Connecticut Administrative Code › Title 38a - Insurance Department › 475 - Connecticut Partnership For Long Term Care › Section 38a-475-5 - Insurer documentation and reporting

Current through July 10, 2024
Unless otherwise noted, the requirements of subsections (a) to
				(f), inclusive, of this section refer to insurer documentation and reporting
				requirements for partnership-approved policies.
(a) Each insurer in fulfilling its reporting
			 requirements shall adhere to the most recent specifications set forth in the
			 Partnership For Long-Term Care Long-Term Care Insurance Uniform Data Set (UDS)
			 and Connecticut state-specific requirements as noted in the Connecticut
			 Partnership for Long-Term Care section of the state specific appendices of the
			 UDS documentation. All reports are due to the Office of Policy and Management
			 no later than thirty (30) days after the close of the reporting periods
			 specified for the respective reports.
(b)
Maintaining Auditing
			 Information.
Each insurer shall maintain information as stipulated in
			 subdivisions (1), (2) and (3) of this subsection, on all policyholders who have
			 ever received any benefit under the policy. Such information shall be updated
			 at least quarterly; but this requirement for updating shall not require the
			 conduct of any assessment, reassessment, or other evaluation of the
			 policyholder's condition which is not otherwise required by federal or state
			 statute or regulation. When a policyholder who has received any benefit dies or
			 lapses his policy for any other reason the insurer shall retain the stipulated
			 information for at least five years after the time when the policy ceases to be
			 in force. At the time the policy ceases to be in force, the insurer shall
			 notify the policyholder of their right to request their service records as
			 stipulated in subdivisions (1), (2) and (3) of this subsection. The insurer
			 shall also, upon request, provide such policyholder and the policyholder's
			 authorized agent, if any, with a complete copy of the insurer's service records
			 as stipulated in subdivisions (1), (2) and (3) of this subsection. These
			 records shall be provided to the policyholder and policyholder's authorized
			 agent, if any, within sixty days of the request. The insurer shall enclose with
			 the records a statement advising the former policyholder that it is in his or
			 her interests to retain the records if he or she may ever wish to establish
			 eligibility for Medicaid.
The information includes:
(1) Evidence that the Insured Event has taken
			 place. The occurrence of the Insured Event may be documented in any of the
			 following ways:
(A) By access agency staff, as
			 part of the initial assessment of the client or as part of a subsequent
			 reassessment.
(B) By an assessment
			 conducted by the Connecticut Home Care Program for the Elderly of the
			 Department of Social Services;
(C)
			 By an assessment of a resident of a Skilled Nursing Facility (SNF) or
			 Intermediate Care Facility (ICF) as required by section 1919 (b)(3) of the
			 Social Security Act;
(D) By an
			 assessment, carried out by or under the supervision of a physician or a
			 registered nurse, which is substantially comparable to any of the methods in
			 subparagraphs (a), (b) and (c) of this subdivision. Assessments described in
			 this subparagraph are valid only for persons for whom evidence was not
			 available or not provided in a manner described in subparagraphs (a), (b) or
			 (c) of this subdivision. These assessments shall be based on direct
			 observations and interviews in conjunction with a medical record review. The
			 physician or registered nurse carrying out or supervising the assessment shall
			 sign and certify the completion of the assessment. Each individual who
			 completes a portion of such assessment shall sign and certify as to the
			 accuracy of that portion of the assessment.