Michigan Laws 500.3913 – Home health care benefits
Current as of: 2023 | Check for updates
|
Other versions
(1) A long-term care insurance policy shall not limit or exclude services for home health care benefits in any of the following ways:
(a) By requiring that the insured would need skilled care in a skilled nursing facility if home health care services were not provided.
Terms Used In Michigan Laws 500.3913
- Acute condition: means that the individual is medically unstable, requiring frequent monitoring by medical professionals in order to maintain his or her health status. See Michigan Laws 500.3901
- Home care services: means 1 or more of the following prescribed services or assessment team recommended services for the long-term care and treatment of an insured that are to be provided in a noninstitutional setting according to a written diagnosis and plan of care or individual assessment and plan of care:
(i) Nursing services under the direction of a registered nurse, including the service of a home health aide. See Michigan Laws 500.3901Long-term care insurance: means an individual or group insurance policy, certificate, or rider advertised, marketed, offered, or designed to provide coverage for at least 12 consecutive months for each covered person on an expense-incurred, indemnity, prepaid, or other basis for 1 or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance, personal, or custodial care services provided in a setting, including an assisted living facility operating legally in this state, but not including an acute care unit of a hospital. See Michigan Laws 500.3901 Policy: means an insurance policy or certificate, rider, or endorsement delivered or issued for delivery in this state by an insurer or subsidiary of a nonprofit health care corporation. See Michigan Laws 500.3901 Skilled nursing facility: means a facility, or a distinct part of a facility, certified by the department of community health to provide skilled nursing care. See Michigan Laws 500.3901
(b) By requiring that the insured first or simultaneously receive nursing or therapeutic services in a home or community 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 by 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 requiring that the insured have an acute condition before home health care services are covered.
(f) By limiting benefits to services provided by medicare-certified agencies or providers.
(2) Home health care coverage may be applied to the nonhome health care benefits provided in the policy when determining maximum coverage under the terms of the policy.
(3) A long-term care insurance policy that provides coverage for home care services or assisted living services shall define and provide a detailed explanation in plain English of what home care services or assisted living services are covered. A long-term care insurance policy that provides coverage for assisted living facility stays shall define in plain English what assisted living facilities are covered.