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62A.49 HOME CARE SERVICES COVERAGE.
    Subdivision 1. Generally. Section 62A.48 does not prohibit the sale of policies, certificates,
subscriber contracts, or other evidences of coverage that provide home care services only. Home
care services only policies may be sold, provided that they meet the requirements set forth in
sections 62A.46 to 62A.56, except that they do not have to meet those conditions that relate to
long-term care in nursing facilities. Disclosures and representations regarding these policies must
be adjusted accordingly to remove references to coverage for nursing home care.
    Subd. 2. Provider networks and managed care. Home health care services issued pursuant
to this section may be provided through a limited provider network and may employ managed
care practices. If these methods are used, they must be adequately disclosed within the policy and
any advertisements or representations regarding coverage. Policies may not be sold in areas where
there are not sufficient providers to meet the needs of the policyholders located in that area.
    Subd. 3. Prohibited limitations. A long-term care insurance policy or certificate shall not, if
it provides benefits for home health care or community care services, limit or exclude benefits by:
(1) requiring that the insured would need care in a skilled nursing facility if home health care
services were not provided;
(2) requiring that the insured first or simultaneously receive nursing or therapeutic services
in a home, community, or institutional setting before home health care services are covered;
(3) limiting eligible services to services provided by a registered nurse or licensed practical
nurse;
(4) 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 licensure or certification;
(5) excluding coverage for personal care services provided by a home health aide;
(6) 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;
(7) requiring that the insured have an acute condition before home health care services
are covered;
(8) limiting benefits to services provided by Medicare-certified agencies or providers;
(9) excluding coverage for adult day care services; or
(10) excluding coverage based upon location or type of residence in which the home health
care services would be provided.
History: 1994 c 485 s 32; 1996 c 446 art 1 s 38; 1Sp2003 c 14 art 2 s 4

Official Publication of the State of Minnesota
Revisor of Statutes