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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Examining the State of the Long-Term Care Insurance Hybrid Market

Join us June 30 for a discussion about the current state of the LTCi hybrid market and its future. Cheri McCourt, assistant general counsel at Northwestern Mutual, will join partners Sandy Jones and Nolan Tully to share their insights on LTCi hybrid issues including:

  • A market shift towards brisk sales of hybrid products and away from stand-alone LTCi
  • Key features of LTCi hybrid products and related legal/regulatory considerations
  • The future of the LTCi hybrid market, including:
  • Can products be designed to reach the middle market?
  • Can this product fill the LTC funding gap or even reduce population-wide reliance on Medicaid for LTC?
  • Are there products or features that could enhance the usefulness of hybrid products by, for instance, introducing wellness incentives for policyholders?
  • Litigation risks to riders/hybrids connected with sales and product confusion

To learn more and to register click here.

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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LTC Task Force Updates From NAIC Spring Meeting

During the National Association of Insurance Commissioners (NAIC) Spring Conference last week, the NAIC LTC Task Force met to discuss various topics and we wanted to share a summary of the discussion:

The bulk of the meeting was the Task Force receiving an update from each of its subgroups:

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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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California Insurance Commissioner Appoints Long Term Care Insurance Task Force

On January 26, California Insurance Commissioner Ricardo Lara announced six appointments to the state’s new Long Term Care Insurance Task Force. The Task Force was established after the passage of AB 567 and is tasked with, among others, exploring the feasibility of developing and implementing a culturally competent statewide public insurance program for long-term care services and support. More information on the Task Force can be found here.  California’s efforts appear to follow a recent trend of policymakers exploring or implementing public programs aimed at long-term care services, including Washington State’s Long Term Care Trust Act and some of the ideas recently discussed at the Federal level, including by U.S. Rep. Thomas R. Suozzi (D-NY).

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Long-Term Care Insurance Fraud, Waste, and Abuse: A discussion with Karen Smyth and Jeff Ferrand

Industry stalwarts Karen Smyth (Vice President of Long Term Care Operations at Wilton Re) and Jeff Ferrand (Vice President of Fraud Services at LTCG) have significant experience developing and implementing anti-fraud, waste, and abuse programs at the carrier and TPA level.

Please listen to the below podcast with Chris Petillo and Jessica Loesing as they discuss Karen’s and Jeff’s views on, among other questions, how fraud, waste, and abuse manifest in the LTCi space, and potential efforts carriers and TPAs can use to prevent and detect fraud, waste, and abuse. Karen also shares her experience as a witness in a criminal trial involving LTCi insurance fraud and Jeff shares his past experience as outside counsel prosecuting insurance fraud cases. Finally, stick around to hear some of the creative and industrious ways Karen and Jeff have been passing the time with their families (at home) during the pandemic.

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