West Virginia Code of State Rules › Agency 114 - Insurance Commission › Title 114 - LEGISLATIVE RULE INSURANCE COMMISSIONER › Series 114-32 - Long-Term Care Insurance › Section 114-32-3 - Policy Definitions

Current through Register Vol. XLI, No. 28, July 12, 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:
3.1. "Activities of daily living" means at least
				bathing, continence, dressing, eating, toileting and transferring.
3.2. "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 his or
				her health status.
3.3. "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.
3.4. "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.
3.5. "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.
3.6.
				"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).
3.7. "Dressing" means putting on
				and taking off all items of clothing and any necessary braces, fasteners or
				artificial limbs.
3.8. "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.
3.9. "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.
3.10. "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.
3.11. "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.
3.12. "Mental or nervous disorder" shall not be
				defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or
				mental or emotional disease or disorder.
3.13. "Personal care" means the provision of
				hands-on services to assist an individual with activities of daily living.
3.14. "Skilled nursing care," "intermediate 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.
3.15. "Toileting" means getting to and from the
				toilet, getting on and off the toilet, and performing associated personal
				hygiene.
3.16. "Transferring" means
				moving into or out of a bed, chair or wheelchair.
3.17. All providers of services, including but not
				limited to "skilled nursing facility," "extended care facility," "intermediate 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 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.