Ga. Comp. R. & Regs. R. 120-2-16-.05 - Policy Definitions
No long-term care insurance policy delivered or issued for delivery in this state shall use the terms set forth below, unless the terms are defined in the policy and the definitions satisfy the following requirements:
(1) "Activities of daily
living" means at least bathing, continence, dressing, eating, toileting and
transferring.
(2) "Acute condition"
means that the individual is medically unstable. Such an individual requires
frequent monitoring by medical professionals, such as physicians and registered
nurses, in order to maintain his or her health status.
(3) "Adult day care" means a program for six
or more individuals, of social and health-related services provided during the
day in a community group setting for the purpose of supporting frail, impaired
elderly or other disabled adults who can benefit from care in a group setting
outside the home.
(4) "Bathing"
means washing oneself by sponge bath; or in either a tub or shower, including
the task of getting into or out of the tub or shower.
(5) "Cognitive impairment" means a deficiency
in a person's short or long-term memory, orientation as to person, place and
time, deductive or abstract reasoning, or judgment as it relates to safety
awareness.
(6) "Continence" means
the ability to maintain control of bowel and bladder function; or, when unable
to maintain control of bowel or bladder function, the ability to perform
associated personal hygiene (including caring for catheter or colostomy
bag).
(7) "Dressing" means putting
on and taking off all items of clothing and any necessary braces, fasteners or
artificial limbs.
(8) "Eating"
means feeding oneself by getting food into the body from a receptacle (such as
a plate, cup or table) or by a feeding tube or intravenously.
(9) "Hands-on assistance" means physical
assistance (minimal, moderate or maximal) without which the individual would
not be able to perform the activity of daily living.
(10) "Home health care services" means
medical and nonmedical services, provided to ill, disabled or infirm persons in
their residences. Such services may include homemaker services, assistance with
activities of daily living and respite care services.
(11) "Medicare" means "The Health Insurance
for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then
Constituted or Later Amended," or "Title I, Part I of Public Law 89-97, as
Enacted by the Eighty-Ninth Congress of the United States of America and
popularly known as the Health Insurance for the Aged Act, as then constituted
and any later amendments or substitutes thereof," or words of similar
import.
(12) "Mental or nervous
disorder" shall not be defined to include more than neurosis, psychoneurosis,
psychopathy, psychosis, or mental or emotional disease or disorder.
(13) "Personal care" means the provision of
hands-on services to assist an individual with activities of daily
living.
(14) "Skilled nursing
care," "personal care," "home care," "specialized care," "assisted living care"
and other services shall be defined in relation to the level of skill required,
the nature of the care and the setting in which care must be
delivered.
(15) "Toileting" means
getting to and from the toilet, getting on and off the toilet, and performing
associated personal hygiene.
(16)
"Transferring" means moving into or out of a bed, chair or
wheelchair.
(17) All providers of
services, including but not limited to "skilled nursing facility," "extended
care facility," "convalescent nursing home," "personal care facility,"
"specialized care providers," "assisted living facility," and "home care
agency" shall be defined in relation to the services and facilities required to
be available and the licensure, certification, registration or degree status of
those providing or supervising the services. When the definition requires that
the provider be appropriately licensed, certified or registered, it shall also
state what requirements a provider must meet in lieu of licensure,
certification or registration when the state in which the service is to be
furnished does not require a provider of these services to be licensed,
certified or registered, or when the state licenses, certifies or registers the
provider of services under another name.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.