Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 37 - LONG-TERM CARE REGULATION › Section 37-5 - Policy Definitions

Current through July 13, 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 persons's short or long-term memory, orientation as to persons, 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.
(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 or wheelchair.
(q) All providers of services, including but
				not limited to "nursing care facility," "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.