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<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>
