La. Admin. Code tit. 37 § XIII-1907

Current through Register Vol. 50, No. 6, June 20, 2024
Section XIII-1907 - Policy Definitions
A. 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.

Activities of Daily Living- at least bathing, continence, dressing, eating, toileting, and transferring.

Acute Condition- 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-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 adults who are frail, impaired and elderly, or have other disabilities and who can benefit from care in a group setting outside the home.

Bathing- 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- 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- 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- putting on and taking off all items of clothing and any necessary braces, fasteners, or artificial limbs.

Eating- feeding oneself by getting food into the body from a receptacle (such as a plate, cup, or table) or by feeding tube or intravenously.

Hands-On Assistance- 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-medical and nonmedical services provided in their residences to persons who are ill, have a disability, or have an infirmity. Such services may include homemaker services, assistance with activities of daily living, and respite care services.

Medicare- "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.

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- the provision of hands-on services to assist an individual with activities of daily living.

Skilled Nursing Care, Intermediate Care, Personal Care, Home Care and Other Services-Repealed.

Toileting- getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

Transferring- 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, 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.

B. 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 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, registered, or when the state licenses, certifies, or registers the provider of services under another name.

La. Admin. Code tit. 37, § XIII-1907

Promulgated by the Department of Insurance, Office of the Commissioner, LR 19:1153 (September 1993), amended LR 23:976 (August 1997), Amended LR 431394 (7/1/2017) (effective 1/1/2018), Amended LR 45279 (2/1/2019).
AUTHORITY NOTE: Promulgated in accordance with R.S. 22:1186(A), 22:1186(E), 22:1188(C), 22:1189, and 22:1190.