§ 18-110. Policy limitations and exclusions -- Home health care services

   (a) "Home health care services" defined. --

   (1) In this section, "home health care services" means medical or nonmedical services provided to ill, disabled, or infirm individuals in their residences.

   (2) "Home health care services" includes:

      (i) homemaker services;

      (ii) assistance with activities of daily living; and

      (iii) respite care services.

(b) Coverage required. -- A policy or certificate of long-term care insurance that provides benefits for home health care services may not limit or exclude benefits by:

   (1) requiring that the insured would need care in a nursing facility if home health care services were not provided;

   (2) requiring that the insured first or simultaneously receive nursing or therapeutic services at home or in a community setting before home health care services are covered.

   (3) limiting eligible services provided by registered nurses or licensed practical nurses;

   (4) requiring that a nurse or therapist provide services covered by the policy or certificate of long-term care insurance that can be provided by a home health aide or other licensed or certified home care worker who acts within the scope of licensure or certification;

   (5) requiring that the insured have an acute condition before home health care services are covered; or

   (6) limiting benefits to services provided by Medicare-certified agencies or providers.

(c) Maximum coverage. -- Coverage for home health care services may be applied to the coverage for other benefits provided in the policy or certificate of long-term care insurance when determining maximum coverage under the terms of the policy or certificate.

HISTORY: An. Code 1957, art. 48A, § 642, 645; 1997, ch. 35, § 2.