Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 52 - INSURANCE POLICIES › Section 836-052-0516 - Policy Definitions

Current through Register Vol. 63, No. 7, July 1, 2024
A long-term care insurance policy delivered or issued for
				delivery in this state shall not use the terms set forth in this rule unless
				the terms are defined in the policy according to the definitions in this rule
				and satisfy the requirements in OAR 836-052-0596:
(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 and 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) "Adult foster
			 care" means any family home or facility in which residential care is provided
			 in a homelike environment for five or fewer adults who are not related to the
			 provider by blood or marriage.
(5)
			 "Assisted living" services means services to persons with unique needs, such
			 as, but not limited to, dementia or traumatic brain injury.
(6) "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.
(7)
			 "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.
(8) "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).
(9) "Dressing" means putting on and taking
			 off all items of clothing and any necessary braces, fasteners or artificial
			 limbs.
(10) "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.
(11) "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.
(12) "Home 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.
(13) "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.
(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) "Residential care"
			 means the provision of room and board and services that assist the resident in
			 activities of daily living, such as assistance with bathing, dressing,
			 grooming, eating, medication management, money management or
			 recreation.
(17) "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.
(18) "Toileting" means
			 getting to and from the toilet, getting on and off the toilet, and performing
			 associated personal hygiene.
(19)
			 "Transferring" means moving into or out of a bed, chair or
			 wheelchair.
(20) All providers of
			 services, including but not limited to "skilled nursing facility," "extended
			 care facility," "convalescent nursing home," "personal care facility,"
			 "specialized care provider," "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.
Stat. Auth.: ORS
				  731.244,
				  742.023,
				  743.013,
				  743.655,
				  743.656 &
				  746.240
Stats. Implemented: ORS
				  731.244,
				  742.003,
				  742.005,
				  742.009,
				  743.010(3),
				  743.013(3),
				  743.650,
				  743.653,
				  743.655,
				  743.656 &
				  746.240