Section 3229. Minimum benefit standards for certain long term care plans  


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  • (a) The minimum standards for an insurance plan, which may qualify under
      the partnership for long term care program  pursuant  to  section  three
      hundred  sixty-seven-f  of the social services law, shall be established
      by  regulations  of  the  superintendent,  in  consultation   with   the
      commissioner  of  health  and  the  director of the state office for the
      aging, as approved by the director of the budget, which shall require at
      a minimum (1) a residential health care facility benefit in an amount to
      be determined by the regulations of the superintendent; (2) a home  care
      benefit  with  personal  care,  nursing  care, adult day health care and
      respite care services, which shall provide total benefits in  an  amount
      determined  by  regulations  of  the  superintendent;  (3) a duration of
      benefits not less than twelve months; and (4) arrangements  through  the
      insurance  plan  for managed care including preauthorized assessment and
      referral programs, utilization controls and use of approved providers.
        (b) In establishing minimum  benefit  standards  for  insurance  plans
      pursuant  to  this  section, the superintendent shall seek to ensure the
      cost effectiveness  of  the  partnership  for  long  term  care  program
      established  pursuant  to  section  three  hundred  sixty-seven-f of the
      social services law, and  may  establish  minimum  permissible  payments
      under  such  insurance  plans.  The  superintendent shall not approve an
      insurance plan which includes an exclusion for  pre-existing  conditions
      that  exceeds six months, or which does not comply with paragraph six of
      subsection (b) of section one thousand one  hundred  seventeen  of  this
      chapter.