Utah Admin. Code R590-148-7 - Minimum Standards for Home Health and Community Care Benefits in a Long-Term Care Insurance Policy

(1) If a policy or certificate provides benefits for home health care services, it may not limit or exclude benefits by:

(a) requiring the insured would need care in a skilled nursing facility if home health care services are not provided;

(b) requiring the insured first or simultaneously receive nursing or therapeutic services, or both, in a home, community, or institutional setting before covering home health care services;

(c) limiting eligible services to services provided by a registered nurse or a licensed practical nurse;

(d) requiring that a nurse or therapist provide covered services that can be provided by a home health aide or other licensed or certified home care worker acting within the scope of the aide or worker's licensure or certification;

(e) excluding coverage for personal care services provided by a home health aide;

(f) requiring that the home health care services be at a level of certification or licensure greater than that required for the eligible service;

(g) requiring that the insured have an acute condition before covering home health care services; (h) limiting benefits to services provided by a Medicare-certified agency or provider; or

(i) excluding coverage for adult day care services.

(2) Home health care coverage may be applied to non-home health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.

(3)

(a) A policy or certificate, if it provides for home care or community care services, shall provide total home care or community care coverage that is a dollar amount equivalent to at least one-half of one year's coverage available for nursing home benefits under the policy or certificate, when covered home care or community care services are received.

(b) The requirement in Subsection (3)(a) does not apply to a policy or certificate issued to a resident of a continuing care retirement community.

Notes

Utah Admin. Code R590-148-7

Adopted by Utah State Bulletin Number 2024-21, effective 10/22/2024