Louisiana Administrative Code › Title 37 - INSURANCE › Part XIII - Regulations › Chapter 19 - Regulation 46-Long-Term Care Insurance › Section XIII-1907 - Policy Definitions

Current through Register Vol. 50, No. 6, June 20, 2024
A. No
				long-term care insurance policy delivered or issued for delivery in this state
				shall use the terms set forth below, unless the terms are defined in the policy
				and the definitions satisfy the following requirements.
Activities of Daily Living
- at least
				  bathing, continence, dressing, eating, toileting, and transferring.
Acute Condition
- that the individual is
				  medically unstable. Such an individual requires frequent monitoring by medical
				  professionals, such as physicians and registered nurses, in order to maintain
				  his or her health status.
Adult Day Care
-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 adults who are frail,
				  impaired and elderly, or have other disabilities and who can benefit from care
				  in a group setting outside the home.
Bathing
- washing oneself by sponge bath; or
				  in either a tub or shower, including the task of getting into or out of the tub
				  or shower.
Cognitive Impairment
- a deficiency in a
				  person's short or long-term memory, orientation as to person, place, and time,
				  deductive or abstract reasoning, or judgment as it relates to safety
				  awareness.
Continence
- the ability to maintain control
				  of bowel and bladder function; or, when unable to maintain control of bowel or
				  bladder function, the ability to perform associated personal hygiene (including
				  caring for catheter or colostomy bag).
Dressing
- putting on and taking off all
				  items of clothing and any necessary braces, fasteners, or artificial
				  limbs.
Eating
- feeding oneself by getting food into
				  the body from a receptacle (such as a plate, cup, or table) or by feeding tube
				  or intravenously.
Hands-On Assistance
- physical assistance
				  (minimal, moderate, or maximal) without which the individual would not be able
				  to perform the activity of daily living.
Home Health Care Services
-medical and
				  nonmedical services provided in their residences to persons who are ill, have a
				  disability, or have an infirmity. Such services may include homemaker services,
				  assistance with activities of daily living, and respite care services.
Medicare
- "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.
Mental or Nervous Disorder
- shall not be
				  defined to include more than neurosis, psychoneurosis, psychopathy, psychosis,
				  or mental or emotional disease or disorder.
Personal Care
- the provision of hands-on
				  services to assist an individual with activities of daily living.
Skilled Nursing Care, Intermediate Care, Personal
				  Care, Home Care and Other Services
-Repealed.
Toileting
- getting to and from the toilet,
				  getting on and off the toilet, and performing associated personal
				  hygiene.
Transferring
- moving into or out of a bed,
				  chair, or wheelchair.
All providers of services including, but not limited to,
Skilled Nursing Facility, Extended Care Facility, Intermediate Care
				  Facility, Convalescent Nursing Home, Personal Care Facility, and Home Care
				  Agency
-shall be defined in relation to the services and facilities
				  required to be available and the licensure or degree status of those providing
				  or supervising the services. The definition may require that the provider be
				  appropriately licensed or certified.
B. All providers of services including, but
				not limited to, skilled nursing facility, extended care facility, convalescent
				nursing home, personal care facility, specialized care providers, assisted
				living facility, and home care agency shall be defined in relation to the
				services and facilities required to be available and the licensure,
				certification, registration, or degree status of those providing or supervising
				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, registered, or when the state
				licenses, certifies, or registers the provider of services under another
				name.
AUTHORITY NOTE:
				  Promulgated in accordance with
				  R.S.
				  22:1186(A),
				  22:1186(E),
				  22:1188(C),
				  22:1189,
				  and
				  22:1190.