Long-Term Care Partnership Offerings

nce Program¹ (“MAP”), for institutional care services or for home and community based services if the ¹ The Medical Assistance Program is commonly referred to as Medicaid. Main Phone: 505-827-4601 Main Fax: 505-827-4734 Toll Free: 1-855-4-ASK-OSI Mailing Address: P.O. Box 1689 Santa Fe, NM 87504-1689 Physical Address: 1120 Paseo de Peralta Santa Fe, NM 87501 Website: WWW.OSI.STATE.NM.US applicant's countable resources, as defined and calculated by the Medical Assistance Division ("MAD") of the New Mexico Human Services Division ("HSD"), do not exceed $2,000, pursuant to Section 8.281.500.1 et seq. NMAC. Some of an applicant's resources are counted in the eligibility determination and some resources are excluded. This state's Qualified State Long-Term Care Insurance Partnership ("QSLTCIP") program is a partnership program that joins MAD with private insurers that offer long-term care insurance policies. Under this program, a MAP applicant's eligibility requirements are adjusted to provide financial incentives for eligible recipients to purchase private QSLTCIP coverage. To this end, an individual's protected asset eligibility limit is adjusted upward in the amount of QSLTCIP benefit payments made to or on the behalf of that individual through application of resource exclusions. See 8.281.500.13(J) NMAC. Furthermore, medical care credits for post-eligibility calculations are computed to allow a deduction for the full amount of QSLTCIP premiums. See 8.281.500.22 (B)(4) NMAC. Additional explanations of the requirements for program eligibility are available through HSD and related statutes and regulations. ### Insurance Carriers: As announced by this Bulletin, OSI shall permit insurers to submit QSLTCIP plans for approval and subsequent issue to New Mexico residents. Insurers seeking approval of QSLTCIP forms for issue in this state shall submit the proposed forms to OSI in SERFF under the TOI-Long-term Care and SubTOI- "Partnership." In order to qualify as a QSLTCIP plan, the plan must satisfy all of the provisions set forth below: Main Phone: 505-827-4601 Main Fax: 505-827-4734 Toll Free: 1-855-4-ASK-OSI Mailing Address: P.O. Box 1689 Santa Fe, NM 87504-1689 Physical Address: 1120 Paseo de Peralta Santa Fe, NM 87501 Website: WWW.OSI.STATE.NM.US 1. A QSLTCIP policy must meet the requirements set forth in section 1917(a) of the Social Security Act and must meet the definition of a “qualified long-term care insurance policy” that is found in section 7702B(b) of the Internal Revenue Code of 1986. 2. The policy insures an individual who is resident of this state at the time that coverage becomes effective. 3. The policy includes inflation protection which must occur at least annually as follows: a. For purchasers under 61 years old, compound annual inflation protection continuing through at least age 66; b. For purchasers 61 through 75 years old, some level of inflation protection continuing for at least 5 years from date of purchase or until age 76, whichever occurs first; or c. For purchasers 76 years or older, inflation protection may be offered but is not required. 4. The policy meets all other applicable federal and state laws relating to qualified state long-term care insurance partnership programs. 5. Although a QSLTCIP policy must satisfy all of the requirements that apply to long-term care insurance coverage as set forth in NMSA 1978, Section 59A-23A et. seq., a long-term care insurance policy does not qualify as a QSLTCIP policy unless the additional requirements set forth in this bulletin are also made a part of the policy. An insurer shall obtain verification that a producer has satisfied the training requirements before the producer may sell, solicit or negotiate the insurer’s long-term care insurance products, including its QSLTCIP policies. Records of training shall be made available to the Superintendent and/or to the Secretary of HSD, upon reasonable request. Main Phone: 505-827-4601 Main Fax: 505-827-4734 Toll Free: 1-855-4-ASK-OSI Mailing Address: P.O. Box 1689 Santa Fe, NM 87504-1689 Physical Address: 1120 Paseo de Peralta Santa Fe, NM 87501 Website: WWW.OSI.STATE.NM.US ## Continuing Education Providers: Continuing education course providers wishing to offer courses that satisfy the requirements for producers desiring to offer QSLTCIP policies must submit their proposed course for approval by OSI's Insurance Continuing Education Committee, as set forth in Section 13.4.7.8 NMAC. All continuing education providers and courses must satisfy the requirements described in Section 13.4.7.11 NMAC. ## Insurance Producers: Once a QSLTCIP policy has been submitted and approved by OSI, it may be offered by a licensed producer who has completed an approved education course, as set forth in Section 13.4.7.10(C)(2)(c) NMAC. Licensees shall receive course credit only for courses that have been approved by the Continuing Education Committee prior to the licensee's enrollment in the course, as set forth in Section 13.4.7.9 NMAC. Pursuant to NMSA 1978, Section 59A-23A-13, "[a] licensed producer that sells or offers for sale an insurance plan, insurance policy, certificate of insurance or rider that is intended to qualify as qualified state long-term care partnership program insurance shall disclose the availability of qualified state long-term care insurance partnership program insurance and outline the requirements and benefits of participation in the qualified state long-term care insurance partnership program." ## Individual Insureds: For a long-term care policy to qualify as a QSLTCIP policy, the applicant or recipient: 1. must have been a resident of this state and purchased the QSLTCIP policy in this state on or after August 15, 2015; or Main Phone: 505-827-4601 Main Fax: 505-827-4734 Toll Free: 1-855-4-ASK-OSI Mailing Address: P.O. Box 1689 Santa Fe, NM 87504-1689 Physical Address: 1120 Paseo de Peralta Santa Fe, NM 87501 Website: WWW.OSI.STATE.NM.US 2. must have been a resident of another state with a CMS approved state plan for state long-term care insurance partnerships on the date that a QSLTCIP policy was purchased; or 3. must be a current New Mexico resident and after August 15, 2015 have purchased a long-term care policy that qualified for and was converted to a QSLTCIP policy through an endorsement, exchange, or rider. When an individual insured person contacts HSD for assistance with enrollment in the state's MAP, HSD will verify that the insured has a QSLTCIP policy by accessing the SERFF database. Any person aggrieved by a bulletin may request a hearing before the Superintendent in accordance with §59A-4-15 NMSA 1978. If you have additional questions regarding this Bulletin, please contact the Life and Health Rate and Form Filing Bureau, Office of Superintendent of Insurance, at LHRFF.osi@state.nm.us or the Producer Licensing Bureau, Office of Superintendent of Insurance, at agents.licensing@state.nm.us. DONE and ORDERED this 25th day of September 2018. Hon. JOHN G. FRANCHINI Superintendent of Insurance Main Phone: 505-827-4601 Main Fax: 505-827-4734 Toll Free: 1-855-4-ASK-OSI Mailing Address: P.O. Box 1689 Santa Fe, NM 87504-1689 Physical Address: 1120 Paseo de Peralta Santa Fe, NM 87501 Website: WWW.OSI.STATE.NM.US