Minimum standards for home health and community care benefits in long-term care insurance policies
Arkansas Code § 23-61-108; Arkansas Code § 23-97-307; Arkansas Code § 23-97-310; Arkansas Code § 23-97-320
(a) A long-term care insurance policy or certificate shall not, if it provides benefits for home healthcare or community care services, limit or exclude benefits by:
- (1) Requiring that the insured or claimant would need care in a skilled nursing facility if home healthcare services were not provided;
- (2) Requiring that the insured or claimant first or simultaneously receive nursing or therapeutic services, or both, in a home, community, or institutional setting before home healthcare services are covered;
- (3) Limiting eligible services to services provided by registered nurses or licensed practical nurses;
- (4) Requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide or other licensed or certified home care worker acting within the scope of his or her licensure or certification;
- (5) Excluding coverage for personal care services provided by a home health aide;
- (6) Requiring that the provision of home healthcare services be at a level of certification or licensure greater than that required by the eligible service;
- (7) Requiring that the insured or claimant have an acute condition before home healthcare services are covered;
- (8) Limiting benefits to services provided by Medicare-certified agencies or providers; or
- (9) Excluding coverage for adult daycare services.
(b)
- (1) 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 (1/2) of one (1) 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.
- (2) This requirement shall not apply to policies or certificates issued to residents of continuing care retirement communities.
- (c) Home healthcare coverage may be applied to the non-home healthcare benefits provided in the policy or certificate when determining maximum coverage under the terms of the policy or certificate.