Nebraska Administrative Code › Topic - INSURANCE, DEPARTMENT OF › Title 210 - NEBRASKA DEPARTMENT OF INSURANCE › Chapter 46 - LONG-TERM CARE INSURANCE › Section 210-46-005 - Policy Definitions and Terms

Current through June 17, 2024
No long-term care insurance policy or certificate delivered
				  or issued for delivery in this state shall use the terms set forth below,
				  unless the terms are defined in the policy or certificate, and the definitions
				  satisfy the following requirements:
005.01 Activities of daily living
"Activities of daily living" means at least bathing,
				  continence, dressing, eating, toileting and transferring.
005.02 Adult day care
"Adult day care" means a program for six (6) 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.
005.03 Acute
				condition
"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.
005.04 Bathing
"Bathing" means 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.
005.05 Cognitive
				impairment
"Cognitive impairment" means a deficiency in a person's short
				  or long-term memory, orientation as to a person, place and time, deductive or
				  abstract reasoning, or judgment as it relates to safety
				  awareness.
005.06 Continence
"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).
005.07 Dressing
"Dressing" means putting on and taking off all items of
				  clothing and any necessary braces, fasteners or artificial
				  limbs.
005.08 Eating
"Eating" means feeding oneself by getting food into the body
				  from a receptacle (such as a plate, cup or table) or by feeding tube or
				  intravenously.
005.09
				Hands-on assistance
"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.
005.10 Home health care services
"Home health care services" means medical and non-medical
				  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.
005.11 Medicare
005.12 Mental or Nervous Disorder
"Mental or Nervous Disorder" shall not be defined to include
				  more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or
				  emotional disease or disorder.
005.13 Personal care
"Personal care" means the provision of hands-on services to
				  assist an individual with activities of daily living.
005.14 Residential care facility
"Residential care facility" means any institution, facility,
				  place or building in which there are provided for a period exceeding
				  twenty-four consecutive hours accommodation, board, and care, such as personal
				  assistance in feeding, dressing, and other essential daily living activities,
				  to four or more non-related individuals who by reason of illness, disease,
				  injury, deformity, disability, or physical or mental infirmity are unable to
				  sufficiently or properly care for themselves or manage their own affairs but do
				  not require the daily services of a licensed registered nurse or licensed
				  practical nurse.
005.15
				"Skilled nursing care", "intermediate care", "residential care", "personal
				care", "home health 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.
005.16
				"Skilled nursing facility", "intermediate care facility", "assisted-living
				facility" shall not be defined more restrictively than the definitions as set
				forth in
Neb.Rev.Stat.
§
									71-401
				et seq.
005.17 Custodial care
				facility
"Custodial care facility" shall not be defined more
				  restrictively than the definitions for "residential care facility" or
				  "assisted-living facility" as set forth in subsection 005.14 and 005.21 of this
				  regulation.
005.18 Toileting
"Toileting" means getting to and from the toilet, getting on
				  and off the toilet, and performing associated personal
				  hygiene.
005.19 Transferring
"Transferring" means moving into or out of a bed, chair or
				  wheelchair."
005.20 All
				providers of services, including but not limited to
,
"skilled nursing facility," "extended care facility," "intermediate care
				facility," "convalescent nursing home," "personal care facility," "home care
				agency," "residential care facility," and "assisted-living facility" 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.
005.21 Assisted Living
				Facility
005.21(A) Assisted-living facility
				means a facility where shelter, food, and care are provided for remuneration
				for a period of more than twenty-four consecutive hours to four or more persons
				residing at such facility who require or request such services due to age,
				illness, or physical disability as provided in
Neb.Rev.Stat.
§
										71-406.
005.21(B) Assisted-living facility does not
				include a home, apartment, or facility where (a) casual care is provided at
				irregular intervals or (b) a competent person residing in such home, apartment,
				or facility provides for or contracts for his or her own personal or
				professional services if no more than twenty-five percent of persons residing
				in such home, apartment, or facility receive such services as provided in
Neb.Rev.Stat.
§
										71-406.