Section 45-06-05-03 - Policy definitions No long-term care insurance policy delivered or issued for delivery in this state may use the terms set forth in this section, unless the terms are defined in the policy and the definitions satisfy the following requirements:
1. "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 the individual's health status. 2. "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. 3. "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. 4. "Medicare" must 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. 5. "Mental or nervous disorder" may not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder. 6. "Personal care" means the provisions of hands-on services to assist an individual with activities of daily living (such as bathing, eating, dressing, transferring, continence, and toileting). 7. "Skilled nursing care", "intermediate care", "personal care", "home care", and other services must be defined in relation to the level of skill required, the nature of the care, and the setting in which care must be delivered. 8. All providers of services, including "skilled nursing facility", "extended care facility", "intermediate care facility", "convalescent nursing home", "personal care facility", and "home care agency" must 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. N.D. Admin Code 45-06-05-03
Effective July 1, 1988; amended effective July 1, 1994.General Authority: NDCC 28-32-02
Law Implemented: NDCC 26.1-45