Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3103 - POLICY DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) No long-term
				care insurance policy or certificate delivered or issued for delivery in
				Montana may use the terms set forth below, unless the terms are defined in the
				policy or certificate as follows in this rule.
(2) "Activities of daily living" as defined
				in
				33-22-1107(1),
				MCA.
(3) "Acute condition" means
				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.
(4) "Adult day care" means 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 frail, impaired
				elderly or other disabled adults who can benefit from care in a group setting
				outside the home.
(5) "Bathing"
				means washing oneself by sponge bath, or in a tub or shower, including the task
				of getting into or out of the tub or shower.
(6) "Cognitive impairment" means 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.
(7) "Continence" means
				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).
(8) "Dressing" means putting on
				and taking off all items of clothing and any necessary braces, fasteners or
				artificial limbs.
(9) "Eating"
				means feeding oneself by getting food into the body from a receptacle (such as
				a plate, cup or table) or by a feeding tube or intravenously.
(10) "Hands-on assistance" means physical
				assistance (minimal, moderate or maximal) without which the individual would
				not be able to perform the activity of daily living.
(11) "Home health care services" means
				medical and nonmedical services, provided to ill, disabled or infirm persons in
				their residences. Such services may include homemaker services, assistance with
				activities of daily living, and respite care services.
(12) "Irreversible dementia" means
				deterioration or loss of intellectual faculties, reasoning power, memory, and
				will due to organic brain disease characterized by confusion, disorientation,
				apathy and stupor of varying degrees which is not capable of being reversed and
				from which recovery is impossible.
(13) "Medicare" shall be defined as "The
				Health Insurance for the Aged Act, Title XVIII of the Social Security
				Amendments of 1965 as Then Constituted or Later Amended," or "Title 1, Part 1
				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.
(14) "Mental or nervous disorder" shall not
				be defined to include more than neurosis, psychoneurosis, psychopathy,
				psychosis, or mental or emotional disease or disorder.
(15) "Personal care" means the provision of
				hands-on services to assist an individual with activities of daily living.
(16) "Skilled nursing care,"
				"personal care," "home care," "specialized care," "assisted living care," and
				other services shall be defined in relation to the level of skill required, the
				nature of the care, and the setting in which care must be delivered.
(17) "Toileting" means getting to and from
				the toilet, getting on and off the toilet, and performing associated personal
				hygiene.
(18) "Transferring" means
				moving into or out of a bed, chair or wheelchair.
(19) 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, or registered,
				or when the state licenses, certifies, or registers the provider of services
				under another name.
AUTH:
					 33-1-313,
					 33-22-1121, MCA
					 IMP:
					 33-22-1101,
					 33-22-1102,
					 33-22-1103,
					 33-22-1107,
					 33-22-1108,
					 33-22-1111,
					 33-22-1112,
					 33-22-1113,
					 33-22-1114,
					 33-22-1115,
					 33-22-1116,
					 33-22-1117,
					 33-22-1119,
					 33-22-1120,
					 33-22-1121,
					 MCA