Md. Code Regs. 32.02.02.01

Current through Register Vol. 51, No. 12, June 14, 2024

Section 32.02.02.01 - Definitions

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

(1) "Act" means the portion of Human Services Article, Title 10, Subtitle 4,, Annotated Code of Maryland, as specified in §10-402(a).

(2) "Actuarial balance sheet" means a balance sheet that uses actuarial principles and practices to determine the value of certain items in the balance sheet based on actuarial techniques involving reasonable assumptions about contingencies, inflation, and the time value of money as applied to current subscribers, which items include the present value of:

(a) Future periodic fees;

(b) The costs of providing promised future services; and

(c) The obligation for refundable entrance fees.

(3) "Agreement" means an agreement between a provider and subscriber that is a contract to provide continuing care at home.

(4) "Assisted living unit" means a unit in which the services rendered will require the provider to be licensed as an assisted living program under Health-General Article, §19-1805, Annotated Code of Maryland.

(5) Authority Recognized by the Department.

(a) "Authority recognized by the Department" means a person whom the Department determines has the knowledge and experience of the continuing care industry necessary to produce the particular materials required by a given regulation in this chapter.

(b) "Authority recognized by the Department" includes an independent consultant or an employee of a provider or related entity.

(6) "Authorized officer" means an individual holding one of the following positions with a provider:

(a) An officer;

(b) A general partner;

(c) Any individual who serves on the governing body; and

(d) A trustee of the provider.

(7) "Break-even point" means the projected point at which a provider's total revenue from continuing care at home agreements will begin to equal or exceed the provider's total expenses.

(8) "Certified financial statement" means a financial statement, prepared in accordance with generally accepted accounting principles by an independent certified public accountant, that includes an audit opinion, balance sheet, income statement, statement of cash flows, and the related notes to the financial statement.

(9) "Certified financial statement for the most recent fiscal year for which a certified financial statement is available" means:

(a) For providers who annually receive a certified financial statement within 120 days of the end of their fiscal year, the most recently dated financial statement; and

(b) For any other providers, assuming that a certified financial statement is obtainable under generally accepted auditing standards, a certified financial statement that is not greater than 120 days old.

(10) "Chief executive officer" means the individual whose primary responsibility is to oversee all aspects of the operation of the provider.

(11) "Committee" means Financial Review Committee.

(12) "Continuing care at home" means furnishing services, either directly or by contractual arrangement, to the public where:

(a) The services include health services and assistance with the maintenance of a subscriber's dwelling;

(b) The health services include:

(i) Medical services,

(ii) Nursing services,

(iii) Assisted living or comprehensive care services in an assisted living or comprehensive care facility, or

(iv) Assistance with the activities of daily living, other than the provision of meals, in a subscriber's dwelling;

(c) The services are offered to individuals who are:

(i) 60 years old or older, and

(ii) Not related to the provider by blood or marriage;

(d) The services are offered for:

(i) The life of the subscriber, or

(ii) A period in excess of 1 year; and

(e) The services are offered under a written agreement that requires:

(i) A transfer of assets from the subscriber to the provider,

(ii) An entrance fee, or

(iii) Both a transfer of assets and an entrance fee.

(13) Control.

(a) "Control" means the power to direct, or cause the direction of, the management and policies of a provider through the ownership of voting securities, by contract, or otherwise.

(b) "Control" includes a parent or sole corporate member of a corporation directly participating in the initiation or approval of policies directly affecting the operations, including approval of budgets or approval of the chief executive officer of the provider.

(14) "Department" means the Maryland Department of Aging.

(15) "Deposit" means a portion of the entrance fee.

(16) Deposit Agreement.

(a) "Deposit agreement" means a preliminary agreement between the subscriber and the provider by which the provider reserves for the subscriber the right to contract for continuing care at home in return for payment by the subscriber of a deposit.

(b) "Deposit agreement" includes any agreement of similar form and use, regardless of title, including priority agreement and reservation agreement.

(17) "DHMH" means the Department of Health and Mental Hygiene.

(18) Entrance Fee.

(a) "Entrance fee" means a sum of money or other consideration, other than a surcharge, paid initially or in deferred payments, that:

(i) Assures a subscriber continuing care at home for a term of more than 1 year or for life; and

(ii) Is at least equal to the greater of either 12 times the monthly cost of the basic periodic fees charged under an agreement or $5,000.

(b) "Entrance fee" includes a fee of similar form and application, regardless of title.

(19) "Escrow agreement" means an agreement between the provider and a financial institution by which deposits and entrance fees are held in Maryland by the financial institution until release is permitted by law or regulation.

(20) "Facility" means a physical plant and related grounds, other than a subscriber's dwelling, used to provide assisted living or comprehensive care services to continuing care at home subscribers, in accordance with this chapter.

(21) "Financial difficulty" means the current or impending financial condition of a provider which currently impairs or may impair the ability of the provider to meet existing or future obligations to subscribers or other creditors.

(22) "Fiscal year" means the fiscal year of the provider.

(23) "Generally accepted accounting principles" means those accounting principles and practices adopted by the Financial Accounting Standards Board and the American Institute of Certified Public Accountants, which include the principles expressed in the American Institute of Certified Public Accountants' "Audit and Accounting Guide for Health Care Organizations".

(24) "Governing body" means an individual or group of individuals with authority to direct, control, and manage the policies and business affairs of the provider, including groups such as boards of directors, boards of trustees, management committees, and executive committees.

(25) "MHCC" means the Maryland Health Care Commission.

(26) "Person" means an individual, firm, association, corporation, company, trust, partnership, limited liability company, public body, or other business or nonprofit entity.

(27) "Processing fee" means a one-time fee charged by the provider to determine the financial, mental, and physical eligibility of an individual who seeks to enter a continuing care at home agreement.

(28) "Provider" means a person who is an applicant for, or the holder of, a certificate of registration to provide continuing care at home.

(29) "Qualified actuary" means a member in good standing of the American Academy of Actuaries.

(30) "Records" means the information, books, and data maintained for the operation of a provider in accordance with this chapter.

(31) "Renewal" means the renewal of a certificate of registration required annually to permit the provider to continue to offer continuing care at home to the public.

(32) "Secretary" means the Secretary of Aging.

(33) "Subscriber" means an individual for whom continuing care at home is purchased under an agreement.

(34) Subscriber's Dwelling.

(a) "Subscriber's dwelling" means a house, apartment, condominium, cooperative, or other place where a subscriber lives and has agreed to live while receiving continuing care at home services.

(b) "Subscriber's dwelling" does not include facilities licensed by the Department of Health and Mental Hygiene as an assisted living program or a comprehensive care facility or by the Department as a continuing care facility under COMAR 32.02.01.

(35) "Surcharge" means a separate and additional charge, other than a second-person entrance fee, imposed simultaneously with the entrance fee, that may be required of some, but not all, subscribers because of a condition or circumstance that applies only to those subscribers.

(36) Unit.

(a) "Unit" means a suite, room, cottage, apartment, or any other type of quarters that is located at a facility in which a subscriber is to reside while receiving assisted living or comprehensive care benefits under a continuing care at home agreement.

(b) "Unit" includes individual beds licensed for assisted living and comprehensive care so that each assisted living bed and comprehensive care bed constitutes a unit.

(c) "Unit" does not include a subscriber's dwelling.

Md. Code Regs. 32.02.02.01