New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 4 - ACTUARIAL SERVICES
Subchapter 14 - HOME HEALTH CARE INSURANCE COVERAGE
Section 11:4-14.2 - Definitions

The following words and terms, when used in this subchapter, shall have the following meanings unless the context clearly indicates otherwise.

"Home health care" means those nursing and other home health care services rendered to a person in his place of residence, under the following conditions:

1. On a part-time and intermittent basis, except when full-time or 24-hour services are needed on a short-term (no more than three-day) basis; and

2. If continuing hospitalization would otherwise have been required if home health care were not provided; and

3. Pursuant to a physician's written order and under a plan of care established by the responsible physician in collaboration with a home health care provider. The benefit may require that the care plan be reviewed by the physician after each 30 days following commencement of home health care, that the physician not be related to the home health care provider by ownership or contract, and that the physician certify that continued confinement in a hospital or skilled nursing facility would otherwise be required. All care plans shall be established within 14 days following the commencement of home health care.

"Home health care services" means any of the following services which are medically necessary for achievement of the care plan set forth for the patient and which are provided for the care of the patient:

1. Nursing care (furnished by or under the supervision of a registered nurse);

2. Physical therapy;

3. Occupational therapy;

4. Medical social work;

5. Nutrition services;

6. Speech therapy;

7. Home health aide services;

8. Medical appliances and equipment, drugs and medications, laboratory services and special meals to the extent such items and services would have been covered under the policy if the covered person had remained in a hospital;

9. Any diagnostic and therapeutic service, including surgical services, performed in a hospital outpatient department, a doctor's office or any other licensed health care facility, to the extent that such service would have been covered under the policy if performed as inpatient hospital services, provided that such service is delivered as part of the home health care plan.

"Home health care provider" means an agency which is licensed by the Commissioner of the Health as a home health agency.