Subdivision 1. Definitions. For purposes of this section, the following terms have the meanings given them:
(a) "Qualified long-term care services" means services that meet the requirements of section 7702(c)(1) of the Internal Revenue Code of 1986, as amended, as follows: necessary diagnostic, preventive, therapeutic, curative, treatment, mitigation, and rehabilitative services, and maintenance or personal care services which are required by a chronically ill individual, and are provided pursuant to a plan of care prescribed by a licensed health care practitioner.
(b) "Chronically ill individual" has the meaning prescribed for this term by section 7702B(c)(2) of the Internal Revenue Code of 1986, as amended. Under this provision, a chronically ill individual means any individual who has been certified by a licensed health care practitioner as being unable to perform, without substantial assistance from another individual, at least two activities of daily living for a period of at least 90 days due to a loss of functional capacity, or requiring substantial supervision to protect the individual from threats to health and safety due to severe cognitive impairment.
The term "chronically ill individual" does not include an individual otherwise meeting these requirements unless within the preceding 12-month period a licensed health care practitioner has certified that the individual meets these requirements.
(c) "Licensed health care practitioner" means a physician, as defined in section 1861(r)(1) of the Social Security Act, an advanced practice registered nurse, a physician assistant, a registered professional nurse, a licensed social worker, or other individual who meets requirements prescribed by the Secretary of the Treasury.
(d) "Maintenance or personal care services" means any care the primary purpose of which is the provision of needed assistance with any of the disabilities as a result of which the individual is a chronically ill individual, including the protection from threats to health and safety due to severe cognitive impairment.
Subd. 2. Services. A qualified long-term care insurance contract shall pay only for qualified long-term care services received by a chronically ill individual provided pursuant to a plan of care prescribed by a licensed health care practitioner.
Subd. 3. Payment of benefits. A qualified long-term care insurance contract shall condition the payment of benefits on a determination of the insured's inability to perform activities of daily living for an expected period of at least 90 days due to a loss of functional capacity or to severe cognitive impairment.
Subd. 4. Certifications. (a) Certifications regarding activities of daily living and cognitive impairment required pursuant to subdivision 3 shall be performed by the following licensed or certified professionals: physicians, registered professional nurses, licensed social workers, or other individuals who meet requirements prescribed by the Secretary of the Treasury.
(b) Certifications required pursuant to subdivision 3 may be performed by a licensed health care professional at the direction of the carrier as is reasonably necessary with respect to a specific claim, except that when a licensed health care practitioner has certified that an insured is unable to perform activities of daily living for an expected period of at least 90 days due to a loss of functional capacity and the insured is in claim status, the certification may not be rescinded and additional certifications may not be performed until after the expiration of the 90-day period.
Subd. 5. Dispute resolution. Qualified long-term care insurance contracts must include a clear description of the process for appealing and resolving disputes with respect to benefit determinations.
2008 c 344 s 35; 2020 c 115 art 4 s 19; 2022 c 58 s 20
Structure Minnesota Statutes
Chapters 59A - 79A — Insurance
Chapter 62S — Qualified Long-term Care Insurance Policies
Section 62S.02 — Qualified Long-term Care Insurance Policy.
Section 62S.021 — Long-term Care Insurance; Initial Filing.
Section 62S.03 — Extraterritorial Jurisdiction.
Section 62S.04 — Prohibitions.
Section 62S.05 — Preexisting Condition.
Section 62S.06 — Prior Hospitalization Or Institutionalization.
Section 62S.07 — Right To Return; Refund.
Section 62S.08 — Coverage Outline.
Section 62S.081 — Required Disclosure Of Rating Practices To Consumers.
Section 62S.09 — Certificate Requirements.
Section 62S.10 — Policy Summary.
Section 62S.11 — Monthly Report.
Section 62S.12 — Claim Denial.
Section 62S.13 — Incontestability Period.
Section 62S.14 — Renewability.
Section 62S.15 — Authorized Limitations And Exclusions.
Section 62S.16 — Extension Of Benefits.
Section 62S.17 — Continuation Or Conversion.
Section 62S.18 — Discontinuance And Replacement.
Section 62S.181 — Electronic Enrollment For Group Policies.
Section 62S.19 — Unintentional Lapse.
Section 62S.20 — Required Disclosure Provisions.
Section 62S.21 — Prohibition Against Postclaims Underwriting.
Section 62S.22 — Minimum Standards For Home Health And Community Care Benefits.
Section 62S.23 — Requirement To Offer Inflation Protection.
Section 62S.24 — Requirements For Application Forms And Replacement Coverage.
Section 62S.25 — Reporting Requirements.
Section 62S.251 — Reserve Standards.
Section 62S.265 — Premium Rate Schedule Increases.
Section 62S.266 — Nonforfeiture Benefit Requirement.
Section 62S.267 — Standards For Benefit Triggers.
Section 62S.27 — Filing Requirement.
Section 62S.28 — Filing Requirements For Advertising.
Section 62S.29 — Standards For Marketing.
Section 62S.291 — Availability Of New Services Or Providers.
Section 62S.292 — Right To Reduce Coverage And Lower Premiums.
Section 62S.31 — Requirement To Deliver Shopper's Guide.
Section 62S.312 — Consumer Protection Standards For Long-term Care Partnership Policies.