§ 58-55-35. Facilities, services, and conditions defined.
§ 58‑55‑35. Facilities, services, and conditions defined.
(a) Whenever long‑termcare insurance provides coverage for the facilities, services, or physical ormental conditions listed below, unless otherwise defined in the policy andcertificate, and approved by the Commissioner, such facilities, services, orconditions are defined as follows:
(1) "Adult carehome" shall be defined in accordance with the terms of G.S. 131D‑2.1(3).
(1a) "Adult day careprogram" shall be defined in accordance with the provisions of G.S. 131D‑6(b).
(2) "Chore"services include the performance of tasks incidental to activities of dailyliving that do not require the services of a trained homemaker or otherspecialist. Such services are provided to enable individuals to remain in theirown homes and may include such services as: assistance in meeting basic careneeds such as meal preparation; shopping for food and other necessities;running necessary errands; providing transportation to essential servicefacilities; care and cleaning of the house, grounds, clothing, and linens.
(3) "Combinationhome" shall be defined in accordance with the terms of G.S. 131E‑101(1a).
(4) Repealed by SessionLaws 1995, c. 535, s. 3.
(5) "Family carehome" shall be defined in accordance with the terms of G.S. 131D‑2.1(9).
(6) Renumbered.
(7) Repealed by SessionLaws 1995, c. 535, s. 3.
(8) "Home healthservices" shall be defined in accordance with the terms of G.S. 131E‑136(3).
(9) "Homemakerservices" means supportive services provided by qualified para‑professionalswho are trained, equipped, assigned, and supervised by professionals within theagency to help maintain, strengthen, and safeguard the care of the elderly intheir own homes. These standards must, at a minimum, meet standards establishedby the North Carolina Division of Social Services and may include: Providingassistance in management of household budgets; planning nutritious meals;purchasing and preparing foods; housekeeping duties; consumer education; andbasic personal and health care.
(10) "Hospice"shall be defined in accordance with the terms of G.S. 131E‑176(13a).
(11) "Intermediatecare facility for the mentally retarded" shall be defined in accordancewith the terms of G.S. 131E‑176(14a).
(12) "Nursinghome" shall be defined in accordance with the terms of G.S. 131E‑101(6).
(13) "Respite care,institutional" means provision of temporary support to the primarycaregiver of the aged, disabled, or handicapped individual by taking over thetasks of that person for a limited period of time. The insured receives carefor the respite period in an institutional setting, such as a nursing home,family care home, rest home, or other appropriate setting.
(14) "Respite care,non‑institutional" means provision of temporary support to the primarycaregiver of the aged, disabled, or handicapped individual by taking over thetasks of that person for a limited period of time in the home of the insured orother appropriate community location.
(15) "Skilled NursingFacility" shall be defined in accordance with the terms of G.S. 135‑40.1(18).
(16) "Supervisedliving facility for developmentally disabled adults" means a residentialfacility, as defined in G.S. 122C‑3(14), which has two to ninedevelopmentally disabled adult residents.
(b) Whenever long‑termcare insurance provides coverage for organic brain disorder syndrome,progressive dementing illness, or primary degenerative dementia, such phrasesshall be interpreted to include Alzheimer's Disease. Clinical diagnosis of"organic brain disorder syndrome", "progressive dementingillness", and "primary degenerative dementia" must be acceptedas evidence that such conditions exist in an insured when a pathologicaldiagnosis cannot be made; provided that such medical evidence substantiallydocuments the diagnosis of the condition and the insured received treatment forsuch condition.
(c) All long‑termcare insurance policies must be filed with and approved by the Commissionerbefore they can be used in this State and are subject to the provisions of Article38 of this Chapter. (1987, c. 331, s. 1; 1989, c. 207, ss. 5, 6; 1991, c. 721, s. 85;1995, c. 535, s. 3; 2001‑209, s. 4; 2008‑187, s. 38(a); 2009‑462,s. 4(a).)