KRS 304.18-037: Group or blanket health insurers to offer home health care

coverage to master policyholder -- Conditions.

(1) All insurers issuing group or blanket health insurance policies and certificates

issued thereunder in the Commonwealth providing coverage on an expense

incurred basis shall make available and offer to the master policyholder

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 group

or blanket 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 a group or blanket health insurance policy 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 group or blanket

health insurance policies and certificates issued thereunder in the

Commonwealth providing coverage on an expense incurred basis which

include 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.