New Mexico Administrative Code › Title 13 - INSURANCE › Chapter 10 - HEALTH INSURANCE › Part 15 - LONG-TERM CARE INSURANCE › Section 13.10.15.8 - USE OF CERTAIN POLICY TERMS

Current through Register Vol. 35, No. 13, July 16, 2024
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.
A.
Activities of
				daily living
means at least bathing, continence, dressing, eating,
				toileting and transferring.
B.
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.
C.
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.
D.
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.
E.
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.
F.
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).
G.
Dressing
means putting on and taking off all items of clothing and any
				necessary braces, fasteners or artificial limbs.
H.
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.
I.
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.
J.
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.
K.
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 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.
L.
Mental or
				nervous disorder
shall not be defined to include more than neurosis,
				psychoneurosis, psychopathy, psychosis, or mental or emotional disease or
				disorder.
M.
Personal
				care
means the provision of hands-on services to assist an individual
				with activities of daily living (such as bathing, eating, dressing,
				transferring and toileting).
N.
Skilled nursing care, intermediate care, personal care, home
				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.
O.
Toileting
means getting to and from the toilet, getting on and off the
				toilet, and performing associated personal hygiene.
P.
Transferring
means moving
				into or out of a bed, chair or wheelchair.
Q.
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.