<section article="ghu" article_name="Human Services" number="10-101" title_number="10" title_name="Department of Aging" subtitle_number="1" subtitle_name="Definitions"> <level label="a"> <text>In this title the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Area agency on aging” means the local agency that the Department designates in accordance with the Older Americans Act of 1965 to administer the delivery of a comprehensive and coordinated system of social and other services and activities for older adults in a planning and service area.</text> </level> <level label="c"> <text>“Community for a Lifetime” means a community certified under § 10–804 of this title.</text> </level> <level label="d"> <text>“Department” means the Department of Aging.</text> </level> <level label="e"> <text>“Longevity Ready Maryland Plan” means a multisector plan on aging that:</text> <level label="1"> <text>transforms programs, services, policies, institutions, and systems to address the growing population of older adults; and</text> </level> <level label="2"> <text>incorporates streamlined, innovative approaches to aging services.</text> </level> </level> <level label="f"> <text>“Planning and service area” means an area of the State that the Department designates in accordance with the Older Americans Act of 1965 for the planning and administration of social, health, and other services for older adults.</text> </level> <level label="g"> <text>“Secretary” means the Secretary of Aging.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-201" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <text>There is a Department of Aging established as a principal department of the State government.</text> </section> <section article="ghu" article_name="Human Services" number="10-202" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <level label="a"> <level label="1"> <text>With the advice and consent of the Senate, the Governor shall appoint the Secretary of Aging.</text> </level> <level label="2"> <text>The Secretary is the head of the Department.</text> </level> </level> <level label="b"> <text>Before taking office, the appointee shall take the oath required by Article I, § 9 of the Maryland Constitution.</text> </level> <level label="c"> <level label="1"> <text>The Secretary serves at the pleasure of the Governor and is responsible directly to the Governor.</text> </level> <level label="2"> <text>The Secretary shall advise the Governor on all matters assigned to the Department and is responsible for carrying out the Governor’s policies on those matters.</text> </level> </level> <level label="d"> <text>The Secretary is entitled to the compensation provided in the State budget.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-203" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <level label="a"> <text>The Secretary is responsible for the operation of the Department and shall establish guidelines and procedures to promote the orderly and efficient operation of the Department.</text> </level> <level label="b"> <text>The Secretary may establish, reorganize, or abolish areas of responsibility in the Department as necessary to fulfill the duties assigned to the Secretary.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-204" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <level label="a"> <text>The Secretary shall administer the programs and activities that the federal government delegates to the State under the Older Americans Act of 1965 that are not otherwise committed by law to another unit of State government.</text> </level> <level label="b"> <text>The Secretary:</text> <level label="1"> <text>is a member of the Governor’s Executive Council; and</text> </level> <level label="2"> <text>shall cooperate with and receive the cooperation of State, federal, and local governmental units to carry out the purposes of this title.</text> </level> </level> <level label="c"> <text>The Secretary shall lead implementation of the Longevity Ready Maryland Plan, with the following goals:</text> <level label="1"> <text>building a longevity ecosystem;</text> </level> <level label="2"> <text>promoting economic opportunity;</text> </level> <level label="3"> <text>preparing State residents to afford longevity; and</text> </level> <level label="4"> <text>optimizing health, wellness, and mobility.</text> </level> </level> <level label="d"> <text>To implement the Longevity Ready Maryland Plan, the Secretary shall:</text> <level label="1"> <text>evaluate the service needs of older adults in the State;</text> </level> <level label="2"> <text>determine the extent to which existing public and private programs, policies, institutions, and systems support older adults;</text> </level> <level label="3"> <text>establish priorities for meeting the needs of older adults; and</text> </level> <level label="4"> <text>coordinate, subject to existing law, assess and evaluate, and educate the public and professionals about all State and local programs and services, both public and private, that:</text> <level label="i"> <text>relate and are important to the well–being of older adults in the State; and</text> </level> <level label="ii"> <text>are designed to assist older adults and family caregivers in leading independent and dignified lives in their own homes and communities.</text> </level> </level> </level> <level label="e"> <text>The Secretary shall:</text> <level label="1"> <text>represent the interests of older adults by serving as an advocate for policy, systems, and institutional change at all levels of government and within the private sector in support of the Longevity Ready Maryland Plan;</text> </level> <level label="2"> <text>emphasize cross–sector collaboration, including consulting and advising units of State government and State boards and commissions about any action the unit, board, or commission may take to assist in implementing the Longevity Ready Maryland Plan;</text> </level> <level label="3"> <text>consult with the Commission on Aging on implementation of the Longevity Ready Maryland Plan;</text> </level> <level label="4"> <text>provide consultation and technical assistance to organizations and other entities or persons developing local services for older adults in partnership with area agencies on aging and other organizations and entities funded by the Department;</text> </level> <level label="5"> <text>maintain a system that provides information, referrals, and counseling for older adults and their caregivers related to the interests of older adults and the implementation of the Longevity Ready Maryland Plan;</text> </level> <level label="6"> <text>review and recommend legislation and other policy action to the Governor on publicly funded plans, programs, institutions, and systems that affect older adults and the implementation of the Longevity Ready Maryland Plan; and</text> </level> <level label="7"> <text>maintain a publicly accessible resource on the Department’s website for monitoring implementation of the Longevity Ready Maryland Plan.</text> </level> </level> <level label="f"> <text>The Secretary may adopt regulations to carry out the provisions of law that are within the jurisdiction of the Secretary.</text> </level> <level label="g"> <level label="1"> <text>In this subsection, “Fund” means the Aging Resilience Fund.</text> </level> <level label="2"> <text>There is an Aging Resilience Fund.</text> </level> <level label="3"> <text>The purpose of the Fund is to support the implementation of the Department’s mission under this title.</text> </level> <level label="4"> <text>The Secretary shall administer the Fund.</text> </level> <level label="5"> <level label="i"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="ii"> <text>The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="6"> <level label="i"> <text>The Fund consists of:</text> <level label="1"> <text>investment earnings of the Fund;</text> </level> <level label="2"> <text>any fees collected under this subtitle; and</text> </level> <level label="3"> <text>any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="ii"> <text>Money received by the Department from the Fund in accordance with this section is supplemental to and is not intended to take the place of funding that otherwise would be appropriated in the annual State operating or capital budget bill for projects or activities of the Department.</text> </level> </level> <level label="7"> <text>The Fund may be used for expenses that align with the Department’s mission under this title, including:</text> <level label="i"> <text>partnership development; and</text> </level> <level label="ii"> <text>any programs, services, or activities within the Department.</text> </level> </level> <level label="8"> <level label="i"> <text>The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.</text> </level> <level label="ii"> <text>Any interest earnings of the Fund shall be credited to the Fund.</text> </level> </level> <level label="9"> <text>Expenditures from the Fund may be made only in accordance with the State budget.</text> </level> <level label="10"> <level label="i"> <text>Notwithstanding the provisions of § 7–213 of the State Finance and Procurement Article, the Governor may not reduce an appropriation for the Fund in the State budget as approved by the General Assembly.</text> </level> <level label="ii"> <text>Except as provided in this subsection, money appropriated for the Fund shall remain in the Fund.</text> </level> </level> <level label="11"> <text>On or before January 1 each year, the Secretary shall report to the Senate Finance Committee and the House Health Committee, in accordance with § 2–1257 of the State Government Article, on the administration of the Fund for the previous fiscal year, including:</text> <level label="i"> <text>the total amount in the Fund;</text> </level> <level label="ii"> <text>the total number of deposits made to the Fund, including amounts and sources; and</text> </level> <level label="iii"> <text>the total number of expenditures made from the Fund, including amounts and purposes.</text> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-205" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <level label="a"> <text>The Secretary shall prepare and submit a budget for the Department.</text> </level> <level label="b"> <text>The Secretary may accept and use any State or federal funds for the purposes specified in this title.</text> </level> <level label="c"> <text>The Secretary may accept and use any federal or private grant funds if:</text> <level label="1"> <text>the grant is for purposes that will benefit Maryland’s older adults; and</text> </level> <level label="2"> <text>the grant funds are accepted and accounted for in accordance with the State Finance and Procurement Article.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-206" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <level label="a"> <text>On or before January 1 each year, the Secretary shall report to the Governor and, subject to § 2–1257 of the State Government Article, to the General Assembly on:</text> <level label="1"> <text>the allocation of funds made available for senior citizen activities centers distributed by the Department; and</text> </level> <level label="2"> <text>a summary of key activities funded at senior citizen activities centers.</text> </level> </level> <level label="b"> <level label="1"> <text>On or before January 1 each year, the Secretary shall report to the Governor and, subject to § 2–1257 of the State Government Article, to the General Assembly.</text> </level> <level label="2"> <text>The report required under paragraph (1) of this subsection shall include a summary of:</text> <level label="i"> <text>the progress made during the immediately preceding year to implement the most recently published comprehensive Longevity Ready Maryland Plan;</text> </level> <level label="ii"> <text>recommendations for legislation, policy change, or other related planning or advocacy efforts made by the Commission on Aging to the Department;</text> </level> <level label="iii"> <text>any study, survey, or other form of research conducted by the Department or the Commission on Aging; and</text> </level> <level label="iv"> <text>any available research and best practices reviewed by the Commission on Aging.</text> </level> </level> </level> <level label="c"> <text>On or before July 1, 2029, and every 4 years on July 1 thereafter, the Secretary shall provide to the Governor and, subject to § 2–1257 of the State Government Article, to the General Assembly an updated comprehensive Longevity Ready Maryland Plan that:</text> <level label="1"> <text>complies with § 10–204 of this subtitle;</text> </level> <level label="2"> <text>includes progress made on existing goals, objectives, and strategies identified in the immediately preceding Longevity Ready Maryland Plan;</text> </level> <level label="3"> <text>maintains existing goals and includes any additional goals;</text> </level> <level label="4"> <text>updates objectives and strategies if appropriate based on evolving circumstances and population projections; and</text> </level> <level label="5"> <text>is informed by the State Plan on Aging as required by the Older Americans Act of 1965 and other relevant State and local plans and agency collaborations.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-207" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <text>The Secretary shall appoint a deputy secretary.</text> </section> <section article="ghu" article_name="Human Services" number="10-208" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <level label="a"> <text>There is a Commission on Aging in the Department.</text> </level> <level label="b"> <level label="1"> <text>The Commission consists of the following members:</text> <level label="i"> <text>one member of the Senate of Maryland, appointed by the President of the Senate;</text> </level> <level label="ii"> <text>one member of the House of Delegates, appointed by the Speaker of the House;</text> </level> <level label="iii"> <text>the Secretary of Aging, or the Secretary’s designee; and</text> </level> <level label="iv"> <text>the following members, appointed by the Governor:</text> <level label="1"> <text>three directors of area agencies on aging, including the president of the Maryland Association of Area Agencies on Aging;</text> </level> <level label="2"> <text>three representatives of organizations located in the State that advocate for older adults and caregivers;</text> </level> <level label="3"> <text>six experts on aging representing the disciplines of health care, technology, academia, innovation, consumer protection, and the private sector and philanthropy;</text> </level> <level label="4"> <text>five individuals with a demonstrated interest in the implementation of the Longevity Ready Maryland Plan; and</text> </level> <level label="5"> <text>one veteran with a demonstrated interest in the implementation of the Longevity Ready Maryland Plan.</text> </level> </level> </level> <level label="2"> <text>To the extent practicable, Commission membership shall reflect the age, race, ethnicity, disability, gender identity, sexual orientation, immigrant heritage, lived and professional experience, and regional geographic representation diversity of the State.</text> </level> </level> <level label="c"> <text>The Department shall provide staff for the Commission.</text> </level> <level label="d"> <level label="1"> <text>The term of a member of the Commission is 4 years.</text> </level> <level label="2"> <text>The terms of new members appointed under subsection (b)(1)(iv) of this section are staggered as required by the terms provided for members of the Commission on October 1, 2026.</text> </level> <level label="3"> <text>A member of the Commission appointed under subsection (b)(1)(iv) of this section may not serve more than two consecutive terms.</text> </level> <level label="4"> <text>At the end of a term, a member continues to serve until a successor is appointed and qualifies.</text> </level> <level label="5"> <text>A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.</text> </level> <level label="6"> <text>A member who fails to attend at least 50% of the meetings during any consecutive 12–month period shall be considered to have resigned.</text> </level> </level> <level label="e"> <text>The Commission shall determine the frequency, dates, times, and places of its meetings.</text> </level> <level label="f"> <level label="1"> <text>From among the members of the Commission, the Secretary:</text> <level label="i"> <text>shall designate the chair of the Commission; and</text> </level> <level label="ii"> <text>may designate a vice chair of the Commission.</text> </level> </level> <level label="2"> <text>A majority of the members then serving on the Commission is a quorum.</text> </level> <level label="3"> <text>The chair may establish subcommittees of the Commission.</text> </level> <level label="4"> <text>The Commission may consult and collaborate with local commissions on aging.</text> </level> </level> <level label="g"> <text>A member of the Commission:</text> <level label="1"> <text>may not receive compensation as a member of the Commission; but</text> </level> <level label="2"> <text>is entitled to reimbursement for expenses under the Standard State Travel Regulations as provided in the State budget.</text> </level> </level> <level label="h"> <text>The Commission shall:</text> <level label="1"> <text>exercise the powers and perform the duties specified in this title;</text> </level> <level label="2"> <text>review and advise the Department on the Longevity Ready Maryland Plan and overall progress of the Department and multisector partners in implementing the recommendations of the most recently published Longevity Ready Maryland Plan;</text> </level> <level label="3"> <text>advise the Secretary on legislative, policy, and other systems changes that could assist with implementation of the Longevity Ready Maryland Plan; and</text> </level> <level label="4"> <text>advise the Secretary on any update to the Longevity Ready Maryland Plan required by § 10–206 of this subtitle, including any update to the goals, objectives, and strategies to be included in subsequent Longevity Ready Maryland plans.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-209" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <text>** IN EFFECT UNTIL JULY 1, 2026 PER CHAPTERS 33 AND 34 OF 2025 **</text> <level label="a"> <level label="1"> <text>The Secretary shall develop congregate housing services programs for seniors in conjunction with:</text> <level label="i"> <text>public or private for profit or nonprofit corporations; or</text> </level> <level label="ii"> <text>State or federal units.</text> </level> </level> <level label="2"> <text>Congregate housing services shall include congregate meals, housekeeping, and personal services.</text> </level> </level> <level label="b"> <level label="1"> <text>An individual is eligible for congregate housing services if the individual is at least 62 years old and has temporary or periodic difficulty with one or more essential activities of daily living, such as feeding, bathing, grooming, dressing, or transferring.</text> </level> <level label="2"> <text>The spouse of an individual described in paragraph (1) of this subsection is eligible for congregate housing services if the spouse is at least 55 years old and has temporary or periodic difficulty with one or more essential activities of daily living, such as feeding, bathing, grooming, dressing, or transferring.</text> </level> </level> <level label="c"> <text>The Secretary shall:</text> <level label="1"> <text>make maximum use of rent and other subsidies available from federal and State sources;</text> </level> <level label="2"> <text>provide for subsidies necessary from State general funds to assist low–income seniors to reside in congregate housing as an alternative to more costly institutional care that is not required;</text> </level> <level label="3"> <text>find sponsors or managers for congregate housing services programs;</text> </level> <level label="4"> <text>assist developers in formulating design concepts and meeting program needs; and</text> </level> <level label="5"> <text>when necessary, provide subsidies for congregate meals, housekeeping, and personal services in congregate housing services programs and develop eligibility requirements for the subsidies.</text> </level> </level> <level label="d"> <text>The Secretary shall adopt regulations to:</text> <level label="1"> <text>govern the certification and operation of congregate housing services programs; and</text> </level> <level label="2"> <text>provide for investigations of criminal records of congregate housing services providers and employees under subsection (e) of this section.</text> </level> </level> <level label="e"> <text>The Secretary is authorized to conduct federal and State criminal background investigations of providers of congregate housing services programs and their employees.</text> </level> <level label="f"> <level label="1"> <text>A congregate housing services program must be certified by the Secretary.</text> </level> <level label="2"> <text>The Secretary shall review the compliance of congregate housing services programs with the regulations governing their certification and operation.</text> </level> <level label="3"> <text>Before the Secretary may certify or renew the certification of a provider of congregate housing services for seniors with Alzheimer’s disease and related disorders, the provider shall have an in–service education program that includes instruction on dementia and the techniques necessary to manage patients with physical, intellectual, and behavioral manifestations of dementia.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-210" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <text>** IN EFFECT UNTIL JULY 1, 2026 PER CHAPTERS 33 AND 34 OF 2025 **</text> <level label="a"> <text>The Secretary may impose a civil money penalty against a provider of congregate housing services for a violation:</text> <level label="1"> <text>that results in conditions presenting an imminent danger or a substantial probability of death or serious physical harm to a resident of congregate housing;</text> </level> <level label="2"> <text>of a resident’s rights as specified in regulations adopted under this title; or</text> </level> <level label="3"> <text>of a State or local fire safety law.</text> </level> </level> <level label="b"> <text>Before imposing a penalty under this section, the Department shall send a notice of violation to the provider that states:</text> <level label="1"> <text>when the provider must submit a plan of correction that is acceptable to the Department;</text> </level> <level label="2"> <text>when each identified violation must be substantially corrected; and</text> </level> <level label="3"> <text>that a civil money penalty may be imposed for failure to:</text> <level label="i"> <text>submit an acceptable plan of correction; or</text> </level> <level label="ii"> <text>correct an identified violation.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>After the time for correcting a violation has ended, the Department shall reinspect the facility to determine whether the violation has been corrected.</text> </level> <level label="2"> <text>After the reinspection, the Secretary may:</text> <level label="i"> <text>extend the time to correct the violation; or</text> </level> <level label="ii"> <text>impose a civil money penalty under subsection (d) of this section.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>The Secretary may impose a civil money penalty not exceeding $20 per violation per resident for each day that a violation remains uncorrected after the time set for correction under subsection (b)(2) of this section.</text> </level> <level label="2"> <text>A penalty imposed under this section may not exceed $1,000 per violation or $5,000 in total.</text> </level> </level> <level label="e"> <level label="1"> <text>The Secretary shall provide written notice of a civil money penalty to the provider.</text> </level> <level label="2"> <text>The notice shall:</text> <level label="i"> <text>be served on the provider by certified mail; and</text> </level> <level label="ii"> <text>state:</text> <level label="1"> <text>each penalty imposed;</text> </level> <level label="2"> <text>the regulation or provision violated;</text> </level> <level label="3"> <text>the amount of the penalty;</text> </level> <level label="4"> <text>the provider’s right to request a reduction of the penalty; and</text> </level> <level label="5"> <text>how to file an administrative appeal of the penalty.</text> </level> </level> </level> </level> <level label="f"> <level label="1"> <text>A provider of congregate housing services may request a reduction of a civil money penalty.</text> </level> <level label="2"> <text>A request for a reduction shall:</text> <level label="i"> <text>be made in writing within 10 days after the provider receives the notice of the civil money penalty; and</text> </level> <level label="ii"> <text>state the reasons for the request.</text> </level> </level> <level label="3"> <text>A request for a reduction of a civil money penalty does not affect the accrual of the penalties under subsection (d) of this section.</text> </level> <level label="4"> <text>Within 14 days after receiving the request for reduction, the Department shall hold an informal conference with the provider on the issue of whether to reduce the civil money penalty.</text> </level> <level label="5"> <text>In deciding whether to reduce the penalty, the Secretary shall consider:</text> <level label="i"> <text>the provider’s history of violations;</text> </level> <level label="ii"> <text>the provider’s current and past diligence in correcting violations; and</text> </level> <level label="iii"> <text>other factors that the Secretary considers appropriate.</text> </level> </level> <level label="6"> <text>The Secretary shall issue a written determination granting or denying the request for a reduction of a civil money penalty that states the reasons for the determination.</text> </level> <level label="7"> <text>As a condition of reducing a penalty, the Secretary shall require correction of all violations.</text> </level> </level> <level label="g"> <text>If a civil money penalty is imposed under this section, the provider has the right to appeal from the order in accordance with Title 10, Subtitle 2 of the State Government Article.</text> </level> <level label="h"> <text>The Secretary may impose a penalty of three times the amount set forth in subsection (d) of this section on a provider of congregate housing services if a penalty was imposed on the provider for the same violation during the 2 years before the date on which the notice of violation was issued.</text> </level> <level label="i"> <level label="1"> <text>An order imposing a civil money penalty is final when the provider has exhausted all opportunities to contest the penalty under subsection (f) or (g) of this section.</text> </level> <level label="2"> <text>A provider shall pay all penalties to the Department within 10 days after the provider receives a final order imposing a penalty.</text> </level> <level label="3"> <text>If a provider does not comply with this section, the Department may file a civil action to recover the penalty.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-211" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <text>** IN EFFECT UNTIL JULY 1, 2026 PER CHAPTERS 33 AND 34 OF 2025 **</text> <level label="a"> <text>In this section, “assisted living program” has the meaning stated in § 19–1801 of the Health – General Article.</text> </level> <level label="b"> <text>The Secretary shall develop assisted living programs for seniors in conjunction with:</text> <level label="1"> <text>public or private for profit or nonprofit corporations; or</text> </level> <level label="2"> <text>State or federal units.</text> </level> </level> <level label="c"> <level label="1"> <text>The Secretary shall:</text> <level label="i"> <text>make maximum use of rent and other subsidies available from federal and State sources; and</text> </level> <level label="ii"> <text>provide for and set, by regulation, the amount of subsidies necessary from State general funds to assist low–income seniors to reside in assisted living programs as an alternative to more costly institutional care that is not required.</text> </level> </level> <level label="2"> <text>Subsidies under paragraph (1)(ii) of this subsection may include, when necessary and in accordance with available funds, monthly subsidies for residents of assisted living programs whose adjusted gross annual income is less than their cost of care for assisted living services.</text> </level> <level label="3"> <text>When necessary and in accordance with available funds, the Secretary shall provide subsidies for congregate meals, housekeeping, and personal services for assisted living programs and develop eligibility requirements for these subsidies.</text> </level> <level label="4"> <text>The Secretary shall adopt regulations to govern eligibility requirements for subsidies.</text> </level> </level> <level label="d"> <text>The Secretary shall:</text> <level label="1"> <text>find sponsors for assisted living programs; and</text> </level> <level label="2"> <text>assist developers in formulating design concepts and meeting program needs.</text> </level> </level> <level label="e"> <text>The Secretary shall review the compliance of assisted living programs with the regulations that the Secretary of Health adopts for licensing these programs to operate in the State.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-214" title_number="10" title_name="Department of Aging" subtitle_number="2" subtitle_name="Department of Aging"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Nursing home” means comprehensive care facilities and extended care facilities.</text> </level> <level label="3"> <text>“Unclaimed deceased nursing home resident” means a resident of a nursing home:</text> <level label="i"> <text>who has not prearranged and prepaid for the disposal of the resident’s body; and</text> </level> <level label="ii"> <text>for whom no person has claimed the body and assumed funeral or burial responsibility on the death of the resident.</text> </level> </level> </level> <level label="b"> <text>The Secretary shall adopt regulations establishing guidelines for nursing home administrators regarding funeral and burial arrangements for unclaimed deceased nursing home residents:</text> <level label="1"> <text>consistent with § 5-406 of the Health - General Article; and</text> </level> <level label="2"> <text>with the cooperation of the State Anatomy Board.</text> </level> </level> <level label="c"> <text>A nursing home administrator shall:</text> <level label="1"> <text>immediately notify the Department of the death of an unclaimed deceased nursing home resident; and</text> </level> <level label="2"> <text>obtain the approval of the Department before burying or making funeral arrangements for the unclaimed deceased nursing home resident.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-301" title_number="10" title_name="Department of Aging" subtitle_number="3" subtitle_name="Interagency Committee on Aging Services"> <level label="a"> <text>The Department may enter into agreements and contracts, adopt regulations, and adopt policies and procedures to implement and coordinate services to older adults under this title.</text> </level> <level label="b"> <text>The Department may collaborate with county agencies, area agencies on aging, nonprofit organizations, or other persons that establish local interagency committees.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-302" title_number="10" title_name="Department of Aging" subtitle_number="3" subtitle_name="Interagency Committee on Aging Services"> <level label="a"> <text>The Department shall establish, coordinate, and supervise a program to provide single points of entry within each planning and service area.</text> </level> <level label="b"> <text>Each area agency on aging shall operate a single point of entry program to assess the needs of older adults and their caregivers and provide appropriate services.</text> </level> <level label="c"> <text>The following services shall be provided through a single point of entry:</text> <level label="1"> <text>providing current information on available programs, services, or benefits;</text> </level> <level label="2"> <text>determining the service needs of each older adult who requests service;</text> </level> <level label="3"> <text>processing requests for service from older adults;</text> </level> <level label="4"> <text>through widely publicized local outreach facilities and communications systems, providing access to available public and private programs and services for older adults, including:</text> <level label="i"> <text>transportation services;</text> </level> <level label="ii"> <text>health and nutrition services;</text> </level> <level label="iii"> <text>financial assistance;</text> </level> <level label="iv"> <text>social services;</text> </level> <level label="v"> <text>educational services;</text> </level> <level label="vi"> <text>services available through volunteer organizations or private agencies;</text> </level> <level label="vii"> <text>appropriate housing arrangements;</text> </level> <level label="viii"> <text>health insurance counseling;</text> </level> <level label="ix"> <text>employment and volunteer opportunities;</text> </level> <level label="x"> <text>respite care services; and</text> </level> <level label="xi"> <text>other programs, information, counseling, or benefits for older adults;</text> </level> </level> <level label="5"> <text>monitoring the outcome of requests for service or information; and</text> </level> <level label="6"> <text>arranging with other agencies for individual assessment to determine the service needs of older adults in need of long–term services and supports.</text> </level> </level> <level label="d"> <text>To the extent possible, each single point of entry shall be:</text> <level label="1"> <text>located in a senior citizen center; and</text> </level> <level label="2"> <text>available for access at least 5 days a week.</text> </level> </level> <level label="e"> <text>Area agencies on aging shall make agreements with nonprofit organizations or other persons as needed and provide staff on a regular basis at the single points of entry to:</text> <level label="1"> <text>provide information and services to older adults; and</text> </level> <level label="2"> <text>administer agency programs.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-303" title_number="10" title_name="Department of Aging" subtitle_number="3" subtitle_name="Interagency Committee on Aging Services"> <text>Each planning and service area shall have a telephone information and referral service that is available on a 24–hour basis.</text> </section> <section article="ghu" article_name="Human Services" number="10-304" title_number="10" title_name="Department of Aging" subtitle_number="3" subtitle_name="Interagency Committee on Aging Services"> <level label="a"> <text>The Department shall develop, coordinate, and administer with area agencies on aging or other persons a system to provide services to older adults in need of long–term services and supports to allow older adults to age in a location selected by the older adult with appropriate services, supports, and housing opportunities.</text> </level> <level label="b"> <text>The services may include:</text> <level label="1"> <text>integrated screening and evaluation;</text> </level> <level label="2"> <text>development of an individual plan of care;</text> </level> <level label="3"> <text>in–home services such as home repair or other home modifications, shopping assistance, homemaking, chore services, personal care, meal delivery or preparation, transportation services, health services, and other supportive services;</text> </level> <level label="4"> <text>community–based services such as day care, food and other meal coordination, and other efforts to assist older adults or adult caregivers;</text> </level> <level label="5"> <text>a subsidy for the costs of an assisted living program as defined in § 19–1801 of the Health – General Article;</text> </level> <level label="6"> <text>any other service that may mitigate the risk of impact to, or improve resilience of, housing or services of older adults by natural, technological, or human–made threats and hazards, including climate change; and</text> </level> <level label="7"> <text>any other service authorized by the Department.</text> </level> </level> <level label="c"> <text>To be eligible to participate in the system, a county, area agency on aging, nonprofit organization, or any other person shall comply with Department standards.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-401" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Assisted living program” has the meaning stated in § 19-1801 of the Health - General Article.</text> </level> <level label="c"> <text>“Certified financial statement” means a complete audit prepared and certified by an independent certified public accountant.</text> </level> <level label="d"> <text>“Continuing care” means:</text> <level label="1"> <text>continuing care in a retirement community; or</text> </level> <level label="2"> <text>continuing care at home.</text> </level> </level> <level label="e"> <text>“Continuing care agreement” means an agreement between a provider and a subscriber to provide continuing care.</text> </level> <level label="f"> <level label="1"> <text>“Continuing care at home” means providing medical, nursing, or other health related services directly or by contractual arrangement:</text> <level label="i"> <text>to an individual who is at least 60 years of age and not related by blood or marriage to the provider;</text> </level> <level label="ii"> <text>for the life of the individual or for a period exceeding 1 year; and</text> </level> <level label="iii"> <text>under a written agreement that requires a transfer of assets or an entrance fee notwithstanding periodic charges.</text> </level> </level> <level label="2"> <text>“Continuing care at home” includes providing assistance with the physical maintenance of the individual’s dwelling.</text> </level> </level> <level label="g"> <text>“Continuing care in a retirement community” means providing shelter and providing either medical and nursing or other health related services or making the services readily accessible through the provider or an affiliate of the provider, whether or not the services are specifically offered in the written agreement for shelter:</text> <level label="1"> <text>to an individual who is at least 60 years of age and not related by blood or marriage to the provider;</text> </level> <level label="2"> <text>for the life of the individual or for a period exceeding 1 year; and</text> </level> <level label="3"> <text>under one or more written agreements that require a transfer of assets or an entrance fee notwithstanding periodic charges.</text> </level> </level> <level label="h"> <level label="1"> <text>“Contractual entrance fee refund” means a repayment of all or part of a subscriber’s entrance fee to the subscriber or the subscriber’s estate or designated beneficiary, as required by the terms of the continuing care agreement.</text> </level> <level label="2"> <text>“Contractual entrance fee refund” does not include a payment required under § 10-446 or § 10-448 of this subtitle.</text> </level> </level> <level label="i"> <text>“Conversion” means converting a physical plant that provides housing or shelter into a facility if:</text> <level label="1"> <text>the residential accommodations exist before a statement of intent is filed under § 10-409(b) of this subtitle; and</text> </level> <level label="2"> <text>at least 60% of the available residential accommodations of the facility owner were occupied during the two fiscal years prior to the filing of a statement of intent.</text> </level> </level> <level label="j"> <text>“Deposit” means a portion of an entrance fee.</text> </level> <level label="k"> <level label="1"> <text>“Entrance fee” means a sum of money or other consideration paid initially or in deferred payments, that:</text> <level label="i"> <text>assures a subscriber continuing care for the life of the subscriber or for a period exceeding 1 year; and</text> </level> <level label="ii"> <text>is at least three times the weighted average of the monthly cost of the periodic fees charged for independent living and assisted living units.</text> </level> </level> <level label="2"> <text>“Entrance fee” includes a fee of similar form and application, regardless of title.</text> </level> <level label="3"> <text>“Entrance fee” does not include a surcharge.</text> </level> </level> <level label="l"> <level label="1"> <text>“Expansion” means any single new capital addition to an existing facility that meets either of the following criteria:</text> <level label="i"> <text>if independent or assisted living units are to be constructed, the number of units to be constructed is less than or equal to 25% of the number of existing independent and assisted living units; or</text> </level> <level label="ii"> <text>if independent or assisted living units are not to be constructed, the total projected cost exceeds the sum of:</text> <level label="1"> <text>10% of the total operating expenses, less depreciation, amortization, and interest expense of the facility as shown on the certified financial statement for the most recent fiscal year for which a certified financial statement is available; and</text> </level> <level label="2"> <text>the amount of the existing reserves properly allocable to, and allocated for, the expansion.</text> </level> </level> </level> <level label="2"> <text>“Expansion” does not include renovation and normal repair and maintenance.</text> </level> </level> <level label="m"> <text>“Facility” means a physical plant in which continuing care in a retirement community is provided in accordance with this subtitle.</text> </level> <level label="n"> <text>“Financial difficulty” means current or impending financial conditions that impair or may impair the ability of a provider to meet existing or future obligations.</text> </level> <level label="o"> <text>“Governing body” means a board of directors, board of trustees, or similar group that ultimately directs the affairs of a provider, but whose members are not required to have an equity interest in the provider.</text> </level> <level label="p"> <level label="1"> <text>“Health related services” means services that are needed by a subscriber to maintain the subscriber’s health.</text> </level> <level label="2"> <text>“Health related services” includes:</text> <level label="i"> <text>priority admission to a nursing home or assisted living program; and</text> </level> <level label="ii"> <text>except for the provision of meals, assistance with the activities of daily living.</text> </level> </level> </level> <level label="q"> <text>“Person” includes a governmental entity or unit.</text> </level> <level label="r"> <text>“Processing fee” means a fee imposed by a provider for determining the financial, mental, and physical eligibility of an applicant for entrance into a facility.</text> </level> <level label="s"> <text>“Provider” means a person who:</text> <level label="1"> <text>undertakes to provide continuing care; and</text> </level> <level label="2"> <text>is:</text> <level label="i"> <text>the owner or operator of a facility; or</text> </level> <level label="ii"> <text>an applicant for or the holder of a preliminary, initial, or renewal certificate of registration.</text> </level> </level> </level> <level label="t"> <text>“Records” means information maintained by a provider for the proper operation of a facility under this subtitle.</text> </level> <level label="u"> <level label="1"> <text>“Renovation” means any single capital improvement to, or replacement of, all or part of an existing facility that will not increase the number of independent or assisted living units and for which the total projected cost exceeds the sum of:</text> <level label="i"> <text>20% of the total operating expenses, less depreciation, amortization, and interest expense of the facility as shown on the certified financial statement for the most recent fiscal year for which a certified financial statement is available; and</text> </level> <level label="ii"> <text>the amount of existing reserves properly allocable to, and allocated for, the renovation.</text> </level> </level> <level label="2"> <text>“Renovation” does not include normal repair or maintenance.</text> </level> </level> <level label="v"> <text>“Subscriber” means an individual for whom a continuing care agreement is purchased.</text> </level> <level label="w"> <level label="1"> <text>“Surcharge” means a separate and additional charge that:</text> <level label="i"> <text>is imposed simultaneously with the entrance fee; and</text> </level> <level label="ii"> <text>may be required of some, but not all, subscribers because of a condition or circumstance that applies only to those subscribers.</text> </level> </level> <level label="2"> <text>“Surcharge” does not include a second person entrance fee.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-402" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>A continuing care at home provider is subject to each provision of this subtitle except Part II and §§ 10–446 and 10–448.</text> </level> <level label="2"> <text>A continuing care in a retirement community provider is subject to each provision of this subtitle except Part VI.</text> </level> </level> <level label="b"> <level label="1"> <text>A continuing care operation that is subject to the provisions of this subtitle is not subject to:</text> <level label="i"> <text>the Maryland Health Maintenance Organization Act under Title 19, Subtitle 7 of the Health – General Article;</text> </level> <level label="ii"> <text>except for § 15–603 of the Insurance Article, the Insurance Article;</text> </level> <level label="iii"> <text>Title 8 of the Real Property Article;</text> </level> <level label="iv"> <text>any county or municipal landlord–tenant law; or</text> </level> <level label="v"> <text>§ 19–310.1 of the Health – General Article.</text> </level> </level> <level label="2"> <text>If a provider contractually utilizes the services of a licensed home health agency or residential service agency and is not itself directly providing the type of services provided by a home health agency or residential service agency, the provider is not subject to Title 19, Subtitles 4 and 4A of the Health – General Article.</text> </level> <level label="3"> <text>Except as provided in paragraphs (1) and (2) of this subsection, a continuing care at home provider is subject to all other applicable licensing or certification requirements of State law.</text> </level> </level> <level label="c"> <text>This subtitle does not apply to an agreement that is regulated as insurance under the Insurance Article.</text> </level> <level label="d"> <text>A provider that offers assisted living program services as part of a continuum of care in accordance with a continuing care agreement may:</text> <level label="1"> <text>execute a separate assisted living resident agreement and a separate assisted living disclosure statement; or</text> </level> <level label="2"> <text>meet the requirements of §§ 10–425(c) and 10–444(e) of this subtitle.</text> </level> </level> <level label="e"> <text>The liability of a provider to the Maryland Department of Health under § 15–603 of the Insurance Article shall be limited to the amount of the refund that would be due to the subscriber if the subscriber were dismissed under § 10–448 of this subtitle at the time of enrollment in services provided by or paid wholly or partly by the Maryland Department of Health.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-403" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>The Department shall:</text> <level label="1"> <text>administer this subtitle;</text> </level> <level label="2"> <text>prepare and furnish all forms necessary or desirable under this subtitle;</text> </level> <level label="3"> <text>establish and collect reasonable filing fees to carry out this subtitle;</text> </level> <level label="4"> <text>adopt regulations necessary to enforce this subtitle; and</text> </level> <level label="5"> <text>prepare and distribute relevant public information and educational materials designed to advise individuals, institutions, and organizations of their rights and responsibilities under this subtitle.</text> </level> </level> <level label="b"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, the Department shall make available to interested persons any information required to be provided to the Department under this subtitle and publicize the availability of the information.</text> </level> <level label="2"> <level label="i"> <text>A feasibility study filed under § 10-408 of this subtitle may not be disclosed until the Department issues an initial certificate of registration for the project.</text> </level> <level label="ii"> <text>Information required to be provided under § 10-434(b)(2) of this subtitle shall be disclosed only to the extent required under the Public Information Act.</text> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-404" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>Medical and nursing services and other health related services may be covered by an entrance fee or periodic charges or, at the option of the subscriber, may be purchased for an additional fee.</text> </section> <section article="ghu" article_name="Human Services" number="10-405" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>In this section, “Fund” means the Continuing Care Fund.</text> </level> <level label="b"> <text>There is a Continuing Care Fund.</text> </level> <level label="c"> <text>The purpose of the Fund is to defray the costs of administering this subtitle.</text> </level> <level label="d"> <text>The Department of Aging shall administer the Fund.</text> </level> <level label="e"> <level label="1"> <text>The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="2"> <text>The State Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.</text> </level> </level> <level label="f"> <text>The Fund consists of:</text> <level label="1"> <text>all fees collected under this subtitle;</text> </level> <level label="2"> <text>money appropriated in the State budget to the Fund;</text> </level> <level label="3"> <text>investment earnings of the Fund; and</text> </level> <level label="4"> <text>any other money from any other source accepted for the benefit of the Fund.</text> </level> </level> <level label="g"> <text>The Fund may be used only for the purposes specified in this subtitle.</text> </level> <level label="h"> <level label="1"> <text>The State Treasurer shall invest the money of the Fund in the same manner as other State money may be invested.</text> </level> <level label="2"> <text>Any investment earnings of the Fund shall be paid into the Fund.</text> </level> </level> <level label="i"> <text>Expenditures from the Fund may be made only in accordance with the State budget.</text> </level> <level label="j"> <text>Money expended from the Fund for administering this subtitle is supplemental to and is not intended to take the place of funding that otherwise would be appropriated for administering this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-407" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>This part applies only to continuing care in a retirement community operations.</text> </section> <section article="ghu" article_name="Human Services" number="10-408" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider shall comply with the applicable provisions of §§ 10-409 through 10-415 of this subtitle before the provider may:</text> <level label="1"> <text>offer continuing care in a retirement community;</text> </level> <level label="2"> <text>enter into or renew continuing care agreements;</text> </level> <level label="3"> <text>begin construction of a new facility;</text> </level> <level label="4"> <text>begin construction of an expansion to or renovation of an existing facility; or</text> </level> <level label="5"> <text>collect deposits for continuing care in this State.</text> </level> </level> <level label="b"> <level label="1"> <text>A new capital addition to a facility that will result in the construction of a number of independent and assisted living units that is greater than 25% of the number of existing units is considered new development and is subject to §§ 10-409 through 10-411 of this subtitle.</text> </level> <level label="2"> <text>A new capital addition to a facility that does not involve the construction of independent or assisted living units and that does not meet the standard of § 10-401(l)(1)(ii) of this subtitle is not subject to review by the Department under §§ 10-409 through 10-415 of this subtitle.</text> </level> <level label="3"> <text>A capital improvement or replacement that does not meet the standard of § 10-401(w) of this subtitle is not subject to review by the Department under §§ 10-409 through 10-415 of this subtitle.</text> </level> </level> <level label="c"> <text>A provider that has more than one facility offering continuing care shall make a separate application for each facility for preliminary, initial, and renewal certificates of registration.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-409" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not collect deposits for continuing care or begin construction of a new facility until the Department approves a feasibility study.</text> </level> <level label="b"> <text>A person who intends to submit a feasibility study under subsection (c) of this section shall file with the Department a statement of intent to provide continuing care at least 30 days before the person submits the feasibility study to the Department.</text> </level> <level label="c"> <text>A feasibility study shall:</text> <level label="1"> <text>be filed in a form satisfactory to the Department; and</text> </level> <level label="2"> <text>include at least the following information:</text> <level label="i"> <text>a statement of the purpose of the proposed construction or conversion;</text> </level> <level label="ii"> <text>documentation of the financial resources of the provider;</text> </level> <level label="iii"> <text>a statement of the capital expenditures necessary to accomplish the project and the plan for acquiring the necessary capital;</text> </level> <level label="iv"> <text>a plan demonstrating the financial feasibility of the proposed project, including future funding sources;</text> </level> <level label="v"> <text>a study that demonstrates the market for the project;</text> </level> <level label="vi"> <text>an actuarial forecast reviewed by a qualified actuary;</text> </level> <level label="vii"> <text>a statement of the planned fee structure, including any proposed escalator or other automatic adjustment provision;</text> </level> <level label="viii"> <text>a description of the facility proposed to be used or being used for continuing care;</text> </level> <level label="ix"> <text>a copy of the proposed escrow and deposit agreements; and</text> </level> <level label="x"> <text>the form and substance of any proposed advertisement, advertising campaign, or promotional material for the facility that is available at the time of filing.</text> </level> </level> </level> <level label="d"> <text>The Department may approve a feasibility study if the Department determines that:</text> <level label="1"> <text>the number of comprehensive care or assisted living beds in the facility for which licenses are required by the Maryland Department of Health is not inconsistent with the State health plan;</text> </level> <level label="2"> <text>a reasonable financial plan has been submitted for developing and operating the project;</text> </level> <level label="3"> <text>a market for the facility appears to exist;</text> </level> <level label="4"> <text>a recognized authority prepared the feasibility study;</text> </level> <level label="5"> <text>the actuarial forecast supports the projections for the project;</text> </level> <level label="6"> <text>the Department has approved the escrow agreement and deposit agreement; and</text> </level> <level label="7"> <text>the approved escrow agreement is executed by the provider and the financial institution.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-410" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may collect deposits from prospective subscribers if:</text> <level label="1"> <text>the Department has approved the provider’s feasibility study; and</text> </level> <level label="2"> <text>funds collected are maintained in an escrow account.</text> </level> </level> <level label="b"> <text>Each deposit agreement shall comply with the requirements of subsection (c) or (d) of this section.</text> </level> <level label="c"> <text>If a deposit agreement is used for a deposit on a unit for which the provider has not received written approval to withdraw deposits, the deposit agreement shall:</text> <level label="1"> <text>state that all deposits and entrance fees will be held in escrow until:</text> <level label="i"> <text>an initial certificate of registration for the unit is issued;</text> </level> <level label="ii"> <text>construction is completed;</text> </level> <level label="iii"> <text>a certificate of occupancy, or its equivalent, is issued by the local jurisdiction; and</text> </level> <level label="iv"> <text>the provider has the appropriate licenses or certificates from the Maryland Department of Health, the Maryland Health Care Commission, and the Department;</text> </level> </level> <level label="2"> <text>describe the disposition of any interest earned on deposits and entrance fees;</text> </level> <level label="3"> <text>state the amount of any processing fee and whether it will be refunded if the deposit agreement is canceled; and</text> </level> <level label="4"> <text>describe the disposition of the deposit if the deposit agreement is canceled before the continuing care agreement is executed.</text> </level> </level> <level label="d"> <text>If a deposit agreement is used for a deposit on a unit for which the provider has received written approval to withdraw deposits, the deposit agreement shall:</text> <level label="1"> <text>state that the provider may use all deposits and entrance fees at any time; or</text> </level> <level label="2"> <text>describe any applicable limitations on the use of deposits and entrance fees.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-411" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not enter into a continuing care agreement until the Department issues a preliminary certificate of registration.</text> </level> <level label="b"> <text>An application for a preliminary certificate of registration shall be filed in a form satisfactory to the Department.</text> </level> <level label="c"> <text>An application shall include at least the following information:</text> <level label="1"> <text>the name and address of the facility and the name and address of any affiliate, parent, or subsidiary;</text> </level> <level label="2"> <text>the organizational structure and management of the provider, including:</text> <level label="i"> <text>for a corporation or limited liability company, its name, the state in which it is incorporated or formed, and the name of the chief executive officer;</text> </level> <level label="ii"> <text>for a partnership, the names of the general partners, the state governing its formation, and the name of the primary individual responsible for managing it;</text> </level> <level label="iii"> <text>for an unincorporated association, the names of the members, the state governing its activities, and the name of the primary individual responsible for managing it;</text> </level> <level label="iv"> <text>for a partnership that has a corporation or limited liability company as one or more of its general partners, the name of each corporation or limited liability company, the state in which it is incorporated or formed, and the name of the chief executive officer;</text> </level> <level label="v"> <text>for a trust, the name of the trustee, the names of the owners of beneficial interests in the trust, the state governing it, and the name of the primary individual responsible for overseeing its activities;</text> </level> <level label="vi"> <text>the name and occupation of each officer, director, trustee, managing or general partner, and each person with a 10% or greater financial equity or beneficial interest in the provider and a description of the person’s financial interest in or occupation with the provider;</text> </level> <level label="vii"> <text>the name and address of any entity in which a person identified in item (vi) of this paragraph has a 10% or greater financial interest and that is anticipated to provide goods, premises, or services with a value of $10,000 or more to the facility or provider in a fiscal year and a description of the goods, premises, or services and their anticipated cost to the facility or provider, which need not include salary, wage, or benefit information of employees of the provider; and</text> </level> <level label="viii"> <text>a statement whether the provider is qualified, or intends to qualify, as a tax–exempt organization under the Internal Revenue Code;</text> </level> </level> <level label="3"> <text>a copy of the corporate charter, partnership agreement, articles of association, membership agreement, trust agreement, or similar instrument or agreement governing the legal organization of the provider;</text> </level> <level label="4"> <level label="i"> <text>a certified financial statement of the provider for as many of the most recent fiscal years, not exceeding 3 years, for which certified financial statements are obtainable under generally accepted accounting principles; and</text> </level> <level label="ii"> <text>if the provider’s fiscal year ended more than 90 days before the date the application is filed, an income statement, which need not be certified, covering the period between the end of the fiscal year and a date not more than 90 days before the date the application is filed;</text> </level> </level> <level label="5"> <text>a statement of any affiliation with a religious, charitable, or other nonprofit organization, the extent of the affiliation, and the extent, if any, to which the affiliate organization will be responsible for the provider’s financial and contractual obligations;</text> </level> <level label="6"> <text>a copy of the proposed continuing care agreement;</text> </level> <level label="7"> <text>a copy of any priority admission agreements between the provider and any health care provider for health related services;</text> </level> <level label="8"> <text>a statement of the current fee structure, including escalator or other automatic adjustment provisions;</text> </level> <level label="9"> <text>a statement of the role of any publicly funded benefit or insurance program in the financing of care;</text> </level> <level label="10"> <text>the form and substance of any advertisement, advertising campaign, or other promotional material for the facility that has not been previously submitted to the Department; and</text> </level> <level label="11"> <text>other reasonable and pertinent information that the Department requires.</text> </level> </level> <level label="d"> <text>The Department shall issue a preliminary certificate of registration to a provider if:</text> <level label="1"> <text>the feasibility study has been approved; and</text> </level> <level label="2"> <text>the Department determines that:</text> <level label="i"> <text>the proposed continuing care agreement meets the requirements of §§ 10–444, 10–445, 10–446, and 10–448 of this subtitle;</text> </level> <level label="ii"> <text>all of the financial and organizational materials required to be submitted under subsection (c) of this section have been submitted to the Department; and</text> </level> <level label="iii"> <text>the form and substance of all advertisements, advertising campaigns, and other promotional materials submitted are not deceptive, misleading, or likely to mislead.</text> </level> </level> </level> <level label="e"> <text>If a preliminary certificate of registration is not issued within 6 months after the feasibility study is approved, or a longer time allowed by the Department for good cause shown, the provider shall refund all deposits and stop marketing continuing care under that application.</text> </level> <level label="f"> <text>A provider that plans to advertise before an initial certificate of registration is issued under § 10–412 of this subtitle shall submit to the Department the form and substance of any advertisement, advertising campaign, or other promotional material before it may be used.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-412" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not provide continuing care until the Department issues an initial certificate of registration.</text> </level> <level label="b"> <text>An application for an initial certificate of registration shall be filed in a form satisfactory to the Department.</text> </level> <level label="c"> <text>An application shall include at least the following information:</text> <level label="1"> <text>for a project other than a conversion, verification that continuing care agreements have been executed with subscribers for at least 65% of the independent living units and at least 10% of the total entrance fee for each contracted unit has been collected;</text> </level> <level label="2"> <text>for a conversion project, verification that at least 80% of the accommodations in the project that are not licensed as assisted living or comprehensive care beds are occupied or reserved in accordance with:</text> <level label="i"> <text>leases;</text> </level> <level label="ii"> <text>continuing care agreements executed with subscribers who have paid a deposit that:</text> <level label="1"> <text>equals at least 10% of the total entrance fee; and</text> </level> <level label="2"> <text>has been deposited by the provider under an escrow agreement approved by the Department; or</text> </level> </level> <level label="iii"> <text>other appropriate contractual arrangements;</text> </level> </level> <level label="3"> <text>verification that the provider has received a written commitment for permanent long–term financing; and</text> </level> <level label="4"> <text>if construction financing is required, verification that the provider has applied for the financing.</text> </level> </level> <level label="d"> <level label="1"> <text>If requested by the permanent financing lender, the Department may issue a letter stating that the requirements of subsection (c)(1) of this section have been met.</text> </level> <level label="2"> <text>If requested by the construction lender, the Department may issue a letter stating that:</text> <level label="i"> <text>the requirements of subsection (c)(1) and (3) of this section have been met; and</text> </level> <level label="ii"> <text>the initial certificate of registration will be issued on the closing of the construction loan.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>The Department shall issue an initial certificate of registration to a provider if the Department determines that:</text> <level label="i"> <text>the provider has a preliminary certificate of registration;</text> </level> <level label="ii"> <text>the provider has submitted the required documents;</text> </level> <level label="iii"> <text>the form and substance of all advertisements, advertising campaigns, and other promotional materials submitted are not deceptive, misleading, or likely to mislead;</text> </level> <level label="iv"> <text>for a project other than a conversion, continuing care agreements have been executed with subscribers for at least 65% of the independent living units and at least 10% of the entrance fee has been paid as a deposit for each contracted unit;</text> </level> <level label="v"> <text>for a conversion project, at least 80% of the accommodations in the project that are not licensed as assisted living or comprehensive care beds are occupied or reserved in accordance with:</text> <level label="1"> <text>leases;</text> </level> <level label="2"> <text>continuing care agreements executed with subscribers who have paid a deposit that:</text> </level> <level label="A"> <text>equals at least 10% of the total entrance fee; and</text> </level> <level label="B"> <text>has been deposited by the provider under an escrow agreement approved by the Department; or</text> </level> <level label="3"> <text>other appropriate contractual arrangements;</text> </level> </level> <level label="vi"> <text>if construction financing is required, closing on the financing has occurred; and</text> </level> <level label="vii"> <text>the provider has a commitment for permanent long–term financing.</text> </level> </level> <level label="2"> <text>The Department may issue the initial certificate of registration for a period not exceeding 18 months.</text> </level> </level> <level label="f"> <text>A deposit held in escrow may not be used until:</text> <level label="1"> <text>an initial certificate of registration has been issued;</text> </level> <level label="2"> <text>construction is completed;</text> </level> <level label="3"> <text>the provider has a certificate of occupancy or the equivalent from the appropriate local jurisdiction; and</text> </level> <level label="4"> <text>the provider has the appropriate licenses or certificates from the Maryland Department of Health or the Department.</text> </level> </level> <level label="g"> <text>If an initial certificate of registration is not issued within 24 months after the issuance of a preliminary certificate of registration, or a longer time allowed by the Department for good cause shown, the provider shall refund all deposits and stop offering continuing care under that application.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-413" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>Each year, within 120 days after the end of a provider’s fiscal year, the provider shall file an application for a renewal certificate of registration in a form satisfactory to the Department.</text> </level> <level label="2"> <text>A renewal application shall contain:</text> <level label="i"> <text>any additions or changes to the information required by §§ 10–408 through 10–410 of this subtitle;</text> </level> <level label="ii"> <text>an audited financial statement for the preceding fiscal year prepared in accordance with an audit guide that the Department adopts;</text> </level> <level label="iii"> <text>an operating budget for the current fiscal year and a projected operating budget for the next fiscal year;</text> </level> <level label="iv"> <text>a cash flow projection for the current fiscal year and the next 2 fiscal years;</text> </level> <level label="v"> <text>a projection of the life expectancy and the number of residents who will require nursing home care;</text> </level> <level label="vi"> <text>an actuarial study reviewed by a qualified actuary and submitted every 3 years, unless the provider is exempted from the requirement for an actuarial study by regulations adopted by the Department exempting categories of providers that the Department determines have substantially limited long–term care liability exposure;</text> </level> <level label="vii"> <text>the form and substance of any proposed advertisement, advertising campaign, or other promotional material not previously submitted to the Department; and</text> </level> <level label="viii"> <text>any further information that the Department requires.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>The Department may charge a late fee if the application and accompanying information are not received by the Department within 120 days after the end of the provider’s fiscal year.</text> </level> <level label="2"> <text>Failure to file the required information within 90 days after the due date is a violation of this subtitle.</text> </level> </level> <level label="c"> <text>The Department shall issue a renewal certificate of registration if the Department determines that:</text> <level label="1"> <text>the required documents have been filed;</text> </level> <level label="2"> <text>any revised continuing care agreements meet the requirements of this subtitle;</text> </level> <level label="3"> <text>if the provider has been found to be in financial difficulty, the provider has complied with Part VII of this subtitle;</text> </level> <level label="4"> <text>when appropriate, the facility has been licensed or certified by the Maryland Department of Health or the Department; and</text> </level> <level label="5"> <text>the form and substance of all advertisements, advertising campaigns, and other promotional materials submitted to the Department are not deceptive, misleading, or likely to mislead.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-414" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not begin construction of a renovation until the provider receives written approval from the Department.</text> </level> <level label="b"> <level label="1"> <text>A provider shall file with the Department a request for approval for each renovation.</text> </level> <level label="2"> <text>At least 30 days before filing the request, the provider shall submit to the Department a written statement of intent to file a request for approval of a renovation.</text> </level> <level label="3"> <text>A request for approval of a renovation shall be in a form satisfactory to the Department.</text> </level> <level label="4"> <text>A request for approval shall include:</text> <level label="i"> <text>a statement of the purpose of and need for the renovation;</text> </level> <level label="ii"> <text>a financial plan that demonstrates to the satisfaction of the Department that the renovation will not have an unreasonably adverse effect on the financial ability of the provider to provide continuing care in accordance with its continuing care agreements and this subtitle at the facility to be renovated and at the provider’s other facilities in the State; and</text> </level> <level label="iii"> <text>any other information that the Department requires.</text> </level> </level> </level> <level label="c"> <text>The Department shall approve a renovation if the Department determines that the proposed renovation will not have an unreasonably adverse effect on the financial ability of the provider to provide continuing care in accordance with its continuing care agreements and this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-415" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not begin construction of an expansion until the provider receives written approval from the Department.</text> </level> <level label="b"> <level label="1"> <text>A provider shall file with the Department a request for approval for each expansion.</text> </level> <level label="2"> <text>At least 30 days before filing the request, the provider shall submit to the Department a written statement of intent to file a request for approval of an expansion.</text> </level> <level label="3"> <text>A request for approval of an expansion shall be in a form satisfactory to the Department.</text> </level> <level label="4"> <text>A request for approval shall include:</text> <level label="i"> <text>a statement of the purpose of and need for the expansion;</text> </level> <level label="ii"> <text>if the expansion involves living units, a plan that demonstrates to the satisfaction of the Department that a market exists for the additional living units;</text> </level> <level label="iii"> <text>a financial plan that demonstrates to the satisfaction of the Department that the expansion will not have an unreasonably adverse effect on the financial ability of the provider to provide continuing care in accordance with its continuing care agreements and this subtitle at the facility to be expanded and at the provider’s other facilities in the State; and</text> </level> <level label="iv"> <text>any other information that the Department requires.</text> </level> </level> </level> <level label="c"> <text>The Department shall approve an expansion and, if appropriate, issue a new certificate of registration if the Department determines that the proposed expansion will not have an unreasonably adverse effect on the financial ability of the provider to provide continuing care in accordance with its continuing care agreements and this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-416" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>For cause, the Department may:</text> <level label="1"> <text>deny a feasibility study approval; or</text> </level> <level label="2"> <text>deny, suspend, or revoke a preliminary, initial, or renewal certificate of registration.</text> </level> </level> <level label="b"> <level label="1"> <text>Grounds for a denial, suspension, or revocation include:</text> <level label="i"> <text>violation of this subtitle;</text> </level> <level label="ii"> <text>violation of a regulation the Department adopts under this subtitle;</text> </level> <level label="iii"> <text>misrepresentation; or</text> </level> <level label="iv"> <text>submission of a false financial statement.</text> </level> </level> <level label="2"> <text>The Department shall set forth in writing its reasons for a denial, suspension, or revocation.</text> </level> </level> <level label="c"> <text>Title 10, Subtitle 2 of the State Government Article governs the appeal of a denial, revocation, or suspension.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-419" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>In this part, “net operating expenses” means the total operating expenses at each facility of a provider, less depreciation, amortization, unusual and infrequent expenses, changes in the obligation to provide future services, and changes in the fair market value of interest rate swap agreements not involving an exchange of funds.</text> </section> <section article="ghu" article_name="Human Services" number="10-420" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>Interest expenses may be excluded from the calculation of net operating expenses for a fiscal year, if the provider funded a debt service reserve or other interest reserve under requirements imposed by a financial institution or under applicable financing documents, to the extent the reserve fund included amounts to cover interest for that fiscal year.</text> </level> <level label="b"> <level label="1"> <text>Except as otherwise provided in this part, a provider shall set aside for each facility subject to this subtitle operating reserves that:</text> <level label="i"> <text>before January 1, 2023, equal 15% of the facility’s net operating expenses for the most recent fiscal year for which a certified financial statement is available; and</text> </level> <level label="ii"> <text>beginning January 1, 2023, equal 25% of the facility’s net operating expenses for the most recent fiscal year for which a certified financial statement is available.</text> </level> </level> <level label="2"> <text>The provider shall keep the operating reserves in a reasonably liquid form in the judgment of the provider.</text> </level> <level label="3"> <text>Beginning January 1, 2014, the assets held by the provider as the operating reserves required under this subsection:</text> <level label="i"> <text>except as provided in paragraph (4) of this subsection, shall be unrestricted cash and investments; and</text> </level> <level label="ii"> <text>may not:</text> <level label="1"> <text>be met with a line of credit; or</text> </level> <level label="2"> <text>except as provided in paragraph (4) of this subsection, be hypothecated, pledged as collateral, or otherwise encumbered by the provider in any manner.</text> </level> </level> </level> <level label="4"> <text>Beginning January 1, 2014, the assets held by the provider as the operating reserves may be encumbered if:</text> <level label="i"> <text>the assets are encumbered by contractual obligations undertaken before January 1, 2014, that have not materially changed since January 1, 2014; or</text> </level> <level label="ii"> <text>the assets are encumbered as part of a general security pledge of assets or similar collateralization that is part of the provider’s long–term capital debt covenants included in the provider’s long–term debt indenture or similar financial instrument but which remain available to the provider to pay operating expenses without substantial restrictions or limitations.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>A provider shall meet the requirements of subsection (b) of this section within 10 full fiscal years after the date of its initial certificate of registration.</text> </level> <level label="2"> <text>A provider shall set aside at least 10% of the reserves required under subsection (b) of this section at the end of each fiscal year after the date of its initial certificate of registration, up to a total of 100% at the end of the 10th fiscal year.</text> </level> <level label="3"> <text>The Department may allow a provider to modify the minimum rate required under paragraph (2) of this subsection or extend the time to meet the requirements of subsection (b) of this section if the modification is necessary to maintain the financial viability of the facility.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-421" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>A provider shall compute operating reserves for each facility as of the end of the facility’s most recent fiscal year.</text> </level> <level label="2"> <text>When a provider files an application for a renewal certificate of registration, the provider shall show compliance with operating reserve requirements by including with the application:</text> <level label="i"> <text>a letter to the Department from a certified public accountant that states the amount set aside; or</text> </level> <level label="ii"> <text>a certified financial statement that states the amount set aside.</text> </level> </level> </level> <level label="b"> <text>A provider may apply toward the operating reserves required by § 10-420(b) of this subtitle any reserves, except debt service reserves, that are maintained under applicable financing document requirements if the reserves are available to the provider to meet the facility’s operating expenses.</text> </level> <level label="c"> <text>For the purpose of computing a provider’s operating reserves, investments held to the credit of the reserves shall be calculated at their market value as of the end of the provider’s most recent fiscal year for which a certified financial statement is available.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-422" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider shall notify the Department in writing immediately on the withdrawal of any amount from the funds available to satisfy the operating reserves required by § 10–420(b) of this subtitle.</text> </level> <level label="b"> <text>Within 30 days after making a withdrawal described in subsection (a) of this section, the provider shall submit to the Department a written plan for restoring the reserves to the level required by § 10–420(b) of this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-423" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>For a facility that has not been the subject of a conversion and that has residents who are not parties to continuing care agreements, the provider shall calculate the amount of operating reserves required under § 10–420 of this subtitle based on the pro rata proportion of the net operating expenses as specified under subsection (b) of this section.</text> </level> <level label="b"> <text>The pro rata proportion of the net operating expenses equals the number of units in the facility for which the Department has issued a certificate of registration divided by the total number of accommodations in the facility multiplied by the net operating expenses for the most recent fiscal year for which a certified financial statement is available.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-424" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>A provider shall give without cost a disclosure statement for each facility for which the provider holds a preliminary, initial, or renewal certificate of registration:</text> <level label="i"> <text>to a prospective subscriber before the earlier of payment of any part of the entrance fee or execution of a continuing care agreement; and</text> </level> <level label="ii"> <text>annually to any subscriber who requests a disclosure statement.</text> </level> </level> <level label="2"> <text>A provider shall submit its initial disclosure statement to the Department for review at least 45 days before giving the statement to any prospective subscriber.</text> </level> </level> <level label="b"> <level label="1"> <text>A provider shall revise the disclosure statement annually and file it with the Department within 120 days after the end of the provider’s fiscal year.</text> </level> <level label="2"> <text>The Department shall review the disclosure statement solely to ensure compliance with § 10–425 of this subtitle.</text> </level> </level> <level label="c"> <level label="1"> <text>An amended disclosure statement is subject to each requirement of this subtitle.</text> </level> <level label="2"> <text>A provider shall file an amended disclosure statement with the Department when it is delivered to a subscriber or prospective subscriber.</text> </level> </level> <level label="d"> <text>A provider shall post the most recent disclosure statement on the provider’s website.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-425" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A disclosure statement shall include:</text> <level label="1"> <text>a table of contents;</text> </level> <level label="2"> <text>the name, address, and description of the facility and the identity of the owner or owners of the facility and the land on which it is located;</text> </level> <level label="3"> <text>the name and address of the provider and of any parent or subsidiary;</text> </level> <level label="4"> <text>the organizational structure and management of the provider, including:</text> <level label="i"> <text>for a corporation or limited liability company, its name, the state in which it is incorporated or formed, and the name of the chief executive officer;</text> </level> <level label="ii"> <text>for a partnership, the names of the general partners, the state governing its formation, and the name of the primary individual responsible for managing it;</text> </level> <level label="iii"> <text>for an unincorporated association, the names of the members, the state governing its activities, and the name of the primary individual responsible for managing it;</text> </level> <level label="iv"> <text>for a partnership that has a corporation or limited liability company as one or more of its general partners, the name of each corporation or limited liability company, the state in which it is incorporated or formed, and the name of the chief executive officer;</text> </level> <level label="v"> <text>for a trust, the name of the trustee, the names of the owners of beneficial interests in the trust, the state governing it, and the name of the primary individual responsible for overseeing its activities; and</text> </level> <level label="vi"> <text>a statement whether the provider is qualified, or intends to qualify, as a tax–exempt organization under the Internal Revenue Code;</text> </level> </level> <level label="5"> <text>the name and occupation of each officer, director, trustee, managing or general partner, and each person with a 10% or greater equity or beneficial interest in the provider, and a description of the person’s financial interest in or occupation with the provider;</text> </level> <level label="6"> <text>the name and address of any entity in which a person identified in item (5) of this subsection has a 10% or greater financial interest and that is anticipated to provide goods, premises, or services with a value of $10,000 or more to the facility or provider in a fiscal year and a description of the goods, premises, or services and their anticipated cost to the facility or provider, which need not include salary, wage, or benefit information of employees of the provider;</text> </level> <level label="7"> <text>a description of any matter in which an individual identified in item (5) of this subsection:</text> <level label="i"> <text>has been convicted of a felony or pleaded nolo contendere to a felony charge, if the felony involved fraud, embezzlement, fraudulent conversion, or misappropriation of property;</text> </level> <level label="ii"> <text>has been held liable or enjoined in a civil action by final judgment, if the civil action involved fraud, embezzlement, fraudulent conversion, or misappropriation as a fiduciary;</text> </level> <level label="iii"> <text>has been subject to an effective injunctive or restrictive order of a court of record in an action that arose out of or related to business activity or health care, including an action that affected a license to operate a facility or service for senior, impaired, or dependent persons; or</text> </level> <level label="iv"> <text>in the past 10 years, had a state or federal license or permit suspended or revoked because a governmental unit brought an action that arose out of or related to business activity or health care, including an action that affected a license to operate a facility or service for senior, impaired, or dependent persons;</text> </level> </level> <level label="8"> <text>a description of the provider’s form of governance and the composition of its governing body, and a statement that the provider will satisfy the requirements of §§ 10–426 and 10–427 of this subtitle;</text> </level> <level label="9"> <text>if the provider has a governing body, a description of the process used by the provider to:</text> <level label="i"> <text>select a subscriber member of its governing body; and</text> </level> <level label="ii"> <text>satisfy the requirements of § 10–427(a) of this subtitle.</text> </level> </level> <level label="10"> <text>a statement of any affiliation of the provider with a religious, charitable, or other nonprofit organization, and the extent of the organization’s responsibility for the financial and contractual obligations of the provider;</text> </level> <level label="11"> <text>if the facility will be managed on a day–to–day basis by a person other than an individual who is directly employed by the provider, the name of the proposed manager or management company and a description of the business experience of the manager or company in operating or managing similar facilities;</text> </level> <level label="12"> <text>a copy of the most recent certified financial statement obtainable under generally accepted accounting principles;</text> </level> <level label="13"> <text>a description of the long–term financing for the facility;</text> </level> <level label="14"> <text>a cash flow forecast for the current and the next two fiscal years;</text> </level> <level label="15"> <text>a description of any activity related to a renovation, expansion, or new development during the preceding fiscal year or proposed for the current fiscal year;</text> </level> <level label="16"> <text>a description of:</text> <level label="i"> <text>the steps that have been or will be taken to comply with the operating reserve requirements under § 10–420(b) of this subtitle; and</text> </level> <level label="ii"> <text>the provider’s investment policy related to the required reserves, including how often and by whom the reserve fund investment is reviewed;</text> </level> </level> <level label="17"> <text>a description of the financial arrangements that the provider has made, if any, to address the renewal and replacement of the buildings and improvements at the facility, such as the establishment of a renewal and replacement fund;</text> </level> <level label="18"> <text>if the facility has not reached 85% occupancy of its independent living units, a summary of the feasibility study;</text> </level> <level label="19"> <text>if applicable, a description of the conditions under which the provider may be issued an initial certificate of registration and may use escrowed deposits;</text> </level> <level label="20"> <text>a description of all basic fees, including entrance fees, fees for health related services, and periodic fees that the provider collects from subscribers, and the amount and frequency of any fee changes during the previous 5 years or, if the facility has been in operation less than 5 years, for each year of operation;</text> </level> <level label="21"> <text>a summary of the basic services provided or proposed to be provided at the facility under the continuing care agreement, including the extent to which health related services are provided, that clearly states which services are indicated in the agreement as included in the basic fee and which services are or will be made available at or by the facility at an extra charge;</text> </level> <level label="22"> <text>if applicable, a statement that it is the provider’s policy to impose a surcharge on some, but not all, subscribers because of a condition or circumstance that applies only to those subscribers and that the surcharge is not part of the entrance fee refund required under § 10–448 of this subtitle;</text> </level> <level label="23"> <text>a description of the role of any resident association;</text> </level> <level label="24"> <text>a description of the internal grievance procedure;</text> </level> <level label="25"> <text>if the provider offers a continuing care agreement that promises a contractual entrance fee refund after occupancy, a statement whether the portion of the entrance fee to be refunded is held in trust or escrow for the subscriber after occupancy, and if so held, a description of where and how the funds are held;</text> </level> <level label="26"> <text>if the provider offers an extensive agreement, the following statement: “If you have a long–term care insurance policy, request your advisors to review the policy and the continuing care agreement to determine whether there are potential areas of duplication or areas where benefits can be coordinated.”;</text> </level> <level label="27"> <text>a statement that the provider will amend its disclosure statement whenever the provider or the Department considers an amendment necessary to prevent the disclosure statement from containing:</text> <level label="i"> <text>a material misstatement of a fact required by this section to be stated in the disclosure statement; or</text> </level> <level label="ii"> <text>an omission of a material fact required by this section to be stated in the disclosure statement; and</text> </level> </level> <level label="28"> <text>any other material information about the facility or the provider that the Department requires or that the provider wishes to include.</text> </level> </level> <level label="b"> <text>The disclosure statement shall contain a cover page that states, in a prominent location and type face:</text> <level label="1"> <text>the date of the disclosure statement; and</text> </level> <level label="2"> <text>that the issuance of a certificate of registration does not:</text> <level label="i"> <text>constitute approval, recommendation, or endorsement of the facility by the Department; or</text> </level> <level label="ii"> <text>evidence or attest to the accuracy or completeness of the information in the disclosure statement.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>This subsection applies to a provider that:</text> <level label="i"> <text>has a continuing care agreement that includes a provision to provide assisted living program services; and</text> </level> <level label="ii"> <text>does not execute a separate assisted living agreement.</text> </level> </level> <level label="2"> <text>In addition to any other requirement of this section, the disclosure statement shall contain the following information about the assisted living program:</text> <level label="i"> <text>the name and address and a description of each facility that the provider operates;</text> </level> <level label="ii"> <text>a statement regarding the relationship of the provider to other providers or services if the relationship affects the care of the resident;</text> </level> <level label="iii"> <text>a description of any special programming, staffing, and training provided by the program for individuals with particular needs or conditions such as cognitive impairment;</text> </level> <level label="iv"> <text>notice of:</text> <level label="1"> <text>the availability of locks for storage;</text> </level> <level label="2"> <text>the availability of locks for the subscriber’s room;</text> </level> <level label="3"> <text>the security procedures that the provider will implement to protect the subscriber and the subscriber’s property; and</text> </level> <level label="4"> <text>the provider’s right, if any, to enter a subscriber’s room;</text> </level> </level> <level label="v"> <text>a statement of the obligations of the provider, the subscriber, or the subscriber’s agent for:</text> <level label="1"> <text>arranging or overseeing medical care;</text> </level> <level label="2"> <text>monitoring the subscriber’s health status;</text> </level> <level label="3"> <text>purchasing or renting essential or desired equipment and supplies; and</text> </level> <level label="4"> <text>ascertaining the cost of and purchasing durable medical equipment;</text> </level> </level> <level label="vi"> <text>an explanation of the assisted living program’s complaint or grievance procedure; and</text> </level> <level label="vii"> <text>notice of any material changes in the assisted living program.</text> </level> </level> <level label="3"> <text>The provider shall:</text> <level label="i"> <text>give to each subscriber annually and without cost revisions to the disclosure statement provisions under paragraph (2) of this subsection;</text> </level> <level label="ii"> <text>ensure that each subscriber or the subscriber’s agent initials the revised disclosure statement to acknowledge the revisions; and</text> </level> <level label="iii"> <text>make copies of the initialed disclosure statements available for inspection by the Maryland Department of Health under Title 19, Subtitle 18 of the Health – General Article.</text> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-426" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>At least quarterly, each provider shall hold a meeting open to all of the provider’s subscribers.</text> </level> <level label="b"> <text>At the meetings, an authorized officer of the provider shall:</text> <level label="1"> <text>summarize the provider’s operations, significant changes from the previous year, and goals and objectives for the next year; and</text> </level> <level label="2"> <text>answer subscribers’ questions.</text> </level> </level> <level label="c"> <text>At the last quarterly meeting of the year, an authorized officer of the provider shall provide an aggregated, deidentified summary of internal grievances submitted under § 10–428 of this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-427" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>If a provider has a governing body, at least one of the provider’s subscribers shall be a full and regular member of the governing body.</text> </level> <level label="2"> <text>If the provider owns or operates more than three facilities in the State, the governing body shall include at least one of the provider’s subscribers for every three facilities in the State.</text> </level> <level label="3"> <level label="i"> <text>If the governing body has only one subscriber, the governing body shall authorize the appointment of an alternate subscriber to serve as a regular member of the governing body if the regular subscriber is unable to fulfill the subscriber’s duties.</text> </level> <level label="ii"> <text>The alternate subscriber may:</text> <level label="1"> <text>attend all meetings of the governing body; and</text> </level> <level label="2"> <text>vote only if the regular subscriber is unable to fulfill the subscriber’s duties as a regular member of the governing body.</text> </level> </level> </level> <level label="4"> <text>Subject to paragraph (5) of this subsection, a regular or alternate member of the governing body who is selected to meet the requirements of this subsection shall be a subscriber at a facility in the State and be selected according to the same general written standards and criteria used to select other members of the governing body.</text> </level> <level label="5"> <text>The governing body shall confer with the resident association at each of the provider’s facilities before the subscriber or alternate subscriber officially joins the governing body.</text> </level> <level label="6"> <level label="i"> <text>A subscriber member or alternate subscriber member of a governing body may report on nonconfidential deliberations, actions, and policies of the governing body to the resident association.</text> </level> <level label="ii"> <text>The governing body in its sole but reasonable discretion shall determine whether a matter is confidential.</text> </level> </level> <level label="7"> <text>The Secretary may waive the requirements of this subsection for a provider in the process of decertifying as a provider, if the Secretary determines that there are no subscribers willing and able to serve on the governing body.</text> </level> </level> <level label="b"> <level label="1"> <text>If a provider does not have a governing body, the provider shall appoint a select committee of its officers or partners to meet at least quarterly with the resident association at each of its facilities to address concerns of the subscribers and to ensure that the opinions of subscribers are relayed to all officers or partners of the provider.</text> </level> <level label="2"> <text>If a facility does not have a resident association, the committee shall meet with a reasonable number of representatives, not required to exceed fifteen, that the subscribers elect.</text> </level> </level> <level label="c"> <text>As determined by the provider’s governing body, the provider shall make available to subscribers either the nonconfidential portions of the minutes of each meeting of the governing body or a summary of the nonconfidential portions of the minutes, within 1 month of approval of the minutes.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-428" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider shall establish an internal grievance procedure to address a subscriber’s grievance.</text> </level> <level label="b"> <text>The internal grievance procedure shall at least:</text> <level label="1"> <text>allow a subscriber or group of subscribers collectively to submit a written grievance to the provider;</text> </level> <level label="2"> <text>require the provider to send a written acknowledgment to the subscriber or group of subscribers within 5 days after receipt of the written grievance;</text> </level> <level label="3"> <text>require the provider to assign personnel to investigate the grievance;</text> </level> <level label="4"> <text>give a subscriber or group of subscribers who file a written grievance the right to meet with management of the provider within 30 days after receipt of the written grievance to present the grievance; and</text> </level> <level label="5"> <text>require the provider to respond in writing within 45 days after receipt of the written grievance regarding the investigation and resolution of the grievance.</text> </level> </level> <level label="c"> <level label="1"> <text>Within 30 days after the conclusion of an internal grievance procedure established under this section, a subscriber, group of subscribers, or provider may seek mediation through one of the Community Mediation Centers in the State or another mediation provider.</text> </level> <level label="2"> <text>If a provider, subscriber, or group of subscribers seeks mediation under paragraph (1) of this subsection, the mediation shall be nonbinding.</text> </level> </level> <level label="d"> <level label="1"> <text>On an annual basis, the Department shall collect from each provider information about internal grievances filed for each of the provider’s facilities, including:</text> <level label="i"> <text>the number of internal grievances filed;</text> </level> <level label="ii"> <text>the aggregated, deidentified summary of internal grievances;</text> </level> <level label="iii"> <text>whether a grievance went to mediation and the outcome of the mediation; and</text> </level> <level label="iv"> <text>the final disposition of each filed grievance.</text> </level> </level> <level label="2"> <text>On or before December 1 each year, the Department shall report to the Senate Finance Committee and the House Health and Government Operations Committee, in accordance with § 2–1257 of the State Government Article, on the data received from each provider under paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-429" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>A provider shall make readily available to its subscribers for review at the facility:</text> <level label="1"> <text>copies of all materials that the provider submits to the Department that are required to be disclosed under the Public Information Act; and</text> </level> <level label="2"> <text>a copy of the most recent finalized budget of the facility.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-430" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>All marketing materials, including disclosure statements, that state that part or all of the entrance fee is or may be refundable shall include a conspicuous disclaimer that states at least the following: “Carefully read the continuing care agreement for the conditions that must be satisfied before the provider is required to pay the entrance fee refund.”.</text> </section> <section article="ghu" article_name="Human Services" number="10-432" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>Subsection (b)(2) of this section does not apply to a transfer of ownership or control of a person that owns or controls a facility, if:</text> <level label="i"> <text>the transfer is part of a business reorganization; and</text> </level> <level label="ii"> <text>the same person or persons holding the right to control or holding a majority of ownership before the business reorganization will retain, directly or indirectly, the right to control or a majority of ownership, respectively, after the business reorganization.</text> </level> </level> <level label="2"> <text>The provider shall notify the Department and the facility’s subscribers 30 days before any reorganization described in paragraph (1) of this subsection.</text> </level> </level> <level label="b"> <text>Unless the Department approves the sale or transfer in accordance with §§ 10–433 through 10–435 of this subtitle:</text> <level label="1"> <text>except for the grant of a mortgage or deed of trust to an unrelated third party, a provider that holds a preliminary, initial, or renewal certificate of registration may not sell or otherwise transfer, directly or indirectly, ownership of a facility or any ownership interest in a facility; and</text> </level> <level label="2"> <text>a person with an ownership interest in or a right to control the provider, through governing body appointments or contractual or similar arrangements, may not sell or otherwise transfer, directly or indirectly, the right to control or more than 50% of the ownership of a person that owns or controls a facility.</text> </level> </level> <level label="c"> <text>Any series of sales or other transfers described in subsection (b) of this section that occur in a 12–month period shall be aggregated for purposes of this section and §§ 10–433 through 10–435 of this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-433" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>At least 90 days before the proposed effective date of a sale or other transfer, a provider subject to § 10–432(b) of this subtitle shall file with the Department a statement of intent to transfer ownership or control.</text> </level> <level label="2"> <text>At least 65 days before the proposed effective date of the sale or other transfer, a provider subject to § 10–432(b) of this subtitle and any proposed new provider shall give written notice of the proposed sale or other transfer, including notice of the place and time of the meeting required by § 10–434(b) of this subtitle, to the subscribers of the affected facility and the Department.</text> </level> </level> <level label="b"> <level label="1"> <text>The written notice to the Department required under subsection (a)(2) of this section shall include:</text> <level label="i"> <text>the name and address of the existing provider and any proposed new provider and the office of each to which comments may be sent under § 10–434 of this subtitle;</text> </level> <level label="ii"> <text>the name and address of the affected facility;</text> </level> <level label="iii"> <text>the organizational structure and management of the provider and the facility after the proposed sale or other transfer is completed, including:</text> <level label="1"> <text>if the provider is to be a corporation or limited liability company, its name, its state of incorporation or formation, and the name of the chief executive officer;</text> </level> <level label="2"> <text>if the provider is to be a partnership, the names of the general partners, the state governing its formation, and the name of the primary individual responsible for managing it;</text> </level> <level label="3"> <text>if the provider is to be an unincorporated association, the names of the members, the state governing its activities, and the name of the primary individual responsible for managing it;</text> </level> <level label="4"> <text>if the provider is to be a trust, the trustee’s name, the names of the owners of beneficial interests in the trust, the state that governs it, and the name of the primary individual responsible for overseeing its activities;</text> </level> <level label="5"> <text>if the provider is to be a partnership that has a corporation or limited liability company as one or more of its general partners, the name of each corporation or limited liability company, its state of incorporation or formation, and the name of its chief executive officer; and</text> </level> <level label="6"> <text>the name and occupation of each officer, director, trustee, general partner, principal, and each person who will have a 10% or greater equity or beneficial interest in the provider or in a person that owns or controls the provider;</text> </level> </level> <level label="iv"> <text>a copy of the corporate charter, partnership agreement, articles of association, membership agreement, or trust agreement that will govern the legal organization of the provider after the sale or transfer;</text> </level> <level label="v"> <text>a statement of any affiliation with a religious, charitable, or other nonprofit organization after the proposed sale or transfer and the extent, if any, of the affiliate organization’s responsibility for the financial and contractual obligations of the provider;</text> </level> <level label="vi"> <text>the name and address of any business or professional entity in which a person identified in item (iii)6 of this paragraph has a 10% or greater financial interest and that is likely to provide goods, premises, or services with a value of $10,000 or more a year to the facility or provider after the sale or transfer, and a description of the goods, premises, or services;</text> </level> <level label="vii"> <text>the name of the proposed manager or management company that will manage the day–to–day operations of the facility after the sale or other transfer, and a description of the business experience of the manager or company in operating or managing similar facilities;</text> </level> <level label="viii"> <text>a description of any matter in which a person identified in item (iii)6 of this paragraph:</text> <level label="1"> <text>has been convicted of a felony or pleaded nolo contendere to a felony charge, if the felony involved fraud, embezzlement, fraudulent conversion, or misappropriation of property;</text> </level> <level label="2"> <text>has been held liable or enjoined in a civil action by final judgment, if the civil action involved fraud, embezzlement, fraudulent conversion, or misappropriation as a fiduciary;</text> </level> <level label="3"> <text>was subject to an effective injunctive or restrictive order of a court of record in an action that arose out of or related to business activity or health care, including an action that affected a license to operate a facility or service for senior, impaired, or dependent persons; or</text> </level> <level label="4"> <text>within the past 10 years, had a state or federal license or permit suspended or revoked because of an action brought by a governmental unit arising out of or relating to business activity or health care, including actions affecting a license to operate a facility or service for senior, impaired, or dependent persons;</text> </level> </level> <level label="ix"> <text>a financial plan provided by the entity that will be the provider after the proposed sale or other transfer is completed in a form reasonably acceptable to the Department that demonstrates the projected effects of the sale or transfer on the financial operations of the provider and the facility, including any obligations of the provider to make payments in connection with the sale or transfer from the financial resources of the provider or the facility; and</text> </level> <level label="x"> <text>a statement by the entity that will be the provider after the proposed sale or transfer is completed that demonstrates that the sale or transfer is not likely to have an unreasonably adverse effect on:</text> <level label="1"> <text>the provider’s financial stability; or</text> </level> <level label="2"> <text>the provider’s capacity to perform its continuing care agreement obligations to subscribers.</text> </level> </level> </level> <level label="2"> <text>In addition to the information required to be provided under paragraph (1) of this subsection, a provider subject to § 10–432(b) of this subtitle and any proposed new provider shall provide to the Department any other information that the Department requires to evaluate the proposed transaction.</text> </level> <level label="3"> <text>On request, the existing provider and any proposed new provider shall give to a subscriber of the affected facility the information included in the written notice to the Department under paragraph (1) of this subsection.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-434" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>Within 15 days after the notice required under § 10–433(a)(2) of this subtitle is given, subscribers may submit to the existing provider, any proposed new provider, and the Department written questions and comments about the proposed sale or transfer.</text> </level> <level label="b"> <level label="1"> <text>Within 25 days after the notice required under § 10–433(a)(2) of this subtitle is given, representatives of the existing provider and any proposed new provider shall hold a meeting with not more than 15 representatives chosen by the subscribers of the affected facility to discuss the proposed sale or transfer.</text> </level> <level label="2"> <text>The subscriber representatives shall give their names and addresses to the existing provider, any proposed new provider, and the Department.</text> </level> <level label="3"> <text>Representatives of the Department may attend the meeting.</text> </level> </level> <level label="c"> <text>Within 10 days after the meeting required under subsection (b) of this section, subscribers may submit to the existing provider, any proposed new provider, and the Department additional written comments about the proposed sale or transfer.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-435" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>After reviewing the information required by §§ 10-433 and 10-434 of this subtitle, the Department shall determine whether the sale or transfer satisfies the standard for approval set forth in subsection (b) of this section.</text> </level> <level label="2"> <text>The Department shall make the determination within 50 days after the date of the notice required under § 10-433(a)(2) of this subtitle unless extended by the Department for good cause.</text> </level> <level label="3"> <text>The Department shall notify the existing provider, any proposed new provider, and the subscriber representatives in writing of the determination and the reasons for it and, if applicable, that the Department intends to transfer the certificate of registration to the new provider.</text> </level> </level> <level label="b"> <text>The Department shall approve a sale or other transfer of ownership or control unless the Department determines that the sale or transfer is likely to have an unreasonably adverse effect on:</text> <level label="1"> <text>the financial stability of the provider; or</text> </level> <level label="2"> <text>the capacity of the provider to perform continuing care agreement obligations to subscribers.</text> </level> </level> <level label="c"> <level label="1"> <text>In accordance with Title 10, Subtitle 2 of the State Government Article, the provider may appeal the Department’s decision on the proposed sale or transfer.</text> </level> <level label="2"> <text>A person other than the provider may not appeal the Department’s decision or be a party in interest to the proceedings.</text> </level> <level label="3"> <text>The Department shall give prompt notice of any appeal and of any decision issued in the appeal to the subscriber representatives.</text> </level> </level> <level label="d"> <text>A sale or other transfer of ownership or control subject to this section and §§ 10-432 through 10-434 of this subtitle may not be completed until 15 days after the later of:</text> <level label="1"> <text>the day the Department issues the notice required under subsection (a)(3) of this section of its decision to approve the sale or transfer; or</text> </level> <level label="2"> <text>if an appeal is taken under subsection (c) of this section, the day the administrative law judge issues a decision to allow the sale or transfer.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-436" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>This section does not apply to:</text> <level label="1"> <text>a transaction undertaken under a contractual obligation in effect on October 1, 1996;</text> </level> <level label="2"> <text>a transaction made in the ordinary course of business of operating a facility;</text> </level> <level label="3"> <text>a refund under a contract entered into in the ordinary course of business;</text> </level> <level label="4"> <text>a transfer of cash, securities, or other investment property in connection with an ordinary investment transaction;</text> </level> <level label="5"> <text>a grant of a mortgage, deed of trust, or security interest to an unrelated third party;</text> </level> <level label="6"> <text>a transaction involving an easement, right-of-way, road widening, or similar conveyance for the benefit of a public body or a utility;</text> </level> <level label="7"> <text>a transaction made for an expansion or renovation; or</text> </level> <level label="8"> <text>any other sale, transfer, or other disposition exempted by the Department by regulation.</text> </level> </level> <level label="b"> <level label="1"> <text>A provider that holds a preliminary, initial, or renewal certificate of registration may not sell, transfer, or otherwise dispose of more than 10% of its total assets in any 12-month period unless the Department approves the sale, transfer, or disposition in accordance with §§ 10-437 and 10-438 of this subtitle.</text> </level> <level label="2"> <text>A provider may not sell, transfer, or otherwise dispose of assets equal to or less than 10% of its total assets if the sale, transfer, or disposition is likely, according to standards set by regulation, to have an unreasonably adverse effect on:</text> <level label="i"> <text>the financial stability of the provider; or</text> </level> <level label="ii"> <text>the capacity of the provider to perform its obligations under its continuing care agreements.</text> </level> </level> <level label="3"> <text>Determinations of total assets shall be based on the provider’s latest certified financial statements available at the time the sale, transfer, or other disposition is made.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-437" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider subject to § 10-436(b)(1) of this subtitle shall:</text> <level label="1"> <text>at least 60 days before the sale, transfer, or other disposition, file with the Department a statement of intent to sell, transfer, or otherwise dispose of assets; and</text> </level> <level label="2"> <text>at least 30 days before the sale, transfer, or other disposition, give written notice to the Department of the proposed sale, transfer, or other disposition of assets.</text> </level> </level> <level label="b"> <text>The statement of intent required to be filed with the Department under subsection (a)(1) of this section shall include:</text> <level label="1"> <text>identification of each asset to be sold, transferred, or otherwise disposed of;</text> </level> <level label="2"> <text>if the provider is subject to § 10-436(b)(1) of this subtitle because of a series of sales, transfers, or other dispositions that have exceeded cumulatively 10% of its total assets, identification of each asset that has been sold, transferred, or disposed of; and</text> </level> <level label="3"> <text>the reason for the sale, transfer, or other disposition identified in item (1) of this subsection.</text> </level> </level> <level label="c"> <text>The notice to the Department required under subsection (a)(2) of this section shall include:</text> <level label="1"> <text>a statement that demonstrates that the proposed sale, transfer, or other disposition is not likely to have an unreasonably adverse effect on:</text> <level label="i"> <text>the financial stability of the provider; or</text> </level> <level label="ii"> <text>the capacity of the provider to perform its obligations under its continuing care agreements; and</text> </level> </level> <level label="2"> <text>any other information that the Department requires.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-438" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>After reviewing the information required by § 10-437 of this subtitle, the Department shall determine whether the sale, transfer, or other disposition satisfies the standard for approval set forth in subsection (b) of this section.</text> </level> <level label="2"> <text>The Department shall make its determination and notify the provider in writing within 25 days after the date of the notice required by § 10-437(a)(2) of this subtitle, unless extended by the Department for good cause.</text> </level> <level label="3"> <text>If the Department does not approve the proposed sale, transfer, or other disposition, the Department shall include the reasons for its determination in the written notice to the provider.</text> </level> </level> <level label="b"> <text>The Department shall approve the sale, transfer, or other disposition of assets unless it determines that the sale, transfer, or disposition is likely to have an unreasonably adverse effect on:</text> <level label="1"> <text>the financial stability of the provider; or</text> </level> <level label="2"> <text>the capacity of the provider to perform its obligations under its continuing care agreements.</text> </level> </level> <level label="c"> <level label="1"> <text>By regulation, the Department shall adopt reasonable objective financial standards for a proposed sale, transfer, or other disposition of assets.</text> </level> <level label="2"> <text>If the Department determines that the provider has met the objective financial standards, the Department shall approve the proposed sale, transfer, or other disposition of assets.</text> </level> <level label="3"> <text>If the Department determines that the provider has not met the objective financial standards, the Department may approve a proposed sale, transfer, or other disposition of assets if it satisfies the requirements set forth in subsection (b) of this section.</text> </level> </level> <level label="d"> <level label="1"> <text>In accordance with Title 10, Subtitle 2 of the State Government Article, the provider may appeal the Department’s decision on the proposed sale, transfer, or other disposition of assets.</text> </level> <level label="2"> <text>A person other than the provider may not appeal the Department’s decision or be a party in interest to the proceedings.</text> </level> </level> <level label="e"> <text>A sale, transfer, or other disposition of assets subject to this part may not be completed until 5 days after the later of:</text> <level label="1"> <text>the day the Department issues the notice required under subsection (a)(2) of this section of its decision to approve the sale, transfer, or other disposition; or</text> </level> <level label="2"> <text>if an appeal is taken under subsection (d) of this section, the day the administrative law judge issues a decision to allow the sale, transfer, or other disposition of assets.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-439" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>A provider whose facility has been the subject of a conversion may not terminate or fail to renew a lease for an accommodation in order to enter into a continuing care agreement for that accommodation.</text> </section> <section article="ghu" article_name="Human Services" number="10-440" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not remove a record or asset of the provider related to the operation of a facility or the provision of services under a continuing care agreement from the State unless the Department consents in writing.</text> </level> <level label="b"> <text>Consent shall be based on the provider’s submission of satisfactory evidence that the removal:</text> <level label="1"> <text>will facilitate and make the operations of the provider more economical; and</text> </level> <level label="2"> <text>will not diminish the service or protection to be given to the provider’s subscribers in the State.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-441" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>The Department may:</text> <level label="1"> <text>inspect a facility that offers continuing care;</text> </level> <level label="2"> <text>examine the facility’s books and records; and</text> </level> <level label="3"> <text>audit or observe a service provided under a continuing care agreement.</text> </level> </level> <level label="b"> <text>If all or part of a facility is subject to licensure by the Maryland Department of Health, the Department shall coordinate its inspections under this section with the Maryland Department of Health to avoid duplication.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-443" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>The provisions of Part IV of this subtitle are in addition to, and not in lieu of, other applicable laws.</text> </section> <section article="ghu" article_name="Human Services" number="10-444" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>Except as provided in subsection (b)(25) of this section, a requirement of this section does not apply to any continuing care agreement entered into before the effective date of the requirement.</text> </level> <level label="b"> <text>In a form acceptable to the Department, each continuing care agreement shall:</text> <level label="1"> <text>show the total consideration paid by the subscriber for continuing care, including the value of all property transferred, donations, entrance fees, subscriptions, monthly fees, and any other fees paid or payable by or on behalf of a subscriber;</text> </level> <level label="2"> <text>specify all services that are to be provided by the provider to each subscriber, such as food, shelter, medical care, nursing care, or other health related services, including in detail all items that each subscriber will receive, and whether the items will be provided for life or for a designated time period;</text> </level> <level label="3"> <text>designate the classes of subscribers according to types of payment plans;</text> </level> <level label="4"> <text>subject to subsection (c) of this section, describe the procedures to be followed by the provider when the provider temporarily or permanently changes the subscriber’s accommodations within the facility or transfers the subscriber to another health facility;</text> </level> <level label="5"> <text>describe the policies that will be implemented if the subscriber becomes unable to pay the monthly fees;</text> </level> <level label="6"> <text>state the policy of the provider concerning changes in accommodations and the procedure to implement that policy if the number of persons occupying an individual unit changes;</text> </level> <level label="7"> <text>provide in clear and understandable language, in boldface type, and in the largest type used in the body of the agreement:</text> <level label="i"> <text>the terms governing the refund of any portion of the entrance fee if the provider discharges the subscriber or the subscriber cancels the agreement; and</text> </level> <level label="ii"> <text>whether monthly fees, if charged, will be subject to periodic increases;</text> </level> </level> <level label="8"> <text>state the terms under which an agreement is canceled by the death of the subscriber;</text> </level> <level label="9"> <text>provide that charges for care paid in advance in a lump sum may not be increased or changed for the duration of the agreed–upon care;</text> </level> <level label="10"> <text>state that the provider represents that the subscriber has received, at least two weeks before signing the agreement:</text> <level label="i"> <text>the current version of the written rules of the provider;</text> </level> <level label="ii"> <text>the continuing care agreement form, with the attachments, exhibits, and addenda; and</text> </level> <level label="iii"> <text>the current disclosure statement, with the attachments, exhibits, and addenda;</text> </level> </level> <level label="11"> <text>describe the living quarters;</text> </level> <level label="12"> <text>if applicable, state the conditions under which a subscriber may assign a unit for the use of another individual;</text> </level> <level label="13"> <text>state the provider’s religious or charitable affiliations and the extent, if any, to which the affiliate organization is responsible for the provider’s financial and contractual obligations;</text> </level> <level label="14"> <text>state the subscriber’s and provider’s respective rights and obligations concerning:</text> <level label="i"> <text>use of the facility; and</text> </level> <level label="ii"> <text>any real and personal property of the subscriber placed in the provider’s custody;</text> </level> </level> <level label="15"> <text>state that subscribers have the right to organize and operate a subscriber association at the facility and to meet privately to conduct business;</text> </level> <level label="16"> <text>state that there is an internal grievance procedure to address a subscriber’s grievance;</text> </level> <level label="17"> <text>state the fee adjustments, if any, that will be made if the subscriber is voluntarily absent from the facility for an extended period of time;</text> </level> <level label="18"> <text>specify the circumstances, if any, under which the subscriber will be required to apply for Medicaid, Medicare, public assistance, or any public benefit program and whether the facility participates in Medicare or medical assistance;</text> </level> <level label="19"> <text>state that the subscriber received a copy of the latest certified financial statement at least two weeks before signing the agreement and that the subscriber has reviewed the statement;</text> </level> <level label="20"> <text>state that the subscriber acknowledges reviewing all of the terms of the entrance fee refund clauses and provisions contained in the continuing care agreement;</text> </level> <level label="21"> <text>provide that, on request, the provider will make available to the subscriber any certified financial statement submitted to the Department;</text> </level> <level label="22"> <text>if applicable, describe the conditions under which the provider may be issued an initial certificate of registration and the conditions under which the provider may use escrowed deposits, and state the amount of the subscriber’s deposit;</text> </level> <level label="23"> <text>state that fees collected by a provider under the terms of a continuing care agreement may only be used for purposes set forth in the agreement;</text> </level> <level label="24"> <text>include one of the following model statements or a substantially similar statement:</text> <level label="i"> <text>“The provider agrees that, for as long as the subscriber’s continuing care agreement remains in effect, the provider shall only use fees paid by the subscribers of the community for purposes directly related to the construction, operation, maintenance, or improvement of the community.”;</text> </level> <level label="ii"> <text>“The provider does not currently use fees paid by subscribers of the community for purposes other than those directly related to the construction, operation, maintenance, or improvement of the community, but the provider reserves the future right to use fees paid by subscribers of the community for purposes unrelated to the construction, operation, maintenance, or improvement of the community.”; or</text> </level> <level label="iii"> <text>“The provider may use fees paid by subscribers of the community for purposes unrelated to the construction, operation, maintenance, or improvement of the community, including for the furtherance of the provider’s corporate mission, to distribute profits, or to benefit an affiliated community.”;</text> </level> </level> <level label="25"> <text>allow a subscriber to designate a beneficiary to receive any refundable portion of the entrance fee that is owed due to the death of the subscriber on or after the date of occupancy, if the designation is:</text> <level label="i"> <text>in writing;</text> </level> <level label="ii"> <text>witnessed by at least two competent witnesses;</text> </level> <level label="iii"> <text>not contingent; and</text> </level> <level label="iv"> <text>specified in percentages and accounts for 100% of the refund due;</text> </level> </level> <level label="26"> <text>state the funeral and burial services, if any, that the provider will provide;</text> </level> <level label="27"> <text>contain a table of contents;</text> </level> <level label="28"> <text>if the provider offers a continuing care agreement that promises a contractual entrance fee refund after occupancy, state whether the portion of the entrance fee to be refunded is held in trust or escrow for the subscriber after occupancy, and if so held, state where and how the funds are held;</text> </level> <level label="29"> <text>if the payment of a contractual entrance fee refund after occupancy is conditioned on the reoccupancy or recontracting of the subscriber’s unit, state that the provider agrees to make reasonable efforts to satisfy the condition; and</text> </level> <level label="30"> <text>contain the following statement in boldface type and in the largest type used in the agreement: “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.”.</text> </level> </level> <level label="c"> <text>A subscriber’s accommodations may be changed only to protect the health or safety of the subscriber or the general and economic welfare of other residents.</text> </level> <level label="d"> <text>A continuing care agreement may contain, in a form acceptable to the Department, any other appropriate provision to effectuate the purpose of the agreement.</text> </level> <level label="e"> <level label="1"> <text>This subsection applies if:</text> <level label="i"> <text>a provider’s continuing care agreement includes a provision to provide assisted living program services; and</text> </level> <level label="ii"> <text>the provider does not execute a separate assisted living agreement.</text> </level> </level> <level label="2"> <text>In addition to any other requirement of this section, the continuing care agreement shall include the following provisions concerning the assisted living program:</text> <level label="i"> <text>a statement of the level of care that the assisted living program is licensed to offer;</text> </level> <level label="ii"> <text>a description of the procedures to be followed by the provider for notifying the subscriber of the level of care the subscriber needs if the subscriber transfers to an assisted living program;</text> </level> <level label="iii"> <text>a statement indicating the options available to a subscriber if the subscriber’s level of care, after admission to an assisted living program, exceeds the level of care for which the provider is licensed;</text> </level> <level label="iv"> <text>based on a sample list of assisted living program services that the Maryland Department of Health maintains, a statement of which services are provided by the assisted living program and which services are not;</text> </level> <level label="v"> <text>a statement of the obligations of the provider and the subscriber or the subscriber’s agent for handling the subscriber’s finances;</text> </level> <level label="vi"> <text>a statement of the obligations of the provider and the subscriber or the subscriber’s agent for disposition of the subscriber’s property on the subscriber’s discharge or death; and</text> </level> <level label="vii"> <text>the applicable rate structure and payment provisions covering:</text> <level label="1"> <text>all rates to be charged to the subscriber, including:</text> </level> <level label="A"> <text>service packages;</text> </level> <level label="B"> <text>fee–for–service rates; and</text> </level> <level label="C"> <text>any other nonservice–related charges;</text> </level> <level label="2"> <text>criteria to be used for imposing additional charges to provide additional services, if the subscriber’s service and care needs change;</text> </level> <level label="3"> <text>payment arrangements and fees, if known, for third–party services not covered by the continuing care agreement, but arranged for by the subscriber, the subscriber’s agent, or the assisted living program;</text> </level> <level label="4"> <text>identification of the persons responsible to pay all fees and charges and a clear indication of whether the person’s responsibility is or is not limited to the extent of the subscriber’s funds;</text> </level> <level label="5"> <text>a provision for notice at least 45 days before any rate increase, except for an increase necessitated by a change in the subscriber’s medical condition; and</text> </level> <level label="6"> <text>fair and reasonable billing and payment policies.</text> </level> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-445" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <level label="i"> <text>If a provider’s feasibility study has been approved under § 10–409 of this subtitle, the Department, within 120 days after receipt of a continuing care agreement or any other related agreement submitted by a provider, shall determine whether the agreement complies with the requirements of this subtitle.</text> </level> <level label="ii"> <text>At any time during the review process, the Department may submit comments to or request additional information from the provider to determine whether the agreement complies with the requirements of this subtitle and other applicable law.</text> </level> <level label="iii"> <text>If the Department submits comments or a request for additional information under subparagraph (ii) of this paragraph, the 120–day review period under subparagraph (i) of this paragraph is suspended.</text> </level> <level label="iv"> <text>On receipt of any requested information or modifications to the agreement necessitated by the Department’s comments under subparagraph (iii) of this paragraph, the Department, within the number of days remaining in the 120–day review period, shall:</text> <level label="1"> <text>complete its review to determine whether the agreement meets the requirements of this subtitle and other applicable law identified by the Department in accordance with subparagraph (ii) of this paragraph; and</text> </level> <level label="2"> <text>approve or disapprove the agreement.</text> </level> </level> <level label="v"> <level label="1"> <text>If the Department does not approve the agreement, the Department shall notify the provider in writing, including citations to the specific provisions of law that the Department determined were not complied with in the agreement.</text> </level> <level label="2"> <text>A provider may appeal the disapproval of an agreement under subparagraph (iv) of this paragraph under the provisions of Title 10, Subtitle 2 of the State Government Article.</text> </level> </level> </level> <level label="2"> <text>If the Department does not act within 120 days, the agreement is deemed approved.</text> </level> </level> <level label="b"> <text>The provider shall maintain the continuing care agreement at the facility and make it available for inspection by the Maryland Department of Health under Title 19, Subtitle 18 and Title 10, Subtitle 3 of the Health – General Article.</text> </level> <level label="c"> <text>If a provider is seeking approval for a modification to an approved continuing care agreement or other related agreement, the Department shall limit its review to:</text> <level label="1"> <text>the section of the agreement being modified and any sections directly affected by the modification; and</text> </level> <level label="2"> <text>any section of the agreement that may have been affected by a change in the law or a regulation that was enacted after the Department approved the agreement.</text> </level> </level> <level label="d"> <text>If the continuing care agreement is not an extensive agreement or a modified agreement and the provider uses a separate assisted living agreement:</text> <level label="1"> <text>the provider is not required to submit the assisted living agreement or any requests for modifications to the Department for approval; and</text> </level> <level label="2"> <level label="i"> <text>the provider shall state in its continuing care agreement that, if the subscriber wishes to transfer to assisted living, the subscriber will be required to sign an additional separate agreement for assisted living services that will not be approved by the Department for compliance with legal requirements or coordination with the continuing care agreement; and</text> </level> <level label="ii"> <text>the provider may include a provision in its continuing care agreement stating that assisted living contracts and services are regulated by the Office of Health Care Quality within the Maryland Department of Health.</text> </level> </level> </level> <level label="e"> <text>If the continuing care agreement is not an extensive agreement or a modified agreement and the provider uses a separate comprehensive care agreement:</text> <level label="1"> <text>the provider is not required to submit the comprehensive care agreement or any requests for modifications to the Department for approval; and</text> </level> <level label="2"> <level label="i"> <text>the provider shall state in its continuing care agreement that, if the subscriber wishes to transfer to comprehensive care, the subscriber will be required to sign an additional separate agreement for comprehensive care services that will not be approved by the Department for compliance with legal requirements or coordination with the continuing care agreement; and</text> </level> <level label="ii"> <text>the provider may include a provision in its continuing care agreement stating that comprehensive care facilities contracts and services are regulated by the Office of Health Care Quality within the Maryland Department of Health.</text> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-446" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A subscriber may rescind a continuing care agreement for any reason before the date of occupancy by the subscriber.</text> </level> <level label="b"> <level label="1"> <text>A continuing care agreement is automatically canceled if, before the date of occupancy:</text> <level label="i"> <text>the subscriber dies;</text> </level> <level label="ii"> <text>the provider determines that the subscriber is ineligible for admission to the facility; or</text> </level> <level label="iii"> <text>the subscriber terminates the continuing care agreement because of a substantial change in the subscriber’s physical, mental, or financial condition.</text> </level> </level> <level label="2"> <text>Within 30 days after a continuing care agreement is canceled under this subsection, the subscriber or the subscriber’s legal representative shall receive a full refund of all money paid to the provider, less:</text> <level label="i"> <text>a processing fee approved by the Department; and</text> </level> <level label="ii"> <text>any special additional costs incurred by the provider due to modifications in the structure or furnishings of the unit specifically requested by the subscriber, if:</text> <level label="1"> <text>the costs do not exceed the costs of modification and the reasonable costs of restoration actually incurred by the provider; and</text> </level> <level label="2"> <text>the costs were set forth in writing in a separate addendum to the agreement signed by the subscriber.</text> </level> </level> </level> </level> <level label="c"> <level label="1"> <text>If the subscriber rescinds the continuing care agreement within 90 days after entering into the agreement and before the date of occupancy for any reason other than the reasons specified in subsection (b)(1) of this section, the provider shall refund the amount described in subsection (b)(2) of this section to the subscriber or the subscriber’s legal representative within 30 days after the date of rescission.</text> </level> <level label="2"> <text>If the subscriber rescinds the continuing care agreement more than 90 days after entering into the agreement and before the date of occupancy for any reason other than the reasons specified in subsection (b)(1) of this section, the provider may retain up to 25% of the subscriber’s entrance fee deposit.</text> </level> </level> <level label="d"> <level label="1"> <text>A subscriber may rescind a continuing care agreement at any time if a term of the agreement violates this subtitle and the subscriber is injured by the violation.</text> </level> <level label="2"> <text>The subscriber is entitled to treble damages for extensive injuries arising from a violation.</text> </level> </level> <level label="e"> <level label="1"> <text>An applicant for admission to a facility who withdraws the application before executing a continuing care agreement shall receive a refund of all money paid to the provider except a processing fee approved by the Department.</text> </level> <level label="2"> <text>The refund shall be paid within 60 days after the applicant withdraws the application.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-447" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Extensive agreement” means a continuing care agreement under which the provider promises to provide residential facilities, meals, amenities, and long-term care services in a licensed assisted living program or comprehensive care program:</text> <level label="i"> <text>for as long as the subscriber needs the services; and</text> </level> <level label="ii"> <text>for no increase in the subscriber’s entrance fee or periodic fees, except for an adjustment to account for increased operating costs caused by inflation or other factors unrelated to the individual subscriber.</text> </level> </level> <level label="3"> <text>“Modified agreement” means a continuing care agreement:</text> <level label="i"> <text>under which the provider promises to provide residential facilities, meals, amenities, and a limited amount of long-term care services in a licensed assisted living program or comprehensive care program:</text> <level label="1"> <text>for as long as the subscriber needs the services; and</text> </level> <level label="2"> <text>for no increase in the subscriber’s entrance fee or periodic fees, except for an adjustment to account for increased operating costs caused by inflation or other factors unrelated to the individual subscriber; and</text> </level> </level> <level label="ii"> <text>that provides that long-term care services in a licensed assisted living program or comprehensive care program beyond the limited amount of services to be provided under item (i) of this paragraph will be provided at a per diem, fee-for-service, or other agreed-upon rate.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>A provider shall provide the assisted living services a subscriber needs in accordance with paragraph (2) of this subsection if:</text> <level label="i"> <text>the subscriber’s continuing care agreement is an extensive or modified agreement that promises the provider will provide assisted living services; and</text> </level> <level label="ii"> <text>the provider does not have an assisted living bed available at the facility when the subscriber needs the promised care.</text> </level> </level> <level label="2"> <text>The provider shall provide assisted living services required under paragraph (1) of this subsection to a subscriber:</text> <level label="i"> <text>at the same rate the subscriber would pay if an assisted living bed were available; and</text> </level> <level label="ii"> <text>at the provider’s option:</text> <level label="1"> <text>in the subscriber’s independent living unit; or</text> </level> <level label="2"> <text>in a nearby licensed assisted living facility.</text> </level> </level> </level> </level> <level label="c"> <level label="1"> <text>A provider shall provide the comprehensive care services a subscriber needs in accordance with paragraph (2) of this subsection if:</text> <level label="i"> <text>the subscriber’s continuing care agreement is an extensive or modified agreement that promises the provider will provide the subscriber with comprehensive care services if the subscriber needs them; and</text> </level> <level label="ii"> <text>the provider does not have a comprehensive care bed available when the subscriber needs the promised care.</text> </level> </level> <level label="2"> <text>The provider shall provide the services required under paragraph (1) of this subsection:</text> <level label="i"> <text>at the same rate the subscriber would pay if a comprehensive bed were available; and</text> </level> <level label="ii"> <text>at the provider’s option:</text> <level label="1"> <text>in the subscriber’s independent or assisted living unit; or</text> </level> <level label="2"> <text>in a nearby licensed comprehensive care facility.</text> </level> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-448" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A continuing care agreement may not allow dismissal or discharge of the subscriber from the facility providing care before the agreement expires unless:</text> <level label="1"> <text>the provider has just cause for the dismissal or discharge; and</text> </level> <level label="2"> <text>the provider gives the subscriber at least 60 days’ advance notice.</text> </level> </level> <level label="b"> <text>If a provider terminates a subscriber’s continuing care agreement for just cause, the provider shall pay the subscriber a refund calculated in accordance with subsection (c) of this section, within 60 days after the later of:</text> <level label="1"> <text>the date of dismissal or discharge; or</text> </level> <level label="2"> <text>the date the subscriber vacates the unit.</text> </level> </level> <level label="c"> <level label="1"> <text>The subscriber’s refund shall equal the entrance fee divided by the subscriber’s years of expected lifetime at admission, multiplied by the subscriber’s years of expected lifetime at dismissal or discharge.</text> </level> <level label="2"> <text>A subscriber’s years of expected lifetime at admission and at dismissal or discharge shall be computed based on the appropriate tables most recently published by the U.S. Department of Health and Human Services at the time of dismissal or discharge.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-449" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A continuing care agreement shall allow a subscriber to terminate the agreement by giving a written termination notice to the provider.</text> </level> <level label="b"> <text>If a continuing care agreement is terminated by the subscriber’s election or death within the first 90 days of occupancy, the provider shall pay any contractual entrance fee refund within 30 days after the earlier to occur of:</text> <level label="1"> <text>the recontracting of the subscriber’s unit by:</text> <level label="i"> <text>another subscriber for whom an entrance fee has been paid; or</text> </level> <level label="ii"> <text>another party who is not a subscriber; or</text> </level> </level> <level label="2"> <text>the later to occur of:</text> <level label="i"> <text>the 90th day after the date the written termination notice is given or the date of death; or</text> </level> <level label="ii"> <text>the day the independent living units at the facility have operated at 95% of capacity for the previous 6 months.</text> </level> </level> </level> <level label="c"> <text>If a continuing care agreement is terminated by the subscriber’s election or death after the first 90 days of occupancy, the provider shall pay any contractual entrance fee refund within 60 days after the subscriber’s death or the effective date of termination, if on the date of death or at any time between the date the written termination notice is given and the effective date of termination:</text> <level label="1"> <text>the subscriber resides in a unit at a higher level of care than the level of care in which the subscriber resided on initially entering the facility; and</text> </level> <level label="2"> <text>the last unit in which the subscriber resided at the initial level of care on entering the facility has been occupied by or reserved for another subscriber who has paid an entrance fee.</text> </level> </level> <level label="d"> <text>This section does not prohibit a provider from requiring that a subscriber’s unit be vacated before any contractual entrance fee refund is paid as a result of the subscriber’s election to terminate a continuing care agreement.</text> </level> <level label="e"> <level label="1"> <text>If an entrance fee refund is conditioned on the reoccupying of a subscriber’s unit and the unit has not been reoccupied within 9 months of the subscriber’s death or the date of the contract termination, a provider shall submit a written report to the subscriber or the subscriber’s beneficiary stating:</text> <level label="i"> <text>that the unit has not been reoccupied; and</text> </level> <level label="ii"> <text>the efforts the provider has made to reoccupy the unit.</text> </level> </level> <level label="2"> <text>After the provider submitted the report required under paragraph (1) of this subsection, the provider shall submit an updated written report to the subscriber or the subscriber’s beneficiary every 6 months until the subscriber’s unit has been reoccupied.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-450" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>An act, agreement, or statement by a subscriber or by an individual purchasing care for a subscriber under an agreement to furnish care to the subscriber is not a valid waiver of any provision of this subtitle intended for the benefit or protection of the subscriber or the individual purchasing care for the subscriber.</text> </section> <section article="ghu" article_name="Human Services" number="10-453" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>This part applies only to continuing care at home operations.</text> </section> <section article="ghu" article_name="Human Services" number="10-454" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>The Department shall adopt regulations that:</text> <level label="1"> <text>set standards for continuing care at home providers; and</text> </level> <level label="2"> <text>provide for the certification of continuing care at home providers and the annual renewal of certificates of registration.</text> </level> </level> <level label="b"> <text>In addition to the provisions required under subsection (a) of this section, the regulations adopted by the Department shall, at a minimum:</text> <level label="1"> <text>provide for and encourage the establishment of continuing care at home programs;</text> </level> <level label="2"> <text>for an individual who is employed by or under contract with a continuing care at home provider and who will enter a subscriber’s home to provide continuing care at home services:</text> <level label="i"> <text>set minimum requirements;</text> </level> <level label="ii"> <text>require a criminal history records check, if the individual will have routine, direct access to a subscriber; and</text> </level> <level label="iii"> <text>require the provider to screen and verify the individual’s character references;</text> </level> </level> <level label="3"> <text>establish standards for the renewal of certificates of registration;</text> </level> <level label="4"> <text>establish standards for entrance fees, deposits, and the number of executed agreements necessary to begin operations;</text> </level> <level label="5"> <text>establish conditions for the release of deposits and entrance fees from escrow accounts;</text> </level> <level label="6"> <text>establish standards for when and how a subscriber or provider may rescind a continuing care at home agreement before continuing care at home services are provided to the subscriber;</text> </level> <level label="7"> <text>allow a subscriber to rescind a continuing care at home agreement at any time if the terms of the agreement violate this subtitle; and</text> </level> <level label="8"> <text>establish that a provider may terminate an agreement or discharge a subscriber only for just cause and establish procedures to carry out the termination or discharge.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-455" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not collect deposits to provide continuing care at home services until the Department approves a feasibility study.</text> </level> <level label="b"> <text>A provider that intends to develop a continuing care at home program and provide continuing care at home services shall file a statement of intent with the Department at least 30 days before submitting the feasibility study required under this section.</text> </level> <level label="c"> <text>A feasibility study shall:</text> <level label="1"> <text>be filed in a form satisfactory to the Department; and</text> </level> <level label="2"> <text>include at least the following information:</text> <level label="i"> <text>a statement of the purpose of the program and the need for the proposed services;</text> </level> <level label="ii"> <text>documentation of the financial resources of the provider;</text> </level> <level label="iii"> <text>a plan demonstrating the financial feasibility of the proposed program, including future funding sources;</text> </level> <level label="iv"> <text>an actuarial forecast that has been reviewed by a qualified actuary;</text> </level> <level label="v"> <text>a study demonstrating the proposed market for the program;</text> </level> <level label="vi"> <text>the form and substance of any proposed advertisements, advertising campaigns, or other promotional materials for the program that is available at the time of filing;</text> </level> <level label="vii"> <text>a detailed statement of the covered services; and</text> </level> <level label="viii"> <text>any other information that the Department requires.</text> </level> </level> </level> <level label="d"> <text>The Department shall approve a feasibility study filed under this section if the Department determines that:</text> <level label="1"> <text>the proposed use of new or existing health facilities is not inconsistent with the State health plan;</text> </level> <level label="2"> <text>a reasonable financial plan has been developed to provide continuing care at home services, including the number of agreements to be executed before beginning operations and the criteria to release funds from escrow;</text> </level> <level label="3"> <text>a market for the continuing care at home program appears to exist;</text> </level> <level label="4"> <text>the feasibility study was prepared by a recognized authority;</text> </level> <level label="5"> <text>the provider has submitted all proposed advertisements, advertising campaigns, and other promotional materials for the program;</text> </level> <level label="6"> <text>the form and substance of all advertisements, advertising campaigns, and other promotional materials submitted are not deceptive, misleading, or likely to mislead;</text> </level> <level label="7"> <text>the actuarial forecast supports the market for the program;</text> </level> <level label="8"> <text>the approved escrow agreement and deposit agreement state the conditions for the release of deposits and entrance fees from escrow;</text> </level> <level label="9"> <text>a copy of the escrow agreement executed by the provider and the financial institution has been filed with the Department; and</text> </level> <level label="10"> <text>any other information requested by the Department has been submitted and approved.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-456" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may collect deposits from prospective subscribers if:</text> <level label="1"> <text>the Department has approved the provider’s feasibility study; and</text> </level> <level label="2"> <text>the provider maintains the funds collected in an escrow account.</text> </level> </level> <level label="b"> <text>Deposits collected under subsection (a) of this section shall be held in escrow until:</text> <level label="1"> <text>the provider has been issued a certificate of registration under § 10-458 of this subtitle; or</text> </level> <level label="2"> <text>a later time that the Department may set by regulation.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-457" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not enter into an agreement to provide continuing care at home services until the Department issues a preliminary certificate of registration to the provider.</text> </level> <level label="b"> <text>An application for a preliminary certificate of registration shall:</text> <level label="1"> <text>be filed in a form satisfactory to the Department; and</text> </level> <level label="2"> <text>include at least the following information:</text> <level label="i"> <text>a copy of the proposed continuing care at home agreement, which shall include the following statement set forth in print no smaller than the largest type used in the body of the agreement:</text> <text>“A certificate of registration is not an endorsement or guarantee of this continuing care at home provider by the State of Maryland. The Maryland Department of Aging urges you to consult an attorney and a suitable financial advisor before signing any documents.”;</text> </level> <level label="ii"> <text>the form and substance of any proposed advertisements, advertising campaigns, or other promotional materials for the program that is available at the time of filing the application and that has not been filed previously with the Department; and</text> </level> <level label="iii"> <text>any other information that the Department requires.</text> </level> </level> </level> <level label="c"> <text>The Department shall issue a preliminary certificate of registration to a provider if the Department determines that:</text> <level label="1"> <text>the proposed continuing care at home agreement is satisfactory;</text> </level> <level label="2"> <text>the provider has submitted all proposed advertisements, advertising campaigns, and other promotional materials for the program;</text> </level> <level label="3"> <text>the form and substance of all advertisements, advertising campaigns, and other promotional materials submitted are not deceptive, misleading, or likely to mislead;</text> </level> <level label="4"> <text>the information and documents submitted with the feasibility study under § 10–455 of this subtitle are current and accurate or have been updated to make them accurate; and</text> </level> <level label="5"> <text>the provider has submitted any other information that the Department requests.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-458" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A provider may not provide continuing care at home services until the Department issues a certificate of registration to the provider.</text> </level> <level label="b"> <text>An application for a certificate of registration shall:</text> <level label="1"> <text>be filed in a form satisfactory to the Department; and</text> </level> <level label="2"> <text>include at least the following information:</text> <level label="i"> <text>except as provided in subsection (d) of this section, verification that the required number of agreements has been executed and the corresponding deposits collected;</text> </level> <level label="ii"> <text>the form and substance of any proposed advertisements, advertising campaigns, or other promotional materials for the program that are available at the time of filing and that have not been filed previously with the Department;</text> </level> <level label="iii"> <text>verification that any other license or certificate required by other appropriate State units has been issued to the provider; and</text> </level> <level label="iv"> <text>any other information that the Department requires.</text> </level> </level> </level> <level label="c"> <text>The Department shall issue a certificate of registration to a provider if the Department determines that:</text> <level label="1"> <text>the information and documents submitted with the feasibility study and application for a preliminary certificate of registration are current and accurate or have been updated to make them accurate;</text> </level> <level label="2"> <text>except as provided in subsection (d) of this section, the required number of agreements has been executed and the corresponding deposits collected;</text> </level> <level label="3"> <text>any other license or certificate required by other appropriate State units has been issued to the provider;</text> </level> <level label="4"> <text>the provider has submitted all proposed advertisements, advertising campaigns, and other promotional materials for the program;</text> </level> <level label="5"> <text>the form and substance of all advertisements, advertising campaigns, and other promotional materials submitted are not deceptive, misleading, or likely to mislead; and</text> </level> <level label="6"> <text>the provider has submitted any other information that the Department required.</text> </level> </level> <level label="d"> <text>Subsections (b)(2)(i) and (c)(2) of this section do not apply to a provider of continuing care at home services that:</text> <level label="1"> <text>meets any capital reserve requirements; and</text> </level> <level label="2"> <text>until the provider has enrolled the minimum number of subscribers needed for its revenues to at least equal its expenses:</text> <level label="i"> <text>holds in escrow the entirety of all entrance fees; or</text> </level> <level label="ii"> <text>maintains a surety bond of at least $1,000,000 or an equivalent replacement security such as cash, irrevocable letters of credit, certificates of deposit, or Treasury bills.</text> </level> </level> </level> <level label="e"> <text>If a provider intends to advertise before the Department issues a certificate of registration under subsection (c) of this section, the provider shall submit to the Department any advertisement, advertising campaign, or other promotional materials before using it.</text> </level> <level label="f"> <text>If a certificate of registration is not issued to a provider within 24 months after the Department approves a feasibility study, or a longer time allowed by the Department for good cause shown, the provider shall refund all deposits collected and stop offering continuing care at home services under that application.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-459" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>Each year, within 120 days after the end of a provider’s fiscal year, the provider shall file an application for a renewal certificate of registration with the Department.</text> </level> <level label="2"> <text>An application shall:</text> <level label="i"> <text>be filed in a form satisfactory to the Department; and</text> </level> <level label="ii"> <text>contain any reasonable and pertinent information that the Department requires.</text> </level> </level> </level> <level label="b"> <text>The Department shall issue a renewal certificate of registration if the Department determines that:</text> <level label="1"> <text>all required documents have been filed and are satisfactory;</text> </level> <level label="2"> <text>any revised agreements for continuing care at home services meet the Department’s requirements;</text> </level> <level label="3"> <text>the proposed use of new or existing health facilities is not inconsistent with the State health plan;</text> </level> <level label="4"> <text>the provider has submitted all proposed advertisements, advertising campaigns, and other promotional materials for the program; and</text> </level> <level label="5"> <text>the form and substance of all advertisements, advertising campaigns, and other promotional materials submitted are not deceptive, misleading, or likely to mislead.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-460" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>For cause, the Department may:</text> <level label="1"> <text>deny a feasibility study approval; or</text> </level> <level label="2"> <text>deny, suspend, or revoke a preliminary, initial, or renewal certificate of registration.</text> </level> </level> <level label="b"> <level label="1"> <text>Grounds for a denial, suspension, or revocation include:</text> <level label="i"> <text>violation of this subtitle;</text> </level> <level label="ii"> <text>violation of a regulation the Department adopts under this subtitle;</text> </level> <level label="iii"> <text>misrepresentation; or</text> </level> <level label="iv"> <text>submission of a false financial statement.</text> </level> </level> <level label="2"> <text>The Department shall set forth in writing its reasons for a denial, suspension, or revocation.</text> </level> </level> <level label="c"> <text>Title 10, Subtitle 2 of the State Government Article governs the appeal of a denial, revocation, or suspension.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-463" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>In this part, “Committee” means the Financial Review Committee established in § 10-464 of this subtitle.</text> </section> <section article="ghu" article_name="Human Services" number="10-464" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>There is a Financial Review Committee in the Department.</text> </section> <section article="ghu" article_name="Human Services" number="10-465" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>The Committee consists of seven members appointed by the Secretary.</text> </level> <level label="2"> <text>Of the seven members:</text> <level label="i"> <text>two shall be knowledgeable in the field of continuing care;</text> </level> <level label="ii"> <text>two shall be certified public accountants;</text> </level> <level label="iii"> <text>one shall be from the financial community; and</text> </level> <level label="iv"> <text>two shall be consumer members.</text> </level> </level> <level label="3"> <text>In appointing the consumer members, the Secretary shall give a preference to subscribers of continuing care facilities.</text> </level> </level> <level label="b"> <level label="1"> <text>The term of a member is 3 years.</text> </level> <level label="2"> <text>The terms of members are staggered as required by the terms provided for members on October 1, 2007.</text> </level> <level label="3"> <text>A member may serve consecutive terms.</text> </level> </level> <level label="c"> <text>The Committee shall elect its chair.</text> </level> <level label="d"> <text>A member:</text> <level label="1"> <text>may not receive compensation as a member of the Committee; but</text> </level> <level label="2"> <text>is entitled to reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.</text> </level> </level> <level label="e"> <text>A member is immune from civil liability as provided in § 5-514 of the Courts Article.</text> </level> <level label="f"> <text>A member may not participate in a review of a provider’s financial condition if that member has an interest, as defined under the Maryland Public Ethics Law in § 5–101 of the General Provisions Article, in the provider.</text> </level> <level label="g"> <text>The deliberations of the Committee and communications between the Department and the Committee, including recommendations of the Committee, shall be confidential.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-466" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>The Department may refer to the Committee for its consideration:</text> <level label="i"> <text>a provider’s application for a renewal certificate of registration after review by the Department; or</text> </level> <level label="ii"> <text>a finding of possible financial difficulty, at any time.</text> </level> </level> <level label="2"> <text>The Department shall provide to the Committee any materials the Department considers necessary.</text> </level> </level> <level label="b"> <level label="1"> <text>The Committee shall review the referral from the Department and may request additional information from the Department.</text> </level> <level label="2"> <text>Except as provided in subsection (c) of this section, within 45 days after receipt of a referral, the Committee shall notify the Department in writing whether the Committee recommends that the Department:</text> <level label="i"> <text>find the provider in financial difficulty; and</text> </level> <level label="ii"> <text>find that the financial difficulty, if any, includes a significant risk of financial failure in accordance with § 10-469 of this subtitle.</text> </level> </level> <level label="3"> <text>In making a recommendation to the Department, the Committee shall state the reason for the recommendation.</text> </level> </level> <level label="c"> <level label="1"> <text>The Committee may request from the Secretary one 30-day extension of the deadline under subsection (b)(2) of this section.</text> </level> <level label="2"> <text>The Secretary may grant or deny the extension.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-467" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>Within 25 days after receipt of the Committee’s recommendations, the Department shall consider the recommendations and make a final determination of whether financial difficulty exists and, if so, whether there is a significant risk of financial failure in accordance with § 10-469 of this subtitle.</text> </level> <level label="b"> <text>If the Department determines that the provider is in financial difficulty it shall immediately notify the provider by certified mail, return receipt requested, and inform the provider whether the Department has determined that there is a significant risk of financial failure.</text> </level> <level label="c"> <text>The provider shall:</text> <level label="1"> <text>advise its subscribers of the Department’s determination in a meeting to be held by the provider with representatives of the subscribers;</text> </level> <level label="2"> <text>hold the meeting within 10 days after the provider’s receipt of notice from the Department; and</text> </level> <level label="3"> <text>advise the Department of the date, time, and location of the meeting.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-468" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>A provider notified of financial difficulty by the Department shall prepare and submit to the Department for its approval a 5-year financial plan to correct the causes of the financial difficulty.</text> </level> <level label="2"> <text>The financial plan shall be submitted within 60 days after receipt of notification.</text> </level> <level label="3"> <text>The provider may request one 30-day extension from the Secretary.</text> </level> <level label="4"> <text>The Secretary may grant or deny the extension.</text> </level> </level> <level label="b"> <level label="1"> <text>The Department shall respond to the provider within 60 days after receipt of the proposed financial plan.</text> </level> <level label="2"> <text>The Department may:</text> <level label="i"> <text>work with the provider to establish the financial plan; and</text> </level> <level label="ii"> <text>consult with the Committee before approving the financial plan.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>On approval, the financial plan shall be implemented.</text> </level> <level label="2"> <text>The provider shall make available to its subscribers copies of its approved financial plan.</text> </level> </level> <level label="d"> <text>The provider shall:</text> <level label="1"> <text>submit to the Department an annual progress report for the term of its financial plan; and</text> </level> <level label="2"> <text>revise its financial plan if the Department determines that revisions are necessary.</text> </level> </level> <level label="e"> <text>The Department may withhold the renewal certificate of registration or withdraw a preliminary, initial, or renewal certificate of registration if:</text> <level label="1"> <text>the provider does not prepare a financial plan;</text> </level> <level label="2"> <text>the provider is unwilling or unable to prepare a financial plan;</text> </level> <level label="3"> <text>the financial plan is inadequate to correct the current or impending financial condition that necessitated the financial plan; or</text> </level> <level label="4"> <text>the provider fails to implement the financial plan.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-469" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>The Department may determine that there exists a significant risk of the financial failure of a provider based on one or more of the following findings or circumstances:</text> <level label="1"> <text>the provider has failed to meet loan covenants that give a lender or a bond trustee the option to exercise remedies on its collateral;</text> </level> <level label="2"> <text>an actuarial report has been provided to the Department reflecting significant underfunding of future liabilities that are unlikely to be readily addressed;</text> </level> <level label="3"> <text>there is a significant shortfall by the provider in maintaining required reserves for a significant period of time;</text> </level> <level label="4"> <text>a significant balloon payment or future loan payment will become due within the next 12 months and the provider is unable to demonstrate that it will obtain a modification from its lender, have the resources to make the payment, or have the ability to refinance;</text> </level> <level label="5"> <text>there has been a significant decline in the occupancy rate that is likely to have a material adverse financial impact on the provider;</text> </level> <level label="6"> <text>there has been a material adverse change in debt service coverage ratio for an extended period of time that reduces the ratio to less than 1.0;</text> </level> <level label="7"> <text>there has been a significant decline in days cash on hand that is unrelated to additions to property, plant, and equipment or other community enhancements and that could result in an inability to pay obligations of the provider as they become due;</text> </level> <level label="8"> <text>there has been a significant increase in the operating ratio, adjusted for unrealized gains and losses on investments, that could result in the inability of the provider to meet its obligations; or</text> </level> <level label="9"> <text>the refusal or inability of the provider to provide accurate information or data required to be submitted to the Department under this subtitle and related regulations.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-472" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>In this part the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Creditor” means a person with a claim against a provider.</text> </level> <level label="c"> <text>“Delinquency proceeding” means a proceeding under this subtitle to liquidate, rehabilitate, reorganize, or conserve a provider.</text> </level> <level label="d"> <text>“General assets” means:</text> <level label="1"> <text>all property that is not specifically mortgaged, pledged, deposited, or otherwise encumbered for the security or benefit of specified persons or a limited class of persons;</text> </level> <level label="2"> <text>to the extent that property of a provider is specifically encumbered, the amount of the property or its proceeds that exceeds the amount necessary to discharge the encumbrance; and</text> </level> <level label="3"> <text>assets held in trust and assets held on deposit for the security or benefit of all subscribers and creditors in the United States.</text> </level> </level> <level label="e"> <text>“Receiver” includes a conservator, rehabilitator, and liquidator.</text> </level> <level label="f"> <level label="1"> <text>“Secured claim” means a claim that:</text> <level label="i"> <text>is secured by mortgage, trust deed, pledge, deposit as security, escrow, or otherwise; or</text> </level> <level label="ii"> <text>has become a lien on specific assets through judicial process.</text> </level> </level> <level label="2"> <text>“Secured claim” does not include a special deposit claim or a claim against general assets.</text> </level> </level> <level label="g"> <level label="1"> <text>“Special deposit claim” means a claim secured by a deposit required by law for the security or benefit of a limited class of persons.</text> </level> <level label="2"> <text>“Special deposit claim” does not include a claim against general assets.</text> </level> </level> <level label="h"> <text>“Transfer” means:</text> <level label="1"> <text>the sale or other direct or indirect disposition of property or an interest in property;</text> </level> <level label="2"> <text>the fixing of a lien on property or an interest in property; or</text> </level> <level label="3"> <text>the retention of a security title to property delivered to a debtor.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-473" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>Notwithstanding any other provision of law and subject to § 10-493 of this subtitle, a delinquency proceeding is the exclusive method of liquidating, rehabilitating, reorganizing, or conserving a provider.</text> </section> <section article="ghu" article_name="Human Services" number="10-474" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>The Secretary, deputy secretary, special deputy secretary, or any person acting as receiver in a rehabilitation, liquidation, or conservation of a provider as a result of a court order shall have the same immunity from liability that the Maryland Insurance Commissioner, deputy commissioner, special deputy commissioner, or any person acting as receiver in a rehabilitation, liquidation, or conservation of an insurer would have under § 5-410 of the Courts Article.</text> </section> <section article="ghu" article_name="Human Services" number="10-475" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>This subsection applies even if a paper or instrument is not:</text> <level label="i"> <text>executed by the Secretary or a deputy, employee, or attorney of record of the Secretary; and</text> </level> <level label="ii"> <text>connected with the commencement of an action or proceeding by or against the Secretary or with the subsequent conduct of the action or proceeding.</text> </level> </level> <level label="2"> <text>Subject to subsection (b) of this section, the Secretary may not be required to pay to a public officer in the State a fee for filing, recording, or issuing a transcript or certificate or for authenticating a paper or instrument that relates to the exercise by the Secretary of a power or duty of the Secretary under this subtitle.</text> </level> </level> <level label="b"> <level label="1"> <text>The Secretary or deputy secretary, when acting as receiver or ancillary receiver under this subtitle, shall pay all court costs out of the assets of the provider before any distribution to creditors or termination of rehabilitation.</text> </level> <level label="2"> <text>In all cases, court costs and those specified in subsection (a) of this section shall:</text> <level label="i"> <text>be charged in the accounts of the Secretary to the court; or</text> </level> <level label="ii"> <text>be paid by the provider as a condition of termination of the action or proceeding.</text> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-476" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>In a delinquency proceeding in which the Secretary has been appointed receiver, the Secretary may:</text> <level label="i"> <text>appoint one or more special deputy secretaries to act for the Secretary; and</text> </level> <level label="ii"> <text>employ counsel, clerks, and assistants.</text> </level> </level> <level label="2"> <text>Compensation of the special deputies, counsel, clerks, and assistants and all expenses of taking possession of the provider and of conducting the delinquency proceeding shall be:</text> <level label="i"> <text>set by the Secretary, subject to approval by the court; and</text> </level> <level label="ii"> <text>paid out of the assets or funds of the provider.</text> </level> </level> <level label="3"> <text>Within the limits of duties imposed on a special deputy concerning a delinquency proceeding, the special deputy:</text> <level label="i"> <text>has all powers given to the receiver; and</text> </level> <level label="ii"> <text>in the exercise of those powers, is subject to all the duties imposed on the receiver concerning the delinquency proceeding.</text> </level> </level> </level> <level label="b"> <text>In a civil proceeding filed against a special deputy secretary appointed under this subtitle, the special deputy secretary is entitled to representation by the Attorney General as specified in Title 12, Subtitle 3, Part II of the State Government Article.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-477" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>The Circuit Court of Baltimore City:</text> <level label="1"> <text>has exclusive original jurisdiction over delinquency proceedings; and</text> </level> <level label="2"> <text>may issue all necessary and proper orders to carry out this subtitle.</text> </level> </level> <level label="b"> <text>If service is made in accordance with the Maryland Rules or other applicable law, a court with subject matter jurisdiction over an action brought under this subtitle also has jurisdiction over:</text> <level label="1"> <text>an officer, director, manager, trustee, organizer, promoter, or attorney in fact of a provider against which a delinquency proceeding has been commenced, in an action resulting from or incidental to the person’s relationship with the provider;</text> </level> <level label="2"> <text>a person that, at the time of or after commencement of the delinquency proceeding, held or was in control of assets in which the receiver claims an interest on behalf of the provider, in an action concerning the assets of the provider; and</text> </level> <level label="3"> <text>a person obligated to the provider in any way, in an action on or incidental to the obligation.</text> </level> </level> <level label="c"> <text>The venue of all delinquency proceedings is in Baltimore City.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-478" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>The Secretary shall commence a delinquency proceeding against a provider by applying to the court for an order that directs the provider to show cause why the court should not grant the relief requested.</text> </level> <level label="b"> <level label="1"> <text>The court may consider an application for commencement of a delinquency proceeding only if the application is filed by the Secretary in the name of the State.</text> </level> <level label="2"> <text>After a hearing under the terms of the show cause order, the court:</text> <level label="i"> <text>shall grant or deny the application; and</text> </level> <level label="ii"> <text>may order other relief as the nature of the case and the interests of the creditors, stockholders, members, subscribers, or the public may require.</text> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-479" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>The Secretary may apply to the court for an order that directs the Secretary to conserve or rehabilitate a provider, if the provider:</text> <level label="1"> <text>is a provider for which the Department has made a determination of significant risk of financial failure under Part VII of this subtitle;</text> </level> <level label="2"> <text>has refused to submit to the Secretary or a deputy or examiner of the Secretary, for reasonable examination, any of the property, books, records, accounts, or affairs of the provider, or of a subsidiary or related company of the provider within the provider’s control;</text> </level> <level label="3"> <text>has concealed or removed its assets or records;</text> </level> <level label="4"> <text>has willfully violated its charter, articles of incorporation, a State law, or an order of the Secretary;</text> </level> <level label="5"> <text>after reasonable notice, has failed promptly and effectively to terminate the employment, status, and influence over the management of the provider of a person that has executive authority in fact over the provider and has refused to be examined under oath about the affairs of the provider in the State or elsewhere;</text> </level> <level label="6"> <text>has been or is the subject of an application for appointment of a receiver, trustee, custodian, sequestrator, or similar fiduciary of the provider or its property in an action that was not filed under this subtitle, regardless of whether the appointment:</text> <level label="i"> <text>has been made;</text> </level> <level label="ii"> <text>may deny the courts of the State jurisdiction; or</text> </level> <level label="iii"> <text>may prejudice an orderly delinquency proceeding under this subtitle;</text> </level> </level> <level label="7"> <text>has consented to the order for conservation or rehabilitation through a majority of its directors, stockholders, members, or subscribers;</text> </level> <level label="8"> <text>has failed to pay a final judgment rendered against it in the State on a continuing care agreement issued or assumed by the provider, within 60 days after the latest of:</text> <level label="i"> <text>the day on which the judgment became final;</text> </level> <level label="ii"> <text>the day on which the time for taking an appeal expired; or</text> </level> <level label="iii"> <text>the day on which an appeal was dismissed before final termination;</text> </level> </level> <level label="9"> <text>after examination by the Secretary, is found to be in a condition in which further transaction of its business will be hazardous to its subscribers, bondholders, creditors, or the public;</text> </level> <level label="10"> <text>has failed to remove a person that has executive authority in fact over the provider after the Secretary has found that person to be dishonest or untrustworthy in a manner that may affect the business of the provider;</text> </level> <level label="11"> <text>has reasonable cause to know, or should have known, that there has been:</text> <level label="i"> <text>embezzlement of funds from the provider;</text> </level> <level label="ii"> <text>wrongful sequestration or diversion of assets of the provider;</text> </level> <level label="iii"> <text>forgery or fraud that affects the provider; or</text> </level> <level label="iv"> <text>other illegal conduct in, by, or with respect to the provider;</text> </level> </level> <level label="12"> <text>is controlled directly or indirectly by a person that the Secretary finds to be untrustworthy; or</text> </level> <level label="13"> <text>has failed to file a financial report required by law within the time allowed by law and, after written demand by the Secretary, has failed to give an immediate and adequate explanation.</text> </level> </level> <level label="b"> <level label="1"> <text>If the appointment of the Secretary as receiver is not then in effect, and even if no previous order has directed the Secretary to rehabilitate a provider, the Secretary may apply to the court for an order that appoints the Secretary as receiver and that directs the Secretary to liquidate the provider if the provider:</text> <level label="i"> <text>has not done business for at least 1 year;</text> </level> <level label="ii"> <text>is a provider determined to have a significant risk of financial failure under Part VII of this subtitle and has commenced voluntary liquidation or dissolution, or attempts to commence or prosecute an action or proceeding to liquidate its business or affairs, to dissolve its corporate charter, or to procure the appointment of a receiver, trustee, custodian, or sequestrator under any law except this title;</text> </level> <level label="iii"> <text>is doing business in a fraudulent manner; or</text> </level> <level label="iv"> <text>is in a condition in which further rehabilitation efforts on any grounds specified in subsection (a) of this section appear to be useless.</text> </level> </level> <level label="2"> <text>If at any time during a rehabilitation proceeding the Secretary determines that further efforts to rehabilitate the provider would be useless, the Secretary may apply to the court for an order of liquidation.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-480" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>An order to rehabilitate a provider shall:</text> <level label="i"> <text>appoint the Secretary as rehabilitator;</text> </level> <level label="ii"> <text>direct the Secretary:</text> <level label="1"> <text>to take possession of the property of the provider and conduct the business of the provider under the general supervision of the court; and</text> </level> <level label="2"> <text>to take action the court directs to remove the causes and conditions that have made rehabilitation necessary;</text> </level> </level> <level label="iii"> <text>vest title to all property of the provider in the rehabilitator; and</text> </level> <level label="iv"> <text>require the rehabilitator to make accountings to the court that:</text> <level label="1"> <text>are at intervals as the court specifies in its order, but not less frequently than two times each year; and</text> </level> <level label="2"> <text>include the opinion of the rehabilitator about the likelihood of success of the rehabilitation.</text> </level> </level> </level> <level label="2"> <text>Issuance of an order of rehabilitation:</text> <level label="i"> <text>does not constitute an anticipatory breach of any contract of the provider; and</text> </level> <level label="ii"> <text>is not grounds for retroactive revocation or retroactive cancellation of a contract of the provider, unless the rehabilitator revokes or cancels the contract.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the Secretary, or an interested person on due notice to the Secretary, may apply to the court at any time for an order that:</text> <level label="i"> <text>terminates a rehabilitation proceeding; and</text> </level> <level label="ii"> <text>allows the provider to resume possession of its property and the conduct of its business.</text> </level> </level> <level label="2"> <text>An order under this subsection may not be issued unless, after a hearing, the court determines that the purposes of the rehabilitation proceeding have been fully accomplished.</text> </level> </level> <level label="c"> <level label="1"> <text>An order to liquidate the business of a provider shall direct the Secretary promptly to:</text> <level label="i"> <text>take possession of the property of the provider;</text> </level> <level label="ii"> <text>liquidate the business of the provider;</text> </level> <level label="iii"> <text>deal with the property and business of the provider in the name of the Secretary or in the name of the provider, as the court directs; and</text> </level> <level label="iv"> <text>notify each creditor that may have a claim against the provider to present the creditor’s claim.</text> </level> </level> <level label="2"> <text>The Secretary may apply for, and the court may issue, an order to dissolve the corporate existence of a provider:</text> <level label="i"> <text>on application of the Secretary for an order to liquidate the provider; or</text> </level> <level label="ii"> <text>at any time after the court has granted the order of liquidation.</text> </level> </level> </level> <level label="d"> <text>An order to conserve the assets of a provider shall require the Secretary promptly to take possession of and conserve the property of the provider in the State, subject to further direction by the court.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-481" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>In this section, “appointed receiver” means a person, other than the Secretary, that the court appoints as a conservator, rehabilitator, or receiver under this section.</text> </level> <level label="b"> <level label="1"> <text>On motion of the court or the Secretary, the court may issue an order that appoints or substitutes a person other than the Secretary as conservator, rehabilitator, or receiver:</text> <level label="i"> <text>on initial application by the Secretary for an order to appoint the Secretary as conservator, rehabilitator, or receiver under this subtitle; or</text> </level> <level label="ii"> <text>at any time during the course of a conservatorship, rehabilitation, or receivership under this subtitle.</text> </level> </level> <level label="2"> <text>An appointed receiver has the same powers and duties that the Secretary has under this subtitle as conservator, rehabilitator, or receiver.</text> </level> </level> <level label="c"> <level label="1"> <text>In addition to any other report required by the court, the court shall require an appointed receiver at least quarterly to file with the Secretary and court a report about:</text> <level label="i"> <text>the status of the conservatorship, rehabilitation, or receivership; and</text> </level> <level label="ii"> <text>the activities of the appointed receiver since the last report filed under this paragraph.</text> </level> </level> <level label="2"> <text>The report required under paragraph (1) of this subsection at a minimum shall include:</text> <level label="i"> <text>information of the character required by Title 13 of the Maryland Rules that applies to receivers generally;</text> </level> <level label="ii"> <text>any other information necessary to provide a complete report on the financial affairs and condition of the conservatorship, rehabilitation, or receivership;</text> </level> <level label="iii"> <text>a complete account of all efforts by the appointed receiver since the last report:</text> <level label="1"> <text>to sell or dispose of the remaining business or assets of the provider; or</text> </level> <level label="2"> <text>to otherwise bring to a prompt conclusion the conservatorship, rehabilitation, or receivership; and</text> </level> </level> <level label="iv"> <text>copies of any actuarial or other evaluations of the business and assets under the control of the appointed receiver.</text> </level> </level> <level label="3"> <text>The report shall be audited unless for good cause the court waives the audit.</text> </level> </level> <level label="d"> <text>Subject to any protective order that the court considers appropriate, information filed under seal shall be provided to the Secretary.</text> </level> <level label="e"> <text>The appointed receiver shall give the Secretary full access to all documents and records related to the conservatorship, rehabilitation, or receivership that are in the possession of the appointed receiver.</text> </level> <level label="f"> <text>The Secretary may be a party to a conservatorship, rehabilitation, or receivership for which there is an appointed receiver.</text> </level> <level label="g"> <level label="1"> <text>Subject to approval of the court, the Secretary may negotiate for sale of all or part of the assets or business of the provider placed in conservatorship, rehabilitation, or receivership.</text> </level> <level label="2"> <text>The appointed receiver:</text> <level label="i"> <text>shall cooperate fully in any sales negotiation under paragraph (1) of this subsection; and</text> </level> <level label="ii"> <text>may object to the terms of a sale of the assets or business of the provider that results from the negotiation.</text> </level> </level> <level label="3"> <text>After notice and an opportunity to be heard, the court may limit the efforts of the Secretary to undertake or continue negotiations for the sale of the assets or business of the provider if the negotiations would impair the ability of the appointed receiver to engage in similar negotiations or discharge other responsibilities.</text> </level> </level> <level label="h"> <level label="1"> <text>If the Secretary determines that an appointed receiver is not adequately discharging the duties and responsibilities of the position, the Secretary may file with the court an application that seeks to discharge the appointed receiver and to appoint the Secretary as conservator, rehabilitator, or receiver or to appoint another receiver.</text> </level> <level label="2"> <text>If the Secretary establishes by a preponderance of the evidence that grounds exist for discharge of an appointed receiver, the court shall grant the application of the Secretary to discharge the appointed receiver and to appoint the Secretary as conservator, rehabilitator, or receiver or to appoint another receiver.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-482" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>Within 15 days after appointment as receiver or conservator for a provider against which a delinquency proceeding has been commenced, the receiver or conservator shall notify each subscriber of the provider, by letter or other means approved by the court, of the commencement of the delinquency proceeding and of the possibility that the continuing care agreement of the subscriber may be canceled.</text> </section> <section article="ghu" article_name="Human Services" number="10-483" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>An appeal may be taken to the Court of Special Appeals from:</text> <level label="1"> <text>an order that grants or refuses rehabilitation, liquidation, or conservation; and</text> </level> <level label="2"> <text>any other order in a delinquency proceeding that has the character of a final order as to the particular part of the delinquency proceeding covered by the order.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-484" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>To facilitate the rehabilitation, liquidation, conservation, or dissolution of a provider under this subtitle, the Secretary, subject to the approval of the court, may:</text> <level label="1"> <text>borrow money;</text> </level> <level label="2"> <text>execute, acknowledge, and deliver notes or other evidences of indebtedness for the loan;</text> </level> <level label="3"> <text>secure the repayment of the loan by the mortgage, pledge, assignment, or transfer in trust of all or part of the property of the provider; and</text> </level> <level label="4"> <text>take any other action necessary and proper to consummate the loan and to provide for its repayment.</text> </level> </level> <level label="b"> <text>The Secretary is not obligated personally or in an official capacity to repay a loan made under this section.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-485" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>Whenever under this subtitle a receiver is to be appointed in a delinquency proceeding for a provider, the court shall:</text> <level label="1"> <text>appoint the Secretary as receiver; and</text> </level> <level label="2"> <text>order the Secretary promptly to take possession of the assets of the provider and to administer the assets under the orders of the court.</text> </level> </level> <level label="b"> <text>Beginning on the date of issuance of an order that directs the Secretary to rehabilitate or liquidate a provider, the Secretary as receiver is vested by operation of law with title to and may take possession of all of the property, contracts, rights of action, books, and records of the provider, wherever located.</text> </level> <level label="c"> <text>The filing of the order that directs possession to be taken, or a certified copy of the order, in an office where instruments affecting title to property are required to be filed provides the same notice as would be provided by a deed, bill of sale, or other evidence of title that is so filed.</text> </level> <level label="d"> <level label="1"> <text>The Secretary as receiver shall administer properly all assets that come into the possession or control of the Secretary.</text> </level> <level label="2"> <text>If considered desirable to protect the assets, the court at any time may require a bond from the Secretary or deputy secretary.</text> </level> <level label="3"> <text>On taking possession of the assets of a provider and subject to the direction of the court, the Secretary immediately shall:</text> <level label="i"> <text>conduct the business of the provider; or</text> </level> <level label="ii"> <text>take action authorized by this subtitle to rehabilitate, liquidate, or conserve the affairs or assets of the provider.</text> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-486" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>During pendency of a delinquency proceeding for a provider, an attachment, garnishment, execution, or similar action or proceeding may not be commenced or maintained in a court of this State against the provider or its assets.</text> </level> <level label="b"> <text>A lien obtained or an action or proceeding prohibited by subsection (a) of this section is void as against any rights arising in the delinquency proceeding, if the lien was obtained or the action or proceeding commenced within 4 months before or at any time after commencement of a delinquency proceeding.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-487" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A transfer of or lien on the property of a provider is voidable if the transfer or lien is:</text> <level label="1"> <text>made or created within 4 months before the issuance of a show–cause order under this subtitle;</text> </level> <level label="2"> <text>made or created with the intent to give a creditor a preference or to enable the creditor to obtain a greater percentage of the debt than another creditor of the same class; and</text> </level> <level label="3"> <text>accepted by the creditor having reasonable cause to believe that the preference will occur.</text> </level> </level> <level label="b"> <text>Each director, officer, employee, stockholder, member, subscriber, and any other person acting on behalf of a provider that is concerned in a voidable transfer under subsection (a) of this section and each person that, as a result of the voidable transfer, receives any property of the provider or benefits from the voidable transfer:</text> <level label="1"> <text>is personally liable; and</text> </level> <level label="2"> <text>shall account to the Secretary.</text> </level> </level> <level label="c"> <text>The Secretary as receiver in a delinquency proceeding may:</text> <level label="1"> <text>avoid a transfer of or lien on the property of a provider that a creditor, stockholder, subscriber, or member of the provider might have avoided; and</text> </level> <level label="2"> <text>recover the transferred property or its value from the person that received it unless that person was a bona fide holder for value before the date of issuance of a show–cause order under this subtitle.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-488" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>The Secretary shall deposit money collected in a delinquency proceeding in a State or national bank, savings bank, or trust company.</text> </level> <level label="2"> <text>Deposits made by the Secretary under paragraph (1) of this subsection have priority of payment equal to any other priority specified by the banking laws of this State if the depository:</text> <level label="i"> <text>is an institution organized and supervised under the laws of this State; and</text> </level> <level label="ii"> <text>becomes insolvent or liquidates voluntarily or involuntarily.</text> </level> </level> <level label="3"> <text>The Secretary may deposit all or part of the money collected in a national bank or trust company as a trust fund.</text> </level> </level> <level label="b"> <text>To the extent that an investment or account is insured by the Federal Deposit Insurance Corporation, the Secretary may invest in shares of or deposits in a savings and loan association or building and loan association.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-489" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>If on issuance of an order of liquidation under this subtitle or at any time during a liquidation proceeding the provider is not clearly solvent, the court, after notice it considers proper and a hearing, shall issue an order that the provider is an impaired provider.</text> </level> <level label="2"> <text>Notwithstanding any previous notice given to creditors, after issuance of an order under paragraph (1) of this subsection, the Secretary shall notify each person that may have a claim against the provider that the claim is forever barred unless the person files the claim with the Secretary at a place and within the time specified in the notice.</text> </level> <level label="3"> <text>The time specified in the notice:</text> <level label="i"> <text>shall be as set by the court for filing claims; but</text> </level> <level label="ii"> <text>may not be less than 6 months after issuance of the order that the provider is an impaired provider.</text> </level> </level> <level label="4"> <text>The notice shall be given in the manner and for the reasonable period of time that the court orders.</text> </level> </level> <level label="b"> <level label="1"> <text>Each claimant shall set forth in reasonable detail:</text> <level label="i"> <text>the amount of the claim or the basis on which the amount can be determined;</text> </level> <level label="ii"> <text>the facts on which the claim is based; and</text> </level> <level label="iii"> <text>any priority asserted by the claimant.</text> </level> </level> <level label="2"> <text>Each claim shall:</text> <level label="i"> <text>be verified by the affidavit of the claimant or a person authorized to act on behalf of the claimant who has knowledge of the facts; and</text> </level> <level label="ii"> <text>be supported by any documents that may be material to the claim.</text> </level> </level> <level label="3"> <text>Each claim shall be filed with the receiver in the State on or before the last date specified under this subtitle for filing of claims.</text> </level> </level> <level label="c"> <text>The receiver shall:</text> <level label="1"> <text>report a claim to the court:</text> <level label="i"> <text>within 10 days after receiving the claim; or</text> </level> <level label="ii"> <text>within an additional period set by the court for good cause shown; and</text> </level> </level> <level label="2"> <text>recommend in the report action to be taken on the claim.</text> </level> </level> <level label="d"> <level label="1"> <text>On receipt of the report of the receiver, the court shall:</text> <level label="i"> <text>set a time for hearing the claim; and</text> </level> <level label="ii"> <text>direct the claimant or receiver to give notice as the court determines to each person that appears to the court to be interested in the claim.</text> </level> </level> <level label="2"> <text>The notice given in accordance with this subsection shall:</text> <level label="i"> <text>specify the time and place of the hearing; and</text> </level> <level label="ii"> <text>state concisely:</text> <level label="1"> <text>the amount and nature of the claim;</text> </level> <level label="2"> <text>any priority asserted by the claimant; and</text> </level> <level label="3"> <text>the recommendation of the receiver about the claim.</text> </level> </level> </level> </level> <level label="e"> <level label="1"> <text>At the hearing specified under subsection (d) of this section:</text> <level label="i"> <text>each person with an interest in the claim may appear; and</text> </level> <level label="ii"> <text>the court shall issue an order in which the court allows in part, or disallows the claim.</text> </level> </level> <level label="2"> <text>An order under this subsection is a final order subject to appeal.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-490" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>In this section, “preferred claim” means a claim that is given priority of payment from the general assets of a provider under the laws of the State or the United States.</text> </level> <level label="b"> <level label="1"> <text>The first $500 of compensation or wages owed to an officer or employee of a provider for services rendered within 3 months before the commencement of a delinquency proceeding against the provider shall be paid before payment of any other debt or claim.</text> </level> <level label="2"> <text>Subject to paragraph (3) of this subsection, the Secretary may pay the compensation required to be paid under this subsection as soon as practicable after commencement of the delinquency proceeding.</text> </level> <level label="3"> <text>At all times, the Secretary shall reserve funds that the Secretary believes are sufficient for expenses of administration.</text> </level> <level label="4"> <text>The priority required under this subsection is instead of any other similar priority that may be authorized by law as to wages or compensation.</text> </level> </level> <level label="c"> <text>Priority over all other claims in a liquidation proceeding, other than claims for wages specified in subsection (b) of this section, expenses of administration, and taxes, shall be given to claims by subscribers that arise from continuing care agreements with the provider, including claims to the statutory refund required by § 10-448 of this subtitle.</text> </level> <level label="d"> <level label="1"> <text>The owner of a secured claim against a provider for which a receiver has been appointed in this State or another state may:</text> <level label="i"> <text>surrender the security and file the claim as a general creditor; or</text> </level> <level label="ii"> <text>have the claim discharged by resort to the security.</text> </level> </level> <level label="2"> <text>If the owner of a secured claim has the claim discharged by resort to the security, any deficiency shall be treated as a claim against the general assets of the provider on the same basis as the claims of unsecured creditors.</text> </level> <level label="3"> <text>The amount of a deficiency is conclusive if adjudicated by a court of competent jurisdiction in a proceeding in which the receiver has been given notice and an opportunity to be heard.</text> </level> <level label="4"> <text>If the amount of a deficiency is not conclusive, the amount shall be determined in a delinquency proceeding in the State.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-491" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>Subject to paragraph (2) of this subsection, contingent and unliquidated claims may not share in a distribution of the assets of a provider that has been adjudicated to be an impaired provider by an order issued under this subtitle.</text> </level> <level label="2"> <text>If properly presented, a contingent and unliquidated claim shall be considered and may be allowed to share if:</text> <level label="i"> <text>the claim becomes absolute against the provider on or before the last day for filing claims against the assets of the provider; or</text> </level> <level label="ii"> <text>there is a surplus and the liquidation is subsequently conducted on the basis that the provider is solvent.</text> </level> </level> </level> <level label="b"> <level label="1"> <text>Except as provided in paragraph (2) of this subsection, a claim of a person that has a secured claim may not be allowed at a sum greater than the difference between:</text> <level label="i"> <text>the value of the claim without security; and</text> </level> <level label="ii"> <text>the value of the security itself on:</text> <level label="1"> <text>the date of issuance of the liquidation order; or</text> </level> <level label="2"> <text>another date set by the court for determining rights and liabilities as provided in subsection (c) of this section.</text> </level> </level> </level> <level label="2"> <text>If the claimant surrenders the security to the Secretary, the claim shall be allowed in the full amount for which it is valued.</text> </level> </level> <level label="c"> <text>Subject to the provisions of this subtitle on the rights of claimants holding contingent claims, and unless otherwise directed by the court, the rights and liabilities of a provider and creditors, stockholders, members, subscribers, and other persons interested in the estate of the provider are fixed on the date on which the order that directs the liquidation of the provider is filed in the office of the clerk of the court that issued the order.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-492" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>Except as provided in subsection (b) of this section, in all cases of mutual debts and credits between a provider and another person in connection with a delinquency proceeding, the debts and credits shall be offset and the balance only shall be allowed or paid.</text> </level> <level label="b"> <text>An offset may not be allowed in favor of another person if:</text> <level label="1"> <text>on the date of issuance of a liquidation order or otherwise, as specified in § 10-491(c) of this subtitle, the obligation of the provider to the person would not entitle the person to share as a claimant in the assets of the provider; or</text> </level> <level label="2"> <text>the obligation of the provider to the person was purchased by or transferred to the person for use as an offset.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-493" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <text>If a provider is the subject of a bankruptcy or receivership action, the claims of subscribers shall be administered in accordance with § 10-490(c) of this subtitle for the purpose of any legal action in conjunction with the bankruptcy or receivership.</text> </section> <section article="ghu" article_name="Human Services" number="10-496" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>A person may not maintain or operate a facility offering continuing care without having obtained an initial or renewal certificate of registration.</text> </level> <level label="b"> <text>A person may not disseminate prohibited advertising or promotional materials.</text> </level> <level label="c"> <text>A person may not provide false registration information to the Department.</text> </level> <level label="d"> <level label="1"> <text>A person who violates any provision of this subtitle is guilty of a misdemeanor and on conviction is subject to imprisonment not exceeding 6 months or a fine not exceeding $1,000 or both.</text> </level> <level label="2"> <text>Each violation of this subtitle constitutes a separate offense.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-497" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>The Secretary may impose a civil money penalty against a provider for an action or inaction that violates this subtitle or any regulation adopted by the Department under this subtitle.</text> </level> <level label="b"> <level label="1"> <text>Before imposing a civil money penalty under subsection (a) of this section, the Department shall issue a notice of violation to the provider.</text> </level> <level label="2"> <text>The notice shall state:</text> <level label="i"> <text>when the provider must submit a plan of correction that is acceptable to the Department;</text> </level> <level label="ii"> <text>when each identified violation must be substantially corrected, which may not be less than 30 days; and</text> </level> <level label="iii"> <text>that failure to submit an acceptable plan of correction as required under item (i) of this paragraph or to correct an identified violation may result in an order imposing a civil money penalty under subsection (d) of this section.</text> </level> </level> </level> <level label="c"> <text>If at the expiration of the time set forth in the notice required under subsection (b) of this section the Department determines a violation has not been corrected, the Secretary may:</text> <level label="1"> <text>extend the time in which the violation must be corrected; or</text> </level> <level label="2"> <text>impose a civil money penalty under subsection (d) of this section.</text> </level> </level> <level label="d"> <level label="1"> <text>The Secretary may impose a civil money penalty not exceeding $5,000 for each violation.</text> </level> <level label="2"> <text>In setting the amount of a civil money penalty under this section, the Secretary shall consider the following factors:</text> <level label="i"> <text>the number, nature, and seriousness of the violations;</text> </level> <level label="ii"> <text>the degree of risk to the health, life, or physical or financial safety of the subscribers caused by the violations;</text> </level> <level label="iii"> <text>the efforts made by the provider to correct the violations;</text> </level> <level label="iv"> <text>whether the amount of the proposed civil money penalty will jeopardize the financial ability of the provider to continue operating; and</text> </level> <level label="v"> <text>other factors as justice may require.</text> </level> </level> <level label="3"> <text>If a civil money penalty is imposed under this section, the Department shall issue an order stating:</text> <level label="i"> <text>the basis on which the order is made;</text> </level> <level label="ii"> <text>each regulation or statute violated;</text> </level> <level label="iii"> <text>each civil money penalty imposed and the total amount of the civil money penalty imposed; and</text> </level> <level label="iv"> <text>the manner in which the amount of the civil money penalty was calculated.</text> </level> </level> <level label="4"> <level label="i"> <text>The Department shall provide written notice to a provider of the imposition of a civil money penalty.</text> </level> <level label="ii"> <text>The notice shall be served on the provider by certified mail and shall include the order and a statement on how to file an administrative appeal.</text> </level> </level> <level label="5"> <text>If a civil money penalty is imposed under this section, the provider has the right to appeal from the order in accordance with Title 10, Subtitle 2 of the State Government Article.</text> </level> </level> <level label="e"> <level label="1"> <text>A provider shall pay a civil money penalty to the Department within 10 days after the provider receives a final order imposing the civil money penalty.</text> </level> <level label="2"> <text>An order imposing a civil money penalty is final when the provider has exhausted all opportunities to contest the civil penalty in accordance with Title 10, Subtitle 2 of the State Government Article.</text> </level> <level label="3"> <text>If a provider does not comply with this section, the Department may file a civil action to recover the penalty.</text> </level> <level label="4"> <text>The Department shall deposit all civil money penalties collected under this section into the General Fund.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-498" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <level label="1"> <text>Any subscriber injured by a violation of this subtitle may bring an action for equitable relief or an action for damages in any court of general jurisdiction.</text> </level> <level label="2"> <text>In an action described in paragraph (1) of this subsection, the court may award reasonable attorney’s fees to a subscriber in whose favor a judgment is entered.</text> </level> </level> <level label="b"> <text>The Department may bring an action for an appropriate temporary restraining order or injunction for a violation of this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-499" title_number="10" title_name="Department of Aging" subtitle_number="4" subtitle_name="Continuing Care"> <level label="a"> <text>The Department may use the receivership provisions of Part VIII of this subtitle to protect the interests of subscribers in:</text> <level label="1"> <text>the substantial advance payments subscribers have made in the form of entrance fees and, when applicable, periodic fees, for future continuing care without necessarily having any ownership in or control of the provider or the facility;</text> </level> <level label="2"> <text>the insurance aspects of continuing care agreements, as applicable; and</text> </level> <level label="3"> <text>the continued delivery of services committed to under continuing care agreements.</text> </level> </level> <level label="b"> <text>The Department may petition for the appointment of a receiver:</text> <level label="1"> <text>if there is a threat of immediate closure of a facility;</text> </level> <level label="2"> <text>if the provider is not honoring its contracts with its subscribers;</text> </level> <level label="3"> <text>to prohibit the improper diversion of the provider’s assets and records from the facility or the State; or</text> </level> <level label="4"> <text>if the Department has made a determination of a significant risk of financial failure in accordance with §§ 10-467 and 10-469 of this subtitle.</text> </level> </level> <level label="c"> <text>The Department may petition for the appointment of a receiver before the provider files a plan of correction.</text> </level> <level label="d"> <text>The receiver may rehabilitate, conserve, or liquidate as provided by the order of appointment and Part VIII of this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-501" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>In this part the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Capital equipment” means essential fixed equipment and furnishings with an expected useful life of at least 15 years.</text> </level> <level label="c"> <level label="1"> <text>“Cost” means all expenses incident to a project.</text> </level> <level label="2"> <text>“Cost” includes:</text> <level label="i"> <text>the cost to acquire any interest in real or personal property in connection with a project;</text> </level> <level label="ii"> <text>the cost of financial, technical, professional, engineering, and legal services in connection with a project whether the expenses are incurred before or after any bond, note, or other evidence of indebtedness or obligation is issued by the State to finance the project;</text> </level> <level label="iii"> <text>the cost of development of a senior citizen activities center master plan; and</text> </level> <level label="iv"> <text>the cost of plans, specifications, surveys, estimates of costs and revenues, feasibility or practicability reports, machinery, equipment, and administrative expenses, and other expenses that are necessary and incident to the financing authorized for the project.</text> </level> </level> </level> <level label="d"> <text>“Grant” means a grant from the State under the Program.</text> </level> <level label="e"> <text>“Improvement” means construction, replacement, extension, or betterment of a senior citizen activities center or real property.</text> </level> <level label="f"> <text>“Master plan” means a comprehensive plan for a local government’s projected need for funds for senior citizen activities centers over 15 years.</text> </level> <level label="g"> <text>“Program” means the Senior Citizen Activities Centers Capital Improvement Grants Program.</text> </level> <level label="h"> <text>“Project” means a capital construction, expansion, renovation, or replacement project for a proposed or existing senior citizen activities center that:</text> <level label="1"> <text>receives or has received a grant for work that is eligible under this part;</text> </level> <level label="2"> <text>is operated under the authority of a unit of local government; and</text> </level> <level label="3"> <text>is:</text> <level label="i"> <text>wholly owned by the unit of local government; or</text> </level> <level label="ii"> <text>leased by a unit of local government if:</text> <level label="1"> <text>the lease is for a minimum term of 15 years after completion of the project or gives the lessee the right of purchase; and</text> </level> <level label="2"> <text>the lessor consents to the recording of a notice of the right of recovery under § 10–506 of this subtitle in the land records of the county in which the facility is located.</text> </level> </level> </level> </level> <level label="i"> <text>“Senior citizen activities center” means a community or neighborhood facility in which a broad spectrum of services are organized and provided to individuals at least 60 years old or their spouses, including health, social, nutritional, educational, and recreational services.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-502" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>A unit of local government may apply to the Secretary for a grant for the cost of:</text> <level label="1"> <text>planning, design, construction, acquisition, conversion, renovation, or improvement of a senior citizen activities center;</text> </level> <level label="2"> <text>developing a master plan;</text> </level> <level label="3"> <text>purchasing capital equipment for a project;</text> </level> <level label="4"> <text>leasing a senior citizen activities center as a lessee or lessor; or</text> </level> <level label="5"> <text>making a subgrant to a nonprofit organization for a purpose described in item (1), (2), (3), or (4) of this subsection.</text> </level> </level> <level label="b"> <text>If the Secretary approves an application for a grant, the Secretary shall file with the Board of Public Works a report describing the scope of the project and a recommendation that the Board make the requested funds available.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-503" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <text>A grant may be used for any of the purposes specified in § 10-502(a) of this subtitle.</text> </section> <section article="ghu" article_name="Human Services" number="10-504" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <level label="1"> <text>Any federal grant that is received for a project shall be applied first to the cost of the project.</text> </level> <level label="2"> <text>Except as provided in subsection (b) of this section, a State grant for a project may not exceed the lesser of $800,000 or 50% of the cost of eligible work remaining unpaid after any federal grant is applied.</text> </level> <level label="3"> <text>A State grant to develop a master plan may not exceed the lesser of $15,000 or 50% of the cost of development of the plan.</text> </level> </level> <level label="b"> <text>The Board of Public Works may authorize a grant for a project that exceeds 50% of the cost of eligible work remaining unpaid after any federal grant is applied, if:</text> <level label="1"> <text>the project involves the conversion, acquisition, renovation, construction, or improvement of a building for use as a senior citizen activities center;</text> </level> <level label="2"> <text>the value of real property and existing improvements made available by the local government equals or exceeds the amount of the State grant; and</text> </level> <level label="3"> <text>the residual value of the real property and existing improvements made available by the local government exceeds the sum of:</text> <level label="i"> <text>any prior amounts used for matching funds under this Program;</text> </level> <level label="ii"> <text>any outstanding State debt relating to the property from another program;</text> </level> <level label="iii"> <text>any prior grant under this Program; and</text> </level> <level label="iv"> <text>any other tangible State investment in the property.</text> </level> </level> </level> <level label="c"> <text>The amount of a State grant for a project shall be determined after consideration of:</text> <level label="1"> <text>the density of the senior population in the area affected by the project;</text> </level> <level label="2"> <text>the proximity of the proposed center to an existing senior citizen activities center; and</text> </level> <level label="3"> <text>other localities eligible for State funding that have not received previous funding under the Program or similar programs.</text> </level> </level> <level label="d"> <text>A grantee who received funds for a project under this subtitle or a prior act authorizing grants for senior citizen activities centers may receive additional grants for the project, but only in an amount that does not exceed the difference between the sum of any prior grants and the maximum funding allowable for the project.</text> </level> <level label="e"> <text>A grantee who received funds for a project under this subtitle for a project at a senior citizen activities center may request an additional grant for a different project at the same senior citizen activities center, if the sum of grants made for any single senior citizen activities center does not exceed $800,000 in any 15–year period.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-505" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <text>At any reasonable time, a representative of the Department may enter a building or place for which a grant was awarded under this part to inspect any pertinent equipment or part of the building or place.</text> </section> <section article="ghu" article_name="Human Services" number="10-506" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>Before State funds are paid under this Program, the grantee shall:</text> <level label="1"> <text>record the notice of the State’s right to recovery in the land records of the county in which the senior citizen activities center is or will be located; and</text> </level> <level label="2"> <text>provide evidence of the recordation to the Department.</text> </level> </level> <level label="b"> <text>The recordation constitutes notice to any potential transferee, potential creditor, or other interested party of the possibility that the State may obtain a lien under this part, but the act of recordation does not create a lien against the property.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-507" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>The State may recover State grant funds if, within 15 years after completion of a project:</text> <level label="1"> <text>the property, with respect to which funds have been paid under this subtitle, ceases to be operated as a senior citizen activities center; or</text> </level> <level label="2"> <text>an interest in property for which funds have been paid under the Program is assigned, transferred, or conveyed:</text> <level label="i"> <text>without approval by the Board of Public Works; or</text> </level> <level label="ii"> <text>for use other than as a senior citizen activities center.</text> </level> </level> </level> <level label="b"> <text>The State is entitled to recover the sum of:</text> <level label="1"> <text>an amount that equals the value of the property, with respect to which funds have been paid under this subtitle, at the time of the recovery multiplied by a fraction:</text> <level label="i"> <text>the numerator of which is the amount of the State funds for the project; and</text> </level> <level label="ii"> <text>the denominator of which is the total cost of all eligible work for the project; and</text> </level> </level> <level label="2"> <text>costs, including reasonable attorney’s fees that the State incurs in recovery proceedings.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-508" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <level label="1"> <text>If a default described in § 10–507(a) of this subtitle is alleged, the Secretary of the Board of Public Works may file a civil action under this part in the circuit court of the county in which the property is located against the owner of the property and any other interested parties, including any transferor that the State wishes to make a party.</text> </level> <level label="2"> <text>The initial filing shall include sworn affidavits stating facts on which the allegations of default are based and a detailed justification of the amount claimed.</text> </level> </level> <level label="b"> <level label="1"> <text>If the court determines from the State’s initial filing that there is probable cause to believe that a default described in § 10–507(a) of this subtitle has occurred, the court shall authorize a temporary lien on the property pending full determination of the State’s claim.</text> </level> <level label="2"> <text>The temporary lien shall be in the amount of the State’s claim, plus any additional amount estimated to be necessary to cover the costs and reasonable attorney’s fees incurred by the State, or another amount that the court determines is reasonable.</text> </level> </level> <level label="c"> <level label="1"> <text>The temporary lien takes effect:</text> <level label="i"> <text>on the date of the court order authorizing the lien if, within 10 days, the Secretary of the Board of Public Works records a notice of temporary lien in the land records of the county in which the property is located; or</text> </level> <level label="ii"> <text>if the Secretary fails to record the notice within 10 days, on the date the notice of temporary lien is recorded.</text> </level> </level> <level label="2"> <text>While the temporary lien is in effect, the owner or any person who acquired an interest in the property after the State first made funds available under the Program may not take an action that would affect the title to the property or institute proceedings to enforce a security interest or other similar rights in the property, without the prior written consent of the State.</text> </level> </level> <level label="d"> <level label="1"> <text>The owner or any other interested party may obtain a release of the temporary lien at any time by filing with the court a bond securing the payment in full of the amount described in subsection (b)(2) of this section.</text> </level> <level label="2"> <text>The owner or other interested party may cause the release to be recorded in the land records of the county in which the property is located.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-509" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>Proceedings to determine the State’s right to recover and the amount of its recovery under the Program have priority over other civil proceedings in the circuit court.</text> </level> <level label="b"> <level label="1"> <text>After a full adversary proceeding, if the court finds that a default described in § 10–507(a) of this subtitle has occurred, the court shall issue a final judgment for the amount the court finds to be recoverable by the State.</text> </level> <level label="2"> <text>All parties involved in the default, including the owner of the property, shall be held jointly and severally liable to the State for the amount of the judgment.</text> </level> <level label="3"> <text>If the court finds that a default described in § 10–507(a) of this subtitle has not occurred or if the court’s judgment is paid in full to the State within 30 days after the court’s final order, any temporary lien shall be released immediately and the Secretary of the Board of Public Works shall cause the release to be recorded in the land records of the county in which the property is located.</text> </level> <level label="4"> <level label="i"> <text>If the judgment remains unpaid for more than 30 days after the court’s final order, the amount shall be a lien on the property.</text> </level> <level label="ii"> <text>Unless the State provides otherwise in a written subordination agreement, the lien is superior to a lien or other interest of any mortgagee, pledgee, purchaser, or judgment creditor whose interest became perfected against third persons after the State awarded a grant.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>A lien issued under this section takes effect on the later of:</text> <level label="i"> <text>the 31st day after the court’s final order if the Secretary of the Board of Public Works records a notice of lien in the land records of the county in which the property is located on or before that day; or</text> </level> <level label="ii"> <text>the date a notice of lien is recorded.</text> </level> </level> <level label="2"> <level label="i"> <text>When the lien takes effect, any temporary lien is automatically and fully released.</text> </level> <level label="ii"> <text>The recorded notice of the lien constitutes notice of the release of the temporary lien.</text> </level> </level> </level> <level label="d"> <text>A lien issued under this part may be enforced and foreclosed in accordance with the Maryland Rules, except that the State or any agent appointed by the State to sell the property need not file a bond.</text> </level> <level label="e"> <level label="1"> <text>The owner or any other interested party may obtain release of a lien issued under this part by paying to the State the full amount of the judgment entered by the circuit court, and any interest that has accrued from the date of judgment.</text> </level> <level label="2"> <text>On payment in full, the Secretary of the Board of Public Works shall cause a release to be recorded in the land records of the county in which the property is located.</text> </level> </level> <level label="f"> <text>Funds recovered under this section shall be deposited in the Annuity Bond Fund and applied to the debt service requirements of the State.</text> </level> <level label="g"> <text>The Board of Public Works may waive the State’s right of recovery if the Board determines that there is good cause for releasing the transferor, transferee, or owner from this obligation.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-510" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <text>Subject to approval by the Board of Public Works, the Secretary may adopt regulations to carry out this part.</text> </section> <section article="ghu" article_name="Human Services" number="10-513" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>In this part the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Fund” means the Senior Citizen Activities Center Operating Fund.</text> </level> <level label="c"> <text>“Senior citizen activities center” means a community or neighborhood facility in which a broad spectrum of services are organized and provided to seniors and their spouses, including health, social, nutritional, educational, and recreational services.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-514" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>There is a Senior Citizen Activities Center Operating Fund.</text> </level> <level label="b"> <text>The Fund shall be used to supplement, but may not be used to supplant, any existing funding for senior citizen activities centers in the State budget.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-515" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>The Secretary shall administer the Fund.</text> </level> <level label="b"> <text>The Secretary may adopt regulations to carry out this part.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-516" title_number="10" title_name="Department of Aging" subtitle_number="5" subtitle_name="Senior Citizen Activities Centers"> <level label="a"> <text>In this section, “distressed county” means:</text> <level label="1"> <text>Baltimore City; and</text> </level> <level label="2"> <text>a county:</text> <level label="i"> <text>with an average rate of unemployment for the most recent 24–month period for which data are available that exceeds:</text> <level label="1"> <text>150% of the average rate of unemployment for the State during that period; or</text> </level> <level label="2"> <text>the average rate of unemployment for the State during that period by at least 2 percentage points;</text> </level> </level> <level label="ii"> <text>with an average per capita personal income for the most recent 24–month period for which data are available that is equal to or less than 67% of the average per capita personal income for the State during that period; or</text> </level> <level label="iii"> <text>that no longer meets either criterion stated in item (i) or (ii) of this item but has met at least one of the criteria at some time during the preceding 24–month period.</text> </level> </level> </level> <level label="b"> <text>The Fund is a continuing, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.</text> </level> <level label="c"> <level label="1"> <text>The Fund consists of appropriations that are made to the Fund from the State budget.</text> </level> <level label="2"> <level label="i"> <text>For each fiscal year, the Governor shall include in the annual State budget an appropriation of $750,000 for the Fund.</text> </level> <level label="ii"> <text>In addition to the funds provided under subparagraph (i) of this paragraph, the Governor shall provide sufficient funds to ensure that each county receives at least $5,000 under subsection (d)(2) of this section.</text> </level> </level> </level> <level label="d"> <level label="1"> <text>$100,000 of the Fund shall be distributed to counties for senior citizen activities centers based on a competitive grant process administered by the Department.</text> </level> <level label="2"> <level label="i"> <text>$400,000 of the Fund shall be distributed to counties based on each county’s proportional share of the statewide population of senior citizens.</text> </level> <level label="ii"> <text>A county shall receive at least $5,000 under this paragraph.</text> </level> </level> <level label="3"> <text>At least $250,000 of the Fund shall be distributed for senior citizen activities centers to distressed counties as follows:</text> <level label="i"> <text>$150,000 shall be divided evenly; and</text> </level> <level label="ii"> <text>$100,000 shall be divided proportionately by each county’s share of the total population of senior citizens in distressed counties.</text> </level> </level> </level> <level label="e"> <text>The Fund shall be invested and reinvested in the same manner as other State funds.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-601" title_number="10" title_name="Department of Aging" subtitle_number="6" subtitle_name="Innovations in Aging Services Program"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Commission” means the Commission on Aging established under § 10–208 of this title.</text> </level> <level label="c"> <text>“Program” means the Innovations in Aging Services Program.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-602" title_number="10" title_name="Department of Aging" subtitle_number="6" subtitle_name="Innovations in Aging Services Program"> <level label="a"> <text>There is an Innovations in Aging Services Program in the Department.</text> </level> <level label="b"> <text>The purposes of the Program are to:</text> <level label="1"> <text>provide competitive funding grants to design and test innovative ideas in programs and services for seniors;</text> </level> <level label="2"> <text>publicly disseminate the results of the tests; and</text> </level> <level label="3"> <text>help meet the need for personnel trained to provide services to seniors in the State.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-603" title_number="10" title_name="Department of Aging" subtitle_number="6" subtitle_name="Innovations in Aging Services Program"> <level label="a"> <level label="1"> <text>With the advice of the Commission, the Secretary shall:</text> <level label="i"> <text>develop annually a Program plan; and</text> </level> <level label="ii"> <text>submit the plan to the Governor and General Assembly for approval as part of the annual State budget.</text> </level> </level> <level label="2"> <text>The plan shall set forth priorities for:</text> <level label="i"> <text>funding grants for innovative services to seniors; and</text> </level> <level label="ii"> <text>training personnel who provide services to seniors in the State.</text> </level> </level> <level label="3"> <text>The plan shall include provisions for:</text> <level label="i"> <text>funding grants that are sought by Communities for a Lifetime to the extent practicable; and</text> </level> <level label="ii"> <text>evaluating any program funded under the plan.</text> </level> </level> </level> <level label="b"> <text>The Secretary may accept money from any public or private source to fund grants awarded under this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-604" title_number="10" title_name="Department of Aging" subtitle_number="6" subtitle_name="Innovations in Aging Services Program"> <level label="a"> <text>The Secretary shall solicit grant proposals to implement the Program priorities approved by the Governor and the General Assembly under § 10–603(a) of this subtitle.</text> </level> <level label="b"> <text>With the advice of the Commission, the Secretary shall award grants funded in accordance with the approved Program priorities.</text> </level> <level label="c"> <text>The Secretary shall provide for the evaluation, by recognized authorities in the field of services to seniors, of the programs funded by the grants.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-606" title_number="10" title_name="Department of Aging" subtitle_number="6" subtitle_name="Innovations in Aging Services Program"> <text>The Secretary shall report annually to the Governor and, subject to § 2-1257 of the State Government Article, to the General Assembly on the evaluations of programs funded under this subtitle.</text> </section> <section article="ghu" article_name="Human Services" number="10-607" title_number="10" title_name="Department of Aging" subtitle_number="6" subtitle_name="Innovations in Aging Services Program"> <text>The Secretary shall adopt regulations to carry out this subtitle.</text> </section> <section article="ghu" article_name="Human Services" number="10-701" title_number="10" title_name="Department of Aging" subtitle_number="7" subtitle_name="Family Caregiver Assistance Program"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Adult dependent” means an individual who is:</text> <level label="1"> <text>at least 18 years old;</text> </level> <level label="2"> <text>an individual with long–term care needs; and</text> </level> <level label="3"> <text>the spouse, parent, stepparent, grandparent, child, stepchild, sibling, aunt, uncle, son–in–law, daughter–in–law, mother–in–law, or father–in–law of a family caregiver.</text> </level> </level> <level label="c"> <text>“Family caregiver” means an individual who cares for an adult dependent.</text> </level> <level label="d"> <text>“Individual with long–term care needs” means an individual who:</text> <level label="1"> <text>is unable to perform at least three activities of daily living without substantial assistance from another individual; or</text> </level> <level label="2"> <level label="i"> <text>is unable to perform at least one activity of daily living without substantial assistance from another individual; and</text> </level> <level label="ii"> <text>requires substantial supervision to protect the individual from threats to the individual’s health and safety due to severe cognitive impairment.</text> </level> </level> </level> <level label="e"> <text>“Program” means the Family Caregiver Assistance Program.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-702" title_number="10" title_name="Department of Aging" subtitle_number="7" subtitle_name="Family Caregiver Assistance Program"> <level label="a"> <text>There is a Family Caregiver Assistance Program in the Department.</text> </level> <level label="b"> <text>The purpose of the Program is to provide grants to eligible family caregivers to supplement the unmet expenses of caring for an adult dependent.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-703" title_number="10" title_name="Department of Aging" subtitle_number="7" subtitle_name="Family Caregiver Assistance Program"> <level label="a"> <text>Funding for the Program shall be as provided in the State budget.</text> </level> <level label="b"> <text>The Secretary may accept money provided by other public and private sources, including federal funds, to provide grants under the Program.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-704" title_number="10" title_name="Department of Aging" subtitle_number="7" subtitle_name="Family Caregiver Assistance Program"> <level label="a"> <text>A family caregiver is eligible for a grant from the Program if:</text> <level label="1"> <text>the family caregiver resides with an adult dependent;</text> </level> <level label="2"> <text>the adult dependent has been certified by a licensed physician in the State as an individual with long–term care needs for at least 180 consecutive days during the year; and</text> </level> <level label="3"> <text>the family caregiver’s household income is 200% or less of the State median income, as adjusted for family size, in accordance with regulations adopted by the Secretary.</text> </level> </level> <level label="b"> <text>The Program may provide eligible family caregivers with a grant of up to $500 per household per year.</text> </level> <level label="c"> <text>A grant may be used to fund goods and services required to provide care for an adult dependent including:</text> <level label="1"> <text>durable medical equipment;</text> </level> <level label="2"> <text>medical bills;</text> </level> <level label="3"> <text>medical supplies;</text> </level> <level label="4"> <text>prescription or over–the–counter medications;</text> </level> <level label="5"> <text>repairs or modifications to the home; and</text> </level> <level label="6"> <text>respite care for the family caregiver.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-705" title_number="10" title_name="Department of Aging" subtitle_number="7" subtitle_name="Family Caregiver Assistance Program"> <text>The Secretary shall:</text> <level label="1"> <text>adopt regulations to implement the Program;</text> </level> <level label="2"> <text>work in cooperation with the Department of Disabilities, the Maryland Department of Health, and the Maryland Commission on Caregiving to promote the Program to family caregivers throughout the State; and</text> </level> <level label="3"> <text>report annually to the Governor and, subject to § 2–1257 of the State Government Article, the General Assembly on:</text> <level label="i"> <text>the number of grant requests received;</text> </level> <level label="ii"> <text>the value of grants provided to family caregivers;</text> </level> <level label="iii"> <text>the purposes for which the grants were provided; and</text> </level> <level label="iv"> <text>the number of grant requests that the Program was unable to fund and the reason why those requests were not funded.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-706" title_number="10" title_name="Department of Aging" subtitle_number="7" subtitle_name="Family Caregiver Assistance Program"> <text>The regulations required to be adopted under § 10–705 of this subtitle shall:</text> <level label="1"> <text>ensure that the total amount of funding available for grants under the Program is allocated among all counties based on each county’s proportion of the total State adult population; and</text> </level> <level label="2"> <text>provide that if a county is unable to use its allocation, any unspent funds shall revert to the Program and be redistributed among all counties.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-801" title_number="10" title_name="Department of Aging" subtitle_number="8" subtitle_name="Maryland Communities for a Lifetime Program"> <text>The purpose of this subtitle is to:</text> <level label="1"> <text>establish a comprehensive, strategic State plan to address the aging–in–place preference of current and future seniors;</text> </level> <level label="2"> <text>provide available resources to local communities to enhance aging–in–place services and facilitate the independence of older adults; and</text> </level> <level label="3"> <text>promote a State aging–in–place program that overcomes barriers in housing, transportation, health care, employment, and social and civic engagement.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-802" title_number="10" title_name="Department of Aging" subtitle_number="8" subtitle_name="Maryland Communities for a Lifetime Program"> <text>There is a Maryland Communities for a Lifetime Program in the Department.</text> </section> <section article="ghu" article_name="Human Services" number="10-803" title_number="10" title_name="Department of Aging" subtitle_number="8" subtitle_name="Maryland Communities for a Lifetime Program"> <text>The Department shall collect and make available best practices on policies to encourage aging–in–place.</text> </section> <section article="ghu" article_name="Human Services" number="10-804" title_number="10" title_name="Department of Aging" subtitle_number="8" subtitle_name="Maryland Communities for a Lifetime Program"> <level label="a"> <text>A county or municipal corporation may establish a process to certify communities as Communities for a Lifetime under the Maryland Communities for a Lifetime Program.</text> </level> <level label="b"> <text>The Department shall recommend criteria that local jurisdictions may use to certify Communities for a Lifetime, including:</text> <level label="1"> <text>the extent to which a community has sought and plans to expand public health, prevention, and wellness programs that serve older adults;</text> </level> <level label="2"> <text>the extent to which a community has sought and plans to expand affordable transportation options;</text> </level> <level label="3"> <text>the extent to which a community has sought and plans to expand affordable rental housing and the ability to own affordable homes;</text> </level> <level label="4"> <text>the extent to which a community has sought and plans to expand employment, civic engagement, recreation, and leisure options for older adults; and</text> </level> <level label="5"> <text>the extent to which a community has sought and plans to expand other initiatives that boost the abilities of older adults to age in place.</text> </level> </level> <level label="c"> <text>A Community for a Lifetime shall submit to the Department on or before September 1 each year a progress report on the community’s efforts to enable aging in place and a report on the community’s plans to enable aging in place in the future.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-901" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Local long–term care ombudsman entity” means an entity designated by the State Long–Term Care Ombudsman to assist in carrying out the duties of the Program.</text> </level> <level label="c"> <text>“Long–term care facility” means:</text> <level label="1"> <text>a nursing facility, as defined in § 19–301 of the Health – General Article; or</text> </level> <level label="2"> <text>an assisted living program, as defined in § 19–1801 of the Health – General Article.</text> </level> </level> <level label="d"> <text>“Office” means the Office of the Long–Term Care Ombudsman established under this subtitle.</text> </level> <level label="e"> <text>“Ombudsman” means:</text> <level label="1"> <text>the State Long–Term Care Ombudsman; and</text> </level> <level label="2"> <text>any individual, whether a paid employee or a volunteer, who is designated by the State Long–Term Care Ombudsman as an ombudsman.</text> </level> </level> <level label="f"> <text>“Program” means the Long–Term Care Ombudsman Program established under this subtitle.</text> </level> <level label="g"> <text>“Resident” means a resident of a long–term care facility located in the State.</text> </level> <level label="h"> <text>“State Long–Term Care Ombudsman” means the individual selected by the Secretary under § 10–903 of this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-902" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <level label="a"> <text>There is a Long–Term Care Ombudsman Program in the Department.</text> </level> <level label="b"> <text>The purpose of the Program is to fulfill the requirements of:</text> <level label="1"> <text>the Program under this subtitle; and</text> </level> <level label="2"> <text>the federal Older Americans Act, including the requirements of 42 U.S.C. § 3058g.</text> </level> </level> <level label="c"> <level label="1"> <text>The Secretary, in consultation with the State Long–Term Care Ombudsman, shall adopt regulations necessary to carry out this subtitle.</text> </level> <level label="2"> <text>The regulations adopted under paragraph (1) of this subsection shall establish:</text> <level label="i"> <text>the requirements for an annual review by the Department of all ombudsman activities; and</text> </level> <level label="ii"> <text>the process for assisting individuals with organizing and operating a resident council and a family council in a long–term care facility.</text> </level> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-903" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <level label="a"> <text>There is an Office of the Long–Term Care Ombudsman in the Department.</text> </level> <level label="b"> <level label="1"> <text>Unless the Secretary is subject to a conflict of interest that cannot be removed, the Secretary shall select a State Long–Term Care Ombudsman.</text> </level> <level label="2"> <text>If the Secretary is subject to a conflict of interest that cannot be removed, the Secretary shall designate another individual, who is not subject to a conflict of interest, to select the State Long–Term Care Ombudsman.</text> </level> </level> <level label="c"> <text>The State Long–Term Care Ombudsman:</text> <level label="1"> <text>shall personally administer the Office;</text> </level> <level label="2"> <text>shall have expertise and experience in the field of long–term care advocacy;</text> </level> <level label="3"> <text>may not have any conflict of interest with the position; and</text> </level> <level label="4"> <text>shall, on a full–time basis, perform duties related to the Program.</text> </level> </level> <level label="d"> <text>The State Long–Term Care Ombudsman shall personally or through designated ombudsmen:</text> <level label="1"> <text>identify, investigate, and resolve complaints from any source made by, or on behalf of, a resident relating to any action, inaction, or decision, that may adversely affect the health, safety, welfare, or rights of a resident including the welfare and rights of residents with respect to the appointment and activities of guardians and representative payees, of:</text> <level label="i"> <text>a provider, or a representative of a provider, of long–term care services;</text> </level> <level label="ii"> <text>a public agency; or</text> </level> <level label="iii"> <text>a health or social service agency;</text> </level> </level> <level label="2"> <text>represent the interests of residents before governmental agencies and seek administrative, legal, and other remedies to protect the health, safety, welfare, and rights of residents;</text> </level> <level label="3"> <text>provide information as appropriate to other agencies and the public regarding the problems and concerns of residents;</text> </level> <level label="4"> <text>inform residents, family members, and others acting on behalf of residents about how to access the assistance and services of the Office and the services and assistance of other providers or agencies, including legal services;</text> </level> <level label="5"> <text>ensure regular and timely access to and response from the Office;</text> </level> <level label="6"> <text>comment on, facilitate public comment on, and recommend changes to existing or proposed laws, rules, regulations, and other governmental policies and actions that affect the health, safety, welfare, and rights of residents;</text> </level> <level label="7"> <text>provide technical support for the development of resident and family councils to protect the well–being and rights of residents;</text> </level> <level label="8"> <text>provide for the education and training of ombudsmen;</text> </level> <level label="9"> <text>educate facilities, agencies, and staff members concerning the rights and welfare of residents;</text> </level> <level label="10"> <text>promote the development of citizen organizations to advocate for the well–being and rights of residents;</text> </level> <level label="11"> <text>provide services to assist residents in protecting the health, safety, welfare, and rights of residents; and</text> </level> <level label="12"> <text>carry out any other activities that the Secretary determines to be appropriate or that are required by the federal Older Americans Act.</text> </level> </level> <level label="e"> <level label="1"> <level label="i"> <text>Subject to subparagraph (ii) of this paragraph, in fiscal year 2027 and each fiscal year thereafter, the Governor shall include in the annual budget bill at least $2,000,000 for the Office from the money remitted by managed care organizations under COMAR 10.67.04.19–4(I) in the second immediately preceding fiscal year.</text> </level> <level label="ii"> <text>If the total amount of money remitted by managed care organizations in the second immediately preceding fiscal year totals less than $2,000,000, the Governor shall include in the annual budget bill a General Fund appropriation equal to the difference between the amount remitted and $2,000,000.</text> </level> </level> <level label="2"> <text>Funds appropriated under this subsection shall be in addition to and may not supplant funding that would otherwise be appropriated for the Office.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-904" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <level label="a"> <text>Entities eligible to be designated as local long–term care ombudsman entities shall:</text> <level label="1"> <text>have demonstrated capability to carry out the responsibilities of the Office;</text> </level> <level label="2"> <text>be public or nonprofit entities;</text> </level> <level label="3"> <text>be free of conflicts of interest; and</text> </level> <level label="4"> <text>meet any additional requirements that the Secretary and the State Long–Term Care Ombudsman specify.</text> </level> </level> <level label="b"> <level label="1"> <text>The Secretary, in consultation with the State Long–Term Care Ombudsman and area agencies on aging, shall adopt regulations to establish requirements for training and designating ombudsmen, including in–service training.</text> </level> <level label="2"> <text>The regulations shall prohibit the State Long–Term Care Ombudsman from designating an individual as an ombudsman unless the individual has successfully completed the required training and satisfied the requirements for designation.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-905" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <text>In accordance with requirements of the federal Older Americans Act, an ombudsman shall have access to:</text> <level label="1"> <text>long–term care facilities and residents;</text> </level> <level label="2"> <text>the medical and social records of a resident, if:</text> <level label="i"> <text>the ombudsman has the permission of the resident or the legal representative of the resident; or</text> </level> <level label="ii"> <text>the resident is unable to consent and has no legal representative;</text> </level> </level> <level label="3"> <text>the records that are necessary to investigate a complaint if:</text> <level label="i"> <text>a legal guardian of the resident refuses to give permission to access the records;</text> </level> <level label="ii"> <text>the ombudsman has reasonable cause to believe that the guardian is not acting in the best interests of the resident; and</text> </level> <level label="iii"> <text>the ombudsman obtains the approval of the State Long–Term Care Ombudsman;</text> </level> </level> <level label="4"> <text>the administrative records, policies, and documents of long–term care facilities to which the residents or members of the general public have access; and</text> </level> <level label="5"> <text>copies of all licensing and certification records maintained by the Maryland Department of Health or any other State unit with respect to long–term care facilities.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-906" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <level label="a"> <text>The Secretary, in consultation with the State Long–Term Care Ombudsman and area agencies on aging, shall adopt regulations to govern conflicts of interest to ensure that:</text> <level label="1"> <text>no individual, or member of the immediate family of an individual, involved in the designation of the State Long–Term Care Ombudsman or a local long–term care ombudsman entity, is subject to a conflict of interest; and</text> </level> <level label="2"> <text>no ombudsman or immediate family member of an ombudsman is subject to a conflict of interest.</text> </level> </level> <level label="b"> <text>The Secretary, in consultation with the State Long–Term Care Ombudsman and area agencies on aging, shall adopt regulations governing the confidentiality of information and documents, including resident records, facility records, and complainant identification.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-907" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <text>The Secretary shall require the State Long–Term Care Ombudsman to coordinate ombudsman services with: </text> <level label="1"> <text>the Maryland Department of Health;</text> </level> <level label="2"> <text>the Department of Human Services;</text> </level> <level label="3"> <text>protection and advocacy systems for individuals with developmental disabilities and mental illnesses; and</text> </level> <level label="4"> <text>legal assistance.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-908" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <text>The Secretary shall establish and maintain a statewide uniform reporting system for the Program to collect and analyze data relating to complaints and conditions in long–term facilities and to residents for the purpose of identifying and resolving significant problems.</text> </section> <section article="ghu" article_name="Human Services" number="10-909" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <text>The State Long–Term Care Ombudsman shall submit an annual report to the Governor and the General Assembly, in accordance with § 2–1257 of the State Government Article, on the activities of the Program that includes recommendations of the State Long–Term Care Ombudsman for improving services for residents.</text> </section> <section article="ghu" article_name="Human Services" number="10-910" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <level label="a"> <text>In accordance with 42 U.S.C. § 3058g(j)(1), a person may not willfully interfere with an ombudsman’s performance of an official duty.</text> </level> <level label="b"> <text>A person may not retaliate or make reprisals with respect to any person who filed a complaint with, or provided information to, an ombudsman.</text> </level> <level label="c"> <text>A person who violates this section is guilty of a misdemeanor and on conviction is subject to a fine not exceeding $1,500.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-911" title_number="10" title_name="Department of Aging" subtitle_number="9" subtitle_name="Long-Term Care Ombudsman Program"> <text>An ombudsman is not liable under State law for good faith performance of official duties.</text> </section> <section article="ghu" article_name="Human Services" number="10-1001" title_number="10" title_name="Department of Aging" subtitle_number="10" subtitle_name="Aging and Disability Resource Center Program"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Aging and Disability Resource Center” has the meaning stated in 42 U.S.C. § 3002(4).</text> </level> <level label="c"> <text>“Long–term services and supports” means the broad range of assistance needed by older adults and individuals with disabilities.</text> </level> <level label="d"> <text>“Options counseling” means an interactive process that:</text> <level label="1"> <text>considers an individual’s needs, preferences, values, and circumstances;</text> </level> <level label="2"> <text>assists and supports the individual and others the individual requests to participate in the process;</text> </level> <level label="3"> <text>determines the individual’s goals for independent living; and</text> </level> <level label="4"> <text>develops an appropriate long–term services and supports plan to achieve those goals.</text> </level> </level> <level label="e"> <text>“Program” means the Aging and Disability Resource Center Program established under this subtitle.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1002" title_number="10" title_name="Department of Aging" subtitle_number="10" subtitle_name="Aging and Disability Resource Center Program"> <level label="a"> <text>There is an Aging and Disability Resource Center Program, known as “Maryland Access Point”, in the Department.</text> </level> <level label="b"> <text>The Program is the State’s Aging and Disability Resource Center for purposes of the federal Older Americans Act Amendments of 2006.</text> </level> <level label="c"> <text>The purpose of the Program is to provide a coordinated system of information and access for individuals seeking long–term services and supports, including in–home, community–based, and institutional services.</text> </level> <level label="d"> <text>The Department shall provide periodic training to the Maryland Access Point network to increase awareness of the availability of the State’s earned income tax credit established under § 10–704 of the Tax – General Article.</text> </level> <level label="e"> <text>The Department shall administer, supervise, and coordinate the Program with the cooperation of the Department of Disabilities, the Department of Human Services, the Governor’s Office of the Deaf, Deafblind, and Hard of Hearing, and the Maryland Department of Health.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1003" title_number="10" title_name="Department of Aging" subtitle_number="10" subtitle_name="Aging and Disability Resource Center Program"> <text>The Program shall designate local Maryland Access Point offices throughout the State to ensure easy access to the Program.</text> </section> <section article="ghu" article_name="Human Services" number="10-1004" title_number="10" title_name="Department of Aging" subtitle_number="10" subtitle_name="Aging and Disability Resource Center Program"> <text>The Program shall, using its available resources, provide:</text> <level label="1"> <text>options counseling;</text> </level> <level label="2"> <text>assistance concerning aging and disability issues and long–term services and supports planning;</text> </level> <level label="3"> <text>written materials regarding the availability of Program services;</text> </level> <level label="4"> <text>a public database, which can be accessed and searched on the Internet, of resources and services that could be useful to:</text> <level label="i"> <text>individuals who may need long–term services and supports;</text> </level> <level label="ii"> <text>caregivers of individuals who need long–term services and supports; and</text> </level> <level label="iii"> <text>individuals involved in long–term services and supports planning; and</text> </level> </level> <level label="5"> <text>other related services necessary for the Program’s success.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1101" title_number="10" title_name="Department of Aging" subtitle_number="11" subtitle_name="Healthy Aging Program"> <level label="a"> <text>There is a Healthy Aging Program in the Department.</text> </level> <level label="b"> <text>The purposes of the Program are to:</text> <level label="1"> <text>promote healthy aging and healthy living by older adults at both the State and local levels;</text> </level> <level label="2"> <text>encourage aging safely at home and in the community;</text> </level> <level label="3"> <text>raise public awareness about the importance of healthy aging and aging safely for both individuals and the public at large;</text> </level> <level label="4"> <text>evaluate the need for improving the quality and accessibility of existing healthy aging opportunities and services;</text> </level> <level label="5"> <text>improve the quality of life and contain health care costs of older adults;</text> </level> <level label="6"> <text>provide competitive funding grants to design and test programs and services that help older adults achieve healthy and safe aging and healthy living; and</text> </level> <level label="7"> <text>publicly disseminate the outcomes of the grants awarded under the Program.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-1102" title_number="10" title_name="Department of Aging" subtitle_number="11" subtitle_name="Healthy Aging Program"> <level label="a"> <text>Funding for the Healthy Aging Program shall be as provided in the State budget.</text> </level> <level label="b"> <text>The Secretary may accept money provided by other public and private sources, including federal funds, to provide grants under the Program.</text> </level> <level label="c"> <text>The Secretary may adopt regulations to implement the Program.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1201" title_number="10" title_name="Department of Aging" subtitle_number="12" subtitle_name="Miscellaneous Grant Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Aging–in–place program” means a program or service that enables an individual to live in the individual’s own home and participate in a community safely, independently, and comfortably, regardless of age, income, or ability level.</text> </level> <level label="3"> <text>“Multigenerational third place” means a community space other than a personal home or workplace that supports social connection, events, or gathering among individuals of different ages.</text> </level> <level label="4"> <text>“Senior village” means a local, member–driven, nonprofit organization that:</text> <level label="i"> <text>supports community members who choose to age in place by:</text> <level label="1"> <text>fostering social connections through activities and events; and</text> </level> <level label="2"> <text>coordinating volunteer help at home using a neighbor–helping–neighbor model; and</text> </level> </level> <level label="ii"> <text>is exempt from taxation under Section 501(c)(3) of the Internal Revenue Code.</text> </level> </level> </level> <level label="b"> <text>The Department may make grants to nonprofit organizations and area agencies on aging to:</text> <level label="1"> <text>expand and establish aging–in–place programs for seniors; and</text> </level> <level label="2"> <text>support social connection for individuals in aging–in–place programs through events or gatherings at multigenerational third places.</text> </level> </level> <level label="c"> <text>Any nonprofit organization or area agency on aging may apply to the Department for a State grant to be applied toward:</text> <level label="1"> <text>the cost of expanding or establishing an aging–in–place program that provides to seniors:</text> <level label="i"> <text>assistance with the costs of in–home personal care services for activities of daily living, including bathing, personal hygiene and grooming, dressing, toileting, functional mobility, food preparation, laundry, and house cleaning;</text> </level> <level label="ii"> <text>psychological, economic, or functional assistance to enable successful health management, access to medical care, or compliance with treatment recommendations;</text> </level> <level label="iii"> <text>awareness of and access to resources, services, and benefits;</text> </level> <level label="iv"> <text>support services and care coordination;</text> </level> <level label="v"> <text>affordable transportation;</text> </level> <level label="vi"> <text>assistance making in–home modifications or repairs to improve safety, mobility, and accessibility; or</text> </level> <level label="vii"> <text>the opportunity to live in a senior village; or</text> </level> </level> <level label="2"> <text>operational costs, including administrative costs or short–term or long–term leases or rental costs, for a senior village to provide access to multigenerational third places.</text> </level> </level> <level label="d"> <text>To be eligible for a State grant to expand an existing aging–in–place program under this section, a nonprofit organization or area agency on aging shall demonstrate an equal match for funds requested.</text> </level> <level label="e"> <text>The Department shall publicize the availability of grant opportunities under the aging–in–place program to eligible organizations at least 6 weeks before grant applications are due.</text> </level> <level label="f"> <text>The amount of the State grant for an aging–in–place program shall be determined after consideration of:</text> <level label="1"> <text>all eligible applicants;</text> </level> <level label="2"> <text>the total amount of State funds available for grants; and</text> </level> <level label="3"> <text>the priorities of area need as may be established by the Department in consultation with area agencies on aging and in alignment with area plans on aging.</text> </level> </level> <level label="g"> <level label="1"> <text>For each fiscal year, the Governor shall include in the annual budget bill an appropriation of at least $100,000 for the purpose of making the State grants under this section.</text> </level> <level label="2"> <text>At least 20% of the funding appropriated under paragraph (1) of this subsection shall be used to support senior villages.</text> </level> </level> <level label="h"> <text>The Department shall notify an area agency on aging within 2 weeks after a grant award to a nonprofit located within the jurisdiction of the area agency on aging.</text> </level> <level label="i"> <text>The Department may adopt regulations for receiving and considering applications and for disbursing funds to applicants.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1202" title_number="10" title_name="Department of Aging" subtitle_number="12" subtitle_name="Miscellaneous Grant Programs"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Caregiver” means an individual who provides care or support to a qualified family member.</text> </level> <level label="3"> <text>“Licensed physician” has the meaning stated in § 14–101 of the Health Occupations Article.</text> </level> <level label="4"> <text>“Physician assistant” has the meaning stated in § 15–101 of the Health Occupations Article.</text> </level> <level label="5"> <text>“Program” means the Caregiver Expense Grant Program.</text> </level> <level label="6"> <level label="i"> <text>“Qualified expenses” means expenses paid or incurred by a caregiver for goods or services that relate directly to the care or support of a qualified family member, including:</text> <level label="1"> <text>the improvement or alteration of the caregiver’s primary residence to enable or assist the qualified family member to be mobile, safe, or independent;</text> </level> <level label="2"> <text>the purchase or lease of equipment to enable or assist the qualified family member to carry out one or more day–to–day activities;</text> </level> <level label="3"> <text>employing a home care aide or personal care attendant; or</text> </level> <level label="4"> <text>the costs for:</text> </level> <level label="A"> <text>adult day care;</text> </level> <level label="B"> <text>specialized transportation;</text> </level> <level label="C"> <text>legal or financial services; or</text> </level> <level label="D"> <text>assistive care technology.</text> </level> </level> <level label="ii"> <text>“Qualified expenses” does not include:</text> <level label="1"> <text>unspecialized food, clothing, or transportation expenses;</text> </level> <level label="2"> <text>ordinary household maintenance or repair expenses that are not directly related to or necessary for the care of the qualified family member; or</text> </level> <level label="3"> <text>any amount that is paid or reimbursed:</text> </level> <level label="A"> <text>under an insurance policy;</text> </level> <level label="B"> <text>by the federal government;</text> </level> <level label="C"> <text>by the State; or</text> </level> <level label="D"> <text>by a political subdivision of the State.</text> </level> </level> </level> <level label="7"> <text>“Qualified family member” means an individual who:</text> <level label="i"> <text>requires assistance with one or more daily living activities, as certified by a licensed physician, physician assistant, or registered nurse practitioner; and</text> </level> <level label="ii"> <level label="1"> <text>is at least 60 years old and is cared for by an adult relative or informal caregiver who is at least 18 years old;</text> </level> <level label="2"> <text>has Alzheimer’s disease or a related disorder and is cared for by an adult relative or informal caregiver who is at least 18 years old; or</text> </level> <level label="3"> <text>is a child or an adult with developmental or functional disabilities and is cared for by a parent, grandparent, or other relative that is at least 55 years old.</text> </level> </level> </level> <level label="8"> <text>“Registered nurse practitioner” has the meaning stated in § 8–101 of the Health Occupations Article.</text> </level> </level> <level label="b"> <text>There is a Caregiver Expense Grant Program in the Department.</text> </level> <level label="c"> <text>Subject to the limitations of this section, the Department may award a grant to a caregiver for qualified expenses paid or incurred by the caregiver if the caregiver’s federal adjusted gross income does not exceed:</text> <level label="1"> <text>$75,000 if the caregiver is filing an individual tax return; or</text> </level> <level label="2"> <text>$150,000 if the caregiver is filing a joint tax return.</text> </level> </level> <level label="d"> <text>A caregiver shall apply for a grant under the Program in the form and manner the Department requires.</text> </level> <level label="e"> <level label="1"> <text>Subject to paragraph (2) of this subsection, the amount of the grant allowed under subsection (c) of this section is equal to 30% of the qualified expenses paid or incurred by the caregiver that exceed $2,000.</text> </level> <level label="2"> <text>For any fiscal year, the amount of the grant may not exceed $2,500.</text> </level> </level> <level label="f"> <text>For any fiscal year, the Governor may include in the annual budget bill an appropriation of up to $5,000,000 to the Program.</text> </level> <level label="g"> <text>The Department may adopt regulations to carry out the provisions of this section.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1301" title_number="10" title_name="Department of Aging" subtitle_number="13" subtitle_name="Long–term Care and Dementia Care Navigation Programs"> <level label="a"> <text>The Department shall:</text> <level label="1"> <text>subject to subsection (b) of this section, oversee and train the staff of long–term care and dementia care navigation programs under this subtitle; and</text> </level> <level label="2"> <text>disseminate best practices and collect interaction data to ensure statewide program integrity.</text> </level> </level> <level label="b"> <text>The work of the long–term care and dementia care navigation programs under this subtitle shall be guided by the recommendations of:</text> <level label="1"> <text>the State Plan on Aging; and</text> </level> <level label="2"> <text>the Virginia I. Jones Alzheimer’s Disease and Related Dementias Council under Title 13, Subtitle 32 of the Health – General Article.</text> </level> </level> <level label="c"> <level label="1"> <text>On or before October 1, 2024, and each October 1 thereafter, the Department shall submit a report to the Governor and, in accordance with § 2–1257 of the State Government Article, the President of the Senate, the Speaker of the House, the Senate Finance Committee, and the House Health and Government Operations Committee, on the services provided under this subtitle.</text> </level> <level label="2"> <text>The report required under this subsection shall include:</text> <level label="i"> <text>the number of direct contacts each long–term care and dementia care navigation program has with State residents; and</text> </level> <level label="ii"> <text>the result of each direct contact, including:</text> <level label="1"> <text>the percentage of individuals referred to service providers;</text> </level> <level label="2"> <text>the number of cognitive screenings conducted;</text> </level> <level label="3"> <text>the number of outreach events conducted; and</text> </level> <level label="4"> <text>the number of State residents contacted through outreach events.</text> </level> </level> </level> <level label="3"> <text>The Department shall publish the report required under this subsection on the Department’s website.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-1302" title_number="10" title_name="Department of Aging" subtitle_number="13" subtitle_name="Long–term Care and Dementia Care Navigation Programs"> <level label="a"> <level label="1"> <text>Subject to paragraph (2) of this subsection, each area agency shall develop a long–term care and dementia care navigation program that consists of new or existing services.</text> </level> <level label="2"> <level label="i"> <text>An area agency may staff the program from existing resources or hire an individual for the program.</text> </level> <level label="ii"> <text>Subject to the limitation of the funding provided to each area agency under § 10–1303 of this subtitle, each area agency shall implement the program developed under paragraph (1) of this subsection.</text> </level> </level> </level> <level label="b"> <text>Subject to subsection (c) of this section, the duties of the long–term care and dementia care navigation program include:</text> <level label="1"> <text>providing information and referrals to long–term care and chronic disease services;</text> </level> <level label="2"> <text>providing cognitive screening for individuals concerned with their cognition;</text> </level> <level label="3"> <text>providing programs that engage individuals who demonstrate symptoms of dementia that interfere with activities of daily living, regular exercise, and social activities;</text> </level> <level label="4"> <text>providing support for caregivers of individuals who demonstrate symptoms of dementia that interfere with activities of daily living;</text> </level> <level label="5"> <text>consulting with and providing technical assistance to area agency staff who interact with individuals with:</text> <level label="i"> <text>dementia diagnoses; or</text> </level> <level label="ii"> <text>cognitive changes that may be associated with dementia; and</text> </level> </level> <level label="6"> <text>establishing relationships with health care providers to facilitate contact between health care providers and:</text> <level label="i"> <text>individuals who demonstrate symptoms of dementia that interfere with activities of daily living; and</text> </level> <level label="ii"> <text>caregivers of individuals who demonstrate symptoms of dementia that interfere with activities of daily living.</text> </level> </level> </level> <level label="c"> <text>The services provided under subsection (b) of this section shall be provided along with the services described in §§ 10–307 and 10–309 of this title.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1303" title_number="10" title_name="Department of Aging" subtitle_number="13" subtitle_name="Long–term Care and Dementia Care Navigation Programs"> <level label="a"> <text>For fiscal year 2025 and each fiscal year thereafter, the Governor shall include in the annual budget bill an appropriation of $2,400,000 to manage the long–term care and dementia care navigation programs statewide and to fund the programs locally.</text> </level> <level label="b"> <text>The funds appropriated under this section shall be distributed proportionally to each area agency based on a formula determined by the Department that considers the number of individuals who will likely need long–term care or dementia care services in each jurisdiction.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1401" effective_note="EFFECTIVE UNTIL JUNE 30, 2028 PER CHAPTERS 340 AND 341 OF 2024" title_number="10" title_name="Department of Aging" subtitle_number="14" subtitle_name="Miriam Kelty Aging and Senior Social Connection Hub and Spoke Pilot Program"> <level label="a"> <text>In this subtitle the following words have the meanings indicated.</text> </level> <level label="b"> <text>“Pilot Program” means the Miriam Kelty Aging and Senior Social Connection Hub and Spoke Pilot Program.</text> </level> <level label="c"> <text>“Village” means local, volunteer–led organizations that aim to support community members who choose to age in place, including by:</text> <level label="1"> <text>fostering social connections through activities and events; and</text> </level> <level label="2"> <text>coordinating volunteer help at home using the neighbor–helping–neighbor model.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-1402" effective_note="EFFECTIVE UNTIL JUNE 30, 2028 PER CHAPTERS 340 AND 341 OF 2024" title_number="10" title_name="Department of Aging" subtitle_number="14" subtitle_name="Miriam Kelty Aging and Senior Social Connection Hub and Spoke Pilot Program"> <level label="a"> <text>There is a Miriam Kelty Aging and Senior Social Connection Hub and Spoke Pilot Program in the Department.</text> </level> <level label="b"> <text>The purpose of the Pilot Program is to:</text> <level label="1"> <text>learn, test, and develop best practices using a hub and spoke model for village administration;</text> </level> <level label="2"> <text>centralize administrative tasks and relieve the burden on volunteers;</text> </level> <level label="3"> <text>better coordinate resources and operations to maximize the reach of services provided;</text> </level> <level label="4"> <text>help develop new and developing or emerging villages; and</text> </level> <level label="5"> <text>build social connection and combat loneliness for seniors aging in place.</text> </level> </level> <level label="c"> <text>The goal of the Pilot Program is to support villages that seek to take advantage of operational proficiencies and existing systems, knowledge, skills, and resources to expand services to more residents in the geographic region.</text> </level> <level label="d"> <text>The Department shall administer the Pilot Program.</text> </level> <level label="e"> <text>The Department shall select the Montgomery County Village Consortium to implement the Pilot Program for a 3–year period.</text> </level> </section> <section article="ghu" article_name="Human Services" number="10-1403" effective_note="EFFECTIVE UNTIL JUNE 30, 2028 PER CHAPTERS 340 AND 341 OF 2024" title_number="10" title_name="Department of Aging" subtitle_number="14" subtitle_name="Miriam Kelty Aging and Senior Social Connection Hub and Spoke Pilot Program"> <level label="a"> <text>The Montgomery County Village Consortium shall:</text> <level label="1"> <text>establish a 3–year strategic plan for the implementation of the Pilot Program; and</text> </level> <level label="2"> <text>submit to the Department a report each year, using quantitative data if available, regarding the implementation of the plan required under item (1) of this subsection.</text> </level> </level> <level label="b"> <text>The report required under subsection (a)(2) of this section shall include a description of the progress of the plan in the following areas:</text> <level label="1"> <text>administration, including hiring, board membership, and board responsibilities;</text> </level> <level label="2"> <text>direct services provided;</text> </level> <level label="3"> <text>communications;</text> </level> <level label="4"> <text>operations;</text> </level> <level label="5"> <text>programming;</text> </level> <level label="6"> <text>fund–raising;</text> </level> <level label="7"> <text>outreach;</text> </level> <level label="8"> <text>financials, including an accounting of the funds required to be appropriated under § 10–1404 of this subtitle; and</text> </level> <level label="9"> <text>client satisfaction among leaders of villages that participate in the Pilot Program.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-1404" effective_note="EFFECTIVE UNTIL JUNE 30, 2028 PER CHAPTERS 340 AND 341 OF 2024" title_number="10" title_name="Department of Aging" subtitle_number="14" subtitle_name="Miriam Kelty Aging and Senior Social Connection Hub and Spoke Pilot Program"> <level label="a"> <text>For fiscal years 2026 through 2028, the Governor shall include in the annual budget bill an appropriation of $80,000 for the Pilot Program.</text> </level> <level label="b"> <text>The funds appropriated under subsection (a) of this section shall be transferred by the Department to the Montgomery County Village Consortium to be used for:</text> <level label="1"> <text>employing an operations manager;</text> </level> <level label="2"> <text>fund–raising;</text> </level> <level label="3"> <text>marketing and outreach; and</text> </level> <level label="4"> <text>programming.</text> </level> </level> </section> <section article="ghu" article_name="Human Services" number="10-1405" effective_note="EFFECTIVE UNTIL JUNE 30, 2028 PER CHAPTERS 340 AND 341 OF 2024" title_number="10" title_name="Department of Aging" subtitle_number="14" subtitle_name="Miriam Kelty Aging and Senior Social Connection Hub and Spoke Pilot Program"> <text>On or before September 1, 2027, the Montgomery County Village Consortium shall report to the Department on the implementation of this subtitle, including:</text> <level label="1"> <text>comprehensive best practices for creating and operating a hub and spoke model, including:</text> <level label="i"> <text>how to create a hub;</text> </level> <level label="ii"> <text>establishing the relationship between the Montgomery County Village Consortium as the hub and the villages as the spokes;</text> </level> <level label="iii"> <text>establishing the responsibilities of the hub and the spokes;</text> </level> <level label="iv"> <text>describing the population that will be served by a hub;</text> </level> <level label="v"> <text>how to establish a board of directors;</text> </level> <level label="vi"> <text>how to identify resources within each hub community, including time, skills, and capabilities;</text> </level> <level label="vii"> <text>how to identify the capacity of each hub, including geographic and population capacity;</text> </level> <level label="viii"> <text>describing which services can be provided;</text> </level> <level label="ix"> <text>how to train volunteers;</text> </level> <level label="x"> <text>how to address overlapping needs of multiple villages’ unique senior communities, including:</text> <level label="1"> <text>support and social activities;</text> </level> <level label="2"> <text>health and wellness; and</text> </level> <level label="3"> <text>education; and</text> </level> </level> <level label="xi"> <text>how to work with villages, including:</text> <level label="1"> <text>how to increase village capacity;</text> </level> <level label="2"> <text>how to recruit new villages; and</text> </level> <level label="3"> <text>how to expand offerings of developing villages; and</text> </level> </level> </level> <level label="2"> <text>recommendations regarding how to support interested diverse and underserved communities with the development of villages.</text> </level> </section>