Virginia Administrative Code › Title 14 - INSURANCE › Agency 5 - STATE CORPORATION COMMISSION, BUREAU OF INSURANCE › Chapter 200 - RULES GOVERNING LONG-TERM CARE INSURENCE › Section 14VAC5-200-50 - Policy definitions

Current through Register Vol. 40, No. 24, July 15, 2024
No long-term care insurance policy delivered or issued for
				  delivery in this Commonwealth shall use the terms set forth below, unless the
				  terms are defined in the policy and the definitions satisfy the following
				  requirements:
"Activities of daily living" means at least bathing,
				  continence, dressing, eating, toileting and transferring.
"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.
"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.
"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.
"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.
"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).
"Dressing" means putting on and taking off all items of
				  clothing and any necessary braces, fasteners or artificial limbs.
"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.
"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.
"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.
"Medicaid" means the program administered in accordance with
				  Title 32.1 of the Code of Virginia.
"Medicare" means "The Health Insurance for the Aged Act,
				  Title XVIII of the Social Security Amendments of 1965" ( 42 USC § 1395 et
				  seq.), or "Title 1, 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" ( Public Law 89-97 79 Stat. 286 July 30, 1965), or
				  words of similar import.
"Mental or nervous disorder" shall not be defined to include
				  more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or
				  emotional disease or disorder.
"Personal care" means the provision of hands-on services to
				  assist an individual with activities of daily living.
"Skilled nursing care," "personal care," "home health 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.
"Toileting" means getting to and from the toilet, getting on
				  and off the toilet, and performing associated personal hygiene.
"Transferring" means moving into or out of a bed, chair or
				  wheelchair.
All providers of services, including but not limited to
				  "skilled nursing facility," "extended care facility," "convalescent nursing
				  home," "personal care facility," "specialized care providers," "assisted living
				  facility," and "home health 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. 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.
Statutory Authority
§§ 12.1-13 and 38.2-223 of the Code of Virginia.