Md. Code Regs. 32.02.02.02

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

Section 32.02.02.02 - General Requirements to Offer Continuing Care at Home

A. A provider may not offer continuing care at home or collect deposits for continuing care at home without having secured the necessary feasibility study approval.

B. A provider may not provide continuing care at home without having secured an initial certificate of registration from the Department.

C. Submissions.

(1) The submissions described in this section shall be filed with and approved by the Department.

(2) Statement of Intent. An entity which intends to offer continuing care at home agreements shall file a statement of intent with the Department at least 30 days before submission of the feasibility study.

(3) Application for Approval of Feasibility Study. A provider shall obtain approval by the Department of a feasibility study before a provider may collect deposits for continuing care at home. Deposits collected for continuing care at home shall be maintained in an escrow account held in Maryland in a federally insured depository under an escrow agreement approved by the Department.

(4) Application for Preliminary Certificate. A preliminary certificate of registration is required before a provider may offer or enter into continuing care at home agreements.

(5) Application for Initial Certificate. An initial certificate of registration is required before a provider may provide services under a continuing care at home agreement.

(6) Application for Renewal of Certificate of Registration. A current certificate of registration or provisional renewal certificate of registration is required to continue to operate as a continuing care at home provider.

D. A provider may not offer or enter into a deposit agreement or an agreement, unless the terms of the agreements have been approved by the Department.

E. Basic Services. A provider shall, at a minimum, provide the following services to all the provider's subscribers as needed:

(1) Care coordination services that assist subscribers to:

(a) Determine what services they need and when they need them,

(b) Access all the services provided or coordinated by the provider,

(c) Identify other entities that can assist subscribers with their needs, and

(d) Apply for and access services in addition to the basic services described in this section;

(2) The number of home inspections required by §F of this regulation, which shall be conducted by an occupational therapist to:

(a) Assess a subscriber's functioning and safety in the subscriber's dwelling, and

(b) Recommend any modifications to the dwelling that would help the subscriber overcome or minimize any safety issues or functional limitations;

(3) Assistance with activities of daily living in the subscriber's dwelling;

(4) Skilled nursing services in the subscriber's dwelling;

(5) The routine services of a licensed assisted living facility;

(6) The routine services of a licensed comprehensive care facility; and

(7) The amount of assistance with the maintenance of a subscriber's dwelling required by §H of this regulation.

F. Home Inspections by Occupational Therapist. The minimum number of home inspections by an occupational therapist that a provider shall pay for is at least:

(1) An initial inspection upon entering the agreement and an additional inspection every other year after that; or

(2) Five inspections during the term of the agreement, which shall be provided when requested by the subscriber.

G. Required Amounts of Assistance with Activities of Daily Living and Nursing Services.

(1) A provider may include in its agreement a lifetime maximum dollar amount it will pay for the services required by §E(3)-(6) of this regulation. If a maximum dollar amount is used, it shall be at least $150,000. Provision of either assistance with activities of daily living or nursing services, whether delivered in the subscriber's dwelling, an assisted living facility, or a comprehensive care facility, may be counted toward the maximum.

(2) Assistance with activities of daily living services shall be provided whenever a subscriber needs assistance with two or more activities of daily living. The threshold for when assistance with activities of daily living services will be provided may be set lower as long as the threshold standard is applied uniformly to all subscribers using consistent assessment practices.

(3) A provider may include in an agreement a daily, weekly, or monthly benefit amount it will pay for particular services required by §E(3)-(6) of this regulation. If it does include amounts in an agreement, the amount for assistance with activities of daily living services shall be at least 50 percent of the amount specified for services of a licensed comprehensive care facility.

(4) A provider may exclude services covered by Medicare from the services for which it otherwise would be required to pay. If a provider includes an exclusion in its agreement, services covered by Medicare may not be counted towards the lifetime maximum dollar amount permitted by §G(1) of this regulation.

H. Assistance with Dwelling Maintenance.

(1) In order to provide assistance with the maintenance of a subscriber's dwelling, a provider shall, at a minimum, provide a referral service that refers subscribers to vendors and suppliers who will contract with a subscriber to perform repair and maintenance services.

(2) The provider shall:

(a) Check the liability insurance coverage, any applicable licenses, and at least two references of vendors or suppliers on the referral list; and

(b) Review the insurance, license, and reference information annually and update its files accordingly.

(3) A provider may also directly provide repair and maintenance services to subscribers through its employees or contractual arrangements with third parties.

I. Payment for Basic Services.

(1) The minimum basic services required by §E of this regulation shall be paid for by the following methods:

(a) An entrance fee paid in advance of the receipt of the basic services;

(b) Regular periodic charges that guarantee basic services when needed;

(c) For some or all of the basic services required by §E(2)-(7) of this regulation, a copayment from the subscriber of 30 percent or less of the actual cost; or

(d) A combination of the arrangements described in §I(1)(a)-(c).

(2) A subscriber may not be charged for the minimum amount of basic services required by §§E-H of this regulation on a fee-for-service basis.

(3) Services in excess of the minimum amount of basic services required by §§E-H of this regulation may be charged for on a fee-for-service basis.

(4) A provider may charge on a fee-for-service basis for services other than those required by §E of this regulation.

J. A provider may not disseminate advertising or circulars which are deceptive, misleading, or likely to mislead.

K. Special Conditions.

(1) A provider applying for a certificate of registration whose personal, professional, or financial history causes the Secretary to question the provider's financial or administrative ability to provide continuing care at home in compliance with this chapter, shall submit to the Department evidence demonstrating financial or administrative soundness, or both, as the Secretary considers appropriate. This information may only be sought in special circumstances and may not be required as a matter of course.

(2) The Secretary shall:

(a) Approve the application unconditionally;

(b) Require the provider to use the services of a management firm; or

(c) Deny the application.

(3) A management firm required by §K(2)(b) of this regulation shall be selected by the provider subject to the approval of the Department. Approval of a management firm that currently does business in Maryland, has projects in good standing under the Act, and which has not had a fiduciary or consultant relationship with the Department may not be denied without cause. The management firm shall assume full operational and financial responsibilities. The Secretary may not require utilization of a management firm for a period that exceeds 24 months.

L. A party aggrieved by a decision of the Secretary under this regulation has the right to appeal under Regulation .31 of this chapter.

M. A provider who is denied approval of submissions required by §C(3) or (4) of this regulation may reapply 1 year after the date of denial.

Md. Code Regs. 32.02.02.02