760 IAC 2-6-1 - Minimum standards for home health and community care benefits
Authority: IC 27-8-12-7
Affected: IC 27-8-12
Sec. 1.
(a) A long
term care insurance policy, certificate, or subscriber agreement shall not, if
it provides benefits for home health and community care services, limit or
exclude benefits as follows:
(1) By requiring
that the insured/claimant need skilled care in a skilled nursing facility if
home health care services were not provided.
(2) By requiring that the insured/claimant
first or simultaneously receive nursing and/or therapeutic services in a home,
community, or institutional setting before home health care services are
covered.
(3) By limiting eligible
services to services provided by registered nurses or licensed practical
nurses.
(4) By requiring that a
nurse or therapist provide services covered by the policy that can be provided
by a home health aide, or other licensed or certified home care worker acting
within the scope of his or her licensure or certification.
(5) By requiring that the insured/claimant
have an acute condition before home health care services are covered.
(6) By limiting benefits to services provided
by Medicare-certified agencies or providers.
(7) By excluding coverage for personal care
services provided by a home health aide.
(8) By requiring that the provision of home
health care services be at a level of certification or licensure greater than
that required by the eligible service.
(9) By excluding coverage for adult day care
services.
(b) Home health
care coverage may be applied to the nonhome health care benefits provided in
the policy or certificate when determining maximum coverage under the terms of
the policy, certificate, or subscriber agreement.
(c) A long term care insurance policy,
certificate, or subscriber agreement, if it provides for home health or
community care services, shall provide total home health or community care
coverage that is a dollar amount equivalent to at least one-half (1/2) of one
(1) year's coverage available for nursing home benefits under the policy,
certificate, or subscriber agreement, at the time covered home health or
community care services are being received. This requirement shall not apply to
policies, certificates, or subscriber agreements issued to residents of
continuing care retirement communities.
Notes
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No prior version found.