arise.
HHS does not intend to use the data to determine asset disregard
levels for individuals who participate in the State Long-Term Care
Partnership Program and eventually apply for Medicaid coverage. We will
not collect data on ``point in time'' information regarding the amount
of insurance benefits used by claimants, nor exact information on when
private insurance benefits may be exhausted, which clearly would depend
upon how claimants use benefits to purchase long-term care services.
The computation of asset disregard levels and the determination of
Medicaid eligibility coverage are matters that will be dealt with among
the insurer, the insured individual, and the State Medicaid eligibility
office. We expect that when insured individuals exhaust their insurance
coverage (or otherwise become eligible for Medicaid prior to the
exhaustion of benefits), insurers will provide them with documentation
of their participation in the State Long-Term Care Partnership Program
and of the amount of benefits that the insured received. This
documentation will become part of the entire documentation provided by
the insured individual at the time he or she applies for Medicaid.
[[Page 76966]]
The Medicaid eligibility office will then determine, based upon the
documentation provided by the applicant, the asset disregard level that
will be applied.
It is possible that State Medicaid programs may wish to access the
collected data for monitoring purposes, to help them anticipate the
number of insured individuals who may become eligible for Medicaid
asset disregards over a projected time period. For example, through
reports provided to each State from the integrated database, States
would know how many partnership policyholders are ``in claim'' during
any 3-month reporting period. States would also know, approximately, to
what extent policyholders who are in claim have utilized the insurance
benefits for which they are eligible and the amount of benefits
remaining under their policy maximums. However, once an insured
individual uses his or her insurance benefits under the policy, his or
her eligibility for Medicaid will still depend upon the amount of
available assets he or she retains, relative to his or her asset
disregard, as well as other Medicaid eligibility criteria. For example,
an insured individual may be eligible for an asset disregard of
$150,000, but still retains $250,000 in countable assets. In this case,
he or she would have to spend down $100,000 of his or her available
assets before applying for Medicaid coverage. Thus, in general terms,
States will be able to use the data to project future applications for
Medicaid (and their potential budgetary impacts) but, at the individual
level, the specific financial circumstances of each insured individual
would determine his or her eligibility for Medicaid coverage.
Comment: One commenter suggested that the Department consider a
broader use of the data to investigate a number of issues related to
long-term care insurance in general as well as issues related to the
Partnership Program.
Response: The Department will explore using the Partnership data to
examine other issues related to long-term care insurance, to the extent
possible. We have modified the preamble discussion above to indicate
this.
Comment: One commenter suggested that the language included in this
section of the preamble of the proposed rule could imply that
participants must exhaust their benefits before they can take advantage
of the Partnership Program.
Response: The commenter is correct in asserting that exhaustion of
benefits is not required by the DRA of 2005. Participants may apply for
a Medicaid asset disregard before they have exhausted their insurance
benefits. We have modified the preamble language in this final rule to
reflect the possibility that someone may apply for Medicaid and seek an
asset disregard before they have exhausted their insurance benefits.
E. Additional State-Mandated Reporting Requirements
The DRA of 2005 explicitly states that there is nothing in the
statute that prohibits States from imposing additional reporting
requirements on insurers participating in the Long-Term Care
Partnership Program, beyond the Federal reporting requirements that we
proposed in the proposed rule and are finalizing in this final rule.
This regulation does not require insurers to report Partnership data to
the Department for States with a Partnership Medicaid State plan
amendment as May 14, 1993. However, we believe that the information
that will be made available to the Secretary and to the States
participating in the Long-Term Care Partnership Program through these
mandated reporting requirements will be sufficient to meet the policy
analysis and program monitoring needs of the States. We, as well as the
stakeholders participating in the development of these reporting
requirements, attempted to achieve a proper balance between the
legitimate needs of the Federal Government and State governments to
monitor the implementation and operation of the State Long-Term Care
Partnership Program, and the desire not to impose undue cost burdens on
participating insurers, to the point where they may consider it not
economically beneficial to participate in the Partnership Program.
Comment: One commenter suggested that the discussion of State-
mandated reporting in the final rule be revised to clarify that nothing
in the regulation prohibits any State (including grandfathered States)
from requiring data from participating Partnership insurers. The
commenter further suggested that the section describe the motivations
of States for requiring State-specific data. The commenter also
suggested that all references to costs of data collection on the part
of insurers be deleted. The commenter stated that the costs of
reporting are ``often minimal or nonexistent.''
Response: We are not modifying the language in this section as the
commenter suggested. The balance between the Government's need for data
and the cost burden on participating insurers is, in our view, a real
issue, especially given the varying size of different participating
States. Finding a balance between the need for data and the cost burden
was part of the charge given to the stakeholder group mandated by the
DRA. We believe the discussion of the costs of data collection in this
section is appropriate and that its presence does not diminish States'
ability to negotiate for State-specific data.
F. Confidentiality of Information
In the proposed rule, we proposed to provide in the regulations
that the data collected and reported under the requirements of the
regulations would be subject to the confidentiality of information
requirements specified in regulations under 42 CFR Part 401, Subpart B,
and 45 CFR Part 5, Subpart F and any other applicable confidentiality
statute or regulation (proposed Sec. 144.212).
We did not receive any public comments on this section. Therefore,
we are adopting as final the proposed Sec. 144.212 without
modification in this final rule.
G. Actions for Noncompliance With Reporting Requirements
In the proposed rule, we proposed under Sec. 144.214 that if an
insurer of a qualified long-term care insurance policy does not submit
the required reports by the due dates specified in the new subpart B of
45 CFR Part 144, the Secretary notifies the appropriate State insurance
commissioner within 45 days after the deadline for submission of the
information and data specified in Sec. 144.208.
We did not receive any comments on this proposed section.
Therefore, we are adopting as final the proposed Sec. 144.214 without
modification.
H. Provision of Reports to Partnership States
Section 1917(b)(1)(C)(v) of the Act provides that the Secretary, as
appropriate, must provide copies of the reports provided by insurers to
the State involved. We plan to make reports containing the reported
data available to States in a timely and efficient manner.
V. Collection of Information Requirements
The Department of Health and Human Services has determined that
this notice of proposed rulemaking contains information collections
that are subject to review by the Office of Management and Budget (OMB)
under the Paperwork Reduction Act of 1995 (PRA) (44 U.S.C. 3501-3520).
In compliance with the requirement of section 3506(c)(2)(A) of the PRA
, the Office of the Secretary
[[Page 76967]]
(OS), Department of Health and Human Services, published in the May 23,
2008, proposed rule the following summary of a proposed information
collection request for public comment. Interested persons were invited
to send comments regarding the burden estimate or any other aspect of
the collection of information, including any of the following subjects:
(1) The necessity and utility of the proposed information collection
for the proper performance of the agency's functions; (2) the accuracy
of the estimated burden; (3) ways to enhance the quality, utility, and
clarity of the information to be collected; and (4) the use of
automated collection techniques or other forms of information
technology to minimize the information collection burden.
Individuals were given the opportunity to request and obtain copies
of the supporting statement and any related forms for the proposed
paperwork collections described below. Written comments and
recommendations for the proposed information collections were due
within 60 days of publication of the proposed rule.
Further, the Department acknowledges that this regulation is
covered under the Privacy Act and that this collection of data
constitutes a System of Records. The Department is publishing elsewhere
in this issue of the Federal Register a System of Records Notice for
this collection of data.
Title: Partnership for Long Term Care Data Set.
Description: This information collected under the final rule is
intended for insurers participating in the State Long-Term Care
Partnership Program as authorized by the DRA of 2005. Insurers will
provide data in the prescribed format to the Department on Partnership
certified long-term care insurance policies for partnership
participants in states with Partnership Medicaid state plan amendments
approved after May 14, 1993. The requirements include the identity of
the policy holder, the type of coverage purchased, and the amount of
insurance benefits used. Data from this submission will be provided to
State Medicaid agencies to assist in determining the amount of asset
protection earned by program participants.
Comment: One commenter brought to our attention two technical
errors in the narrative portion of the instruction document and another
error in the detailed data element specifications.
Response: We have made the appropriate changes to the instruction
document, which is now listed as Version 1.1. This instruction document
is available on the Web site at: http://aspe.hhs.gov/daltcp/reports/
2008/PartRepReg.pdf.
It is estimated that insurers participating in the Partnership
Program will be able to provide the necessary reports from data
currently within their insurance operations systems. Fulfilling the
reporting requirements will require that they write programs to extract
the data in the manner specified by the Department. There are no costs
to the respondents, other than their time.
Estimated Annualized Burden Hours and Burden Costs
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number of Average response
CFR Section Type of respondent Number of responses per per respondent Total burden
respondents respondents (in hours) hours
--------------------------------------------------------------------------------------------------------------------------------------------------------
45 CFR 144.206.............................. Insurers...................... 30 6 45/60 135
--------------------------------------------------------------------------------------------------------------------------------------------------------
We indicated that public comments addressed as a result of the
notice in the proposed rule would be taken into account in the formal
OMB request for clearance for this data collection. The new information
collection provisions in this final rule have been approved by OMB
under OMB control number 0990-0333, effective through December 31,
2011.
VI. Regulatory Impact Analysis
A. Overall Impact
We have examined the impacts of this final rule as required by
Executive Order 12866 (September 1993, Regulatory Planning and Review)
and the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L.
96-354), section 1102(b) of the Social Security Act, the Unfunded
Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
B. Executive Order 12866
Executive Order 12866 (as amended by Executive Order 13258, which
merely reassigns responsibility of duties) directs agencies to assess
all costs and benefits of available regulatory alternatives and, if
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, distributive impacts, and equity). A
regulatory impact analysis (RIA) must be prepared for major rules with
economically significant effects ($100 million or more in any 1 year).
While we have determined that this final rule is not economically
significant, it is, however, a significant regulatory action. We
estimate that the aggregate cost to participating private insurers of
implementing the reporting requirements in this final rule will be
approximately $1.5 million.
C. Regulatory Flexibility Act (RFA)
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and government agencies.
Most insurance companies are not considered to be small entities
because they generally have revenues of more than $29 million in any 1
year. (For details, see the Small Business Administration's final rule
that sets forth size standards for industries at 65 FR 69432, November
17, 2000.) For purposes of the RFA, all insurance companies are not
considered to be small entities. Individuals and States are not
included in the definition of a small entity. However, we solicited
comments on our estimates and analysis of the impact on insurers of the
proposed rule.
There are approximately 100 insurance companies located nationwide
that issue long-term care insurance policies. We expect that, of these
100 companies, approximately 30 insurance companies will participate in
qualified State Long-Term Care Partnership Programs. Currently, there
are 15 to 20 companies operating in States that are selling or have
issued qualified long-term care insurance policies under the State
Long-Term Care Partnership Programs. As of December 2007, approximately
300,000 policies have been sold. We believe this represents
approximately 80 percent of the policies that might be sold when the
Partnership Programs are established nationwide. We anticipate that the
number of insurance companies selling qualified long-term care
insurance
[[Page 76968]]
partnership policies might increase by about 10 as more States obtain
approved State plan amendments to operate State Long-Term Care
Partnership Programs.
As we stated earlier, insurers participating in the original four
Partnership Programs have been reporting data on policies sold and
benefits used in the program for more than a decade. The reporting
requirements in this final rule were designed to take advantage of data
already available in insurer data sets. Insurers will not be asked to
collect new data, but simply to recode existing data into a common
format for submission to the Secretary. It is estimated that
participating insurers will have to make a one-time investment to
produce the computer programs necessary to compile the reports. Should
the reporting requirement change in the future, there will also be a
cost to make the necessary changes. We are estimating that the
programming will require 400 hours of labor on average (this number
will vary widely by company depending on the type of systems used) to
create the necessary changes. We also estimate an average cost per hour
of programming time of $125. The cost per company is estimated at
$50,000 and the total estimate for all companies is estimated at $1.5
million.
Subsequently, there will be a much smaller investment to run the
quarterly and semi-annually reports. The data submissions were designed
to be primarily snapshots of data elements in the insurers' files with
very little tabulation or summary reporting. We note that all of the
currently participating insurers participated in the development of the
reporting requirements in this final rule and have given their
consensus to the requirements.
D. Small Rural Hospitals
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis for any proposed rule (and subsequent final
rule) that may have a significant impact on the operations of a
substantial number of small rural hospitals. This analysis must conform
to the provisions of section 603 of the RFA. This final rule does not
affect small rural hospitals.
E. Unfunded Mandates
Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L.
104-4) also requires that agencies assess anticipated costs and
benefits before issuing any rule whose mandates require spending in any
1 year of $100 million in 1995 dollars, updated annually for inflation.
That threshold level is currently approximately $120 million. This
final rule will not mandate any requirements for State, local, or
tribal governments. However, it will affect private sector costs to
insurance companies who sell qualified long-term care insurance
partnership policies. We note that participation by insurers in the
Partnership Program is voluntary. We have also determined that the
costs of reporting the required data are not significant.
F. Federalism
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) that imposes substantial direct requirement costs on State
and local governments, preempts State law, or otherwise has Federalism
implications. As stated above, this final rule will not have a
substantial effect on State and local governments.
List of Subjects in 45 CFR Part 144
Health care, Health insurance, Reporting and recordkeeping.
0
For the reasons stated in the preamble of this final rule, we are
amending 45 CFR Subtitle A, Subchapter B, Part 144 as set forth below:
Subchapter B--Requirements Relating to Health Care Access
PART 144--REQUIREMENTS RELATING TO HEALTH INSURANCE COVERAGE
0
1. The authority citation for Part 144 is revised to read as follows:
Authority: Secs. 2701 through 2763, 2791, and 2792 of the Public
Health Service Act (42 U.S.C. 300gg through 300gg-63, 300gg-91,
300gg-92 as amended by HIPAA (Pub. L. 104-191, 110 Stat. 1936), MHPA
(Pub. L. 104-204, 110 Stat. 2944, as amended by Pub. L. 107-116, 115
Stat. 2177), NMHPA (Pub. L. 104-204, 110 Stat. 2935), WHCRA (Pub. L.
105-227, 112 Stat. 2681-436)) and section 103(c)(4) of HIPAA; and
secs. 1102 and 1917(b)(1)(C)(iii)(VI) of the Social Security Act (42
U.S.C. 1302 and 1396p(b)(1)(C)(iii)(VI)).
0
2. A new Subpart B is added to read as follows:
Subpart B--Qualified State Long-Term Care Insurance Partnerships:
Reporting Requirements for Insurers
Sec.
144.200 Basis.
144.202 Definitions.
144.204 Applicability of regulations.
144.206 Reporting requirements.
144.208 Deadlines for submission of reports.
144.210 Form and manner of reports.
144.212 Confidentiality of information.
144.214 Notifications of noncompliance with reporting requirements.
Subpart B--Qualified State Long-Term Care Insurance Partnerships:
Reporting Requirements for Insurers
Sec. 144.200 Basis.
This subpart implements--
(a) Section 1917(b)(1)(C) (iii)(VI) of the Social Security Act,
(Act) which requires the issuer of a long-term care insurance policy
issued under a qualified State long-term care insurance partnership to
provide specified regular reports to the Secretary.
(b) Section 1917(b)(1)(C)(v) of the Act, which specifies that the
regulations of the Secretary under section 1917(b)(1)(C)(iii)(VI) of
the Act shall be promulgated after consultation with the National
Association of Insurance Commissioners, issuers of long-term care
insurance policies, States with experience with long-term care
insurance partnership plans, other States, and representatives of
consumers of long-term care insurance policies, and shall specify the
type and format of the data to be reported and the frequency with which
such reports are to be made. This section of the statute also provides
that the Secretary provide copies of the reports to the States
involved.
Sec. 144.202 Definitions.
As used in this Subpart--
Partnership qualified policy refers to a qualified long-term care
insurance policy issued under a qualified State long-term care
insurance partnership.
Qualified long-term care insurance policy means an insurance policy
that has been determined by a State insurance commissioner to meet the
requirements of sections 1917(b)(1)(C)(iii)(I) through (IV) and
1917(b)(5) of the Act. It includes a certificate issued under a group
insurance contract.
Qualified State long-term care insurance partnership means an
approved Medicaid State plan amendment that provides for the disregard
of any assets or resources in an amount equal to the insurance benefit
payments that are made to or on behalf of an individual who is a
beneficiary under a long-term care insurance policy that has been
determined by a State insurance commissioner to meet the requirements
of section 1917(b)(1)(C)(iii) of the Act.
Sec. 144.204 Applicability of regulations.
The regulations contained in this subpart for reporting data apply
only to those insurers that have issued qualified
[[Page 76969]]
long-term care insurance policies to individuals under a qualified
State long-term care insurance partnership. They do not apply to the
reporting of data by insurers for States with a Medicaid State plan
amendment that established a long-term care partnership on or before
May 14, 1993.
Sec. 144.206 Reporting requirements.
(a) General requirement. Any insurer that sells a qualified long-
term care insurance policy under a qualified State long-term care
insurance partnership must submit, in accordance with the requirements
of this section, data on insured individuals, policyholders, and
claimants who have active partnership qualified policies or
certificates for a reporting period.
(b) Specific requirements. Insurers of qualified long-term care
insurance policies must submit the following data to the Secretary by
the deadlines specified in paragraph (c) of this section:
(1) Registry of active individual and group partnership qualified
policies or certificates. (i) Insurers must submit data on--
(A) Any insured individual who held an active partnership qualified
policy or certificate at any point during a reporting period, even if
the policy or certificate was subsequently cancelled, lost partnership
qualified status, or otherwise terminated during the reporting period;
and
(B) All active group long-term care partnership qualified insurance
policies, even if the identity of the individual policy/certificate
holder is unavailable.
(ii) The data required under paragraph (b)(1)(i) of this section
must cover a 6-month reporting period of January through June 30 or
July 1 through December 31 of each year; and
(iii) The data must include, but are not limited to--
(A) Current identifying information on the insured individual;
(B) The name of the insurance company and issuing State;
(C) The effective date and terms of coverage under the policy.
(D) The annual premium.
(E) The coverage period.
(F) Other information, as specified by the Secretary in ``State
Long-Term Care Partnership Insurer Reporting Requirements.''
(2) Claims paid under partnership qualified policies or
certificates. Insurers must submit data on all partnership qualified
policies or certificates for which the insurer paid at least one claim
during the reporting period. This includes data for employer-paid core
plans and buy-up plans without individual insured data. The data must--
(i) Cover a quarterly reporting period of 3 months;
(ii) Include, but are not limited to--
(A) Current identifying information on the insured individual;
(B) The type and cash amount of the benefits paid during the
reporting period and lifetime to date;
(C) Remaining lifetime benefits;
(D) Other information, as specified by the Secretary in ``State
Long-Term Care Partnership Insurer Reporting Requirements.''
Sec. 144.208 Deadlines for submission of reports.
(a) Transition provision for insurers who have issued or exchanged
a qualified partnership policy prior to the effective date of these
regulations.
The first reports required for these insurers will be the reports
that pertain to the reporting period that begins no more than 120 days
after the effective date of the final regulations.
(b) All reports on the registry of qualified long-term care
insurance policies issued to individuals or individuals under group
coverage specified in Sec. 144.206(b)(1)(ii) must be submitted within
30 days of the end of the 6-month reporting period.
(c) All reports on the claims paid under qualified long-term care
insurance policies issued to individual and individuals under group
coverage specified in Sec. 144.206(b)(2)(i) must be submitted within
30 days of the end of the 3-month quarterly reporting period.
Sec. 144.210 Form and manner of reports.
All reports specified in Sec. 144.206 must be submitted in the
form and manner specified by the Secretary.
Sec. 144.212 Confidentiality of information.
Data collected and reported under the requirements of this subpart
are subject to the confidentiality of information requirements
specified in regulations under 42 CFR Part 401, Subpart B, and 45 CFR
Part 5, Subpart F.
Sec. 144.214 Notifications of noncompliance with reporting
requirements.
If an insurer of a qualified long-term care insurance policy does
not submit the required reports by the due dates specified in this
subpart, the Secretary notifies the appropriate State insurance
commissioner within 45 days after the deadline for submission of the
information and data specified in Sec. 144.208.
Dated: August 15, 2008.
Mary M. McGeein,
Principal Deputy Assistant Secretary for Planning and Evaluation.
Dated: August 21, 2008.
Michael O. Leavitt,
Secretary.
Editorial Note: This document was received in the Office of the
Federal Register on November 24, 2008.
[FR Doc. E8-28388 Filed 12-17-08; 8:45 am]
BILLING CODE 4154-05-P