{"data":{"id":"us-ky/krs-304.38-210","jurisdiction":"us-ky","citation":"KRS 304.38-210","heading":"Health maintenance  organizations as insurers to offer home","body":"health care coverage -- Conditions.\n(1) Health maintenance organizations issuing policies in the Commonwealth  which\nprovide hospital, medical, or surgical expense benefits shall make  available\nand offer to include benefits for home health care. On group benefits the option\nfor home  health care benefits shall be made  available and offered to the\nmaster policyholder. The coverage may contain a limitation on the number of\nhome  health care visits for which benefits are payable, but the number of such\nvisits shall not be less than sixty (60) in any calendar year or in any continuous\nperiod of twelve (12) months for each person covered under the policy. Each\nvisit by an authorized representative of a home  health agency shall be\nconsidered as one (1) home health care visit except that at least four (4) hours\nof home health service shall be considered as one (1) home health visit.\n(2) Home  health care coverage shall be subject to the same  deductible and\ncoinsurance provisions as are other services covered by health maintenance\norganizations which issue policies in the Commonwealth  that provide hospital,\nmedical, or surgical expense benefits.\n(3) Home  health care shall not be reimbursed unless an attending physician, an\nadvanced  practice registered nurse, or a physician assistant certifies that\nhospitalization or confinement in a skilled nursing facility as defined by the\nKentucky  Health Facilities and  Health Services Certificate of Need  and\nLicensure Board would otherwise be required if home  health care was not\nprovided.\n(4) Medicare beneficiaries shall be deemed  eligible to receive home  health care\nbenefits under a policy, contract or plan entered into, issued, delivered, or\namended  in this state by a health maintenance organization which provides\nhospital, medical, or surgical expense  benefits provided that the policy,\ncontract or plan shall only pay for those home  health care services which are\nnot paid for by Medicare and do not exceed the maximum  liability of the policy,\ncontract or plan.\n(5) Pursuant to the provisions of this section, all health maintenance organizations\nissuing policies in the Commonwealth  which provide hospital, medical, or\nsurgical expense benefits or coverage for home  health care shall inform the\nbeneficiaries of such policies, in writing, of the specific home  health care\nbenefits which are covered. Such written notification shall take place at the\ntime of issuance or reissuance of the policy.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=50734","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:56Z","sha256":"49d9c30eefadb3d86a75194a1e444c7ed3d77e383e996d389012470617b7e8fe","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.38-205","next":"us-ky/krs-304.38-220"},"notice":"GroundRules: Original legal text. Not legal advice."}