Indiana Administrative Code › Title 760 - DEPARTMENT OF INSURANCE › Article 2 - LONG TERM CARE INSURANCE COVERAGE › Rule 20 - Indiana Long Term Care Program › Section 20-38 - Maintaining auditing information

Current through July 10, 2024
Authority: IC
				  27-8-12-7.1
Affected: IC
				  12-15-2; IC
				  12-15-39.6
Sec. 38.
(a) Each
				issuer shall maintain information as stipulated in subsection (f) on all
				policyholders or certificateholders who have ever received any benefit under
				the policy or certificate. Such information shall be updated at least
				quarterly. This requirement for updating shall not require the conduct of any
				assessment, reassessment, or other evaluation of the policyholder's or
				certificateholder's condition which is not otherwise required by federal or
				state statute or regulation.
(b)
				When a policyholder or certificateholder who has received any benefits dies or
				when a policyholder or certificateholder who has received any benefits lapses
				his or her policy or certificate for any reason, the issuer must retain the
				stipulated information for a period of at least five (5) years after the time
				the policy or certificate ceases to be in force or after the documented death
				of the policyholder or certificateholder. Unless notified by the department of
				insurance to the contrary during this period, after the five (5) years, the
				service summary provided by the issuer will be deemed to comply with all asset
				protection reporting, record keeping, and auditing requirements of this rule.
				The issuer may use microfiche, microfilm, optical storage media, or any other
				cost effective method of record storage as alternatives to storage of paper
				copies of stipulated information.
(c) At the time the policy or certificate
				ceases to be in force, the issuer shall notify the policyholder or
				certificateholder of his or her right to request his or her service records as
				stipulated in subsection (f).
(d)
				The issuer shall also, upon request in writing, provide such policyholder or
				certificateholder or the policyholder's or certificateholder's authorized
				designee, if any, with a copy of the issuer's service records as required in
				subsection (f) which are necessary to establish the asset disregard. These
				records shall be provided to the policyholder or certificateholder or the
				policyholder's or certificateholder's authorized designee, if requested, within
				sixty (60) days of the request. The issuer may charge a reasonable fee to cover
				the costs of providing each set of requested service record copies.
(e) The issuer shall enclose with the records
				a statement advising the former policyholder or certificateholder that it is in
				his or her interest to retain the records if he or she may ever wish to
				establish eligibility for Medicaid.
(f) The information to be maintained includes
				the following:
(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 case
				management agency staff, as part of the initial assessment of the client or as
				part of a subsequent reassessment.
(B) By an assessment conducted as part of the
				preadmission screening program of DDARS.
(C) By an assessment of a resident of a
				nursing facility as required by Section 1919(b)(3) of the Social Security Act.
				(D) For persons for whom clauses (A) through (C) are not available or do not
				provide the required information, 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 clauses (A) through (C). These assessments
				must 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 must 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.