Md. Code Regs. 32.02.02.05

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

Section 32.02.02.05 - Feasibility Study

A. The feasibility study shall be prepared in a form satisfactory to the Department, by an authority recognized by the Department, and shall include at least the following information:

(1) A statement of the purpose for the proposed continuing care at home project;

(2) A summary of the proposed continuing care at home project, which shall include the following information:

(a) A description of the proposed geographic area in which the continuing care at home project will operate;

(b) A statement regarding any affiliation of the provider with a religious, charitable, or other nonprofit organization, and the extent to which the organization will be responsible for the financial and contractual obligations of the provider;

(c) The number of subscribers projected to be enrolled in 10 years;

(d) The number of proposed assisted living units or comprehensive care units the provider plans to use; and

(e) A description of any community spaces to be provided, such as doctor's offices, craft centers, meeting rooms, or exercise centers;

(3) A summary of the organizational structure of the proposed provider and development team, which shall include the following information:

(a) The ownership of the provider, including whether it is for-profit;

(b) A description of the qualifications of the proposed manager or management company if the project is, or will be, managed on a day-to-day basis by a person other than an individual directly employed by the provider, including the business experience the manager or management company has operating or managing similar projects; and

(c) A description of the qualifications of any other person who is significantly involved in the development of the continuing care at home project;

(4) A summary of plans to provide for assisted living and comprehensive care units, which shall include the following:

(a) A schedule showing the number of assisted living and comprehensive care units the provider anticipates needing as the subscriber population grows and ages;

(b) A statement describing whether the provider plans to:

(i) Operate its own assisted living or comprehensive care facilities,

(ii) Contract with other facilities to provide assisted living or comprehensive care services to subscribers, or

(iii) Create some other arrangement to provide facility-based assisted living and comprehensive care services to its subscribers;

(c) If the provider plans to be licensed for and operate its own assisted living and nursing home facilities, a general description of the anticipated square footage of each type of unit; and

(d) If the provider plans to be licensed for and operate its own assisted living and nursing home facilities, the number of anticipated assisted living and comprehensive care units categorized as:

(i) Private,

(ii) Semiprivate, and

(iii) Suites;

(5) A summary of the services that will be included in the periodic service fee;

(6) A summary of the ancillary services that will not be included in the periodic service fee;

(7) A statement describing any plans the provider has to require a subscriber to have long-term care insurance or supplemental health insurance coverage;

(8) A statement describing any plans the provider has to become Medicare or Medicaid certified;

(9) A statement describing any plans the provider has to offer priority access to assisted living or comprehensive care facilities;

(10) A study that demonstrates a market exists for the proposed project, which study shall include:

(a) A description of the market area as defined by the provider;

(b) A table of population information including age, sex, number, income distribution, and trends of the total population and individuals 60 years old and older within the market area;

(c) A calculation of the potential impact on the proposed project of existing continuing care at home providers, continuing care at home projects for which letters of intent have been filed with the Department, and other ventures that offer similar services in the market area, which calculation shall include the following information for each provider, project, or venture in the market:

(i) The number of continuing care subscribers,

(ii) The number of assisted living units and comprehensive care units,

(iii) If services are not yet being provided, the proposed start date,

(iv) The area marketed to,

(v) The amount and type of entrance fees and monthly service fees, and

(vi) The services offered;

(d) A calculation of the potential impact on the proposed project of existing continuing care retirement communities, continuing care retirement communities for which letters of intent have been filed with the Department, and other ventures that offer similar services in the market area, which calculation shall include the following information for each community, provider, project, or venture in the market:

(i) The number of independent living units, assisted living units, and comprehensive care units,

(ii) The number of continuing care subscribers,

(iii) If services are not yet being provided, the proposed start date, and

(iv) The area marketed to;

(e) A calculation of the market penetration rate for the proposed market;

(f) A table of home values in the market area;

(g) A description of the minimum age, income, and net worth eligibility requirements for the anticipated subscribers of the proposed project;

(h) A description of new entrant assumptions by age, sex, and couple ratio;

(i) A description of the results of testing the potential demand and acceptance of the proposed project's services and concept characteristics;

(j) If the area in which the project is to be marketed has limited continuing care at home experience and a demographically similar area exists that has had experience with continuing care at home, a comparison that shows the:

(i) Similarities and dissimilarities of the two markets, and

(ii) Experiences of one or more continuing care at home providers in the comparable market, including their initial utilization experience and their penetration rates into the eligible population; and

(k) A statement describing the estimated presales period, including when the provider projects it will have executed agreements and collected at least 10 percent of the entrance fee for at least the greater of 10 percent of the number of subscribers needed for the provider to reach its break-even point or 30 subscribers;

(11) A plan demonstrating the financial feasibility of the proposed project including the following:

(a) The anticipated costs of the project, including financing expenses, marketing costs, legal and administrative costs, fees and permits, and other costs;

(b) The anticipated sources and uses of funds to finance the project, including documentation of the financial resources of the provider;

(c) A description of the proposed financing, including anticipated terms and costs of financing the project;

(d) Projected financial statements that are based on the information required in §(A)(12)(b) of this regulation and prepared in accordance with:

(i) §B of this regulation,

(ii) Generally accepted accounting principles, and

(iii) Regulation .14 of this chapter;

(e) A schedule of anticipated fees for a 10-year period, including any proposed escalator or other automatic adjustment provisions;

(f) A schedule of the anticipated number of new agreements to be signed each month up to the month in which the break-even point is reached;

(g) The proposed start date for providing services under the agreements;

(h) A statement indicating compliance with the requirements of Regulation .14 of this chapter; and

(i) A calculation that demonstrates the minimum number of subscribers that need to be enrolled in order for the provider to reach its break-even point;

(12) An actuarial study, prepared or reviewed by a qualified actuary, which includes:

(a) An actuarial balance sheet that demonstrates that, for a typical cohort of new subscribers, the sum of the entrance fees paid plus the actuarial present value of the periodic fees expected at the beginning of the agreement exceeds the actuarial present value of the costs of performing all obligations assumed by the provider, with appropriate provision for surplus;

(b) Supporting detailed documentation for the actuarial balance sheet required in §A(12)(a) of this regulation, including a:

(i) Projection of future population flows and service needs covered by the provider's agreements for the first 20 years, using appropriate mortality, morbidity, withdrawal, and other demographic assumptions, and

(ii) Description of the actuarial data, assumptions, inflation factors, and methods used to create the projection;

(c) Cash flow projection for a 20-year period, which project positive cash balances; and

(d) The opinion of the actuary that the data and assumptions used are appropriate, the methods employed are consistent with sound actuarial principles and practices, and provision has been made for all actuarial liabilities and related statement items;

(13) A copy of the proposed deposit agreement between the provider and prospective subscribers governing the disposition of the escrowed funds and the interest earned on them;

(14) A copy of the proposed escrow agreement between the provider and the depository;

(15) Proposed payment arrangements under the agreement for:

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

(b) The health-related benefits;

(16) A copy of a certificate of need issued by MHCC for any proposed comprehensive care beds the provider plans to operate for its subscribers;

(17) The form and substance of any advertising campaign or proposed advertisement for the proposed project that is available at the time of filing; and

(18) Any further information that the Department requires.

B. In §A(11)(d) of this regulation, the provider shall submit projected financial statements for a minimum of the first 10 years of operation that include:

(1) Balance sheets;

(2) Income statements, including separate supplemental income statements for each group of subscribers in each of the following environments:

(a) Subscriber's dwelling,

(b) Assisted living, and

(c) Comprehensive care;

(3) Statements of cash flow; and

(4) The key assumptions used in preparing the projected financial statements, including, when applicable, assumptions related to utilization, turnover, inflation, debt service, personnel staffing and related salaries, interest rates, depreciation and amortization, amortization of entrance fees, raw food, insurance, real estate taxes, and reserve assumptions.

Md. Code Regs. 32.02.02.05