210 Neb. Admin. Code, ch. 46, § 005

Current through September 17, 2024
Section 210-46-005 - Policy Definitions and Terms

No long-term care insurance policy or certificate delivered or issued for delivery in this state shall use the terms set forth below, unless the terms are defined in the policy or certificate, and the definitions satisfy the following requirements:

005.01 Activities of daily living

"Activities of daily living" means at least bathing, continence, dressing, eating, toileting and transferring.

005.02 Adult day care

"Adult day care" means a program for six (6) 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.

005.03 Acute condition

"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.

005.04 Bathing

"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.

005.05 Cognitive impairment

"Cognitive impairment" means a deficiency in a person's short or long-term memory, orientation as to a person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.

005.06 Continence

"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).

005.07 Dressing

"Dressing" means putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.

005.08 Eating

"Eating" means feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by feeding tube or intravenously.

005.09 Hands-on assistance

"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.

005.10 Home health care services

"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.

005.11 Medicare
005.12 Mental or Nervous Disorder

"Mental or Nervous Disorder" shall not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder.

005.13 Personal care

"Personal care" means the provision of hands-on services to assist an individual with activities of daily living.

005.14 Residential care facility

"Residential care facility" means any institution, facility, place or building in which there are provided for a period exceeding twenty-four consecutive hours accommodation, board, and care, such as personal assistance in feeding, dressing, and other essential daily living activities, to four or more non-related individuals who by reason of illness, disease, injury, deformity, disability, or physical or mental infirmity are unable to sufficiently or properly care for themselves or manage their own affairs but do not require the daily services of a licensed registered nurse or licensed practical nurse.

005.15 "Skilled nursing care", "intermediate care", "residential care", "personal care", "home health 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.
005.16 "Skilled nursing facility", "intermediate care facility", "assisted-living facility" shall not be defined more restrictively than the definitions as set forth in Neb.Rev.Stat. § 71-401 et seq.
005.17 Custodial care facility

"Custodial care facility" shall not be defined more restrictively than the definitions for "residential care facility" or "assisted-living facility" as set forth in subsection 005.14 and 005.21 of this regulation.

005.18 Toileting

"Toileting" means getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

005.19 Transferring

"Transferring" means moving into or out of a bed, chair or wheelchair."

005.20 All providers of services, including but not limited to, "skilled nursing facility," "extended care facility," "intermediate care facility," "convalescent nursing home," "personal care facility," "home care agency," "residential care facility," and "assisted-living facility" 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.
005.21 Assisted Living Facility
005.21(A) Assisted-living facility means a facility where shelter, food, and care are provided for remuneration for a period of more than twenty-four consecutive hours to four or more persons residing at such facility who require or request such services due to age, illness, or physical disability as provided in Neb.Rev.Stat. § 71-406.
005.21(B) Assisted-living facility does not include a home, apartment, or facility where (a) casual care is provided at irregular intervals or (b) a competent person residing in such home, apartment, or facility provides for or contracts for his or her own personal or professional services if no more than twenty-five percent of persons residing in such home, apartment, or facility receive such services as provided in Neb.Rev.Stat. § 71-406.

210 Neb. Admin. Code, ch. 46, § 005