Md. Code Regs. 32.02.01.28

Current through Register Vol. 51, No. 22, November 1, 2024

Section 32.02.01.28 - Continuing Care Agreement

A. Each continuing care agreement shall, in a form acceptable to the Department:

(1) List the total consideration paid, or to be paid, by the subscriber for continuing care, including a schedule or inventory that sets forth in one place the value of all entrance fees, subscription fees, property transferred, surcharges, periodic fees, donations, and other fees;

(2) Describe in detail all items of service to be provided to the subscriber, such as food, shelter, medical or nursing care, and other health-related services;

(3) State whether the items described for §A(2) of this regulation are to be provided for a designated time period or for life;

(4) If a subscriber is offered a priority for nursing home admission, state:

(a) The name of the nursing home or homes with which the provider has a formal priority arrangement;

(b) What provisions for care will be made if a nursing home bed is not available at a facility identified in §A(4)(a) of this regulation at the time the bed is needed;

(c) What the payment provisions will be for care at a facility identified in §A(4)(a) of this regulation; and

(d) That the provider shall promptly notify the subscriber and the Department of any change in the formal priority arrangement between the provider and the nursing home;

(5) Designate the categories of subscribers at the facility according to the types of entrance fee plans offered;

(6) State that a subscriber may not be relocated from the subscriber's unit except to protect the health or safety of the subscriber or for the general and economic welfare of other subscribers of the facility;

(7) While recognizing the constraints of §A(6) of this regulation, describe the procedures the parties to the agreement are to follow in order to temporarily transfer a subscriber:

(a) From the unit in which the subscriber resides to another unit within the facility; or

(b) To an accommodation outside of the facility;

(8) Describe the procedures the parties to the agreement are to follow in order to return a subscriber to the unit in which the subscriber resided before a temporary change;

(9) While recognizing the constraints of §A(6) of this regulation, describe the procedures the parties to the agreement are to follow in order to permanently transfer a subscriber:

(a) From the unit in which the subscriber resides to another unit within the facility; or

(b) To an accommodation outside of the facility;

(10) If the agreement is an extensive contract or modified contract, as defined in Human Services Article, § 10-447, Annotated Code of Maryland, include provisions in accordance with the applicable requirements of Human Services Article, § 10-447, Annotated Code of Maryland;

(11) Describe how the procedures for changes, transfers, and returns, whether temporary or permanent, will operate if a unit is occupied by more than one subscriber;

(12) State whether there will be a partial refund of an entrance fee, an additional fee, or any increase or decrease in a periodic fee in the event of an increase or decrease in the number of people occupying a unit;

(13) Describe the policies of the facility regarding subscribers unable to meet the periodic charges;

(14) State in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, the terms governing the refund of any portion of the entrance fee in the event of:

(a) Discharge by the provider; or

(b) Termination by the subscriber;

(15) Include provisions governing contractual entrance fee refunds in accordance with the applicable requirements of Human Services Article, § 10-449, Annotated Code of Maryland;

(16) State the terms under which an agreement is canceled by the death of a subscriber;

(17) State in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, whether or not periodic fees, if charged, will be subject to periodic increases;

(18) If periodic fees are subject to increase, state in clear and understandable language, and in all capital, underlined, and bold letters of the largest type used in the body of the agreement, the number of days of notice that will be given by the provider before an increase becomes effective;

(19) State that the charges for prepaid care may not be increased, if the agreement provides that care is paid for in advance, in one lump sum;

(20) State whether funeral and burial services are furnished by the provider;

(21) Identify the specific living unit initially assigned to the subscriber;

(22) State whether the subscriber may assign the use of a unit to another and, if so, under what conditions;

(23) If any additional costs or charges will be incurred by the subscriber for any modifications to the unit requested by the subscriber, provide a separate, written addendum to the agreement that:

(a) Describes the costs or charges;

(b) Is signed by the subscriber;

(c) States whether the additional costs or charges will be refunded in the event of cancellation or termination; and

(d) States whether there will be charges or costs assessed against the subscriber or the subscriber's estate for restoration when the subscriber permanently releases the unit;

(24) Describe any religious or charitable affiliations of the provider;

(25) Describe the extent to which an affiliate organization will be responsible for the financial and contractual obligations of the provider;

(26) State the subscriber's and provider's respective rights and obligations as to any real and personal property of the subscriber transferred to or placed in the custody of the provider;

(27) State the rights and obligations a subscriber has regarding the use of the facility, including common areas;

(28) State the rights and obligations a provider has regarding its use of the facility, including what, if any, rights the provider has to enter a subscriber's unit;

(29) State that subscribers have the right to:

(a) Organize and operate a subscriber's association at the facility; and

(b) Meet privately at the facility to conduct business;

(30) State that there is an internal grievance procedure to investigate the grievances of subscribers;

(31) State what fee adjustments, if any, will be made by the provider in the event of a subscriber's voluntary absence from the facility for an extended period of time;

(32) Specify the circumstances, if any, under which a subscriber will be required to apply for Medicaid, Medicare, public assistance, or any public benefit program;

(33) State whether the facility is or plans to be a participant in Medicare or Medicaid;

(34) In a separate paragraph, signed by each subscriber, state: "I have received a copy of the provider's latest certified financial statement at least 2 weeks before signing this agreement, and I have reviewed the certified financial statement provided.";

(35) State that the provider will make available to each subscriber, upon request, any certified financial statement or disclosure statement submitted to the Department;

(36) If an agreement is executed before the provider has received an initial certificate for the unit identified in the agreement, state:

(a) The conditions that the provider must meet to be issued an initial certificate of registration by the Department; and

(b) That all deposits and entrance fees shall be held in an escrow account in Maryland in a financial institution until:

(i) An initial certificate of registration is issued,

(ii) A certificate of occupancy is received,

(iii) Construction is complete, and

(iv) The provider has been issued appropriate licenses or certificates by DHMH, MHCC, and the Department;

(37) State that fees collected by a provider under the terms of a continuing care agreement may not be used for purposes other than those set forth in the agreement;

(38) Allow a subscriber to designate a beneficiary for receipt of any refundable portion of the entrance fee, if:

(a) The designation is in writing;

(b) The designation is witnessed by two or more competent witnesses;

(c) The designation is noncontingent; and

(d) The designation is specified in percentages and accounts for 100 percent of the refund due;

(39) State in boldface type of the largest font used in the body of the contract: "A preliminary certificate of registration or certificate of registration is not an endorsement or guarantee of this facility by the State of Maryland. The Maryland Department of Aging urges you to consult with an attorney and a suitable financial advisor before signing any documents.";

(40) State the legal remedies available to a subscriber in the event of injury caused by a provider's violation of the Act;

(41) In a separate paragraph, signed by each subscriber, state: "I have received a copy of the provider's latest disclosure statement, and I have reviewed the disclosure statement provided."; and

(42) State that if there are differences between the requirements for continuing care certification and the licensure requirements for assisted living and comprehensive care facilities, the applicable requirements most favorable to the subscriber will prevail while the subscriber is residing in an assisted living or comprehensive care unit.

B. Each continuing care agreement may contain any other provisions which are:

(1) Agreed upon by the provider and the subscriber to effectuate the purpose of the contract; and

(2) Not in conflict with the Act or this chapter, as determined by the Department.

C. A preliminary certificate of registration may not be issued by the Department if the agreement submitted with the application does not contain all of the provisions of §A of this regulation. The Department shall return to the provider for revision any agreement which it finds in violation of the applicable requirements of the Act or this chapter. The provider shall submit the agreement to an attorney for legal sufficiency as to content and form before resubmission to the Department.

D. The provider shall request approval from the Department for any modification, addition, or deletion to the terms of a continuing care agreement, before the agreement is offered to or used with subscribers.

E. Except as provided in §A(38) of this regulation, agreements are governed by the version of this regulation that was in effect at the time the agreement was executed by the parties.

F. If changes to the form of any continuing care agreement currently in use are proposed for implementation, the provider or its attorney shall submit a separate cover letter to the Department with the following:

(1) Two clean copies of the entire proposed continuing care agreement or such portion of the proposed continuing care agreement as is acceptable to the Department under the circumstances;

(2) Two redlined copies that highlight all proposed additions, deletions, and other changes, by underlining, italic type, blacklining, or such other method or symbols that indicate clearly any changes, to:

(a) If applicable, the last version of the document in question that was approved by the Department;

(b) If requested by the Department, the provider's prior draft of the document in question; and

(c) If requested by the Department, the provider's other similar version of the document in question; and

(3) If the continuing care agreement is being substantially revised, a completed copy of a contract worksheet form issued by the Department.

Md. Code Regs. 32.02.01.28

Regulations .28 adopted effective July 27, 1998 (25:15 Md. R. 1192)
Regulation .28C amended effective March 22, 2010 (37:6 Md. R. 481)
Regulation .28A, E amended effective November 6, 2006 (33:22 Md. R. 1734)
Regulation .28F adopted effective March 22, 2010 (37:6 Md. R. 481)