§ 3229. Minimum benefit standards for certain long term care plans.\n(a) The minimum standards for an insurance plan, which may qualify under\nthe partnership for long term care program pursuant to section three\nhundred sixty-seven-f of the social services law, shall be established\nby regulations of the superintendent, in consultation with the\ncommissioner of health and the director of the state office for the\naging, as approved by the director of the budget, which shall require at\na minimum (1) a residential health care facility benefit in an amount to\nbe determined by the regulations of the superintendent;
(2)a home care\nbenefit with personal care, nursing care, adult day health care and\nrespite care services, which shall provide total benefits in an amount\ndetermined by regu
Free access — add to your briefcase to read the full text and ask questions with AI
§ 3229. Minimum benefit standards for certain long term care plans.\n(a) The minimum standards for an insurance plan, which may qualify under\nthe partnership for long term care program pursuant to section three\nhundred sixty-seven-f of the social services law, shall be established\nby regulations of the superintendent, in consultation with the\ncommissioner of health and the director of the state office for the\naging, as approved by the director of the budget, which shall require at\na minimum (1) a residential health care facility benefit in an amount to\nbe determined by the regulations of the superintendent; (2) a home care\nbenefit with personal care, nursing care, adult day health care and\nrespite care services, which shall provide total benefits in an amount\ndetermined by regulations of the superintendent; (3) a duration of\nbenefits not less than twelve months; and (4) arrangements through the\ninsurance plan for managed care including preauthorized assessment and\nreferral programs, utilization controls and use of approved providers.\n (b) In establishing minimum benefit standards for insurance plans\npursuant to this section, the superintendent shall seek to ensure the\ncost effectiveness of the partnership for long term care program\nestablished pursuant to section three hundred sixty-seven-f of the\nsocial services law, and may establish minimum permissible payments\nunder such insurance plans. The superintendent shall not approve an\ninsurance plan which includes an exclusion for pre-existing conditions\nthat exceeds six months, or which does not comply with paragraph six of\nsubsection (b) of section one thousand one hundred seventeen of this\nchapter.\n