02-031 C.M.R. ch. 425, § 5 - Policy Definitions

Current through 2022-14, April 6, 2022

No long-term care insurance policy shall use the terms set forth in this section unless the terms are defined in the policy and are consistent with the following definitions:

A. "Activities of daily living" means, at a minimum, bathing, continence, dressing, eating, toileting and transferring.

B. "Acute condition" means that the individual is medically unstable and requires frequent monitoring by medical professionals, such as physicians and registered nurses, in order to maintain his or her health status.

C. "Adult day care" means a program for six or more individuals of social and health-related services provided during the 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 group setting outside the home.

D. "Bathing" means washing oneself by sponge bath, or in a tub or shower, including the task of getting into or out of the tub or shower.

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

F. "Continence" means the ability to maintain control of bowel or bladder functions, or, when unable to maintain such control, the ability to perform associated personal hygiene, including caring for a catheter or colostomy bag.

G. "Dressing" means putting on and taking off all items of clothing and any necessary brace, fastener or artificial limb.

H. "Eating" means feeding by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenous line.

I. "Hands-on assistance" means physical assistance (minimal, moderate or maximal) without which the individual would not be able to perform the activity of daily living.

J. "Home health care services" means medical and non-medical services rendered in their residences to ill, disabled or infirm persons, including homemaker services, assistance with activities of daily living and respite care.

K. "Medicare" means "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments 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 the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof," or words of similar import.

L. "Mental or nervous disorder" means any one of the following: neurosis, psychoneurosis, psychopathy, psychosis, or other mental or emotional disease or disorder.

M. "Personal care" means the rendering of hands-on services by another person to assist the individual in the activities of daily living.

N. "Skilled nursing care," "personal care," "home care," "specialized care," "assisted living care" and other service described in the policy shall be defined in relation to the level of skill required, the nature of the care and the setting in which the services are provided.

O. "Skilled nursing facility," "extended care facility," "convalescent nursing home," "personal care facility," "specialized care providers," "assisted living facility," and "home care agency" and all other service providers shall be defined in relation to the facilities and the required available services, together with the licensure, certification, registration or degree status of the persons who provide services and those who supervise the services. When the definition requires that the provider be appropriately licensed, certified or registered, it shall also state what requirements a provider must meet in lieu of licensure, certification or registration when the state in which the service is to be furnished does not require a provider of these services to be licensed, certified or registered, or when the state licenses, certifies or registers the provider of services under another name.

P. "Toileting" means getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

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

Notes

02-031 C.M.R. ch. 425, § 5