2014 Kentucky Revised Statutes CHAPTER 304 - INSURANCE CODE Subtitle 38 - Health Maintenance Organizations 38.38-210 Health maintenance organizations as insurers to offer home health care coverage -- Conditions.
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304.38-210 Health maintenance organizations as insurers to offer home
health care coverage -- Conditions.
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Health maintenance organizations issuing policies in the Commonwealth which
provide hospital, medical, or surgical expense benefits shall make available
and offer 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.
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.
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.
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.
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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