Section 26-A2699. DEFINITIONS

 

2699.1"Activities of daily living" - at least bathing, continence, dressing, eating, toileting and transferring.

 

2699.2"Acute condition" - that the individual is medically unstable. Such an individual requires frequent monitoring by medical professionals, such as physicians and registered nurses, in order to maintain his or her health status.

 

2699.3"Adult day care" - a program for six (6) or more individuals, of social and health-related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly or other disabled adults who can benefit from care in a group setting outside the home.

 

2699.4"Bathing" - washing oneself by sponge bath; or in either a tub or shower, including the task of getting into or out of the tub or shower.

 

2699.5"Cognitive impairment" - a deficiency in a person's short or long-term memory, orientation as to person, place and time, deductive or abstract reasoning, or judgment as it relates to safety awareness.

 

2699.6"Continence" - the ability to maintain control of bowel and bladder function; or, when unable to maintain control of bowel or bladder function, the ability to perform associated personal hygiene (including caring for catheter or colostomy bag).

 

2699.7"Dressing" - putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.

 

2699.8"Eating" feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or intravenously.

 

2699.9"Hands-on assistance" - physical assistance (minimal, moderate or maximal) without which the individual would not be able to perform the activity of daily living.

 

2699.10"Home health care services" - medical and nonmedical services, provided to ill, disabled or infirm persons in their residences. Such services may include homemaker services, assistance with activities of daily living and respite care services.

 

2699.11"Incidental" - as used in subsection 2616.10, is the value of the long-term care benefits provided is less than ten percent (10%) of the total value of the benefits provided over the life of the policy. These values shall be measured as of the date of issue.

 

2699.12"Medicare" - "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended," or "Title I, Part I of Public Law 89-97, as Enacted by the Eighty-Ninth Congress of the United States of America and popularly known as the Health Insurance for the Aged Act, as then constituted and any later amendments or substitutes thereof," of words of similar import.

 

2699.13"Mental or nervous disorder" - Not defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder.

 

2699.14"Personal care" - the provision of hands-on services to assist an individual with activities of daily living.

 

2699.15"Qualified actuary" - a member in good standing of the American Academy of Actuaries.

 

2699.16"Similar policy forms" - all of the long-term care insurance policies and certificates issued by an insurer in the same long-term care benefit classification as the policy form being considered. Certificates of groups that meet the definition in D.C. Official Code § 31-3601 are not considered similar to certificates or policies otherwise issued as long-term care insurance, but are similar to other comparable certificates with the same long-term care benefit classifications. For purposes of determining similar policy forms, long-term care benefit classifications are defined as follows: institutional long-term care benefits only, non-institutional long-term care benefits only, or comprehensive long-term care benefits.

 

2699.17"Toileting" - getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene.

 

2699.18"Transferring" - moving into or out of a bed, chair or wheelchair.

 

source

Final Rulemaking published at 52 DCR 10902 (December 16, 2005).