(1) A long-term care insurance policy or
certificate may not, if it provides benefits for homehealth care services,
limit or exclude benefits:
(a) by
requiring that the insured or claimant would need skilled care in a skilled
nursing facility if home health care services were not provided;
(b) by
requiring that the insured or claimant first or simultaneously receive nursing
or therapeutic services in a home, community or institutional setting before
home health care services are covered;
(c) by
limiting eligible services to services provided by registered nurses or
licensed practical nurses;
(d) by
requiring that a nurse or therapist provide services covered by the policy or
certificate that can be provided by a home health aide, or other licensed or
certified home care worker acting withing the scope of his or her licensure of
certification;
(e) by
excluding coverage for personal care services provided by a home health aide;
(f) by
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;
(g) by
requiring that the insured or claimant have an acute condition before home
health care services are covered;
(h) by
limiting benefits to services provided by medicare-certified agencies or
providers.
(i) by excluding coverage for adult day
care services.
(2) A long-term care insurance policy
or certificate, if it provides for home health or community care services,
shall provide total home health or community care coverage that is a dollar
amount equivalent to at least one-half of one year's coverage available
for nursing home benefits under the policy or certificate, at the time covered
home health or community care
services
are being received. This requirement shall not apply to policies or
certificates issued to residents of continuing care retirement communities.
(3) Home
health care coverage may be applied to the non-home health care benefits
provided in the policy or certificate when determining maximum coverage under
the terms of the policy or certificate.