There is a newer version of the Kentucky Revised Statutes
2009 Kentucky Revised Statutes
Subtitle 38. Health Maintenance Organizations
304.38.210 Health maintenance organizations as insurers to offer home health care coverage -- Conditions.
Download pdfoffer to include benefits for home health care. On group benefits the option for
home health care benefits shall be made available and offered to the master
policyholder. The coverage may contain a limitation on the number of home health
care visits for which benefits are payable, but the number of such visits shall not be
less than sixty (60) in any calendar year or in any continuous period of twelve (12)
months for each person covered under the policy. Each visit by an authorized
representative of a home health agency shall be considered as one (1) home health
care visit except that at least four (4) hours of home health service shall be
considered as one (1) home health visit. (2) Home health care coverage shall be subject to the same deductible and coinsurance provisions as are other services covered by health maintenance organizations which
issue policies in the Commonwealth that provide hospital, medical, or surgical
expense benefits. (3) Home health care shall not be reimbursed unless an attending physician certifies that hospitalization or confinement in a skilled nursing facility as defined by the
Kentucky Health Facilities and Health Services Certificate of Need and Licensure
Board would otherwise be required if home health care was not provided. (4) Medicare beneficiaries shall be deemed eligible to receive home health care benefits under a policy, contract or plan entered into, issued, delivered, or amended in this
state by a health maintenance organization which provides hospital, medical, or
surgical expense benefits provided that the policy, contract or plan shall only pay
for those home health care services which are not paid for by Medicare and do not
exceed the maximum liability of the policy, contract or plan. (5) Pursuant to the provisions of this section, all health maintenance organizations issuing policies in the Commonwealth which provide hospital, medical, or surgical
expense benefits or coverage for home health care shall inform the beneficiaries of
such policies, in writing, of the specific home health care benefits which are
covered. Such written notification shall take place at the time of issuance or
reissuance of the policy. Effective: January 1, 1981
History: Created 1980 Ky. Acts ch. 61, sec. 5, effective January 1, 1981.
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