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§ 15-808. Home health care

West's Annotated Code of MarylandInsurance

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 8. Required Health Insurance Benefits (Refs & Annos)
MD Code, Insurance, § 15-808
§ 15-808. Home health care
Currentness
Home health care defined
(a) In this section, “home health care” means the continued care and treatment of a covered individual if:
(1) institutionalization of the individual would have been required if home health care was not provided; and
(2) the individual's physician establishes and approves in writing the plan of treatment covering the home health care service.
Application of section
(b) This section applies to each individual, group, or blanket health insurance policy that is issued or delivered in the State by an insurer or nonprofit health service plan.
Coverage for home health care
(c) A policy subject to this section that provides coverage for inpatient hospital care on an expense-incurred basis shall provide benefits for the expenses of home health care that is provided by a person licensed under the Health Occupations Article.
Home health care provided by hospitals or licensed home health agencies
(d) Home health care shall be provided by:
(1) a hospital that has a valid operating certificate and is certified to provide home health care services; or
(2) a public or private health service or agency that is licensed as a home health agency under Title 19, Subtitle 4 of the Health-General Article to provide coordinated home health care.
Limit to number of home health care visits
(e)(1) A contract may limit the number of home health care visits, but not to fewer than 40 visits in a calendar year or in a continuous 12-month period for each individual covered under the contract.
(2) In determining the benefits for home health care available to a covered individual:
(i) each visit by a member of a home health care team is considered one home health care visit; and
(ii) up to 4 hours of home health care service is considered one home health care visit.

Credits

Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997.
Formerly Art. 48A, § 470J.
MD Code, Insurance, § 15-808, MD INSURANCE § 15-808
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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