NAC687B.325. Coverage for short-term services provided to person recovering at home.

     1. For a 1990 standardized benefit plan, coverage for short-term services provided to a person recovering from an illness, injury or surgery in his or her home must comply with the following requirements:

     (a) The insured’s attending physician must certify that the specific type and frequency of recovery services provided at home are necessary because of a condition for which a plan of treatment provided at home was approved by Medicare.

     (b) Coverage must be limited to:

          (1) No more than the number and type of recovery visits certified as necessary by the insured’s attending physician. The total number of recovery visits may not exceed the number of visits approved by Medicare pursuant to a plan of treatment provided at home that has been approved by Medicare.

          (2) The actual charges for each recovery visit not to exceed a maximum reimbursement of $40 per visit.

          (3) A maximum reimbursement of $1,600 per calendar year.

          (4) Seven visits in any 1 week.

          (5) Care furnished on a visiting basis in the insured’s home.

          (6) Services provided by a provider of health care.

          (7) Recovery visits received:

               (I) While the insured is covered under the policy to supplement Medicare or the certificate and not otherwise excluded.

               (II) During the period the insured is receiving services at home which are approved by Medicare or no later than 8 weeks after the date of the last recovery visit approved by Medicare.

     (c) Coverage must be excluded for:

          (1) Recovery visits paid for by Medicare or another governmental program.

          (2) Care provided by members of the insured’s family, unpaid volunteers or other persons who are not providers of health care.

     2. As used in this section:

     (a) “Home” means any location used by the insured as a place of residence if that location would qualify as a residence for health care services provided at home which are covered by Medicare. The term does not include a hospital or skilled nursing facility.

     (b) “Provider of health care” means a qualified or licensed aide or homemaker who provides health care in the home, an aide who provides personal care or a nurse provided through a licensed agency for home health care or referred by a licensed referral agency or licensed registry for nurses.

     (c) “Recovery visit” means a visit required to provide care to the insured at home, without a limit on the duration of the visit, except each consecutive 4 hours of services in a 24-hour period is one visit.

     (Added to NAC by Comm’r of Insurance, 7-16-92, eff. 7-30-92; A by R049-09, 10-27-2009)