reglab/statecodes huggingface dataset:
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58021 - Licensed Health Care Practitioner

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Licensed Health Care Practitioner" means any physician
						(as defined in Title 42, United States Code, Section
						1395 x(r)(1)) and any registered
						professional nurse, licensed social worker, or other individual who meets such
						requirements as may be prescribed by the Secretary of the Treasury.
The Licensed Health Care Practitioner must be employed by
						a Care Management Provider Agency or be a Qualified Official Designee of a Care
						Management Provider Agency.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Repealer and new section filed 10-1-98 as an emergency;
						operative 10-1-98. Submitted to OAL for printing only pursuant to Welfare and
						Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order,
						including amendment of section, transmitted to OAL 1-28-99 and filed 3-15-99
						(Register 99, No. 12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22006(c),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58022 - Long-Term Care Services Countable Toward Medi-Cal Property Exemption

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Long-Term Care Services Countable Toward Medi-Cal
						Property Exemption" means those services that may be covered in a Policy or
						Certificate which will qualify for the Medi-Cal Property Exemption. These
						services include the following:
(a)
					 long-term care in nursing facilities, as defined in Sections
					 51120 and
					 51123;
(b) home health services, as defined in
					 Section 51337;
(c) home and community-based services
					 approved under 42 U.S.C.
					 Section 1396n(c), and
					 provided in the Welfare and Institutions Code, Section
					 14132(s) and
					 (t);
(d) Residential Care Facility
					 Services;
(e) personal care
					 services as defined in California Code of Regulations, Title 22, Section
					 51183;
(f) adult day health care services as defined
					 in California Code of Regulations, Title 22, Section
					 54103;
(g) hospice services as defined in California
					 Code of Regulations, Title 22, Sections
					 51180 through
					 51180.7; and
(h) other services approved by the Department
					 of Health Services.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58022 to section
						58020 and renumbering and
						amendment of former section
						58023 to section
						58022 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a)(3),
						  Welfare and Institutions Code. Reference: Section
						  22006,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58023 - Medi-Cal Asset Protection

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Medi-Cal Asset Protection" means the right extended to
						the insured by California when the insured uses the benefits of this Policy.
						This right allows the insured to protect one dollar of assets for every dollar
						this Policy pays out in benefits, in the event the insured later applies for
						Medi-Cal benefits or for other qualifying State long-term care benefits. The
						amount of this asset protection at any time is equal to the sum of all benefit
						payments made for the insured's care by this Policy. Should the insured later
						apply for Medi-Cal benefits or for other qualifying public long-term care
						benefits, he or she will not be required to expend the protected assets prior
						to becoming eligible for these public benefits. The insured's protected assets
						will also be exempt from any claim the State of California may have against his
						or her estate to recover the costs of State-paid long-term care or medical
						services provided to the insured.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58023 to section
						58022 and new section
						58023 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22004
						  and
						  22006(c),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58024 - Medi-Cal Property Exemption

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Medi-Cal Property Exemption" means the total equity
						value of real and personal property not otherwise exempt under Medi-Cal
						regulations (California Code of Regulations, Title 22, Section
						50000 et seq.) equal to the sum of
						qualifying insurance benefit payments made on behalf of the
						insured.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Amendment filed 10-1-98 as an emergency; operative 10-1-98.
						Submitted to OAL for printing only pursuant to Welfare and Institutions Code
						section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22001,
						  22003,
						  22006,
						  22008.5
						  and
						  22009(c)(2),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58025 - Partnership Long-Term Care Insurance Policy or Certificate, or Partnership Policy or Certificate

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Partnership Long-Term Care Insurance Policy or
						Certificate" or "Partnership Policy or Certificate" means any long-term care
						insurance Policy or Certificate approved by the Department of Health Services
						and the Department of Insurance for issue or delivery to California residents
						as meeting the requirements set forth in Section
						22005(e)
						of the Welfare and Institutions Code.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58025 to section
						58026 and new section
						58025 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Sections
						  22005
						  and
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58026 - Personal Care Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Personal Care Services" means:
(a) Ambulation assistance, including help in
					 walking or moving around (i.e. wheelchair) outside or inside the place of
					 residence, changing locations in a room, moving from room to room to gain
					 access for the purpose of engaging in other activities. Ambulation assistance
					 does not include movement solely for the purpose of exercise.
(b) Bathing and grooming including cleaning
					 the body using a tub, shower or sponge bath, including getting a basin of
					 water, managing faucets, getting in and out of tub or shower, reaching head and
					 body parts for soaping, rinsing, and drying. Grooming includes hair combing and
					 brushing, shampooing, oral hygiene, shaving and fingernail and toenail
					 care.
(c) Dressing including
					 putting on and taking off, fastening and unfastening garments and
					 undergarments, and special devices such as back or leg braces, corsets, elastic
					 stockings/garments and artificial limbs or splints.
(d) Bowel, bladder and menstrual care
					 including assisting the person on and off toilet or commode and emptying
					 commode, managing clothing and wiping and cleaning body after toileting,
					 assistance with using and emptying bedpans, ostomy and/or catheter receptacles
					 and urinals, application of diapers and disposable barrier pads.
(e) Repositioning, transfer skin care, and
					 range of motion exercises, including moving from one sitting or lying position
					 to another sitting or lying position; e.g., from bed to or from a wheelchair,
					 or sofa, coming to a standing position and/or rubbing skin and repositioning to
					 promote circulation and prevent skin breakdown. Motion exercises shall include
					 the carrying out of maintenance programs, i.e. the performance of the
					 repetitive exercises required to maintain function, improve gait, maintain
					 strength or endurance, passive exercises to maintain range of motion in
					 paralyzed extremities, and assistive walking.
(f) Feeding, hydration assistance, including
					 reaching for, picking up, grasping utensil and cup; getting food on utensil;
					 bringing food, utensil, cup to mouth, and manipulating food on plate. Cleansing
					 face and hands as necessary following meal.
(g) Assistance with self-administration of
					 medications.
(h) Assistance with
					 Instrumental Activities of Daily Living, which include:
(1) domestic or cleaning services;
(2) laundry services;
(3) reasonable food shopping and
					 errands;
(4) meal preparation and
					 cleanup;
(5) transportation
					 assistance to and from medical appointments; and,
(6) heavy cleaning which involves thorough
					 cleaning of the home to remove hazardous debris or dirt; and,
(7) using the telephone.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58027 - Plan of Care

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Plan of Care" means a written individualized plan of
						services prescribed by a Licensed Health Care Practitioner which specifies the
						type, frequency, and providers of all Formal and Informal Long-Term Care
						Services required for the individual, and the cost, if any, of any Formal
						Long-Term Care Services prescribed. Changes in the Plan of Care must be
						documented to show that such alterations are required by changes in the
						client's medical situation, functional and/or cognitive abilities, behavioral
						abilities or the availability of social supports.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58027 to section
						58028 and renumbering and
						amendment of former section
						58026 to section
						58027 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22005(a)
						  and
						  22006(b),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58028 - Policy

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Policy" means any contract, rider, or endorsement
						delivered or issued for delivery in the State of California by an
						Issuer.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58028 to section
						58030 and renumbering and of
						former section
						58027 to section
						58028 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58029 - Qualified Long-Term Care Services

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Qualified Long-Term Care Services" means necessary
						diagnostic, preventive, therapeutic, curing, treating, mitigating, and
						rehabilitative services, and maintenance or personal services which are needed
						to assist the insured with the disabling conditions that cause the insured to
						be a Chronically Ill Individual.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58029 to section
						58031 and new section
						58029 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22006(c),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58030 - Qualified Official Designee of a Care Management Provider Agency

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Qualified Official Designee of a Care Management
						Provider Agency" means an individual who meets the Care Manager/Coordinator
						qualifications and is designated by the Care Management Provider Agency to
						certify the insured is a Chronically Ill Individual and/or to perform Care
						Management/Care Coordination.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58030 to section
						58032 and renumbering and
						amendment of former section
						58028 to section
						58030 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005(a),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58031 - Quarterly/Annually

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Quarterly/Annually", unless otherwise stated, refers to
						periods aligned with the State Fiscal Year of July 1 to June
						30.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order, including amendment of section, transmitted to OAL 12-30-93 and
						filed 1-28-94 (Register 94, No. 4).
3. Renumbering of former section
						58031 to section
						58033 and renumbering of former
						section 58029 to section
						58031 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005(d),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58032 - Residential Care Facility

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Residential Care Facility" means a facility licensed as
						a Residential Care Facility for the Elderly or a residential care facility as
						defined in the California Health and Safety Code. Outside California, eligible
						providers are facilities licensed or certified by the appropriate state agency
						to provide ongoing care and related services sufficient to support needs
						resulting from an inability to perform Activities of Daily Living or Severe
						Cognitive Impairment or if no licensure or certification is required,
						facilities engaged primarily in providing on-going care and related services
						sufficient to support needs resulting from an inability to perform Activities
						of Daily Living or Severe Cognitive Impairment and which also:
(a) provide such care and services on a
					 twenty four (24) hour a day basis; and
(b) have a trained ready-to-respond employee
					 on duty in the facility at all times to provide such care and services;
					 and
(c) provide three meals a day
					 and accommodates special dietary needs; and
(d) have arrangements to ensure that
					 residents receive the medical care services of a physician or nurse in case of
					 emergency; and
(e) have appropriate
					 methods and procedures to provide necessary assistance to residents in the
					 management of prescribed medications.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58032 to section
						58034 and renumbering of former
						section 58030 to section
						58032, including amendment of
						section and NOTE, filed 10-1-98 as an emergency; operative 10-1-98. Submitted
						to OAL for printing only pursuant to Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  10232.92,
						  Insurance Code; and Section
						  22006,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58033 - Respite Care

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Respite Care" means the supervision and care of
						Chronically Ill Individuals in the home or out of the home while the family or
						other individuals who normally provide care take short-term leave or rest that
						provides them with temporary relief from the responsibilities of
						caregiving.
A Partnership Long-Term Care Insurance Policy or
						Certificate shall not, if it provides Respite Care, limit or exclude benefits
						by requiring that the provision of Respite Care be at a level of certification
						or licensure greater than that required by the eligible service or by limiting
						benefits to services provided by Medicare-certified agencies or
						providers.
Eligible providers for Respite Care include: a Nursing
						Facility, a Residential Care Facility, community-based programs such as an
						Adult Day Health/Social Care provider, persons employed by a home health
						agency, and a person who is qualified by training and/or experience to provide
						the care.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering of former section
						58033 to section
						58036 and renumbering of former
						section 58031 to section
						58033, including amendment of
						section and NOTE, filed 10-1-98 as an emergency; operative 10-1-98. Submitted
						to OAL for printing only pursuant to Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  10232.9,
						  Insurance Code; Sections
						  22005(b)
						  and
						  22006(c),
						  Welfare and Institutions Code; 42 Code of Federal Regulations Section
						  488.1 et
						  seq.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58034 - Service Summary

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Service Summary" means a written summary, prepared by an
						issuer for a qualified insured, which identifies the following:
(a) the Partnership Policy or
					 Certificate,
(b) the total benefits
					 paid for services as of the end of the previous quarter,
(c) the total benefits paid for services in
					 the current quarter,
(d) the total
					 amount of benefits paid as of the end of the previous quarter qualifying for a
					 Medi-Cal Property Exemption,
(e)
					 The total amount of benefits paid for services in the current quarter
					 qualifying for a Medi-Cal Property Exemption, and
(f) remaining benefit amount.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Renumbering and amendment of former section
						58032 to new section
						58034 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22003(b),
						  22004
						  and
						  22005(b),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58035 - Severe Cognitive Impairment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Severe Cognitive Impairment" means a loss or
						deterioration in intellectual capacity that:
(a) is comparable to (and includes)
					 Alzheimer's disease and similar forms of irreversible dementia and;
(b) is measured by clinical evidence and
					 standardized tests prescribed or approved by the California Partnership for
					 Long-Term Care.
1. New
						section filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for
						printing only pursuant to Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
2. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22003,
						  22004
						  and
						  22005,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58036 - Shortened Benefit Period Nonforfeiture Benefit

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Shortened Benefit Period Nonforfeiture Benefit" means
						that, when premiums cease being paid, the covered benefits will be paid by the
						Issuer at the rate specified in the Partnership Policy or Certificate but the
						lifetime maximum benefit payable will be reduced to an amount less than
						provided in the Partnership Policy or Certificate at date of
						issue.
1.
						Renumbering and amendment of former section
						58033 to new section
						58036 filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
2. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005(b),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58037 - Standby Assistance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Standby Assistance" means the presence of another person
						within arm's reach of the insured that is necessary to prevent, by physical
						intervention, injury to the insured while the insured is performing an Activity
						of Daily Living (such as being ready to catch insured if he or she falls while
						getting into or out of the bathtub or shower as part of bathing, or being ready
						to remove food from the insured's throat if he or she chokes while
						eating).
1. New
						section filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for
						printing only pursuant to Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
2. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22003(b),
						  22004
						  and
						  22005(d),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 1 - DEFINITIONS › Section 58038 - Substantial Supervision

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
"Substantial Supervision" means continual supervision
						(which may include cuing by verbal prompting, gestures, or other
						demonstrations) by another person that is necessary to protect a person who has
						Severe Cognitive Impairment from threats to his or her health or safety (such
						as may result from wandering).
1. New
						section filed 10-1-98 as an emergency; operative 10-1-98. Submitted to OAL for
						printing only pursuant to Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
2. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Section
						  22005(b),
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 2 - CONDITIONS OF ISSUER PARTICIPATION › Section 58050 - Issuer Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Each issuer must offer, prominently advertise, and actively market a
					 Partnership Comprehensive Policy or Certificate (paying benefits on an expense
					 incurred or expense reimbursable basis) that contains the following minimum
					 benefits:
(1) a lifetime maximum benefit set
					 in dollars and equivalent in dollars to three hundred sixty-five (365) times
					 eighty percent (80%) of the Average Daily Private Pay Rate for Nursing
					 Facilities;
(2) a thirty-day
					 Elimination Period;
(3) coverage
					 for services in a nursing facility and coverage of the home and community-based
					 care services as specified in Section
					 58059(e);
(4) a Respite Care benefit not subject to an
					 Elimination Period;
(5) Care
					 Management/Care Coordination;
(6)
					 except for previously approved Partnership Policies, if offered on an expense
					 reimbursable basis,
(A) a nursing facility per
					 diem benefit of eighty (80%) of the Average Daily Private Pay Rate for Nursing
					 Facilities, rounded to the nearest multiple of ten dollars ($10);
(B) a Residential Care Facility
					 benefit;
(C) a monthly home and
					 community-based care benefit of fifty percent (50%) of the nursing facility per
					 diem benefit contained in the Partnership Policy or Certificate multiplied by
					 thirty; and
(D) automatic increases
					 of five percent (5%) each year over the previous year for each year the
					 contract is in force for all covered benefits and for the lifetime maximum
					 benefit;
(7) except for
					 previously approved Partnership Policies if offered on an expense incurred
					 basis,
(A) benefits that pay eighty percent
					 (80%) of the costs incurred by the insured for nursing facility services up to
					 eighty percent (80%) of the Average Daily Private Pay Rate for Nursing
					 Facilities, rounded to the nearest one dollar ($1);
(B) benefits that pay eighty percent (80%) of
					 the costs incurred by the insured for care in a Residential Care Facility up to
					 fifty percent (50%) of the Average Daily Private Pay Rate for Nursing
					 Facilities, rounded to the nearest one dollar ($1);
(C) benefits that pay eighty percent (80%) of
					 the costs incurred by the insured for home and community-based care;
(D) a lifetime maximum benefit that
					 automatically increases by five percent (5%) each year over the previous year
					 for each year the contract is in force; and
(8) all other benefits and provisions defined
					 in Sections
					 58059(f), (g) and
					 (
l
), 58060, and 58061.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 2 - CONDITIONS OF ISSUER PARTICIPATION › Section 58051 - Targeting Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Issuers may issue or deliver Partnership individual Policies or Certificates to
					 California residents only.
(b)
					 Issuers are responsible for taking appropriate measures to assure that a
					 substantial number and proportion of their total sales of Partnership Policies
					 or Certificates each year are to individuals within the target population. The
					 target population for the purchase of a Partnership Policy or Certificate or
					 replacement of current long-term care coverage with a Partnership Policy or
					 Certificate is California residents between the ages of 55 and 74 years old
					 with assets greater than 365 times eighty percent (80%) of the Average Daily
					 Private Pay Rate for Nursing Facilities and with annual incomes less than the
					 seventy-fifth (75) percentile for their age cohort, provided that the annual
					 premium for the Partnership Policy or Certificate does not exceed seven percent
					 (7%) of the prospective purchaser's annual income. The California Partnership
					 for Long-Term Care shall annually distribute to participating Issuers the
					 annual incomes equivalent to the seventy-fifth (75) percentile in the target
					 populations based on data from the U.S. Department of Commerce, Bureau of the
					 Census Current Population Survey.
Individuals with ages outside the target population,
						and/or with assets lower or incomes higher than the target population, are
						eligible to purchase Partnership Policies or Certificates.
(c) Each prospective Issuer, prior to
					 approval by the Department of Health Services, shall submit a detailed
					 marketing plan describing the Issuer's strategy for marketing a substantial
					 number and proportion of their total sales of Partnership Policies and
					 Certificates to the target population. The Issuer's marketing plan will cover
					 the following issues:
(1) identify the
					 primary and secondary markets and how marketing efforts directed to these
					 markets will result in sales to individuals in the target population;
(2) describe the distribution and sale system
					 to be used, the marketing methods to be used, and how these are appropriate to
					 reach the target population;
(3)
					 detail the resources and materials to be used and how these will result in
					 sales to the target population; and
(4) describe the methods to be used to
					 monitor success in marketing a substantial portion of their Partnership
					 Policies and Certificates to the target population.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 2 - CONDITIONS OF ISSUER PARTICIPATION › Section 58054 - Conversion of Certified Policies and Certificates to Non-Certified Status. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order transmitted to OAL 12-30-93 and filed 1-28-94 (Register 94, No.
						4).
3. Repealer filed 10-1-98 as an emergency; operative 10-1-98.
						Submitted to OAL for printing only pursuant to Welfare and Institutions Code
						section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22004
						  and
						  22005,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 2 - CONDITIONS OF ISSUER PARTICIPATION › Section 58055 - Issuer's Liability

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Issuers of Partnership Policies or Certificates approved
						by the California Partnership for Long-Term Care shall be held liable for
						intentional or fraudulent material misrepresentation made by any agent, broker,
						solicitor, or Issuer representative regarding any feature or benefit of a
						Partnership Policy or Certificate that causes financial harm to the Policy or
						Certificate holder. In addition to any other applicable requirements of
						California Insurance Code, the Issuer shall be liable for the difference
						between the benefit promised by the agent, broker, solicitor, or other Issuer
						representative and the actual benefit provided under the Policy or Certificate.
						The liability of Issuers shall not diminish or otherwise mitigate the statutory
						obligations and liabilities of licensed agents and brokers, solicitors, or
						other Issuer representatives.
1. New
						section filed 8-30-93 as an emergency; operative 8-30-93 (Register 93, No. 36).
						Submitted for printing only pursuant to section
						22009,
						Welfare and Institutions Code.
2. Certificate of Compliance as to
						8-30-93 order, including amendment of section, transmitted to OAL 12-30-93 and
						filed 1-28-94 (Register 94, No. 4).
3. Amendment filed 10-1-98 as an
						emergency; operative 10-1-98. Submitted to OAL for printing only pursuant to
						Welfare and Institutions Code section
						22009(d)
						(Register 98, No. 41). A Certificate of Compliance must be transmitted to OAL
						by 1-29-99 or emergency language will be repealed by operation of law on the
						following day.
4. Certificate of Compliance as to 10-1-98 order
						transmitted to OAL 1-28-99 and filed 3-15-99 (Register 99, No.
						12).
Note: Authority cited: Section
						  22009(a),
						  Welfare and Institutions Code. Reference: Sections
						  22001,
						  22003,
						  22004,
						  22005
						  and
						  22006,
						  Welfare and Institutions Code.
California Code of Regulations › Title 22 - Social Security › Division 3 - Health Care Services › Subdivision 1 - California Medical Assistance Program › Chapter 8 - CALIFORNIA PARTNERSHIP FOR LONG-TERM CARE › Article 2 - CONDITIONS OF ISSUER PARTICIPATION › Section 58058 - Conditions Governing Discontinuance of Sales by the Issuer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Pursuant to the authority granted by Welfare and
						Institutions Code Section
						22005(e)
						and Insurance Code Section
						12921, the
						following shall apply:
(a) No
					 Partnership Long-Term Care Insurance Policy or Certificate shall be sold,
					 transferred, or otherwise ceded to another Issuer without first having obtained
					 approval from the Commissioner of the Department of Insurance.
(b) The Commissioner of the Department of
					 Insurance shall not approve any sale, transfer, or ceding of any Partnership
					 Long-Term Care Insurance Policy or Certificate if such action would result in
					 premium increases for either the transferred Policy or Certificate holders or
					 the Partnership Policies or Certificates that were not transferred, unless the
					 Commissioner determines such a sale, transfer, or ceding to be in the public
					 interest. The provision does not apply to:
(1)
					 any reinsurance agreement or transaction in which the ceding Issuer continues
					 to remain directly liable for its insurance obligations or risks under the
					 contracts of insurance subject to the reinsurance agreement; and
(2) the ceding Issuer remains responsible for
					 complying with all requirements of this Chapter and those imposed by Insurance
					 Code Sections
					 1070 et
					 seq. and
					 1090 et
					 seq.