(1) No long-term care insurance policy or
certificate delivered or issued for delivery in Montana shall use the terms set
forth below, unless the terms are defined in the policy or certificate and the
definitions satisfy the following requirements:
(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 non-medical 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) "Irreversible dementia" means deterioration or loss of intellectual
faculties, reasoning power, memory, and will due to organic brain disease
characterized by confusion, disorientation, apathy and stupor of varying
degrees which is not capable of being reversed and from which recovery is
impossible.
(12) "Medicare" shall be defined as "The Health Insurance for the
Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then
Constituted or Later Amended," or "Title 1, Part 1 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.
(13) "Mental or nervous disorder" shall be defined to include more than
neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional
disease or disorder.
(14) "Personal care" means the provision of hands-on services to
assist an individual with activities of daily living.
(15) "Skilled nursing care," "intermediate care," "personal
care," "home 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.
(16) "Toileting" means getting to and from the toilet, getting on and off
the toilet, and performing associated personal hygiene.
(17) "Transferring" means moving
into or out of a bed,
chair or
wheelchair.
(18) All
providers of services, including but not limited to "skilled nursing
facility," "extended care facility," "intermediate care
facility," "convalescent nursing home," "personal care
facility," and "home care agency" shall be defined in relation
to the services and facilities required to be available and the licensure or
degree status of those providing or supervising the services. The definition
may require that the provider be appropriately licensed or certified.