North Dakota Administrative Code › Title 45 - Insurance, Commissioner of › Article 45-06 - Accident and Health Insurance › Chapter 45-06-05.1 - LONG-TERM CARE INSURANCE MODEL REGULATION › Section 45-06-05.1-03 - Policy definitions

Current through Supplement No. 393, July, 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:
1. "Activities of daily
				living" means at least bathing, continence, dressing, eating, toileting, and
				transferring.
2. "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 the individual's health status.
3. "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.
4. "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.
5. "Cognitive impairment" means a deficiency
				in a person's short-term or long-term memory; orientation as to person, place,
				and time; deductive or abstract reasoning; or judgment as it relates to safety
				awareness.
6. "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.
7. "Dressing" means putting on
				and taking off all items of clothing and any necessary braces, fasteners, or
				artificial limbs.
8. "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.
9. "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.
10. "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.
11. "Medicare" means "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.
12. "Mental or nervous disorder"
				shall not be defined to include more than neurosis, psychoneurosis,
				psychopathy, psychosis, or mental or emotional disease or disorder.
13. "Personal care" means the provision of
				hands-on services to assist an individual with activities of daily
				living.
14. "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.
15. "Toileting" means getting to and from the
				toilet, getting on and off the toilet, and performing associated personal
				hygiene.
16. "Transferring" means
				moving into or out of a bed, chair, or wheelchair.
17. All providers of services, including
				"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 the provider be appropriately licensed ,
				certified, or registered, it also must 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.
General Authority:
NDCC 28-32-02
Law Implemented:
NDCC 26.1-45