KRS 304.38-210: Health maintenance organizations as insurers to offer home

health care coverage -- Conditions.

(1) 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.

(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, 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 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.