KRS 304.17-313: Individual health insurers to offer home health care coverage --

Conditions.

(1) All insurers issuing individual health insurance policies in the Commonwealth

providing coverage on an expense incurred basis shall make available and

offer to the purchaser coverage for home health care. 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 aide 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 insurers issuing

individual health insurance policies in the Commonwealth.

(3) Home health care shall not be reimbursed unless an attending physician, an

advanced practice registered nurse, or a physician assistant 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 an individual health insurance policy providing coverage on an

expense incurred basis provided that the policy 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.

(5) Pursuant to the provisions of this section, all insurers issuing individual health

insurance policies in the Commonwealth on an expense incurred basis 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.