Updates to the Long-Term Care Insurance NAIC Model Act and Model Regulation

As part of its effort to revamp and modernize the Model Laws, the National Association of Insurance Commissioners (NAIC) is updating the Long-Term Care Insurance Model Act, Model 640-1, and the Long-Term Care Insurance Model Regulation, Model 641-1 (combined, the Models). The current versions of the Models were finalized in 2017, and all states have adopted the current Models or similar legislation.

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Is the WISH Act the Answer to Concerns About the Cost of an Aging Population?

A new bill proposed in Congress seeks to address financial concerns due to an aging population through the Well-Being Insurance for Seniors to be at Home Act (“WISH Act”). The current population of the United States is aging rapidly, leading to an increasing percentage of the population aged 65 and over. In fact, it is estimated that by 2050 the number of people living over the age of 65 will almost double and the number of people living over the age of 85 will triple.

The WISH Act, introduced on July 1, 2021 by U.S. Representative Tom Suozzi (NY), cautions that “the typical U.S. senior could afford only about 12 months of nursing home care, assisted living care, or extensive home care using their financial wealth.” This is consistent with the idea that over “half of Americans entering old age today will have a long-term need for constant attendance by another person, averaging $298,000 costs per person for about 2 years of serious self care disability (as defined in HIPAA), and more than half will be out-of-pocket, according to the U.S. Department of Health and Human Services (HHS).”

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Aging at Home is More Than Just a Passing Fad

An astounding 88% of Americans would prefer to receive any ongoing living assistance they need as they age at home or with loved ones, according to a new nationwide survey released this week by The Associated Press-NORC Center for Public Affairs Research.

Furthermore, 69% of participants reported they have done only a little or no planning for their long-term care needs, and 49% of participants over the age of 40 reported that they expect the majority of their long-term care costs will be paid by Medicare. Considering Medicare currently covers very limited long-term care costs, and the Medicare trust fund is at risk to become insolvent in the near future, 89% of participants reported that strengthening the Medicare trust fund should be a priority for the Biden administration and Congress.

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Colorado Bill Restricting Insurers’ Use of External Data and Algorithms Passes First Hurdle

Recently, long-term care insurers have focused a substantial investment of resources in evaluating and assessing the feasibility of wellness programs aimed at keeping policyholders healthier and at home as they age. This goal meets the stated desires of almost all policyholders, and also delays and/or lessens the severity of any long term care insurance claims that policyholders might be eligible for. Many of these wellness programs utilize predictive analytics of various types, including algorithmic data analysis, predictive models and artificial intelligence. Regulators and lawmakers have been focused on these types of Insurtech offerings, and have been particularly attentive to potential discrimination issues that might arise.

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Proposed Revisions to HIPAA Privacy Rule and Extension for Public Comment

On March 9, 2021, the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services announced that it was extending public comment on the proposed changes to the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule from March 22, 2021 to May 6, 2021.

OCR first released the proposed modifications to the HIPAA Privacy Rule on December 10, 2020. Specifically, OCR announced it was proposing changes “to support individuals’” engagement in their care, remove barriers to coordinate care and reduce the regulatory burdens on the health care industry.”

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NAIC Releases 2021 Strategic Priorities

The National Association of Insurance Commissioners (NAIC) is out this week with its strategic priorities for 2021, including a renewed commitment to long-term care insurance (LTCi).

NAIC says “state insurance regulators will continue on-going efforts to improve the consistency around LTCi rate review processes; examine insurer reserve adequacy; facilitate innovative product offerings; engage with federal policymakers on LTCi policy; and educate consumers on LTCi products and alternative benefit options.” NAIC’s LTCi (EX) Task Force is expected to deliver its proposal to the organization’s Executive Committee by the 2021 Summer National Meeting.

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NAIC Committee Leadership Updates

On January 11, the NAIC picked its “letter committee” leadership for 2021 – Chairs and Vice-chairs of the broad committees in charge of policy-making for sub-sectors of the industry or particular areas of regulation. Among the new assignments, North Dakota’s Jon Godfread will now chair the health-focused “B” committee, Oklahoma’s Glen Mulready will vice-chair the life and annuity-focused “A” committee, and Colorado’s Michael Conway will vice-chair the “E” committee, focused on financial regulation. A list of all the NAIC letter committee leadership assignments is linked here.

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What Insurers Need to Know About the Elections

2020 is an unusual election year, with many high-level outcomes still undetermined weeks after the polls closed. Despite this uncertainty, insurance industry stakeholders need to look ahead to the future. Thought leaders from Faegre Drinker’s insurance team participated in a post-election roundtable — and have helpful insights to share as we head into 2021.

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