PART II. LONG-TERM CARE INSURANCE MODEL REGULATION

 

§431:10H-201  Policy definitions.  (a) No long-term care insurance policy delivered or issued for delivery in thisState shall use the terms set forth in this section, unless the terms aredefined in the policy and the definitions satisfy the following requirements:

"Activities of daily living" means atleast bathing, continence, dressing, eating, toileting, and transferring.

"Acute condition" means that theindividual is medically unstable.  This individual requires frequent monitoringby medical professionals such as physicians and registered nurses, in order tomaintain the individual's health status.

"Adult day care" means a program forsix or more individuals, of social and health-related services provided duringthe day in a community group setting for the purpose of supporting frail,impaired elderly or other disabled adults who can benefit from care in a groupsetting outside the home.

"Bathing" means washing oneself bysponge bath, or in either a tub or shower, including the task of getting intoor out of the tub or shower.

"Cognitive impairment" means adeficiency in a person's short- or long-term memory, orientation as to person,place, and time, deductive or abstract reasoning, or judgment as it relates tosafety awareness.

"Continence" means the ability tomaintain control of bowel and bladder function, or when unable to maintaincontrol of bowel or bladder function, the ability to perform associatedpersonal hygiene (including caring for catheter or colostomy bag).

"Dressing" means putting on andtaking off all items of clothing and any necessary braces, fasteners, orartificial limbs.

"Eating" means feeding oneself bygetting food into the body from a receptacle (such as a plate, cup, or table)or by a feeding tube or intravenously.

"Hands-on assistance" means physicalassistance (minimal, moderate, or maximal) without which the individual wouldnot be able to perform the activity of daily living.

"Home health care services" means medicaland nonmedical services, provided to ill, disabled, or infirm persons in theirresidences.  These services may include homemaker services, assistance withactivities of daily living, and respite care services.

"Medicare" shall be defined as"The Health Insurance for the Aged Act, Title XVIII of the Social SecurityAmendments of 1965 as Then Constituted or Later Amended", or Title I,Part I of Public Law 89-97, as Enacted by the Eighty-Ninth Congress of theUnited States of America and popularly known as the Health Insurance for theAged Act, as then constituted and any later amendments or substitutes thereof,or words of similar import.

"Mental or nervous disorder" meansneurosis, psychoneurosis, psychopathy, psychosis, or mental or emotionaldisease or disorder, and shall not be defined beyond these terms.

"Personal care" means the provisionof hands-on services to assist an individual with activities of daily living.

"Skilled nursing care","personal care", "home care", "specialized care","assisted living care", and other services shall be defined inrelation to the level of skill required, the nature of the care, and thesetting in which care must be delivered.

"Toileting" means getting to and fromthe toilet, getting on and off the toilet, and performing associated personalhygiene.

"Transferring" means moving into orout of a bed, chair, or wheelchair.

(b)  All providers of services, including butnot limited to a "skilled nursing facility", "extended carefacility", "convalescent nursing home", "personal carefacility", "assisted living facility", "home careagency", and "specialized care providers" shall be defined inrelation to the services and facilities required to be available and the licensure,certification, registration, or degree status of those providing or supervisingthe services.  The definition may require that the provider be appropriatelylicensed, certified, or registered; provided that when the definition sorequires, it shall also state what requirements a provider shall meet in lieuof licensure, certification, or registration when the state in which theservice is to be furnished does not require a provider of these services to belicensed, certified, or registered, or when the state licenses, certifies, orregisters the provider of services under another name. [L 1999, c 93, pt of §2;am L 2007, c 233, §10]