[§431:10H-219]  Minimum standards for homehealth and community care benefits.  (a)  A long-term care insurance policyor certificate shall not, if it provides benefits for home health care orcommunity care services, limit or exclude benefits by:

(1)  Requiring that the insured or claimant would needcare in a skilled nursing facility if home health care services were notprovided;

(2)  Requiring that the insured or claimant first orsimultaneously receive nursing or therapeutic services, or both, in a home,community, or institutional setting before home health care services arecovered;

(3)  Limiting eligible services to services providedby registered nurses or licensed practical nurses;

(4)  Requiring that a nurse or therapist provideservices covered by the policy that can be provided by a home health aide, orother licensed or certified home care worker acting within the scope of theperson's licensure or certification;

(5)  Excluding coverage for personal care servicesprovided by a home health aide;

(6)  Requiring that the provision of home health careservices be at a level of certification or licensure greater than that requiredby the eligible service;

(7)  Requiring that the insured or claimant have anacute condition before home health care services are covered;

(8)  Limiting benefits to services provided bymedicare-certified agencies or providers; or

(9)  Excluding coverage for adult day care service.

(b)  A long-term care insurance policy orcertificate, if it provides for home health or community care services, shallprovide total home health or community care coverage that is a dollar amountequivalent to at least one-half of one year's coverage available for nursinghome benefits under the policy or certificate, at the time covered home healthor community care services are being received.  This requirement shall notapply to policies or certificates issued to residents of continuing careretirement communities.

(c)  Home health care coverage may be appliedto nonhome health care benefits provided in the policy or certificate whendetermining maximum coverage under the terms of the policy or certificate. [L1999, c 93, pt of §2]