Section 284-83-050 - Minimum standards for home health and community care benefits in long-term care insurance policies(1) If a long-term care insurance policy or certificate provides benefits for home health care or community care services, it must not limit or exclude benefits: (a) By requiring that the insured or claimant would need care in a nursing facility if home health care services were not provided;(b) By requiring that the insured or claimant first or simultaneously receive nursing or therapeutic services, or both, in a home, community, or institutional setting before home health care services are covered;(c) By limiting eligible services to services provided by registered nurses or licensed practical nurses;(d) By requiring that a nurse or therapist provide services covered under the policy that can be provided by a home health aide or other licensed or certified home care worker acting within the scope of his or her licensure or certification;(e) By excluding coverage for personal care services provided by a home health aide;(f) By requiring that the provision of home health care services be at a level of certification or licensure greater than that required by the eligible service;(g) By requiring that the insured or claimant have an acute condition before home health care services are covered;(h) By limiting benefits to services provided by medicare-certified agencies or providers; or(i) By excluding coverage for adult day care services.(2) If a long-term care insurance policy or certificate provides for home health or community care services, it must provide total home health or community care coverage that is a dollar amount equivalent to at least one-half of one year's coverage available for nursing home benefits under the policy or certificate, at the time covered home health or community care services are being received. This requirement does not apply to policies or certificates issued to residents of continuing care retirement communities.(3) Home health care coverage may be applied to the nonhome health care benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate. (a) This permits the home health care benefits to be counted toward the maximum length of long-term care coverage under the policy.(b) Home health care benefits must not be restricted to a period of time which would make the benefit illusory. For example, fewer than three hundred sixty-five benefit days and less than a twenty-five dollar daily maximum benefit are considered illusory home health care benefits.Wash. Admin. Code § 284-83-050
Statutory Authority: RCW 48.02.060, 48.83.070, 48.83.110, 48.83.120, 48.83.130(1), and 48.83.140(4)(a). 08-24-019 (Matter No. R 2008-09), § 284-83-050, filed 11/24/08, effective 12/25/08.