Connecticut Administrative Code › Title 38a - Insurance Department › 475 - Connecticut Partnership For Long Term Care › Section 38a-475-2 - Definitions

Current through July 10, 2024
As used in sections
				38a-475-1
				to
				38a-475-6,
				inclusive:
(a) "Connecticut
			 Partnership for Long-Term Care" means the program authorized in section
			 17b-252
			 of the general statutes.
(b)
			 "Long-Term Care Insurance Policy" means an insurance policy or certificate, the
			 form of which has been approved by the commissioner in accordance with section
			 38a-481
			 or section
			 38a-513
			 of the general statutes, which meets the requirements of section
			 38a-501
			 or section
			 38a-528
			 of the general statutes and sections
			 38a-501-8
			 to
			 38a-501-24,
			 inclusive, or sections
			 38a-528-1
			 to
			 38a-528-17,
			 inclusive, of the regulations of Connecticut state agencies.
(c) "Partnership-Approved Policy" or
			 "Precertified Long-Term Care Insurance Policy" or "Precertified Policy" means
			 any long-term care insurance policy that is a qualified long-term care policy
			 as defined in section 7702B(b) of the Internal Revenue Code of 1986 issued for
			 delivery to any resident of this state which is designed to provide, within the
			 terms and conditions of the policy, contract or certificate, benefits on an
			 expense-incurred, indemnity or prepaid basis for necessary care or treatment of
			 an injury, illness or loss of cognitive or functional capacity provided by a
			 certified or licensed health care provider in a setting other than an acute
			 care hospital, for no less than one (1) year at issue after a reasonable
			 elimination period and the form of which is precertified by the insurance
			 department in accordance with section
			 38a-475
			 of the general statutes.
(d)
			 "Commissioner" means the insurance commissioner.
(e) "Activities of Daily Living (ADLs)" means
			 each of the following items: dressing, bathing, eating, toileting, continence
			 and transferring. In each instance, an ADL deficiency is determined by
			 reference to the need for substantial human assistance or supervision in
			 performing that activity.
(f)
			 "Mental Status Questionnaire (MSQ)" means the Short Portable questionnaire
			 comprised of 10 questions for clinicians to grade a person's cognitive
			 status.
(g) "Folstein Mini Mental
			 State Examination" means a method for clinicians to grade a person's cognitive
			 status.
(h) "Asset Protection"
			 means the right extended by sections
			 17b-252
			 and
			 17b-253
			 of the general statutes to persons purchasing partnership-approved long-term
			 care insurance policies to retain amounts of assets equal to the sum of
			 qualifying insurance payments made on their behalf in determining eligibility
			 for the Medicaid program.
(i)
			 "Authorized Agent" means a person who has been designated as agent by the
			 insured in writing to the insurance company, or is acting for the insured under
			 a duly executed power of attorney, or is the insured's duly appointed
			 conservator or guardian.
(j)
(1) "Insured Event" means, for purposes of
			 determining asset protection for a privately insured individual, that any one
			 of the following criteria shall have been satisfied:
(A) The individual has a documented need for
			 substantial human assistance, or supervision, with two or more of the following
			 Activities of Daily Living (ADL's): dressing, bathing, eating, toileting,
			 continence and transferring; or
(B)
			 The individual has been assessed using the Mental Status Questionnaire, and has
			 seven or more incorrect responses on the test; or
(C) The individual exhibits specific behavior
			 problems requiring daily supervision, including but not limited to wandering,
			 abusive or assaultive behavior, poor judgement or uncooperativeness which poses
			 a danger to self or others, and extreme or bizarre personal hygiene habits; and
			 has either taken the MSQ and has four or more incorrect responses, or has taken
			 the Folstein Mini Mental State Examination and achieved a score of 23 or
			 lower.