Subdivision 1. Applicability.
The definitions in this section apply to sections
Subd. 2. Long-term care policy.
"Long-term care policy" means an individual or group
policy, certificate, subscriber contract, or other evidence of coverage that provides benefits for
prescribed long-term care, including nursing facility services or home care services, or both
nursing facility services and home care services, pursuant to the requirements of sections
do not apply to a long-term care policy
issued to (a) an employer or employers or to the trustee of a fund established by an employer
where only employees or retirees, and dependents of employees or retirees, are eligible for
coverage or (b) to a labor union or similar employee organization. The associations exempted
from the requirements of sections
62A.31, subdivision 1
, clause (c)
shall not be subject to the provisions of sections
until July 1, 1988.
Subd. 3. Nursing facility.
"Nursing facility" means (1) a facility that is licensed as a nursing
home under chapter 144A; (2) a facility that is both licensed as a boarding care home under
and certified as an intermediate care facility for purposes of the medical
assistance program; and (3) in states other than Minnesota, a facility that meets licensing and
certification standards comparable to those that apply to the facilities described in clauses (1)
Subd. 4. Home care services.
"Home care services" means one or more of the following
prescribed services for the long-term care and treatment of an insured that are provided by a
home health agency in a noninstitutional setting according to a written diagnosis or assessment
and plan of care:
(1) nursing and related personal care services under the direction of a registered nurse,
including the services of a home health aide;
(2) physical therapy;
(3) speech therapy;
(4) respiratory therapy;
(5) occupational therapy;
(6) nutritional services provided by a licensed dietitian;
(7) homemaker services, meal preparation, and similar nonmedical services;
(8) medical social services; and
(9) other similar medical services and health-related support services.
Subd. 5. Prescribed long-term care.
"Prescribed long-term care" means a service, type of
care, or procedure that could not be omitted without adversely affecting the patient's illness or
condition and is specified in a plan of care prepared by either: (1) a physician and a registered
nurse and is appropriate and consistent with the diagnosis; or (2) a registered nurse or licensed
social worker based on an assessment of the insured's ability to perform the activities of daily
living and to perform basic cognitive functions appropriately.
Subd. 6. Qualified insurer.
"Qualified insurer" means an entity licensed under chapter
62A or 62C.
Subd. 7. Physician.
"Physician" means a medical practitioner licensed or holding a
temporary permit under sections
, or holding a residency permit
Subd. 8. Plan of care.
"Plan of care" means a written document prepared and signed by
either: (1) a physician and registered nurse that specifies medically prescribed long-term care
services or treatment that are consistent with the diagnosis; or (2) by a registered nurse or licensed
social worker that specifies prescribed long-term care services or treatment that are consistent
with an assessment of the insured's ability to perform the activities of daily living and to perform
basic cognitive functions appropriately. The plan of care must be prepared in accordance with
accepted standards of practice and must contain services or treatment that could not be omitted
without adversely affecting the patient's illness or condition.
Subd. 9. Insured.
"Insured" means a person covered under a long-term care policy.
Subd. 10. Home health agency.
"Home health agency" means an entity that provides home
care services and is (1) certified for participation in the Medicare program; or (2) licensed as a
home health agency where a state licensing statute exists, or is otherwise acceptable to the insurer
if licensing is not required.
Subd. 11. Benefit period.
"Benefit period" means one or more separate or combined periods
of confinement covered by a long-term care policy in a nursing facility or at home while receiving
home care services. A benefit period begins on the first day the insured receives a benefit under
the policy and ends when the insured has received no benefits for the same or related cause for
an interval of 180 consecutive days.
Subd. 12. Homebound or house confined.
"Homebound or house confined" means that a
person is physically unable to leave the home without another person's aid because the person has
lost the capacity of independent transportation or is disoriented.
Subd. 13. Benefit day.
"Benefit day" means each day of confinement in a nursing facility
or each visit for home care services. For purposes of section
62A.48, subdivision 1
, if the
policyholder receives more than one home care service visit within a 24-hour period, each visit
constitutes one benefit day.
History: 1986 c 397 s 3; 1987 c 337 s 58; 1989 c 330 s 18; 1990 c 551 s 1-4; 1993 c 21 s 1;
1995 c 258 s 31,32; 1996 c 446 art 1 s 36; 2005 c 17 art 1 s 14