SB 5291 — Implementing the recommendations of the long-term services and supports trust commission.

7.

(1) ((Beginning January 1, 2023, the)) The employment security department shall accept and approve applications for voluntary exemptions from the premium assessment under RCW 50B.04.080 for any p.employee who meets criteria established by the employment security department for an exemption based on the employee's status as:

13 ESSB 5291 employee who meets criteria established by the employment security department for an exemption based on the employee's status as:

(c) ((AnAn employee who holds a nonimmigrant visa for temporary workers, as recognized by federal law, and is employed by an employer in Washington;

or((or)) (d)))(d) An employee who is employed by an employer in Washington, but maintains a permanent address outside of Washington as the employee's primary location of residence;

or (d)(e) Beginning January 1, 2026, an active duty service member in the United States armed forces, whether or not deployed or stationed within or outside of Washington, who is concurrently engaged in off- duty civilian employment as an employee of an employer.

(2)p. The employment security department shall adopt criteria, procedures, and rules for verifying the information submitted by the applicant for an exemption under subsection (1) of this section.

13 SB 5291 (2) The employment security department shall adopt criteria, procedures, and rules for verifying the information submitted by the applicant for an exemption under subsection (1) of this section.

(b) An exemption granted in accordance with the conditions under subsection (1)(c)(1)(d) of this section must be discontinued within 90 days of establishing a permanent address within Washington as the employee's primary location of residence.

(c) An exemption granted in accordance with the conditions under subsection (1)(d)(1)(e) of this section must be discontinued within 90 days of the discharge or separation from military service.

p.(5)(a) Within 90 days of the occurrence of ((either of)) the events described in (((a) of this)) subsection (4) of this section, an employee who has received an exemption under subsection (1) of this section shall:

14 ESSB 5291 (5)(a) Within 90 days of the occurrence of ((either of)) the events described in (((a) of this)) subsection (4) of this section, an employee who has received an exemption under subsection (1) of this section shall:

(((d))) (c) Failure to begin paying the premium established under RCW 50B.04.080 within 90 days of the occurrence of ((either of)) the eventsp. described in (((a) of this)) subsection (4) of this section shall result in the payment of any unpaid premiums from the employee, with interest at the rate of one percent per month or fraction thereof, by the employee to the employment security department from the date on which the payment should have begun.

(((5)(a)14 AnSB exemption5291 grantedevents described in accordance(((a) withof thethis)) conditions under subsection (1)(c)(4) of this section mustshall beresult discontinuedin withinthe 90payment days of anany employeeunpaid changingpremiums from the employee'semployee, nonimmigrantwith visainterest forat temporarythe workersrate statusof one percent per month or fraction thereof, by the employee to becomethe aemployment permanentsecurity residentdepartment orfrom citizenthe employeddate inon Washington.which the payment should have begun.

(b)(((5))) Within(6)(a) An exemption granted in accordance with the conditions under subsection (1)(((c))) (d) of this section must be discontinued within 90 days of thean employee changing the employee's nonimmigrant visa for temporary workers status to become a permanent resident or citizen employed in Washington,Washington. the employee who has received an exemption under subsection (1)(c) of this section shall:

(b) Within 90 days of the employee changing the employee's nonimmigrant visa for temporary workers status to become a permanent resident or citizen employed in Washington, the employee who has received an exemption under subsection (1)(((c))) (d) of this section shall:

and (ii) Notify the employee's employer that the employee no longer holds a nonimmigrant visa for temporary workers and is a permanent resident or citizen employed in Washington, and that the employer p.must begin collecting premiums from the employee in accordance with RCW 50B.04.080.

15 ESSB 5291 must begin collecting premiums from the employee in accordance with RCW 50B.04.080.

(d) Failure to begin paying the premium established under RCW 50B.04.080 within 90 days of an employee no longer holding a nonimmigrant visa for temporary workers and becoming a permanent resident or citizen employed in Washington shall result in the payment of any unpaid premiums from the employee, with interest at the rate of one percent per month or fraction thereof, by the employee to the employment security department from the date on which the payment should have begun.))begun. (6)(a) An exemption granted in accordance with the conditions under subsection (1)(d) of this section must be discontinued within 90 days of an employee establishing a permanent address within Washington as the employee's primary location of residence.

(b)(((6))) Within(7)(a) 90An daysexemption ofgranted thein employeeaccordance establishingwith athe permanentconditions addressunder withinsubsection Washington(1)(((d))) as(e) theof employee'sthis primarysection locationmust ofbe residence,discontinued thewithin employee90 whodays hasof received an exemptionemployee underestablishing subsectiona (1)(d)permanent ofp. this section shall:

15 SB 5291 address within Washington as the employee's primary location of residence.

(b) Within 90 days of the employee establishing a permanent address within Washington as the employee's primary location of residence, the employee who has received an exemption under subsection (1)(((d))) (e) of this section shall:

p.(((7))) (8) Exempt employees are not entitled to a refund of any premium deductions made before the effective date of an approved exemption, except for premiums collected prior to the effective date of the premium assessment under RCW 50B.04.080.

16(((8))) ESSB(9) 5291An (7)employee Exemptwho employeeshas arereceived notan entitledexemption pursuant to athis refundsection ofshall anyprovide premiumwritten deductionsnotification madeto beforeall thecurrent effectiveand datefuture employers of an approved exemption,exemption. except for premiums collected prior to the effective date of the premium assessment under RCW 50B.04.080.

(8)(((9))) An(10) If an exempt employee whofails hasto receivednotify an exemptionemployer pursuantof an exemption, the exempt employee is not entitled to thisa sectionrefund shallof provideany writtenpremium deductions made before notification tois allprovided, currentexcept andfor futurepremiums employerscollected prior to the effective date of anthe approvedpremium exemption.assessment under RCW 50B.04.080.

(9)(((10))) If(11) anEmployers exemptmay employeenot failsdeduct topremiums notifyafter anbeing employernotified ofby an exemption, the exempt employee is not entitled to a refund of anyan premiumapproved deductionsexemption madeissued before notification is provided, except for premiums collected prior to the effective date of the premium assessment under RCWthis 50B.04.080.section.

(10) Employers may not deduct premiums after being notified by an employee of an approved exemption issued under this section.

(b)p. An employer who deducts premiums after being notified by the employee of an exemption is solely responsible for refunding to the employee any premiums deducted after the notification.

16 SB 5291 (b) An employer who deducts premiums after being notified by the employee of an exemption is solely responsible for refunding to the employee any premiums deducted after the notification.

(11)(((11))) (12) The provisions of RCW 50B.04.085 do not apply to the exemptions issued pursuant to this section.

(12)(((12))) (13) The employment security department shall adopt rules necessary to implement and administer the activities specified in this section related to the program, including rules on the submission and processing of applications under this section.

8.7.

(2)(a)(i) Except for qualified individuals residing outside of Washington as provided in (a)(ii) of this subsection, beginning July 1, 2026, a qualified individual may become an eligible beneficiary by filing an application with the department of social and health services and undergoing an eligibility determination which includes p.an evaluation that the individual requires assistance with at least three activities of daily living, as defined by the department of social and health services for long-term services and supports programs, which is expected to last for at least 90 days.

17 ESSB 5291 an evaluation that the individual requires assistance with at least three activities of daily living, as defined by the department of social and health services for long-term services and supports programs, which is expected to last for at least 90 days.

Eating, toileting, transferring, bathing, dressing, or continence, or (B) requires substantial supervision to protect such individualp. from threats to health and safety due to severe cognitive impairments.

17 SB 5291 individual from threats to health and safety due to severe cognitive impairments.

9.8.

p.(1)(a) Benefits provided under this chapter shall be paid periodically and promptly to long-term services and supports providers who provide approved services to:

18 ESSB 5291 (1)(a) Benefits provided under this chapter shall be paid periodically and promptly to long-term services and supports providers who provide approved services to:

(c) Qualified family members may be paid for approved personal care services in the same way as individual providers, through a licensed home care agency, or through a third option ((if)) as recommendedp. by the commission ((and)) if adopted by the department of social and health services.

18 SB 5291 recommended by the commission ((and)) if adopted by the department of social and health services.

10.9.

To facilitate the premium rate setting the office of the state actuary must perform a p.biennial actuarial audit and valuation of the fund and make recommendations to the pension funding council.

19 ESSB 5291 biennial actuarial audit and valuation of the fund and make recommendations to the pension funding council.

(b)p. To the extent feasible, the employment security department shall use the premium assessment, collection, and reporting procedures in Title 50A RCW.

19 SB 5291 (b) To the extent feasible, the employment security department shall use the premium assessment, collection, and reporting procedures in Title 50A RCW.

11.10.

((An exempt employee may not become a qualified individual or eligible p.beneficiary and is permanently ineligible for coverage under this title.)) (2)(a) The employment security department must accept applications for exemptions only from October 1, 2021, through December 31, 2022.

20 ESSB 5291 beneficiary and is permanently ineligible for coverage under this title.)) (2)(a) The employment security department must accept applications for exemptions only from October 1, 2021, through December 31, 2022.

(7)p. If an exempt employee fails to notify an employer of an exemption, the exempt employee is not entitled to a refund of any premium deductions made before notification is provided.

20 SB 5291 (7) If an exempt employee fails to notify an employer of an exemption, the exempt employee is not entitled to a refund of any premium deductions made before notification is provided.

The employee will be subject to premium assessments under RCW 50B.04.080 or 50B.04.090 upon notification to the employment security department p.of the rescission.

21 ESSB 5291 of the rescission.

12.11.

(1)p. The long-term services and supports trust account is created in the custody of the state treasurer.

All21 receiptsSB from5291 employers(1) underThe RCWlong-term 50B.04.080services and fromsupports out-of-statetrust participantsaccount underis RCWcreated 50B.04.180,in 50B.04.090,the andcustody 50B.04.095, delinquent premiums, penalties, and interest received pursuant to sections 13 and 14 of this act, and any funds attributable to savings derived through a waiver with the federalstate centerstreasurer. for medicare and medicaid services pursuant to RCW 50B.04.130 must be deposited in the account.

All receipts from employers under RCW 50B.04.080 and from out-of-state participants under RCW 50B.04.180, delinquent premiums, penalties, and interest received pursuant to sections 12 and 13 of this act, and any funds attributable to savings derived through a waiver with the federal centers for medicare and medicaid services pursuant to RCW 50B.04.130 must be deposited in the account.

These funds may not be used either in whole or in part to supplant existing state or p.county funds for programs that meet the definition of approved services.

22 ESSB 5291 county funds for programs that meet the definition of approved services.

13.12.

(1) In the form and at the times specified in this chapter and by the commissioner of the employment security department, an employer shall make reports, furnish information, and collect and remit premiums as required by this chapter to the employment security department.p.

22 SB 5291 department.

p.(a) An employer that fails under this chapter to make the required reports, or fails to remit the full amount of the premiums when due;

23 ESSB 5291 (a) An employer that fails under this chapter to make the required reports, or fails to remit the full amount of the premiums when due;

(ii) for the third occurrence, the penaltyp. is $150;

23 SB 5291 penalty is $150;

(b) An employer who willfully fails to remit the full amount of the premiums when due is liable, in addition to the full amount of premiums due and amounts assessed as interest under sectionsubsection 14(3)(5) of this act,section, to a penalty equal to the premiums and interest.

14.13.

The order and notice of assessment shall be served upon p.the delinquent employer in the manner prescribed for the service of a summons in a civil action, or using a method by which the mailing can be tracked or the delivery can be confirmed.

24 ESSB 5291 the delinquent employer in the manner prescribed for the service of a summons in a civil action, or using a method by which the mailing can be tracked or the delivery can be confirmed.

(3) If premiums are not paid on the date on which they are due and payable as prescribed by the commissioner of the employment security department, the whole or part thereof remaining unpaid shall bear interest at the rate of one percent per month or fraction thereofp. from and after such date until payment plus accrued interest is received by the commissioner of the employment security department.

24 SB 5291 thereof from and after such date until payment plus accrued interest is received by the commissioner of the employment security department.

(4)(a) If the amount of premiums, interest, or penalties assessed by the commissioner of the employment security department by order and notice of assessment provided in this chapter is not paid within 10 days after the service or mailing of the order and notice of p.assessment, the commissioner of the employment security department or a duly authorized representative may collect the amount stated in the assessment by the distraint, seizure, and sale of the property, goods, chattels, and effects of the delinquent employer.

25 ESSB 5291 assessment, the commissioner of the employment security department or a duly authorized representative may collect the amount stated in the assessment by the distraint, seizure, and sale of the property, goods, chattels, and effects of the delinquent employer.

The sale may be adjourned from time to time at the discretion of the commissioner of the employment security department, butp. not for a time to exceed a total of 60 days.

25 SB 5291 but not for a time to exceed a total of 60 days.

The p.proceeds of any sale under this subsection (4), except in those cases in which the property has been acquired by the employment security department, shall be first applied by the commissioner of the employment security department in satisfaction of the delinquent account, and out of any sum received in excess of the amount of delinquent premiums, interest, and penalties the account shall be reimbursed for the costs of distraint and sale.

26 ESSB 5291 proceeds of any sale under this subsection (4), except in those cases in which the property has been acquired by the employment security department, shall be first applied by the commissioner of the employment security department in satisfaction of the delinquent account, and out of any sum received in excess of the amount of delinquent premiums, interest, and penalties the account shall be reimbursed for the costs of distraint and sale.

(5) The commissioner of the employment security department may issue to any person, firm, corporation, political subdivision, or department of the state, a notice and order to withhold and deliver property of any kind when the commissioner of the employment security departmentp. has reason to believe that there is in the possession of such person, firm, corporation, political subdivision, or department, property which is due, owing, or belonging to any person, firm, or corporation upon whom the employment security department has served a notice and order of assessment for premiums, interest, or penalties.

26 SB 5291 department has reason to believe that there is in the possession of such person, firm, corporation, political subdivision, or department, property which is due, owing, or belonging to any person, firm, or corporation upon whom the employment security department has served a notice and order of assessment for premiums, interest, or penalties.

In the event there is in the possession of any such person, firm, corporation, political subdivision, or department, any property which may be subject to the claim of the employment security department of the state, the property must be delivered immediately to the commissioner of the employment security department or a representative upon demand to be held in trust by the p.commissioner of the employment security department for application on the indebtedness involved or for return, without interest, in accordance with final determination of liability or nonliability, or in the alternative, a good and sufficient bond satisfactory to the commissioner of the employment security department must be provided conditioned upon final determination of liability.

27 ESSB 5291 commissioner of the employment security department for application on the indebtedness involved or for return, without interest, in accordance with final determination of liability or nonliability, or in the alternative, a good and sufficient bond satisfactory to the commissioner of the employment security department must be provided conditioned upon final determination of liability.

(6) Whenever any order and notice of assessment or jeopardy assessment has become final in accordance with the provisions of this chapter the commissioner of the employment security department may file with the clerk of any county within the state a warrant in the amount of the notice of assessment plus interest, penalties, and a filingp. fee under RCW 36.18.012(10).

27 SB 5291 filing fee under RCW 36.18.012(10).

(7) The claim of the employment security department for any premiums, interest, or penalties not paid when due, shall be a lien prior to all other liens or claims and on a parity with prior tax p.liens against all property and rights to property, whether real or personal, belonging to the employer.

28 ESSB 5291 liens against all property and rights to property, whether real or personal, belonging to the employer.

When any such notice of lien has been so filed, the commissioner of the employment security department may release the lien by filing a certificate of release when it appears that the amountp. of delinquent premiums, interest, and penalties have been paid, or when the assurance of payment shall be made as the commissioner of the employment security department may deem to be adequate.

28 SB 5291 amount of delinquent premiums, interest, and penalties have been paid, or when the assurance of payment shall be made as the commissioner of the employment security department may deem to be adequate.

In the event of an employer's adjudication in bankruptcy, judicially confirmed extension proposal, or composition, under the federal bankruptcy act of 1898, p.as amended, premiums, interest, or penalties due shall be entitled to such priority as provided in that act, as amended.

29 ESSB 5291 as amended, premiums, interest, or penalties due shall be entitled to such priority as provided in that act, as amended.

(b) Any employer that is not a resident of this state and that exercises the privilege of having one or more individuals perform service for it within this state, and any resident employer that exercisesp. that privilege and thereafter removes from this state, shall be deemed thereby to appoint the secretary of state as its agent and attorney for the acceptance of process in any action under this chapter.

29 SB 5291 exercises that privilege and thereafter removes from this state, shall be deemed thereby to appoint the secretary of state as its agent and attorney for the acceptance of process in any action under this chapter.

(10) Any employer who is delinquent in the payment of premiums, interest, or penalties may be enjoined upon the suit of the state of Washington from continuing in business in this state or employing persons herein until the delinquent premiums, interest, and penalties have been paid, or until the employer has furnished a good and sufficient bond in a sum equal to double the amount of premiums, interest, and penalties already delinquent, plus further sums as the p.court deems adequate to protect the employment security department in the collection of premiums, interest, and penalties which will become due from the employer during the next ensuing calendar year, the bond to be conditioned upon payment of all premiums, interest, and penalties due and owing within thirty days after the expiration of the next ensuing calendar year or at an earlier date as the court may fix.

30 ESSB 5291 court deems adequate to protect the employment security department in the collection of premiums, interest, and penalties which will become due from the employer during the next ensuing calendar year, the bond to be conditioned upon payment of all premiums, interest, and penalties due and owing within thirty days after the expiration of the next ensuing calendar year or at an earlier date as the court may fix.

(11) The commissioner of the employment security department may compromise any claim for premiums, interest, or penalties due and owing from an employeremployer, and any amount owed by an individual because of benefit overpayments existing or arising under this chapter in any case in which collection of the full amount due and owing, whether reduced to judgment or otherwise, would be against equity and good conscience.

Whenever a compromise is made by the commissioner of the employmentp. security department in the case of a claim for premiums, interest, or penalties, whether reduced to judgment or otherwise, the employment security department shall file a statement of the amount of premiums, interest, and penalties imposed by law and claimed due, attorneys' fees and costs, if any, a complete record of the compromise agreement, and the amount actually paid in accordance with the terms of the compromise agreement.

30 SB 5291 employment security department in the case of a claim for premiums, interest, or penalties, whether reduced to judgment or otherwise, the employment security department shall file a statement of the amount of premiums, interest, and penalties imposed by law and claimed due, attorneys' fees and costs, if any, a complete record of the compromise agreement, and the amount actually paid in accordance with the terms of the compromise agreement.

(12) The commissioner of the employment security department may charge off as uncollectible and no longer an asset of the account, any delinquent premiums, interest, penalties, credits, or credits,benefit overpayments if the commissioner of the employment security department is satisfied that there are no cost-effective means of collecting the premiums, interest, penalties, credits, or credits.benefit overpayments.

15.14.

p.(1) When a qualified individual applies for benefits as provided in RCW 50B.04.060, the department of social and health services must:

31(a) ESSBAsk 5291whether (1)the When a qualified individual applieshas forsupplemental benefitslong-term care insurance as provided in chapter 48.--- RCW 50B.04.060,(the thenew departmentchapter ofcreated socialin andsection health40 servicesof must:this act);

(a) Ask whether the qualified individual has supplemental long-term care insurance as provided in chapter 48.--- RCW (the new chapter created in section 41 of this act);

(3) Only basic demographic information that would allow a person to be identified in the program may be shared if the qualified individualp. consents to sharing information.

31 SB 5291 individual consents to sharing information.

16.15.

p.(3) The employment security department, the department of social and health services, and the department of health may adopt rules necessary to implement this section.

32 ESSB 5291 (3) The employment security department, the department of social and health services, and the health care authority may adopt rules necessary to implement this section.

17.16.

NEWp. SECTION.

32 SB 5291 NEW SECTION.

18.17.

(1) This chapter applies to all supplemental long-term care insurance policies, contracts, or riders delivered or issued for delivery in this state on or after MayJanuary 1, 2026.

19.18.

p.(1) "Applicant" means:

33 ESSB 5291 (1) "Applicant" means:

(a)p. One or more employers;

33 SB 5291 (a) One or more employers;

p.(A) The association or associations hold regular meetings at least annually to further the purposes of the members;

34 ESSB 5291 (A) The association or associations hold regular meetings at least annually to further the purposes of the members;

and (iii)p. The benefits are reasonable in relation to the premiums charged.

34 SB 5291 (iii) The benefits are reasonable in relation to the premiums charged.

(8) "Supplemental long-term care insurance" means an insurance policy, contract, or rider that is advertised, marketed, offered, or designed to provide coverage for at least 12 consecutive months for a covered person after benefits provided under chapter 50B.04 RCW have p.been exhausted.

35 ESSB 5291 been exhausted.

(i) Accelerate the death benefit specifically for one or more of the qualifying events of terminal illness, medical conditions requiring extraordinary medical intervention, or permanent institutional confinement;p.

35 SB 5291 confinement;

20.19.

p.(3) A form or rate shall not knowingly be issued, delivered, or used if the commissioner's approval does not then exist.

36 ESSB 5291 (3) A form or rate shall not knowingly be issued, delivered, or used if the commissioner's approval does not then exist.

21.20.

A group supplemental long-term care insurance policy may not be offered to a resident of this state under a group policy issued in another state to a group described in section 19(5)(d)18 (5)(d) of this act, unless this state or another state having statutory and regulatory supplemental long-term care insurance requirements substantially similar to those adopted in this state has made a determination that such requirements have been met.

22.21.

(1) A supplemental long-term care insurance policy or certificate may not define "preexisting condition" more restrictively than as a condition for which medical advice or treatment was recommended by or received from a provider of health care services, within six months preceding the effective date of coverage of an insured person, unless the policy or certificate appliesp. to group supplemental long-term care insurance under section 19(5) (a), (b), or (c) of this act.

(2)36 ASB 5291 applies to group supplemental long-term care insurance policyunder orsection certificate18(5) may(a), not(b), exclude coverage for a loss or confinement(c) that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured person, unless the policy or certificate applies to a group as defined in section 19(5)(a) of this act.

(2) A supplemental long-term care insurance policy or certificate may not exclude coverage for a loss or confinement that is the result of a preexisting condition unless the loss or confinement begins within six months following the effective date of coverage of an insured person, unless the policy or certificate applies to a group as defined in section 18 (5)(a) of this act.

p.NEW SECTION.

37 ESSB 5291 NEW SECTION.

23.22.

(e)p. Condition eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care;

37 SB 5291 (e) Condition eligibility for benefits provided in an institutional care setting on the receipt of a higher level of institutional care;

(ii) The issuer must accept notice from the department of social and health services that the policyholder has exhausted the benefits provided under chapter 50B.04 RCW as evidence of satisfying the p.deductible.

38 ESSB 5291 deductible.

(2)p. A supplemental long-term care insurance policy or certificate may be field-issued if the compensation to the field issuer is not based on the number of policies or certificates issued.

38 SB 5291 (2) A supplemental long-term care insurance policy or certificate may be field-issued if the compensation to the field issuer is not based on the number of policies or certificates issued.

24.23.

(4) This section does not apply to certificates issued pursuant to a policy issued to a group defined in section 19(5)(a)18(5)(a) of this act.

25.24.

(1) An outline of coverage must be delivered to a prospective applicant for supplemental long-term care insurance at the time of initial solicitation through means that p.prominently direct the attention of the recipient to the document and its purpose.

39 ESSB 5291 prominently direct the attention of the recipient to the document and its purpose.

(iv)p. That premiums continue after retirement;

39 SB 5291 (iv) That premiums continue after retirement;

(d) If a policy is issued to a group as defined in section 19(5)(a)18(5)(a) of this act, an outline of coverage is not required to be delivered, if the information that the commissioner requires to be included in the outline of coverage is in other materials relating to enrollment.

In a direct p.response solicitation, the issuer must deliver the policy summary, upon request, before delivery of the policy, if the applicant requests a summary.

40 ESSB 5291 response solicitation, the issuer must deliver the policy summary, upon request, before delivery of the policy, if the applicant requests a summary.

(iv) A statement that any supplemental long-term care inflation protection option required by section 3231 of this act is not available under this policy;

and (v)p. If applicable to the policy type, the summary must also include:

40 SB 5291 (v) If applicable to the policy type, the summary must also include:

26.25.

(1) Allow the policyholder options for reduction of benefits or nonforfeiture of premiums as provided in section 3231 of this act if the premiums increase or the policyholder's circumstances change and the policyholder is unable or unwilling to pay the increased premiums;

If the issuer makes a determination p.that the care setting or providers are not suited to meeting the care and safety needs of the policyholder, the issuer may require a change of care setting or provider under the policy, effective 90 days after the transition from the benefits provided under chapter 50B.04 RCW.

41 ESSB 5291 that the care setting or providers are not suited to meeting the care and safety needs of the policyholder, the issuer may require a change of care setting or provider under the policy, effective 90 days after the transition from the benefits provided under chapter 50B.04 RCW.

27.26.

If the policyholder providesp. written consent, the issuer must inform the department of social and health services that the policyholder has purchased a supplemental long-term care insurance policy and share any information with the department for the purposes of any potential care coordination.

41 SB 5291 provides written consent, the issuer must inform the department of social and health services that the policyholder has purchased a supplemental long-term care insurance policy and share any information with the department for the purposes of any potential care coordination.

28.27.

29.28.

WithinAll 30supplemental businesslong-term care denials must be made within 30 days after receipt of alla thewritten requestedrequest additionalmade information,by ana insurerpolicyholder mustor paycertificate aholder, claimor p.the policyholder's representative.

42All ESSBdenials 5291of for benefits under a supplemental long-term care insuranceclaims policyby orthe certificateissuer ifmust itprovide is a cleanwritten claim,explanation orof sendthe areasons writtenfor notice that the insurerdenial isand decliningmake available to paythe allpolicyholder or partcertificate ofholder theall claiminformation anddirectly therelated specificto reasonthe or reasons for denial.

30.29.

or (b) A policy or certificate has been in force for at least six months but less than two years, upon a showing of misrepresentation thatp. is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.

42 SB 5291 that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought.

31.30.

32.31.

(1) Except as provided by this section, a supplemental long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy p.or certificate that includes a nonforfeiture benefit.

43 ESSB 5291 or certificate that includes a nonforfeiture benefit.

However, if the policy is issued as group supplemental long-term care insurance as defined in section 19(5)(d)18(5)(d) of this act other than to a continuing care retirement community or other similar entity, the offering must be made to each proposed certificate holder.

(3)p. The commissioner must adopt rules specifying the type or types of nonforfeiture benefits to be offered as part of supplemental long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse.

43 SB 5291 (3) The commissioner must adopt rules specifying the type or types of nonforfeiture benefits to be offered as part of supplemental long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding contingent benefit upon lapse, including a determination of the specified period of time during which a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse.

33.32.

(2) The insurance producer education required by this section may not include training that is issuer or company product-specific or p.that includes any sales or marketing information, materials, or training, other than those required by state or federal law.

44 ESSB 5291 that includes any sales or marketing information, materials, or training, other than those required by state or federal law.

(5)(a) Issuers must maintain records with respect to the training of its producers concerning the distribution of its long-term care partnership policies that will allow the commissioner to provide assurance to the state department of social and health services, medicaidp. division, that insurance producers engaged in the sale of supplemental long-term care insurance contracts have received the training required by this section and any rules adopted by the commissioner, and that producers have demonstrated an understanding of the partnership policies and their relationship to benefits offered under chapter 50B.04 RCW and public and private coverage of long-term care, including medicaid, in this state.

44 SB 5291 medicaid division, that insurance producers engaged in the sale of supplemental long-term care insurance contracts have received the training required by this section and any rules adopted by the commissioner, and that producers have demonstrated an understanding of the partnership policies and their relationship to benefits offered under chapter 50B.04 RCW and public and private coverage of long-term care, including medicaid, in this state.

34.33.

and p.(c) Maintain a copy of its suitability standards and make the standards available for inspection, upon request.

45 ESSB 5291 (c) Maintain a copy of its suitability standards and make the standards available for inspection, upon request.

and (c) The values, benefits, and costs of the applicant's existing health or long-term care coverage, if any, when compared to the values,p. benefits, and costs of the recommended purchase or replacement.

45 SB 5291 values, benefits, and costs of the recommended purchase or replacement.

35.34.

36.35.

37.36.

(1) The commissioner must adopt rules that include standards for full and fair disclosure setting forth the manner, content, and required disclosures for the sale of supplemental long-term care insurance policies, terms of p.renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms.

46 ESSB 5291 renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents, preexisting conditions, termination of insurance, continuation or conversion, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions of terms.

The commissioner must adopt rules to promote premium adequacy and to protect policyholders in the event of proposed substantial rate increases, and to establish minimum standards for producer education, marketing practices, producer compensation,p. producer testing, penalties, and reporting practices for supplemental long-term care insurance.

46 SB 5291 compensation, producer testing, penalties, and reporting practices for supplemental long-term care insurance.

38.37.

This information and counseling should educate these consumers as to potential out-of-pocket costs they may be p.subject to before supplemental long-term care insurance will begin paying claims and strategies for managing the gap between benefits payable under chapter 50B.04 RCW and coverage under supplemental long-term care insurance.

47 ESSB 5291 subject to before supplemental long-term care insurance will begin paying claims and strategies for managing the gap between benefits payable under chapter 50B.04 RCW and coverage under supplemental long-term care insurance.

NEWp. SECTION.

47 SB 5291 NEW SECTION.

39.38.

This chapter does not apply to supplemental long-term care insurance as defined in section 1918 of this act.

40.39.

41.40.

Sections 1716 through 3837 of this act constitute a new chapter in Title 48 RCW.

42.41.

43.42.

(5) Demographic information on program participants, including age, gender, race, ethnicity, geographic distribution by county, and legislative district((,district ((, and employment sector));

and p.(6) The extent to which the operation of the program has resulted in savings to the medicaid program by avoiding costs that would have otherwise been the responsibility of the state.

48 ESSB 5291 (6) The extent to which the operation of the program has resulted in savings to the medicaid program by avoiding costs that would have otherwise been the responsibility of the state.

44.43.

Sec.p.

45.48 SB 5291 Sec.

44.

46.45.

p.(3) An individual providing home care through a direct agreement with a recipient of care in an individual's permanent or temporary residence;

49 ESSB 5291 (3) An individual providing home care through a direct agreement with a recipient of care in an individual's permanent or temporary residence;

(7)p. Facilities and institutions, including but not limited to nursing homes under chapter 18.51 RCW, hospitals under chapter 70.41 RCW, adult family homes under chapter 70.128 RCW, assisted living facilities under chapter 18.20 RCW, developmental disability residential programs under chapter 71A.12 RCW, other entities licensed under chapter 71.12 RCW, or other licensed facilities and institutions, only when providing services to persons residing within the facility or institution;

49 SB 5291 (7) Facilities and institutions, including but not limited to nursing homes under chapter 18.51 RCW, hospitals under chapter 70.41 RCW, adult family homes under chapter 70.128 RCW, assisted living facilities under chapter 18.20 RCW, developmental disability residential programs under chapter 71A.12 RCW, other entities licensed under chapter 71.12 RCW, or other licensed facilities and institutions, only when providing services to persons residing within the facility or institution;

For the purposes of this subsection, "case management" means the assessment, coordination, authorization, planning, training, and monitoring of p.home health, hospice, and home care, and does not include the direct provision of care to an individual;

50 ESSB 5291 home health, hospice, and home care, and does not include the direct provision of care to an individual;

(17)p. A person who provides home care services without compensation;

50 SB 5291 (17) A person who provides home care services without compensation;

47.46.

SectionsThis 17 through 39 of this act taketakes effect MayJanuary 1, 2026.

NEW SECTION.

Sec.

48.

Sections 12 through 14 of this act take effect January 1, 2027.

NEW SECTION.

Sec.

49.

Sections 1 through 11, 15, 16, and 40 through 46 of this act take effect January 1, 2026.

51 ESSBSB 5291