[Federal Register: September 2, 2008 (Volume 73, Number 170)]
[Notices]
[Page 51302-51305]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr02se08-60]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Secretary
Office of the Assistant Secretary for Planning and Evaluation;
State Long-Term Care Partnership Program: State Reciprocity Standard
AGENCY: Office of the Assistant Secretary for Planning and Evaluation
(OASPE), HHS.
[[Page 51303]]
ACTION: Notice with Comment Period.
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SUMMARY: Under section 6021 of Public Law 109-171, the Deficit
Reduction Act of 2005 (DRA), States may provide asset disregards (and
related estate recovery offsets) for Medicaid applicants who receive
benefits under qualified long term care insurance policies (Partnership
policies) that were purchased in the same State. This notice sets forth
standards for states that choose to enter into a reciprocity agreement
under section 6021(b) of the DRA, under which they agree to provide the
same disregards and offsets for qualified Partnership policies that a
Medicaid applicant purchased in another State that participates in the
reciprocity agreement.
DATES: To be assured consideration, comments must be received at the
address provided below, no later than 5 p.m. on November 3, 2008.
ADDRESSES: In commenting, please refer to file code ASPE-PLTC. Because
of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
You may submit comments in one of four ways (no duplicates,
please):
1. Electronically. You may submit electronic comments on specific
issues in this notice to http://www.Regulations.gov. Click on the link
``Comment or Submission'' and enter the keyword ``PLTC-RS''.
(Attachments should be in Microsoft Word, WordPerfect, or Excel;
however, we prefer Microsoft Word.)
2. By regular mail. You may mail written comments (one original and
two copies) to the following address ONLY: Office of Disability, Aging,
and Long-Term Care, Office of the Assistant Secretary for Planning and
Evaluation, Department of Health and Human Services, Attention: PLTC-
RS, Hunter McKay, 200 Independence Avenue, SW., Room 424-E, Washington,
DC 20201.
Please allow sufficient time for mailed comments to be received
before the close of the comment period.
3. By express or overnight mail. You may send written comments (one
original and two copies) to the following address only: Office of
Disability, Aging, and Long-Term Care, Office of the Assistant
Secretary for Planning and Evaluation, Department of Health and Human
Services, Attention: PLTC-RS, Hunter McKay, 200 Independence Avenue,
SW., Room 424-E, Washington, DC 20201.
4. By hand or courier. If you prefer, you may deliver (by hand or
courier) your written comments (one original and two copies) before the
close of the comment period to the following address: Room 424-E,
Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington,
DC 20201.
(Because access to the interior of the Hubert H. Humphrey Building
is not readily available to persons without Federal Government
identification, commenters are encouraged to leave their comments in
the mail drop slots located in the main lobby of the building. A stamp-
in clock is available for persons wishing to retain proof of filing by
stamping in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and received after the comment
period.
Submitting Comments: We welcome comments from the public on all
issues set forth in this notice to assist us in fully considering
issues and developing policies. You can assist us by referencing the
file code PLTC-RS and the specific ``issue identifier'' that precedes
the section on which you choose to comment.
Inspection of Public Comments: All comments received before the
close of the comment period are available for viewing by the public,
including any personally identifiable or confidential business
information that is included in a comment. We post all comments
received before the close of the comment period on the following Web
site as soon as possible after they have been received: http://
www.Regulations.gov. Click on the link ``Comment or Submission'' on
that Web site to view public comments.
Comments received timely will also be available for public
inspection as they are received, generally beginning approximately 3
weeks after publication of a document, at the headquarters of the
Department of Health and Human Services, 200 Independence Avenue, SW.,
Washington, DC, 20201, Monday through Friday of each week from 8:30
a.m. to 4 p.m.
The Department of Health and Human Services will also post
communications from stake-holders, as they gain experience with the
program, on the web-site for the Office of the Assistant Secretary for
Planning and Evaluation: http://aspe.os.dhhs.gov/_/index.cfm.
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. Legislative Background
Medicaid is a joint Federal/State program established pursuant to
title XIX of the Social Security Act. State Medicaid programs under
title XIX generally cover medical and long-term care costs for certain
people with limited income and resources, pursuant to ``State Plans''
approved by the Secretary of Health and Human Services (``the
Secretary''). In general, individuals must have assets below a
specified level in order to be eligible for Medicaid. Under certain
circumstances, when a State calculates an applicant's assets for
purposes of determining Medicaid eligibility, the statute permits the
State to disregard an amount equal to benefits paid to or on behalf of
the individual under a qualifying long-term care insurance policy
purchased in the same State. The statute also allows States to exempt
benefits paid under the policy from Medicaid estate recovery after the
insured's death.
A State that wishes to apply this asset disregard must submit a
Medicaid State Plan Amendment (SPA) for approval by the Secretary. The
SPA creates a ``Long-Term Care Partnership'' (``Partnership'') and the
long-term care policies that qualify for the asset disregard are
referred to here as ``Partnership policies.'' States that have an
approved SPA are referred to as ``Partnership States.''
There are two types of Partnership States: those that had SPAs
approved before May 14, 1993 (referred to here as ``Original''
Partnership States) and those that have submitted SPAs pursuant to
section 6021 of the DRA (referred to here as ``DRA'' Partnership
States).
Section 6021(b) of the DRA directs the Secretary to develop
standards for Partnership States that wish to provide reciprocal
disregards for Medicaid applicants who have purchased a qualified
Partnership policy in another Partnership State. Section 6021(b)
further provides that these standards must contain the following
provisions:
[[Page 51304]]
Benefits paid under such Partnership policies will be
treated the same by all such States; and
States with Partnership Programs established under the DRA
shall be subject to these standards unless the State notifies the
Secretary in writing of the State's election to be exempt
II. Reciprocity Standards in the Provision of a Medicaid Asset
Disregard For Eligibility Determination and Estate Recovery
DRA Partnership States that have not elected (under section V,
below) to be exempt from the reciprocity standards described below, and
Original Partnership States that have elected to adopt such reciprocity
standards (as described in Section VI below), are referred to here as
``Participating States.'' Each Participating State agrees as follows:
1. Any individual who has purchased a Partnership policy in any
Participating State; who has received benefits under the policy; and
who applies for Medicaid in a Participating State other than the one in
which the policy was issued, will receive an asset disregard in an
amount equal (dollar for dollar) to the benefits received under the
policy;
2. The asset disregard procedure and calculation will be the same
for every individual with a Partnership policy that applies for
Medicaid in the Participating State, without regard to whether the
policy was purchased in another State, or the date the policy was
purchased;
3. An amount equal to the benefits received under the Partnership
policy will be exempt from Medicaid estate recovery provisions; and,
4. If a person moves from the State in which his or her Partnership
policy was issued; later applies for Medicaid in another Participating
State; and is determined to be eligible using a Partnership asset
disregard, the Partnership asset disregard will not be revoked upon
eligibility re-determination should the State subsequently decide to
become exempt from the reciprocity agreement.
III. Other State Medicaid Eligibility Provisions Not Affected
These reciprocity standards only apply to the asset disregard
described in Section II, above. Individuals who have received benefits
under a Partnership policy, and qualify for an asset disregard, must
meet all other Medicaid eligibility requirements in the State in which
they are applying for Medicaid coverage. These may include requirements
that relate to the Partnership policy, but only if those requirements
do not affect the asset disregard.
Example: Some Partnership States may require Medicaid applicants
holding Partnership policies to exhaust all of the benefits under
the policy before becoming eligible for Medicaid. Other Partnership
States may allow applicants to apply for Medicaid coverage (and
receive dollar for dollar asset disregard) even if residual benefits
remain in the policy.
IV. Effective Date
These reciprocity standards will become effective on January 1,
2009.
V. Deemed Participation of States With Partnership Programs Established
Under the DRA
As required by the statute, all DRA Partnership States will be
deemed to be participating in the reciprocity agreement unless they
elect to be exempt from the reciprocity standards by notifying the
Secretary, in writing, of their election.
All States with State Plan Amendments effective dates prior to
January 1, 2009, will be deemed to be participating in the reciprocity
standards unless, prior to the effective date of these standards, the
State elects exemption from the standards through a new SPA.
States with State Plan Amendment effective dates after January 1,
2009 will also be deemed to be participating in the reciprocity
standards unless they elect exemption through a SPA.
VI. Participation by States Operating a Partnership Under the Authority
of a State Plan Amendment Approved Prior to May 14, 1993
States with State Plan Amendments approved prior to May 14, 1993
may elect to adopt these reciprocity standards, and participate with
those States operating a Partnership under the authority of the DRA. To
do so, those States must submit a new SPA to that effect. Such States
must agree to accept all of the reciprocity standards with respect to
all other Participating States.
VII. Effect of Reciprocity Exemption
In order for a Medicaid applicant to be eligible for the asset
disregard, both the State in which the individual is applying, and the
State in which the Partnership policy was purchased, must currently be
participating in the reciprocity standards. Accordingly, a State that
elects an exemption from the reciprocity standards will not provide an
asset disregard for Medicaid applicants who originally purchased
Partnership policies in other, participating, Partnership States.
Similarly, persons who originally purchased Partnership policies in a
State that elected exemption from the reciprocity standards will not be
eligible for asset disregards in other Partnership States. Once a State
elects exemption from the standards, the exemption applies regardless
of when a Medicaid applicant originally purchased a Partnership policy
in another State (i.e., even if the Medicaid applicant purchased the
policy prior to the date on which a State elected exemption from the
reciprocity standards).
VIII. Notice of Exemption by Currently Participating States
States that are currently participating in the reciprocity
agreement agree that they will provide written notice to the Secretary
at least 60 days prior to the effective date of electing an exemption
from the reciprocity standards. The 60-day notification period makes it
possible for the Department to notify other Participating States that,
as of the effective date of withdrawal, asset disregards should no
longer be made available to Medicaid applicants who originally
purchased their policies in the State electing an exemption.
IX. Withdrawal of Reciprocity Exemption
A State which has elected exemption from the Partnership
reciprocity standards may also withdraw its election at any point. A
State may do so by submitting a new SPA. Once a State withdraws its
election, the State agrees that reciprocity will be applied to all
people holding Partnership policies regardless of when the policy was
originally purchased.
X. Outside Agreements
There is nothing in these reciprocity standards which prohibits
states from entering into reciprocity agreements with other states on a
state-by-state basis, should they elect exemption from these
reciprocity standards. The Department will create a communication
mechanism for informing states and the public about which states have
approved Partnership programs and which states are participating in
these reciprocity standards.
XI. Change in Participation Status
States that wish to change their participation status should submit
a new state plan amendment.
[[Page 51305]]
Dated: August 20, 2008.
Mary M. McGeein,
Principal Deputy Assistant Secretary for Planning and Evaluation.
[FR Doc. E8-20225 Filed 8-29-08; 8:45 am]
BILLING CODE 4154-05-P