Secure Choice

Secure Choice - Title I: Long - Term Care Provisions - Amends the Social Security Act to establish a new Federal program to provide grants to States for making long-term care assistance to low-income functionally impaired elderly individuals under a State plan approved under a new title XXI entitled "Long-Term Care Assistance Programs For The Elderly." Outlines: (1) requirements for State plans for long-term care assistance; and (2) conditions for the approval of such plans by the Secretary of Health and Human Services.

Allows States to impose sanctions on service providers who overcharge such individuals.

Disregards payments under title XVI (Supplemental Security Income) to an individual who is eligible for long-term care assistance under the plan and is in a nursing facility at the time such benefits are paid for purposes of determining the amount of any post-eligibility contribution by the individual toward the cost of the care and services provided by the nursing facility.

Allows States to exclude any individual or entity for participation under the State plan for any reason for which the Secretary could exclude the individual or entity from participation in Medicare (title XVIII of the Social Security Act) and State health care programs.

Requires States to provide for making long-term care assistance available, including at least the services described below in items 2 and 3, to all individuals aged 55 or older: (1) who are impaired because they are limited in performing specified activities of daily living or have Alzheimer's disease or a similar dementia; (2) whose income and resources do not exceed the minimum prescribed levels the State is required by this Act to establish; and (3) who are likely to receive the care and services described below for at least 45 consecutive days.

Defines "long-term care assistance" as payment of part or all of the cost of the following care and services (if provided in or after the third month before the month in which the recipient makes application for assistance) for the individuals described above: (1) nursing facility services (other than services in an institution for mental diseases); (2) home and community-based services that include homemaker/home health aide services, personal care services, adult day care, nursing services, physical therapy, and respite care; (3) case management services provided by a qualified community-care case manager; (4) respiratory care services; (5) prescription drugs; and (6) any other long-term care and any other type of remedial care (other than room and board) recognized under State law and specified by the Secretary.

Gives States the option to cover individuals with incomes up to 240 percent of the Federal poverty level.

Outlines provisions for determining the amount of funds the Secretary must pay to a State for expenditures for long-term care assistance provided under its approved plan.

Prohibits State plans from imposing enrollment fees, premiums, or similar charges for services furnished to severely functionally impaired individuals who, as a condition for receiving services under the plan, must spend for the costs of long-term care all but a minimal amount of their income required for personal needs. Requires any deductible, cost sharing, or similar charge imposed under the plan with respect to other such individuals or other care and services to be nominal in amount. Requires State plans to require that no provider participating under the State plan may deny care or services to an individual eligible for such care or services under the plan on account of such individual's inability to pay a deduction, cost sharing, or similar charge. Makes an individual to whom such care or services were furnished liable for applicable charges.

Sets forth provisions regarding: (1) liens, adjustments, and recoveries with respect to debts incurred for long-term care; and (2) transfers of assets and eligibility for long-term care assistance.

Sets forth special rules for the treatment of income and resources of impaired spouses.

Establishes the Secure Choice Insurance Option program under part B of new title XXI under which a State, if it chooses to participate, will subsidize long-term care insurance for individuals aged 55 or older who have incomes between 240 and 400 percent of the Federal poverty level and who are provided with care and services under a qualified long-term care insurance policy. Specifies the requirements an insurance policy must meet in order to qualify as a long-term care insurance policy. Requires that an individual, in order to be eligible to purchase a qualified long-term care insurance policy under the program, must, at the time such individual elects to purchase such policy: (1) be a resident of the State; and (2) meet the standard underwriting requirements of an insurer which has been certified by the State's Standards and Performance Organization as having met specified requirements set forth in this Act in order to be able to provide qualified long-term care insurance policies under the State plan.

Requires States, in order to be eligible to participate in the new program, to establish a Standards and Performance Organization to: (1) ensure that qualified long-term care insurance policies cover the required care and services; (2) determine that insurers desiring to become qualified insurers comply with applicable State standards; (3) ensure that information concerning the program is made available to qualified participants within the State; (4) assess the quality and appropriateness of the case management services provided to qualified participants; (5) determine whether qualified insurers are using appropriate managed care techniques in the provision of program services; (6) determine whether long-term care is being provided under the program in settings that meet State standards; (7) establish standards applicable to qualified issuers regarding rejection rates for underwriting, and provide for consumer protection; (8) determine and verify on an annual basis the income of qualified participants and their compliance with income and resource requirements; (9) notify qualified insurers of any changes in the income and resources of participants; (10) carry out the educational program discussed below; (11) hear appeals of certain denials and establish appropriate appeals procedures; (12) establish a sliding scale for determining the amount of the benefit subsidy a State is required to pay under a long-term care insurance policy; and (13) carry out such other functions as the Secretary may require.

Outlines provisions applicable to qualified participants who change their State of residence.

Requires the amount of the premium to be charged by a qualified insurer for a qualified long-term care insurance policy to be determined by each qualified insurer, subject to State insurance regulations, on the basis of the minimum benefits that must be provided under the policy. Requires the State insurance commission to ensure that the premium rate structure applicable to a qualified long-term care insurance policy remains level throughout the policy's life. Sets forth procedures for the periodic review of premium rates in order to determine if qualified insurers may make adjustments.

Establishes maximum daily and lifetime benefit amounts for nursing facility services and home- and community-based care under a qualified long-term care insurance policy for which the qualified insurer is liable for payment to the service provider.

Outlines additional requirements a State plan must meet applicable to the Secure Choice Insurance Option program.

Requires the Secretary to reimburse each participating State for program costs, according to a specified formula.

States that to be eligible as a qualified provider an entity must agree to accept the payment rate specified under the program as payment in full for services provided to qualified participants.

Requires the Standards and Performance Organization of the State that elects to participate in the program to implement a comprehensive public information and education program that shall be directed to individuals age 55 and above but which shall attempt to educate the general public as whole concerning the need for long-term care insurance. Specifies the requirements for such education program.

Requires States participating in the programs under new title XXI to ensure that any long-term care insurance policy offered within the State meets specified: (1) requirements of the long-term care insurance model regulation, and the long-term care insurance model Act, respectively, promulgated by the National Association of Insurance Commissioners (NAIC); (2) tax disclosure requirements; and (3) requirements relating to nonforfeitability. Outlines additional responsibilities of participating States with respect to any individual or entity selling or offering for sale in the State a long-term care insurance policy, including responsibilities of participating States for ensuring that such individuals or entities comply with specified NAIC model regulations and Act provisions.

Directs NAIC to promulgate standards for the use of uniform language and definitions in long-term care insurance policies.

Directs the Secretary to provide that individuals eligible for services under title XIX (Medicaid) of the Social Security Act which, effective upon the enactment of this Act, are provided under new title XXI shall continue to be eligible to receive such services in the same manner as previously provided.

Amends the Medicaid program to repeal provisions concerning home and community care for functionally disabled elderly individuals.

Directs the Comptroller General to study and report to the Congress on the appropriateness and adequacy of using the Federal medical assistance percentage utilized under Medicaid for payment of services provided under new title XXI.

Directs the Secretary to conduct studies to: (1) develop appropriate criteria for determining eligibility for long-term care services under a program similar to the Secure Choice program for mentally retarded or developmentally disabled individuals; and (2) determine the feasibility of establishing a data collection system for public and private long-term care services.

Directs the Secretary to establish a new organizational unit within the Health Care Financing Administration to administer the new long-term care assistance program under title XXI.

Title II: Long-Term Care Tax Provisions - Subtitle A: Tax Treatment of Long-Term Care - Private Long-Term Care Insurance Act of 1991 - Amends the Internal Revenue Code to allow an individual an itemized deduction for qualified long-term care services. Defines such services as necessary diagnostic, preventive, therapeutic, and rehabilitative services, and maintenance and personal care services which: (1) are required by a chronically ill individual; (2) have as their primary purpose the provision of needed assistance with daily living activities which the individual is certified as being unable to perform; and (3) are provided pursuant to a continuing plan of care prescribed by a licensed health practitioner.

Provides for: (1) long-term care insurance contracts to be treated as accident or health insurance contracts; (2) amounts received under such contracts with respect to qualified long-term care services to be treated as amounts received for personal injuries or sickness; (3) employer plans providing such services to be treated as an accident or health plan; and (4) per diem and other periodic payments to be treated as payments made with respect to qualified long-term care services, with specified limitations. Declares that a qualified long-term care insurance contract is one in which the only insurance protection provided is coverage of qualified long-term care services.

Prohibits borrowing under such a contract and its assignment or pledging as collateral for a loan. Prohibits it from covering expenses to the extent that such expenses are reimbursable under Medicare.

Provides for the tax treatment of policyholders based on dollar limitations on per diem and other periodic payments.

Makes the continuation coverage excise tax inapplicable to qualified long-term care insurance contracts or plans of employers that provide such coverage.

Sets forth specified consumer protection provisions to be satisfied by qualified long-term care insurance contracts, including the NAIC model Act.

Imposes an excise tax of $5,000 on any person who fails to meet specified requirements for such contracts with respect to: (1) regulation of sales practices; (2) model Act provisions; and (3) disclosure.

Requires NAIC to promulgate standards for the use of uniform language and definitions in long-term care insurance policies by January 1, 1993.

Subtitle B: Treatment of Accelerated Death Benefits - Provides for the treatment of amounts paid to a terminally ill individual as death benefits. Allows insurance companies to issue such accelerated death benefit riders on life insurance contracts and requires spousal consent for such treatment and riders.

Amends title XI of the Social Security Act to prohibit applicants or recipients under public assistance programs from being required to make an election respecting accelerated death benefits under life insurance policies.