<subtitle num="01" heading="Procedural Regulations"> <chapter num="01" heading="Procedures for Hearings before the Secretary"> <regulation prefix="Regulation" num=".01" heading="Scope."> <paragraph num="A."> <text>These regulations apply to all formal hearings before the Secretary of Aging or a hearing officer designated by the Secretary.</text> </paragraph> <paragraph num="B."> <text>These regulations do not apply to or limit the authority of a hearing officer to hold additional conferences or informal proceedings at which no formal ruling or decision is made.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".02" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Department” means the Department of Aging.</text> </paragraph> <paragraph num="(2)"> <text>“Person” means an individual, receiver, trustee, guardian, personal representative, fiduciary, or representative of any kind and any partnership, firm, association, corporation, or other entity.</text> </paragraph> <paragraph num="(3)"> <text>“Secretary” means the Secretary of Aging.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Commencement of Procedures."> <paragraph num="A."> <text>A person entitled to request a hearing before the Secretary may do so by filing a written request for a hearing with the Secretary.</text> </paragraph> <paragraph num="B."> <text>The request for a hearing shall include:</text> <paragraph num="(1)"> <text>The name, address, and telephone number of the party filing the request;</text> </paragraph> <paragraph num="(2)"> <text>The decision, order, action, or inaction which is the subject of the appeal; and</text> </paragraph> <paragraph num="(3)"> <text>A brief statement of the grounds for appeal to be raised at the hearing.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The petition shall be filed in the Office of the Secretary by the party filing the request within 30 days of the action which is the subject of the petition. The request for a hearing shall be deemed timely if it is mailed or received within 30 days.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Notice of Hearing."> <paragraph num="A."> <text>The Secretary or the Secretary's designee shall send written notice of the hearing, not later than 20 days before the beginning of the hearing, to the party requesting the hearing and any other interested party who is entitled to participate or has been given leave to participate under Regulation .05 of this chapter.</text> </paragraph> <paragraph num="B."> <text>The notice of hearing shall specify the:</text> <paragraph num="(1)"> <text>Date, time, and place of the hearing;</text> </paragraph> <paragraph num="(2)"> <text>Legal authority and jurisdiction under which the hearing is to be held, including citation to any statute or regulation that is pertinent;</text> </paragraph> <paragraph num="(3)"> <text>Nature and subject matter of the hearing;</text> </paragraph> <paragraph num="(4)"> <text>Asserted grounds for appeal to be raised at the hearing;</text> </paragraph> <paragraph num="(5)"> <text>Name, mailing address, and telephone number of the presiding officer and of each party to whom the notice is sent; and</text> </paragraph> <paragraph num="(6)"> <text>Name, title, address, and telephone number of any attorney who has been designated to appear for the Secretary at the hearing.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The notice shall be accompanied by a copy of any prehearing order rendered before the date of the notice.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Parties Representation."> <paragraph num="A."> <text>The parties shall consist of:</text> <paragraph num="(1)"> <text>The party requesting the hearing;</text> </paragraph> <paragraph num="(2)"> <text>A person entitled as of right to participate as a party; and</text> </paragraph> <paragraph num="(3)"> <text>A person who applies for and is granted leave to participate as a party upon a satisfactory showing of interest in the matter, including a person admitted as a party for a limited purpose.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Parties shall have the right to:</text> <paragraph num="(1)"> <text>Appear in proper person or by or with counsel;</text> </paragraph> <paragraph num="(2)"> <text>Be accompanied, represented, and advised by counsel.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Time and Place for Hearing."> <text>The hearing shall be:</text> <paragraph num="A."> <text>Held within 90 days of the date on which the Secretary receives the request for a hearing, unless by consent of all parties another hearing date is selected;</text> </paragraph> <paragraph num="B."> <text>Open to the public, and may not be held at a time or in a place that would unreasonably deter the attendance of members of the public.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".07" heading="The Presiding Officer."> <paragraph num="A."> <text>The Secretary may, at the Secretary's discretion, appoint a hearing officer to serve as presiding officer at the hearing and prepare proposed findings of fact and proposed conclusions of law.</text> </paragraph> <paragraph num="B."> <text>If the Secretary elects not to appoint a hearing officer, then the hearing shall be conducted before the Secretary.</text> </paragraph> <paragraph num="C."> <text>Powers of the Presiding Officer. The presiding officer shall have the authority and duty to conduct a full, fair, and impartial hearing, to take action to avoid unnecessary delay in the resolution of the case, and to maintain order. Specifically, but without limitation, the presiding officer shall have the power to:</text> <paragraph num="(1)"> <text>Regulate the course of the hearing, the scope of the issues, and the conduct of the parties and their counsel;</text> </paragraph> <paragraph num="(2)"> <text>Administer oaths and affirmations;</text> </paragraph> <paragraph num="(3)"> <text>Admit evidence and rule on the admissibility of evidence;</text> </paragraph> <paragraph num="(4)"> <text>Consider and decide all procedural, preliminary, and other motions, including applications for leave to participate under Regulation .05A(3) of this chapter;</text> </paragraph> <paragraph num="(5)"> <text>Examine witnesses and call witnesses not otherwise called by the parties;</text> </paragraph> <paragraph num="(6)"> <text>Limit the time for presentations, limit unduly repetitious testimony, and otherwise establish appropriate schedules, dates, timetables, and deadlines;</text> </paragraph> <paragraph num="(7)"> <text>Require parties to submit prehearing or posthearing briefs, proposed findings of fact, proposed conclusions of law, and stipulations;</text> </paragraph> <paragraph num="(8)"> <text>Adjourn or recess the hearing from time to time, and grant continuances for good cause shown;</text> </paragraph> <paragraph num="(9)"> <text>Determine whether a prehearing conference should be held, and, if so, preside at the prehearing conference; and</text> </paragraph> <paragraph num="(10)"> <text>Make decisions and take any other appropriate actions authorized by law.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Duties of the Presiding Officer if a Party is not Represented by an Attorney.</text> <paragraph num="(1)"> <text>The presiding officer shall provide the party with a copy of these regulations and shall satisfy himself that the party:</text> <paragraph num="(a)"> <text>Understands the nature of the proceedings;</text> </paragraph> <paragraph num="(b)"> <text>Understands the language and intent of these regulations; and</text> </paragraph> <paragraph num="(c)"> <text>Is cognizant of the rights to which he may be entitled under any applicable statutes governing the subject of the hearing and the rights under these regulations.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>If the presiding officer is unable to satisfy himself that the party is fully informed as to these matters, the presiding officer shall continue the hearing for a reasonable time, and provide the party with a list of legal assistance providers. If the party remains unrepresented, the hearing officer shall note this on the record.</text> </paragraph> <paragraph num="(3)"> <text>At the time the decision or order is rendered, the hearing officer shall fully apprise an unrepresented party of his right to an appeal from a decision or order and the methods and procedures by which an appeal can be made.</text> </paragraph> </paragraph> <paragraph num="E."> <text>An individual may not serve as a hearing officer if the individual:</text> <paragraph num="(1)"> <text>Has personal knowledge of or personal interest in the matter that is the subject of the hearing;</text> </paragraph> <paragraph num="(2)"> <text>Is related to or maintains an ongoing business or social relationship with a person who either is involved in the matter that is the subject of the hearing or will appear as a witness;</text> </paragraph> <paragraph num="(3)"> <text>Is currently employed or was formerly employed by a party; or</text> </paragraph> <paragraph num="(4)"> <text>Is biased, prejudiced, or otherwise incapable of discharging impartially the duties of a hearing officer.</text> </paragraph> </paragraph> <paragraph num="F."> <text>A party who has reason to believe that grounds exist for the disqualification of a hearing officer shall immediately file a petition for disqualification. The petition shall be addressed to the Secretary, and shall state with particularity the grounds upon which it is based. The Secretary may invite responses from other parties and the person whose disqualification is sought. The Secretary shall rule promptly on the petition, and shall indicate in writing the reasons for the decision and the facts upon which it is based.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".08" heading="Prehearing Procedure."> <paragraph num="A."> <text>Discovery and Disclosure.</text> <paragraph num="(1)"> <text>Although parties are not entitled to compel discovery, they are encouraged to cooperate as much as possible in complying with good-faith requests for informal discovery.</text> </paragraph> <paragraph num="(2)"> <text>A party shall have the right to review at reasonable hours and locations and to copy at its own expense any document that is accessible under the Maryland Access to Public Records Act, State Government Article, §§10-611—10-628, Annotated Code of Maryland.</text> </paragraph> <paragraph num="(3)"> <text>If required by the presiding officer, each party shall produce and make available to all other parties and to the presiding officer, in advance of the hearing, a copy of each document that the party intends to offer into evidence, and a list of all witnesses who will testify at the hearing for that party. The presiding officer may prohibit the introduction of any documentary or testimonial evidence not disclosed before the hearing as provided in this section.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Prehearing Conference.</text> <paragraph num="(1)"> <text>Before the hearing, the presiding officer may hold a prehearing conference. The principal purpose of the prehearing conference is to simplify the hearing by resolving preliminary matters.</text> </paragraph> <paragraph num="(2)"> <text>The presiding officer shall give written notice to all parties of the date, time, and place of the prehearing conference.</text> </paragraph> <paragraph num="(3)"> <text>At the discretion of the presiding officer, and subject to the consent of the parties, the prehearing conference may be conducted by telephone or other electronic means.</text> </paragraph> <paragraph num="(4)"> <text>The following subjects may be considered or decided at the prehearing conference:</text> <paragraph num="(a)"> <text>Stipulations and admissions of fact;</text> </paragraph> <paragraph num="(b)"> <text>Stipulations as to the authenticity and admissibility of documents;</text> </paragraph> <paragraph num="(c)"> <text>Evidentiary objections;</text> </paragraph> <paragraph num="(d)"> <text>Pending motions;</text> </paragraph> <paragraph num="(e)"> <text>The timetable for filing prehearing briefs and posthearing submissions;</text> </paragraph> <paragraph num="(f)"> <text>Problems relating to the sequence, scheduling, and qualification of witnesses;</text> </paragraph> <paragraph num="(g)"> <text>Settlement possibilities; and</text> </paragraph> <paragraph num="(h)"> <text>Any other matter relating to the conduct, scope, or substance of the hearing.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Prehearing Order.</text> <paragraph num="(1)"> <text>If a prehearing conference is held, the presiding officer shall prepare after the prehearing conference and send to all parties, a written prehearing order reciting the subjects discussed and actions taken.</text> </paragraph> <paragraph num="(2)"> <text>If a prehearing conference is not held, the presiding officer shall resolve any preliminary matters by issuing and sending to all parties an appropriate prehearing order.</text> </paragraph> <paragraph num="(3)"> <text>The prehearing order shall become part of the record of the case.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Motions.</text> <paragraph num="(1)"> <text>Motions shall be in writing and shall be filed not later than 10 days before the date of the prehearing conference or 20 days before the date of the hearing, whichever is earlier. Copies of motions shall be served by first-class mail or hand-delivery on all parties.</text> </paragraph> <paragraph num="(2)"> <text>A party wishing to oppose a motion shall file a written opposition within 7 days of receipt of the motion, and shall serve copies of the opposition on all parties in the manner prescribed in §D(1) of this regulation.</text> </paragraph> <paragraph num="(3)"> <text>For good cause shown, the presiding officer may extend or shorten any of the time limits for filing or opposing a motion. The time limits may also be extended or shortened by mutual consent of all parties, provided, however, that a deadline may not be extended beyond the date of the prehearing conference or, in the absence of a prehearing conference, the date of the hearing.</text> </paragraph> <paragraph num="(4)"> <text>If a party so requests in a motion or opposition, oral argument on the motion shall be permitted at the prehearing conference, at a specially convened motion hearing, or before the beginning of the hearing. The presiding officer may limit each party's time for oral argument.</text> </paragraph> </paragraph> <paragraph num="E."> <text>Postponement of Hearing. Upon written request, the presiding officer may grant a postponement of the hearing. Except in extraordinary circumstances, requests for postponement shall be denied if made after the date of the prehearing conference. A request for postponement may not be granted unless the party making the request shows that the request is made in good faith and that hardship will result from its denial.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".09" heading="Conduct of Hearing."> <paragraph num="A."> <text>Rights of the Parties. Each party shall be entitled at the hearing to:</text> <paragraph num="(1)"> <text>Call witnesses;</text> </paragraph> <paragraph num="(2)"> <text>Offer evidence, including rebuttal evidence;</text> </paragraph> <paragraph num="(3)"> <text>Cross-examine opposing witnesses; and</text> </paragraph> <paragraph num="(4)"> <text>Present summation and argument.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Record of Hearing.</text> <paragraph num="(1)"> <text>The presiding officer shall prepare an official record which shall include all pleadings, testimony, exhibits, and other memoranda or material filed in the case.</text> </paragraph> <paragraph num="(2)"> <text>The hearing shall be recorded by tape recording, stenographic notes, or other means, at the expense of the Department. The record need not be transcribed unless requested by the Secretary, the presiding officer, or a party.</text> </paragraph> <paragraph num="(3)"> <text>The cost of transcription shall be paid by the party requesting the transcript, except:</text> <paragraph num="(a)"> <text>The cost shall be paid by the Department if the person requesting the transcript is the Secretary or the presiding officer; or</text> </paragraph> <paragraph num="(b)"> <text>For good cause shown, the Secretary may order the cost to be paid by the Department.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Evidence.</text> <paragraph num="(1)"> <text>The presiding officer is not bound by the technical rules of evidence.</text> </paragraph> <paragraph num="(2)"> <text>The presiding officer may accept into evidence any testimonial or documentary evidence that possesses probative value.</text> </paragraph> <paragraph num="(3)"> <text>Upon proper objection, the presiding officer may exclude evidence that is incompetent, irrelevant, immaterial, unduly repetitious, or excludable on constitutional or statutory grounds or on the basis of a privilege recognized by law.</text> </paragraph> <paragraph num="(4)"> <text>Expert testimony may be accepted by the presiding officer if, in the presiding officer's opinion, the testimony as proffered would aid in an understanding of the case.</text> </paragraph> <paragraph num="(5)"> <text>Evidence may not be excluded solely on the ground that it constitutes hearsay, but shall be given the weight it deserves in light of the entire case.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Order of Procedure and Burden of Proof. The presiding officer shall determine the:</text> <paragraph num="(1)"> <text>Order in which the parties shall present their case;</text> </paragraph> <paragraph num="(2)"> <text>Burden of proof.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".10" heading="Posthearing Submissions."> <paragraph num="A."> <text>The presiding officer may require the parties to submit posthearing briefs, and may also require the submission of proposed findings of fact and proposed conclusions of law.</text> </paragraph> <paragraph num="B."> <text>The presiding officer, by appropriate order, may:</text> <paragraph num="(1)"> <text>Establish a schedule for the filing of posthearing submissions;</text> </paragraph> <paragraph num="(2)"> <text>Require the parties to address specified issues; and</text> </paragraph> <paragraph num="(3)"> <text>Establish page limitations or other restrictions on the scope of posthearing submissions.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".11" heading="Decision and Order."> <paragraph num="A."> <text>Generally. Each case shall be decided on the basis of credible evidence, exclusively on the record, and according to the applicable burdens of proof.</text> </paragraph> <paragraph num="B."> <text>Cases Tried Before a Hearing Officer.</text> <paragraph num="(1)"> <text>As soon as practicable after the conclusion of the hearing and, if required, the filing of posthearing submissions, the hearing officer shall submit to the parties and the Secretary a written report consisting of proposed findings of fact, proposed conclusions of law, and a recommended decision or remedy.</text> </paragraph> <paragraph num="(2)"> <text>Each party shall have 20 days from the date of receipt of the hearing officer's report in which to file written exceptions with the Secretary. Copies of exceptions shall be served by first-class mail or hand-delivered on all other parties, who shall then have 10 days from the date of receipt to file, and serve on all parties in the manner specified in the preceding sentence, written comments on the exceptions. These time limitations may not be extended except with the approval of the Secretary.</text> </paragraph> <paragraph num="(3)"> <text>If a party files exceptions, the Secretary shall set a time for the presentation of oral argument by a party that wishes to be heard. The Secretary shall notify all parties of the date, time, and place of oral argument. At the Secretary's discretion, the Secretary may limit the time given to each party to present oral argument.</text> </paragraph> <paragraph num="(4)"> <text>After hearing oral argument and considering the record as appropriate, the Secretary shall:</text> <paragraph num="(a)"> <text>Adopt the hearing officer's report as the final decision of the agency;</text> </paragraph> <paragraph num="(b)"> <text>Modify the hearing officer's proposed findings of fact, proposed conclusions of law, or proposed decision or remedy, in whole or in part, and then adopt the report with modifications as the final decision of the agency; or</text> </paragraph> <paragraph num="(c)"> <text>Remand the matter to the hearing officer for further proceedings.</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>The decision of the Secretary shall be communicated in writing to all parties. The Secretary's decision shall include a specific ruling on each exception. It shall also include a short and plain statement of the available procedures and time limitations for seeking judicial review. Unless the matter is remanded for further proceedings, the date of the written decision shall be the date of the final decision of the agency.</text> </paragraph> <paragraph num="(6)"> <text>The Secretary may not entertain motions for reconsideration or applications for stay pending judicial appeal.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Cases Tried Before the Secretary. If the Secretary elects not to appoint a hearing officer, then as soon as practicable after the conclusion of the hearing and, if required, the filing of posthearing submission, the Secretary shall render in writing a final decision. The final decision shall contain findings of fact, conclusions of law, and the decision or remedy. Copies of the final decision shall be mailed to all parties. The final decision shall include a short and plain statement of the available procedures and time limitations for seeking judicial review. The Secretary may not entertain motions for reconsideration or applications for stay pending judicial appeal.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".12" heading="Ex Parte Communication."> <paragraph num="A."> <text>The presiding officer may not communicate, directly or indirectly, with any party or person who has an interest or is otherwise involved in the hearing, including employees of the Department, without giving notice to all parties and an opportunity, if appropriate, to participate. The same prohibition shall apply to the Secretary, except that the Secretary may not be prohibited from communicating with counsel concerning a case pending before the Secretary.</text> </paragraph> <paragraph num="B."> <text>A party or a party's representative may not communicate directly with a presiding officer or Secretary concerning a pending case except by:</text> <paragraph num="(1)"> <text>Written communication submitted to the hearing officer and served on the other parties or their representatives; or</text> </paragraph> <paragraph num="(2)"> <text>Oral communication with the hearing officer in the presence of all other parties or their representatives.</text> </paragraph> </paragraph> </regulation> <annotations> <annotation type="Authority">State Government Article, §10-201 et seq., Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: December 26, 1980 (7:26 Md. R. 2424)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01—.11 repealed and new Regulations .01—.12 adopted</annotation> <annotation type="History" subtype="Administrative History">effective October 31, 1988 (15:22 Md. R. 2558)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.03 to COMAR 32.01.01, October 2000</annotation> </annotations> </chapter> <chapter num="02" heading="Public Information Act Requests"> <regulation prefix="Regulation" num=".01" heading="General."> <text>These regulations set out procedures for filing requests with the Department of Aging for the inspection and copying of records under the Public Information Act, State Government Article, §§10-611—10-628, Annotated Code of Maryland. It is the policy of the Department to facilitate public access to the records of the Department, when access is allowed by law, by minimizing costs and time delays to persons requesting information. These regulations also protect the confidentiality of certain information collected from program participants in the conduct of the Department's responsibilities, in accordance with 45 CFR §1321.51.</text> </regulation> <regulation prefix="Regulation" num=".02" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Act” means the Public Information Act, State Government Article, §§10-611—10-628, Annotated Code of Maryland.</text> </paragraph> <paragraph num="(2)"> <text>“Applicant” means a person requesting disclosure of public records.</text> </paragraph> <paragraph num="(3)"> <text>“Custodian” means an authorized person employed by the Department having personal custody and control of public records of the Department.</text> </paragraph> <paragraph num="(4)"> <text>“Department” means the Maryland Department of Aging.</text> </paragraph> <paragraph num="(5)"> <text>“Official custodian” means the person who is responsible for the maintenance, care, and keeping of the public records of the Department. Unless otherwise provided by law, the Secretary is the official custodian of the Department's records.</text> </paragraph> <paragraph num="(6)"> <text>Participant.</text> <paragraph num="(a)"> <text>“Participant” means an individual who applies for, receives, or participates in any service, benefit, or program administered, sponsored, funded, or regulated in whole or in part by the Department, including a service, benefit, or program which is administered, sponsored, funded, or regulated in conjunction with an area agency on aging.</text> </paragraph> <paragraph num="(b)"> <text>“Participant” does not include an applicant or holder of a contract, grant, license, or certificate by the Department, or a provider of any service, benefit, or program which is administered, sponsored, funded, or regulated by the Department.</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>“Person in interest” means:</text> <paragraph num="(a)"> <text>An individual who is the subject of a public record; or</text> </paragraph> <paragraph num="(b)"> <text>An authorized representative of the individual.</text> </paragraph> </paragraph> <paragraph num="(8)"> <text>Public Records.</text> <paragraph num="(a)"> <text>“Public records” means all paper, correspondence, forms, books, photographs, photostats, films, microfilms, sound recordings, maps, drawings, or other written documents, regardless of physical form or characteristics.</text> </paragraph> <paragraph num="(b)"> <text>“Public records” includes:</text> <paragraph num="(i)"> <text>All copies made or received by the Department in connection with the transaction of public business;</text> </paragraph> <paragraph num="(ii)"> <text>The salaries of all employees of the Department.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(9)"> <text>“Secretary” means the Secretary of Aging.</text> </paragraph> <paragraph num="(10)"> <text>Sociological information.</text> <paragraph num="(a)"> <text>“Sociological information” means information that names or, with reasonable certainty, otherwise identifies a participant.</text> </paragraph> <paragraph num="(b)"> <text>“Sociological information” includes the following information about a participant:</text> <paragraph num="(i)"> <text>Name;</text> </paragraph> <paragraph num="(ii)"> <text>Social Security number;</text> </paragraph> <paragraph num="(iii)"> <text>Personal street address;</text> </paragraph> <paragraph num="(iv)"> <text>Personal phone number;</text> </paragraph> <paragraph num="(v)"> <text>Date of birth;</text> </paragraph> <paragraph num="(vi)"> <text>Medical assistance number; and</text> </paragraph> <paragraph num="(vii)"> <text>Identity of participant's relatives, emergency contacts, or representatives.</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>To the extent that such information, in combination, may identify a participant, “sociological information” also includes the following information about a participant:</text> <paragraph num="(i)"> <text>Age, gender, race, religious preference, disabilities, or sexual orientation;</text> </paragraph> <paragraph num="(ii)"> <text>Marital status or living arrangements;</text> </paragraph> <paragraph num="(iii)"> <text>Education;</text> </paragraph> <paragraph num="(iv)"> <text>Work history;</text> </paragraph> <paragraph num="(v)"> <text>Military service;</text> </paragraph> <paragraph num="(vi)"> <text>Medical information, including treatments or medications;</text> </paragraph> <paragraph num="(vii)"> <text>Financial information, including income and assets;</text> </paragraph> <paragraph num="(viii)"> <text>Assessment of participant's ability to perform routine activities of daily living;</text> </paragraph> <paragraph num="(ix)"> <text>Assessment of participant's medical, financial, transportation, social, or housing needs; and</text> </paragraph> <paragraph num="(x)"> <text>Information related to receipt of any government benefits.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(11)"> <text>“Working day” means a day other than Saturday, Sunday, or State holiday.</text> </paragraph> <paragraph num="(12)"> <text>“Written documents” means all books, papers, maps, photographs, cards, tapes, recordings, computerized records, and other documentary materials, regardless of physical form or characteristics.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Who May Request."> <text>Any person may request to inspect or copy public records of the Department.</text> </regulation> <regulation prefix="Regulation" num=".04" heading="Necessity for Written Request."> <paragraph num="A."> <text>Inspections.</text> <paragraph num="(1)"> <text>Except as otherwise provided in this chapter, the custodian shall generally make public records available for inspection by an applicant without demanding a written request.</text> </paragraph> <paragraph num="(2)"> <text>The custodian shall require a written request if:</text> <paragraph num="(a)"> <text>The custodian reasonably believes that the Act of any other law may prevent the disclosure of the record to the applicant or that a written request will materially assist the Department in responding to the request; or</text> </paragraph> <paragraph num="(b)"> <text>The requested record contains sociological information.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>Copies. If the applicant is requesting a copy of any public record, the custodian may require a written request by the applicant.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Contents of Written Request."> <text>A written request shall:</text> <paragraph num="A."> <text>Contain the applicant's name and address;</text> </paragraph> <paragraph num="B."> <text>Be signed by the applicant; and</text> </paragraph> <paragraph num="C."> <text>Reasonably identify by brief description the record sought.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Filing Written Request."> <text>A written request shall be addressed to the custodian of the record. If the custodian is unknown to the applicant, the request may be addressed to the Secretary.</text> </regulation> <regulation prefix="Regulation" num=".07" heading="Response to Written Request."> <paragraph num="A."> <text>If the custodian decides to grant a written request for inspection, the custodian shall produce the record for inspection immediately or within a reasonable period, not to exceed 30 days from the date of the request when this period of time is needed to retrieve the information.</text> </paragraph> <paragraph num="B."> <text>If the custodian decides to deny the written request, the custodian shall do so within 30 days of the written request and immediately upon deciding to deny the request, notify the applicant of the denial.</text> </paragraph> <paragraph num="C."> <text>If a requested public record is not in the custody or control of the person to whom written application is made, that person shall, within 10 working days of the receipt of the request, so notify the applicant. If that person knows the name of the custodian of the record or the location or possible location of the record, this information shall also be given to the applicant.</text> </paragraph> <paragraph num="D."> <text>With the consent of the applicant, any time limit imposed by this regulation may be extended for an additional period not to exceed 30 days.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".08" heading="Notification of Persons Who May be Affected by Disclosure."> <text>Unless prohibited by law, the custodian should notify any person who could be adversely affected by disclosure of a record that a request for inspection or copying of the record has been made. The custodian may consider the views of that person before deciding whether to disclose the record to the applicant.</text> </regulation> <regulation prefix="Regulation" num=".09" heading="Records Temporarily Unavailable."> <text>If a requested public record is in the custody and control of the person to whom written application is made but is not immediately available for inspection or copying, the custodian shall, within 10 working days of the receipt of the request, so notify the applicant and set a date and hour within a reasonable time for inspection or copying.</text> </regulation> <regulation prefix="Regulation" num=".10" heading="Records Destroyed or Lost."> <text>If a requested record has been destroyed or lost, the custodian to whom the application is made shall, within 10 working days of the request, notify the applicant of this fact and explain in the response the reasons why the record cannot be produced.</text> </regulation> <regulation prefix="Regulation" num=".11" heading="Review of the Denial."> <paragraph num="A."> <text>If a written request is denied by the custodian for a reason other than that the record is temporarily unavailable, the applicant may, within 30 days after receipt of the notice of the denial, request an administrative hearing.</text> </paragraph> <paragraph num="B."> <text>If the applicant requests a hearing, the hearing shall be conducted by a hearing officer designated by the Director, and the hearing shall be governed by State Government Article, §§10-205—10-214, Annotated Code of Maryland. After the hearing, the hearing officer shall prepare a recommended decision for the Secretary. The Secretary shall issue the final decision of the Department.</text> </paragraph> <paragraph num="C."> <text>If the hearing results in a total or partial denial of the written request, the applicant may file an appropriate action in the circuit court under State Government Article, §10-623, Annotated Code of Maryland.</text> </paragraph> <paragraph num="D."> <text>If the applicant chooses not to request a hearing under §A of this regulation, the applicant may file an action for judicial enforcement under §10-623 of the Act without exhausting that administrative remedy.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".12" heading="Disclosure Against Public Interest."> <text>If, in the opinion of the Secretary, disclosure of any public record that is otherwise required to be disclosed under the Act would do substantial injury to the public interest, the Secretary may temporarily deny the request in writing and apply within 10 working days of the denial to the appropriate circuit court for an order permitting continued denial or restriction of access. Notice of the application filed with the circuit court shall be served on the applicant in the same manner that is provided for service of process by the Maryland Rules of Procedure.</text> </regulation> <regulation prefix="Regulation" num=".13" heading="Sociological Information."> <paragraph num="A."> <text>The Department, or an area agency on aging which collects sociological information as directed by the Department, may not disclose any part of a public record containing sociological information to an applicant, except that sociological information may be disclosed:</text> <paragraph num="(1)"> <text>To public employees in the performance of their public duties, including authorized federal, State, or local agencies for monitoring of programs initiated pursuant to the Older American Act, 42 U.S.C. §§3001—3058ee;</text> </paragraph> <paragraph num="(2)"> <text>To an authorized agent or employee assisting a public employee in the performance of public duties;</text> </paragraph> <paragraph num="(3)"> <text>To the person in interest;</text> </paragraph> <paragraph num="(4)"> <text>With the consent of the person in interest;</text> </paragraph> <paragraph num="(5)"> <text>Pursuant to a court order; or</text> </paragraph> <paragraph num="(6)"> <text>If disclosure is otherwise required by law.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The Department, or an area agency on aging which collects sociological information as directed by the Department, may issue public reports which summarize and discuss data compiled from sociological information, as long as the information cannot be used to identify a participant.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".14" heading="Fees."> <paragraph num="A."> <text>The fee schedule for copying and certifying copies of records is as follows:</text> <paragraph num="(1)"> <text>Copies. The fee for each copy is 15 cents per page if reproduction is made by a photocopying machine within the Department. If records are not susceptible to photocopying, for example, punch cards, magnetic tapes, blueprints, and microfilm, the fee for copies shall be based on the actual cost of reproduction.</text> </paragraph> <paragraph num="(2)"> <text>Certification of Copies. If a person requests that a copy of a record be certified as a true copy, an additional fee of $1 per page or, if appropriate, per item shall be charged.</text> </paragraph> <paragraph num="(3)"> <text>Minimum Fee Charged. A charge may not be made if the total amount of the fee is $1 or less.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Notwithstanding §A of this regulation, if the fees for copies, printouts, photographs, or certified copies of any record are specifically prescribed by a law other than the Act or this regulation, the prescribed fee shall be charged.</text> </paragraph> <paragraph num="C."> <text>If the custodian is unable to copy a record within the Department, the custodian shall make arrangements for the prompt reproduction of the record at public or private facilities outside the Department. The custodian shall either collect from the applicant a fee to cover the actual cost of reproduction or direct the applicant to pay the cost of reproduction directly to the facility making the copy.</text> </paragraph> <paragraph num="D."> <text>Before copying a record, the custodian shall estimate the cost of reproduction and either obtain the agreement of the applicant to pay the cost or demand prepayment of any estimated fee before reproducing the record.</text> </paragraph> <paragraph num="E."> <text>Except as provided in §F of this regulation, the official custodian may charge reasonable fees for the official's or employee's time expended searching for requested records or for any time expended preparing records for inspection and copying.</text> </paragraph> <paragraph num="F."> <text>The official custodian may not charge any search or preparation fee for the first 2 hours of official or employee time that is needed to respond to a request for information.</text> </paragraph> <paragraph num="G."> <text>Upon request, the official custodian may waive or reduce any fee charged pursuant to this regulation if the custodian determines that the waiver or reduction is in the public interest. The official custodian shall consider, among other relevant factors, the ability of the applicant to pay the cost or fee.</text> </paragraph> <paragraph num="H."> <text>If the applicant requests that copies be mailed or delivered to the applicant, the custodian may charge the applicant for the cost of postage or delivery to the applicant.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".15" heading="Time of Inspection."> <text>An applicant may inspect any public record that the applicant is entitled to inspect during the normal working hours of the Department.</text> </regulation> <regulation prefix="Regulation" num=".16" heading="Place of Inspection."> <text>The place of inspection shall be the place where the document is located unless the custodian, after taking into account the applicant's expressed wish, determines that another place of inspection is more suitable and convenient.</text> </regulation> <annotations> <annotation type="Authority">State Government Article, §§10-611—10-628, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: March 10, 1986 (13:5 Md. R. 547)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.06 to COMAR 32.01.02, October 2000</annotation> <annotation type="History" subtype="Administrative History">Regulation .01 amended effective January 21, 2002 (29:1 Md. R. 28)</annotation> <annotation type="History" subtype="Administrative History">Regulation .02B amended effective January 21, 2002 (29:1 Md. R. 28)</annotation> <annotation type="History" subtype="Administrative History">Regulation .04A amended effective January 21, 2002 (29:1 Md. R. 28)</annotation> <annotation type="History" subtype="Administrative History">Regulations .13—15 recodified to Regulations .14—.16 and new Regulation .13 adopted effective January 21, 2002 (29:1 Md. R. 28)</annotation> </annotations> </chapter> <chapter num="03" heading="Open Meetings—Attendance, Recording, Photographing, and Broadcasting of Sessions"> <regulation prefix="Regulation" num=".01" heading="Definition."> <text>“Public body” means the entity defined in State Government Article, §10-502(h), Annotated Code of Maryland.</text> </regulation> <regulation prefix="Regulation" num=".02" heading="Public Attendance."> <paragraph num="A."> <text>At any open session of a public body of the Department of Aging, the general public is invited to attend and observe.</text> </paragraph> <paragraph num="B."> <text>Except in instances when a public body of the Department on Aging expressly invites public testimony, questions, comments, or other forms of public participation, or when public participation is otherwise authorized by law, a member of the public attending an open session may not participate in the session.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Disruptive Conduct."> <paragraph num="A."> <text>Prohibition. An individual attending an open session of a public body of the Department of Aging may not engage in any conduct, including visual demonstrations such as the waving of placards, signs, or banners, that disrupts the session or that interferes with the right of members of the public to attend and observe the session.</text> </paragraph> <paragraph num="B."> <text>Action to Restore Order. The presiding officer may:</text> <paragraph num="(1)"> <text>Order an individual who persists in conduct prohibited by §A of this regulation, or who violates any other regulation concerning the conduct of the open session, to be removed from the session;</text> </paragraph> <paragraph num="(2)"> <text>Request police assistance to restore order; and</text> </paragraph> <paragraph num="(3)"> <text>Recess the session while order is restored.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Recording, Photographing, and Broadcasting of Open Sessions."> <paragraph num="A."> <text>A member of the public, including a representative of the news media, may record discussions of a public body of the Department of Aging at an open session by means of a tape recorder or any other recording device, if the:</text> <paragraph num="(1)"> <text>Device does not create an excessive noise that disturbs members of a public body of the Department of Aging or other individuals attending the session;</text> </paragraph> <paragraph num="(2)"> <text>Device does not otherwise interfere with an individual's observation of or participation in the session; and</text> </paragraph> <paragraph num="(3)"> <text>Recording is done openly so that it is obvious to those in attendance that the session is being recorded.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A member of the public, including a representative of the news media, may photograph or videotape the proceedings of a public body of the Department of Aging at an open session by means of any type of camera if the camera:</text> <paragraph num="(1)"> <text>Is operated without excessively bright artificial light that disturbs members of a public body of the Department of Aging or other individuals attending the session;</text> </paragraph> <paragraph num="(2)"> <text>Does not create an excessive noise that disturbs members of a public body of the Department of Aging or other individuals attending the session;</text> </paragraph> <paragraph num="(3)"> <text>Does not otherwise interfere with an individual's observation of or participation in the session; and</text> </paragraph> <paragraph num="(4)"> <text>Is used openly so that it is obvious to those in attendance that the session is being recorded.</text> </paragraph> </paragraph> <paragraph num="C."> <text>A representative of the news media may broadcast or televise the proceedings of a public body of the Department of Aging at an open session if the equipment used:</text> <paragraph num="(1)"> <text>Is operated without excessively bright artificial light that disturbs members of a public body of the Department of Aging or other individuals attending the session;</text> </paragraph> <paragraph num="(2)"> <text>Does not create an excessive noise that disturbs members of a public body of the Department of Aging or other individuals attending the session;</text> </paragraph> <paragraph num="(3)"> <text>Does not otherwise interfere with an individual's observation of or participation in the session; and</text> </paragraph> <paragraph num="(4)"> <text>Is used openly so that it is obvious to those in attendance that the session is being broadcast or televised.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The presiding officer may restrict the movement of an individual who is using a recording device, camera, or broadcasting or televising equipment if the restriction is necessary to maintain the orderly conduct of the session.</text> </paragraph> <paragraph num="E."> <text>A public body of the Department of Aging may require that an individual who intends to record, photograph, videotape, broadcast, or televise an open session register in advance of the beginning of the meeting.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Recordings Not Part of Record."> <text>A recording of an open session made by a member of the public or any transcript derived from this recording is not considered a part of the record of any proceeding of a public body of the Department of Aging.</text> </regulation> <annotations> <annotation type="Authority">State Government Article, §10-507(b), Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: September 12, 1994 (21:18 Md. R. 1512)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.08 to COMAR 32.01.03, October 2000</annotation> </annotations> </chapter> <chapter num="04" heading="Declaratory Ruling"> <regulation prefix="Regulation" num=".01" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Declaratory ruling” means a ruling made by a promulgating authority with respect to the manner in which the promulgating authority would apply a regulation or order of the promulgating authority, or a statute that the promulgating authority enforces, to a person or a property based on a given set of facts.</text> </paragraph> <paragraph num="(2)"> <text>“Department” means the Department of Aging.</text> </paragraph> <paragraph num="(3)"> <text>“Person” means:</text> <paragraph num="(a)"> <text>An individual, receiver, trustee, guardian, personal representative, fiduciary, or representative of any kind;</text> </paragraph> <paragraph num="(b)"> <text>A partnership, firm, association, corporation, or other entity; or</text> </paragraph> <paragraph num="(c)"> <text>A political subdivision of the State or an instrumentality of a political subdivision.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>“Promulgating authority” means the promulgating authority's designee or an officer or unit of the Department that is authorized by law to adopt regulations subject to State Government Article, §§10-101—10-139, Annotated Code of Maryland, or adjudicate contested cases subject to State Government Article, §§10-201—10-226, Annotated Code of Maryland.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".02" heading="Petition for Declaratory Ruling."> <paragraph num="A."> <text>An interested person may file with the promulgating authority a petition for a declaratory ruling.</text> </paragraph> <paragraph num="B."> <text>The petition for a declaratory ruling shall be filed in writing and shall describe in detail:</text> <paragraph num="(1)"> <text>The interest of the petitioner in making the request;</text> </paragraph> <paragraph num="(2)"> <text>The issues involved;</text> </paragraph> <paragraph num="(3)"> <text>A detailed statement of the facts;</text> </paragraph> <paragraph num="(4)"> <text>A list of documents or statements the petitioner believes should be considered; and</text> </paragraph> <paragraph num="(5)"> <text>A sworn statement by the petitioner that the facts contained in the petition are true to the best of the person's knowledge and belief.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Consideration and Disposition."> <paragraph num="A."> <text>The promulgating authority:</text> <paragraph num="(1)"> <text>Shall consider the petition and may issue the declaratory ruling requested; and</text> </paragraph> <paragraph num="(2)"> <text>Shall notify the petitioner in writing of the action decided upon and state the reasons for the decision.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Publication and Inspection.</text> <paragraph num="(1)"> <text>The promulgating authority shall keep a record of each declaratory ruling issued and index all declaratory rulings issued by reference to statutes or regulations involved.</text> </paragraph> <paragraph num="(2)"> <text>The promulgating authority may publish declaratory rulings of general interest subject to the mandates of the Public Information Act, State Government Article, §10-601 et seq., Annotated Code of Maryland, and allow inspection of the declaratory rulings subject to the Public Information Act.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Appeal."> <text>A declaratory ruling is subject to judicial review as provided in State Government Article, §10-305, Annotated Code of Maryland.</text> </regulation> <annotations> <annotation type="Authority">State Government Article, §§10-301—10-305, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: August 27, 2007 (34:17 Md. R. 1510)</annotation> </annotations> </chapter> </subtitle> <subtitle num="02" heading="Provider Regulations"> <chapter num="01" heading="Certificate of Registration for Continuing Care Facilities and Providers"> <regulation prefix="Regulation" num=".01" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Act” means Human Services Article, Title 10, Subtitle 4, Parts I—V and VII—IX, Annotated Code of Maryland.</text> </paragraph> <paragraph num="(2)"> <text>“Actuarial balance sheet” means a balance sheet that uses actuarial principles and practices to determine the value of certain items in the balance sheet based on actuarial techniques involving reasonable assumptions about contingencies, inflation, and the time value of money as applied to current subscribers, which items include the present value of:</text> <paragraph num="(a)"> <text>Future periodic fees;</text> </paragraph> <paragraph num="(b)"> <text>The costs of providing promised future services; and</text> </paragraph> <paragraph num="(c)"> <text>The obligation for refundable entrance fees.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>“Agreement” means the residence and care agreement between the provider and subscriber that is the contract to provide continuing care.</text> </paragraph> <paragraph num="(4)"> <text>“Assisted living unit” means a unit in which the services rendered will require the provider to be licensed either as an assisted living program under Health-General Article, §19-1805, Annotated Code of Maryland, or as a domiciliary care home under Health-General Article, §19-318, Annotated Code of Maryland.</text> </paragraph> <paragraph num="(5)"> <text>Authority Recognized by the Department.</text> <paragraph num="(a)"> <text>"Authority recognized by the Department" means a person whom the Department determines has the knowledge and experience of the continuing care industry necessary to produce the particular materials required by a given regulation in this chapter.</text> </paragraph> <paragraph num="(b)"> <text>"Authority recognized by the Department" includes an independent consultant or an employee of a provider or related entity.</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>“Authorized officer” means an individual holding one of the following positions with a provider:</text> <paragraph num="(a)"> <text>An officer;</text> </paragraph> <paragraph num="(b)"> <text>A general partner;</text> </paragraph> <paragraph num="(c)"> <text>Any individual that serves on the governing body; or</text> </paragraph> <paragraph num="(d)"> <text>A trustee of the provider.</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>“Certified financial statement” means a financial statement, prepared in accordance with generally accepted accounting principles by an independent certified public accountant, that includes an audit opinion, balance sheet, income statement, statement of cash flows, and the related notes to the financial statement.</text> </paragraph> <paragraph num="(8)"> <text>“Certified financial statement for the most recent fiscal year for which a certified financial statement is available” means:</text> <paragraph num="(a)"> <text>For providers who annually receive a certified financial statement within 120 days of the end of their fiscal year, the most recently dated financial statement; and</text> </paragraph> <paragraph num="(b)"> <text>For any other providers, assuming that a certified financial statement is obtainable under generally accepted auditing standards, a certified financial statement that is not greater than 120 days old.</text> </paragraph> </paragraph> <paragraph num="(9)"> <text>“Chief executive officer” means the individual whose primary responsibility is to oversee all aspects of the operation of the provider.</text> </paragraph> <paragraph num="(10)"> <text>“Committee” means Financial Review Committee.</text> </paragraph> <paragraph num="(11)"> <text>“Continuing care” means furnishing shelter and services to the public under all the following conditions:</text> <paragraph num="(a)"> <text>Services consist of shelter plus health services;</text> </paragraph> <paragraph num="(b)"> <text>Health services provided shall include at least one of the following services:</text> <paragraph num="(i)"> <text>Medical and nursing services,</text> </paragraph> <paragraph num="(ii)"> <text>A formal arrangement between the provider and a nursing home by which the nursing home grants priority to subscribers for admission to the nursing home, or</text> </paragraph> <paragraph num="(iii)"> <text>Assistance with the activities of daily living other than the provision of meals;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>Services may be paid for by the following methods:</text> <paragraph num="(i)"> <text>An entrance fee in advance of receipt of services,</text> </paragraph> <paragraph num="(ii)"> <text>Regular periodic charges which guarantee health services whenever needed,</text> </paragraph> <paragraph num="(iii)"> <text>Purchase of services at the option of the subscriber as services are needed, or</text> </paragraph> <paragraph num="(iv)"> <text>Any combination of the arrangements in §B(11)(c)(i)—(iii) of this regulation;</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>Services are offered to individuals who are:</text> <paragraph num="(i)"> <text>60 years old or older, and</text> </paragraph> <paragraph num="(ii)"> <text>Not related to the provider by blood or marriage;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>Services are offered for:</text> <paragraph num="(i)"> <text>The life of the subscriber, or</text> </paragraph> <paragraph num="(ii)"> <text>A period in excess of 1 year; and</text> </paragraph> </paragraph> <paragraph num="(f)"> <text>Services are offered under a written agreement that may require periodic charges and shall require:</text> <paragraph num="(i)"> <text>A transfer of assets from the subscriber to the provider,</text> </paragraph> <paragraph num="(ii)"> <text>An entrance fee, or</text> </paragraph> <paragraph num="(iii)"> <text>Both a transfer of assets and an entrance fee.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(12)"> <text>Control.</text> <paragraph num="(a)"> <text>“Control” means the power to direct, or cause the direction of, the management and policies of a provider through the ownership of voting securities, by contract, or otherwise.</text> </paragraph> <paragraph num="(b)"> <text>“Control” includes a parent or sole corporate member of a corporation directly participating in the initiation or approval of policies directly affecting the operations, including approval of budgets or approval of the chief executive officer of the provider.</text> </paragraph> </paragraph> <paragraph num="(13)"> <text>“Department” means the Maryland Department of Aging.</text> </paragraph> <paragraph num="(14)"> <text>“Deposit” means a portion of the entrance fee.</text> </paragraph> <paragraph num="(15)"> <text>Deposit Agreement.</text> <paragraph num="(a)"> <text>“Deposit agreement” means the preliminary agreement between the subscriber and the provider by which the provider reserves for the subscriber the right to contract for continuing care in return for payment by the subscriber of a deposit.</text> </paragraph> <paragraph num="(b)"> <text>“Deposit agreement” includes any agreement of similar form and use, regardless of title, including priority agreement and reservation agreement.</text> </paragraph> </paragraph> <paragraph num="(16)"> <text>Entrance Fee.</text> <paragraph num="(a)"> <text>“Entrance fee” means a sum of money or other consideration, other than a surcharge, paid initially or in deferred payments, that:</text> <paragraph num="(i)"> <text>Assures a subscriber continuing care for a term of more than 1 year or for life; and</text> </paragraph> <paragraph num="(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> </paragraph> </paragraph> <paragraph num="(b)"> <text>“Entrance fee” includes a fee of similar form and application, regardless of title.</text> </paragraph> </paragraph> <paragraph num="(17)"> <text>“Escrow agreement” means an agreement between the provider and a financial institution by which deposits and entrance fees are held in Maryland by the financial institution until release is permitted by law or regulation.</text> </paragraph> <paragraph num="(18)"> <text>“Expansion” means any single new capital addition, excluding renovation and normal repair and maintenance, that meets either of the following criteria:</text> <paragraph num="(a)"> <text>If independent living or assisted living units are to be constructed, then the number of units to be constructed is less than or equal to 25 percent of the number of existing independent living units and assisted living units; or</text> </paragraph> <paragraph num="(b)"> <text>If independent living or assisted living units are not to be constructed, then the total projected cost is an amount that is more than the sum of:</text> <paragraph num="(i)"> <text>10 percent of the total operating expenses of the facility, less depreciation, amortization, and interest expense, as shown on the certified financial statement for the most recent fiscal year for which a certified financial statement is available, and</text> </paragraph> <paragraph num="(ii)"> <text>The amount of the existing reserves properly allocable to, and so allocated for, the expansion.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(19)"> <text>“Facility” means a physical plant and related grounds used to provide continuing care in accordance with this chapter.</text> </paragraph> <paragraph num="(20)"> <text>“Financial difficulty” means the current or impending financial condition of a provider which currently impairs or may impair the ability of the provider to meet existing or future obligations to subscribers or other creditors.</text> </paragraph> <paragraph num="(21)"> <text>“Fiscal year” means the fiscal year of the provider.</text> </paragraph> <paragraph num="(22)"> <text>“Generally accepted accounting principles” means those accounting principles and practices adopted by the Financial Accounting Standards Board and the American Institute of Certified Public Accountants, which include the principles expressed in the American Institute of Certified Public Accountants' “Audit and Accounting Guide for Health Care Organizations”.</text> </paragraph> <paragraph num="(23)"> <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> </paragraph> <paragraph num="(24)"> <text>“MDH” means the Maryland Department of Health.</text> </paragraph> <paragraph num="(25)"> <text>“MHCC” means the Maryland Health Care Commission.</text> </paragraph> <paragraph num="(26)"> <text>“New units” means independent living or assisted living units that are:</text> <paragraph num="(a)"> <text>Part of a new facility; or</text> </paragraph> <paragraph num="(b)"> <text>Additions to an existing facility that are greater than 25 percent of the number of existing independent and assisted living units at the existing facility.</text> </paragraph> </paragraph> <paragraph num="(27)"> <text>“Person” means an individual, firm, association, corporation, company, trust, partnership, limited liability company, public body, or other business or nonprofit entity.</text> </paragraph> <paragraph num="(28)"> <text>“Processing fee” means a one-time fee charged by the provider to determine the financial, mental, and physical eligibility of an individual seeking admission into a facility.</text> </paragraph> <paragraph num="(29)"> <text>“Provider” means a person who undertakes to provide continuing care and who is an:</text> <paragraph num="(a)"> <text>Owner or operator of a facility; or</text> </paragraph> <paragraph num="(b)"> <text>Applicant for, or the holder of, a certificate of registration.</text> </paragraph> </paragraph> <paragraph num="(30)"> <text>“Qualified actuary” means a member in good standing of the American Academy of Actuaries.</text> </paragraph> <paragraph num="(31)"> <text>“Records” means the information, books, and data maintained for the operation of the facility or the provider in accordance with this chapter.</text> </paragraph> <paragraph num="(32)"> <text>“Renewal” means the renewal of a certificate of registration required annually to permit the provider to continue to offer continuing care to the public.</text> </paragraph> <paragraph num="(33)"> <text>Renovation.</text> <paragraph num="(a)"> <text>“Renovation” means any single capital improvement to, or replacement of, all or part of the existing facility that does not increase the number of independent living or assisted living units and for which the total projected cost is an amount that is more than the sum of:</text> <paragraph num="(i)"> <text>20 percent of the total operating expenses of the facility, less depreciation, amortization, and interest expense, as shown on the certified financial statement for the most recent fiscal year for which a certified financial statement is available; and</text> </paragraph> <paragraph num="(ii)"> <text>The amount of the existing reserves properly allocable to, and so allocated for, the renovation.</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>“Renovation” does not include normal repair and maintenance.</text> </paragraph> </paragraph> <paragraph num="(34)"> <text>“Secretary” means Secretary of Aging.</text> </paragraph> <paragraph num="(35)"> <text>“Subscriber” means an individual for whom continuing care is purchased under an agreement.</text> </paragraph> <paragraph num="(36)"> <text>“Surcharge” means a separate and additional charge, other than a second-person entrance fee, imposed simultaneously with the entrance fee, that may be required of some, but not all, subscribers because of a condition or circumstance that applies only to those subscribers.</text> </paragraph> <paragraph num="(37)"> <text>Unit.</text> <paragraph num="(a)"> <text>“Unit” means a suite, room, cottage, apartment, or any other type of quarters that is located at a facility and in which a subscriber is to reside while receiving the benefits of a continuing care agreement, including quarters for independent living, assisted living, and comprehensive care.</text> </paragraph> <paragraph num="(b)"> <text>“Unit” includes individual beds licensed for domiciliary care, assisted living, and comprehensive care so that each assisted living bed, domiciliary care bed, and comprehensive care bed constitutes a unit.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".02" heading="General Requirements to Offer Continuing Care."> <paragraph num="A."> <text>A provider may not offer continuing care, enter into or renew an agreement for continuing care, begin construction for a new facility, or collect deposits for continuing care without having secured the necessary feasibility study approval or certificate of registration from the Department.</text> </paragraph> <paragraph num="B."> <text>Submissions.</text> <paragraph num="(1)"> <text>The submissions described in this section shall be filed with and approved by the Department.</text> </paragraph> <paragraph num="(2)"> <text>Statement of Intent. Any person that intends to offer continuing care agreements for new units or to file a feasibility study under Regulation .05 of this chapter shall file a statement of intent with the Department at least 30 days before submission of the feasibility study.</text> </paragraph> <paragraph num="(3)"> <text>Application for Approval of Feasibility Study. A provider shall obtain approval by the Department of a feasibility study before a provider may collect deposits or enter into deposit agreements for new units. Deposits for new units collected after the feasibility study has been approved shall be maintained in an escrow account held in Maryland in a federally insured depository under an escrow agreement approved by the Department.</text> </paragraph> <paragraph num="(4)"> <text>Application for Preliminary Certificate. A preliminary certificate of registration is required before a provider may offer or enter into continuing care agreements for any new units.</text> </paragraph> <paragraph num="(5)"> <text>Application for Initial Certificate. An initial certificate of registration is required before a provider may operate a facility offering continuing care.</text> </paragraph> <paragraph num="(6)"> <text>Request for Approval to Use Deposits. A provider may not use deposits collected from subscribers for new units until:</text> <paragraph num="(a)"> <text>The Department has issued the provider an initial certificate of registration for any new units;</text> </paragraph> <paragraph num="(b)"> <text>Construction of the new units has been completed;</text> </paragraph> <paragraph num="(c)"> <text>A certificate of occupancy or equivalent has been obtained from the appropriate local jurisdiction; and</text> </paragraph> <paragraph num="(d)"> <text>Appropriate licenses or certificates required by MHCC, MDH, and the Department have been issued.</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>Application for Renewal of Certificate of Registration. A current certificate of registration is required to continue to operate or maintain a facility offering continuing care.</text> </paragraph> </paragraph> <paragraph num="C."> <text>All approvals and certificates of registration issued by the Department shall approve or certify a specific number of units designated by type as:</text> <paragraph num="(1)"> <text>Independent living;</text> </paragraph> <paragraph num="(2)"> <text>Assisted living;</text> </paragraph> <paragraph num="(3)"> <text>Comprehensive care; or</text> </paragraph> <paragraph num="(4)"> <text>Other type approved by the Department.</text> </paragraph> </paragraph> <paragraph num="D."> <text>A provider who operates or plans to operate more than one facility shall file separately for each facility the submissions and applications set forth in §B of this regulation.</text> </paragraph> <paragraph num="E."> <text>A provider may not begin construction of an expansion or renovation unless the provider has complied with the applicable provisions of Regulations .15 and .17 of this chapter. Any new capital addition that in a 2-year period will result in the construction of a number of independent living and assisted living units that is greater than 25 percent of the number of existing independent living and assisted living units is considered new development, is subject to §B of this regulation and Regulations .03—.09 of this chapter, and requires an initial certificate of registration to include the new units. Any new capital addition that is not an expansion and that does not involve the construction of independent living or assisted living units is not subject to review under Regulation .15 or .17 of this chapter. Any capital improvement or replacement that is not a renovation is not subject to Department review under Regulation .15 or .17 of this chapter. An expansion of comprehensive care beds, regardless of number, requires a certificate of need or a certificate of need exemption from MHCC.</text> </paragraph> <paragraph num="F."> <text>A provider may not offer or enter into a deposit agreement or an agreement, unless the terms have been approved by the Department.</text> </paragraph> <paragraph num="G."> <text>A provider may not disseminate advertising or circulars which are deceptive, misleading, or likely to mislead.</text> </paragraph> <paragraph num="H."> <text>Special Conditions.</text> <paragraph num="(1)"> <text>A provider applying for a certificate of registration whose past or current performance in the operation of a continuing care facility, whether that facility is located within or outside of Maryland, causes the Secretary to question the provider's financial or administrative ability to maintain a continuing care facility in compliance with this chapter, shall submit to the Department evidence demonstrating financial or administrative soundness, or both, as the Secretary considers appropriate. This information is sought only in special circumstances and is not required as a matter of course.</text> </paragraph> <paragraph num="(2)"> <text>The Secretary shall:</text> <paragraph num="(a)"> <text>Approve the application unconditionally;</text> </paragraph> <paragraph num="(b)"> <text>Require the provider to use the services of a management firm; or</text> </paragraph> <paragraph num="(c)"> <text>Deny the application.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>A management firm required by §H(2)(b) of this regulation shall be selected by the provider subject to the approval of the Department. Approval of a management firm that currently does business in Maryland, has projects in good standing under the Act, and which has not had a fiduciary or consultant relationship with the Department may not be denied without cause. The management firm shall assume full operational and financial responsibilities. The Secretary may not require utilization of a management firm for a period that exceeds 24 months.</text> </paragraph> </paragraph> <paragraph num="I."> <text>A party aggrieved by a decision of the Secretary under this regulation has the right to appeal under Regulation .36 of this chapter.</text> </paragraph> <paragraph num="J."> <text>A provider who is denied approval of submissions required by §B(3), B(4), or E of this regulation may reapply 1 year after the date of denial.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Preliminary Certificate of Registration."> <paragraph num="A."> <text>Process to Obtain a Preliminary Certificate of Registration. A person shall file a:</text> <paragraph num="(1)"> <text>Statement of intent under Regulation .04 of this chapter;</text> </paragraph> <paragraph num="(2)"> <text>A feasibility study under Regulation .05 of this chapter; and</text> </paragraph> <paragraph num="(3)"> <text>An application under Regulation .06 of this chapter.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Forms and Fees for Feasibility Study and Application.</text> <paragraph num="(1)"> <text>A feasibility study and an application for a preliminary certificate of registration shall be submitted with forms provided by the Department.</text> </paragraph> <paragraph num="(2)"> <text>When new units are to be created and the project is neither an expansion nor a renovation, the following fees shall accompany the feasibility study:</text> <paragraph num="(a)"> <text>$14,000 for 1—99 new units;</text> </paragraph> <paragraph num="(b)"> <text>$20,000 for 100—199 new units;</text> </paragraph> <paragraph num="(c)"> <text>$30,000 for 200—499 new units;</text> </paragraph> <paragraph num="(d)"> <text>$40,000 for 500—999 new units; and</text> </paragraph> <paragraph num="(e)"> <text>$50,000 for 1,000 or more new units.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>The Department may charge an additional fee, not to exceed the original fee, if resubmission of a feasibility study to the Department is required due to:</text> <paragraph num="(a)"> <text>Significant changes in the assumptions upon which the feasibility study was based;</text> </paragraph> <paragraph num="(b)"> <text>Correction of significant errors in the feasibility study; or</text> </paragraph> <paragraph num="(c)"> <text>A significant omission in the original feasibility study submission.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Statement of Intent to Apply for a Preliminary Certificate."> <paragraph num="A."> <text>Statement of Intent. Any person that intends to offer continuing care agreements for new units or to file a feasibility study under Regulation .05 of this chapter shall file a statement of intent with the Department at least 30 days before submission of a feasibility study. If a feasibility study is not filed by the provider within 60 days after the statement of intent is filed, a new statement of intent shall be filed with the Department at least 30 days before submission of a feasibility study.</text> </paragraph> <paragraph num="B."> <text>Contents. A statement of intent shall contain, at a minimum, the following information:</text> <paragraph num="(1)"> <text>The name of both the provider and the proposed facility;</text> </paragraph> <paragraph num="(2)"> <text>Whether entrance fees will be refundable or nonrefundable;</text> </paragraph> <paragraph num="(3)"> <text>The types of agreements proposed, such as extensive, modified, or fee-for-service;</text> </paragraph> <paragraph num="(4)"> <text>The number of proposed units by type, such as independent living, assisted living, and comprehensive care;</text> </paragraph> <paragraph num="(5)"> <text>Whether the provider is proposed to be for-profit or nonprofit;</text> </paragraph> <paragraph num="(6)"> <text>The name of the management company, if any, that will operate the facility;</text> </paragraph> <paragraph num="(7)"> <text>If applicable, the name of the:</text> <paragraph num="(a)"> <text>Development company proposing to develop the facility;</text> </paragraph> <paragraph num="(b)"> <text>Marketing consultant;</text> </paragraph> <paragraph num="(c)"> <text>Provider's attorney; and</text> </paragraph> <paragraph num="(d)"> <text>Preparer of the feasibility study, along with the preparer's qualifications;</text> </paragraph> </paragraph> <paragraph num="(8)"> <text>A statement indicating whether any proposed comprehensive care beds will need a new certificate of need or a new exemption from the certificate of need requirements of MHCC; and</text> </paragraph> <paragraph num="(9)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Feasibility Study."> <paragraph num="A."> <text>The feasibility study shall be prepared in a form satisfactory to the Department, by an authority recognized by the Department, and shall include at least the following information:</text> <paragraph num="(1)"> <text>A statement of the purpose for the proposed project or construction;</text> </paragraph> <paragraph num="(2)"> <text>A summary of the proposed project, which shall include the following information:</text> <paragraph num="(a)"> <text>A description of the proposed project;</text> </paragraph> <paragraph num="(b)"> <text>A statement regarding any affiliation of the provider with a religious, charitable, or other nonprofit organization, and the extent to which the organization will be responsible for the financial and contractual obligations of the provider;</text> </paragraph> <paragraph num="(c)"> <text>The location, address, city, county, size, and description of the site;</text> </paragraph> <paragraph num="(d)"> <text>The number of proposed independent living units, assisted living units, and comprehensive care units; and</text> </paragraph> <paragraph num="(e)"> <text>A description of any common areas and community spaces to be provided such as lobbies, dining rooms, doctor's Departments, convenience stores, craft rooms, meeting rooms, and exercise rooms;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>A summary of the organizational structure of the proposed provider and development team, which shall include the following information:</text> <paragraph num="(a)"> <text>The ownership of the provider, including whether it is for-profit;</text> </paragraph> <paragraph num="(b)"> <text>The owner of the facility if other than the provider;</text> </paragraph> <paragraph num="(c)"> <text>A description of the qualifications of the proposed manager or management company if the facility is, or will be, managed on a day-to-day basis by a person other than an individual directly employed by the provider, including the business experience the manager or management company has operating or managing similar facilities; and</text> </paragraph> <paragraph num="(d)"> <text>A description of the qualifications of any other person who is significantly involved in the development of the facility;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>A summary description of the location of the proposed project, which shall include the following information:</text> <paragraph num="(a)"> <text>A map indicating the location of the proposed community;</text> </paragraph> <paragraph num="(b)"> <text>A general description of the surrounding land use and the access to public transportation and highways; and</text> </paragraph> <paragraph num="(c)"> <text>The availability and attractiveness of proximate services such as shopping, cultural, recreational, and educational facilities, health services, churches, theaters, and libraries;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>A full description of the site of the proposed project which shall include the following information:</text> <paragraph num="(a)"> <text>The size;</text> </paragraph> <paragraph num="(b)"> <text>A general description of its boundaries;</text> </paragraph> <paragraph num="(c)"> <text>Any access roads;</text> </paragraph> <paragraph num="(d)"> <text>From whom the site was acquired and the former usage of the site;</text> </paragraph> <paragraph num="(e)"> <text>Any unique characteristics of the site such as water, ponds, or woods;</text> </paragraph> <paragraph num="(f)"> <text>Any current buildings, services, or facilities at the site and their intended use;</text> </paragraph> <paragraph num="(g)"> <text>A site development plan indicating existing features and structures, if any, and the proposed new facilities;</text> </paragraph> <paragraph num="(h)"> <text>Any planned post-application development;</text> </paragraph> <paragraph num="(i)"> <text>The availability of utilities and proximity to site;</text> </paragraph> <paragraph num="(j)"> <text>The zoning status and any required changes; and</text> </paragraph> <paragraph num="(k)"> <text>The type of site control or ownership, including such information as:</text> <paragraph num="(i)"> <text>The date the site was acquired,</text> </paragraph> <paragraph num="(ii)"> <text>The date it was optioned,</text> </paragraph> <paragraph num="(iii)"> <text>The terms of any rights of first refusal, or</text> </paragraph> <paragraph num="(iv)"> <text>Any other significant terms of the acquisition;</text> </paragraph> </paragraph> </paragraph> <paragraph num="(6)"> <text>A summary of any independent living component of the facility, which shall include the following:</text> <paragraph num="(a)"> <text>A broad description of the type and number of independent living units, such as cottages, clustered duplexes, or apartments;</text> </paragraph> <paragraph num="(b)"> <text>A description of the type of construction that may be used, such as new construction or rehabilitation of existing structures;</text> </paragraph> <paragraph num="(c)"> <text>The square footage of the independent living area that corresponds to each type of independent living unit offered;</text> </paragraph> <paragraph num="(d)"> <text>A summary of the access to the independent living units; and</text> </paragraph> <paragraph num="(e)"> <text>The schematics of each different type of independent living unit;</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>A summary of the common and service areas of the facility, which shall include the following:</text> <paragraph num="(a)"> <text>A listing of the square footage of the common, service, administrative, and any other non-health-related areas and their location in relation to the independent living units; and</text> </paragraph> <paragraph num="(b)"> <text>The schematics of the common, service, administrative, and any other non-health-related areas;</text> </paragraph> </paragraph> <paragraph num="(8)"> <text>A summary of any plans for assisted living or comprehensive care units, which shall include the following:</text> <paragraph num="(a)"> <text>A general description of the square footage of each type of unit and the location of each type in relation to the independent living units and the common areas;</text> </paragraph> <paragraph num="(b)"> <text>The number of assisted living and comprehensive care units categorized as:</text> <paragraph num="(i)"> <text>Private,</text> </paragraph> <paragraph num="(ii)"> <text>Semiprivate, and</text> </paragraph> <paragraph num="(iii)"> <text>Suites;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>The total number of assisted living and comprehensive care units;</text> </paragraph> <paragraph num="(d)"> <text>A description of the types of any doctors' Departments that will be in the facility; and</text> </paragraph> <paragraph num="(e)"> <text>The schematics of any space for assisted living, comprehensive care, or doctors' Departments;</text> </paragraph> </paragraph> <paragraph num="(9)"> <text>A summary of the services that will be included in the monthly service fee;</text> </paragraph> <paragraph num="(10)"> <text>A summary of the ancillary services that will not be included in the monthly service fee;</text> </paragraph> <paragraph num="(11)"> <text>A statement describing any plans the provider has to require a subscriber to have long-term care insurance or supplement health insurance coverage;</text> </paragraph> <paragraph num="(12)"> <text>A statement describing any plans the provider has to become Medicare or Medicaid certified;</text> </paragraph> <paragraph num="(13)"> <text>A statement describing any plans the provider has to offer priority access to health-related services at an offsite location;</text> </paragraph> <paragraph num="(14)"> <text>A statement describing any plans to delay the refund of any entrance fees until the resale of a subscriber's unit;</text> </paragraph> <paragraph num="(15)"> <text>A study that demonstrates a market exists for the proposed project, which study shall include:</text> <paragraph num="(a)"> <text>A description of the primary and secondary market area as defined by the provider;</text> </paragraph> <paragraph num="(b)"> <text>A table of population information including age, sex, number, income distribution, and trends of the total population and individuals 60 years old and older within the primary and secondary market area;</text> </paragraph> <paragraph num="(c)"> <text>A calculation of the potential impact on the proposed project of existing facilities, facilities for which letters of intent have been filed with the Department, and other projects that offer similar services in the primary and secondary market area, which calculation shall include the following information for each facility in the primary and secondary markets:</text> <paragraph num="(i)"> <text>The number of independent living units, assisted living units, and comprehensive care units,</text> </paragraph> <paragraph num="(ii)"> <text>The opening date or proposed opening date of the facility,</text> </paragraph> <paragraph num="(iii)"> <text>The area marketed to,</text> </paragraph> <paragraph num="(iv)"> <text>The utilization experience,</text> </paragraph> <paragraph num="(v)"> <text>The amount and type of entrance fees and monthly service fees, and</text> </paragraph> <paragraph num="(vi)"> <text>The services offered;</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>A calculation of the market penetration rate for the proposed facility for both the primary and secondary markets;</text> </paragraph> <paragraph num="(e)"> <text>A table of home values in the primary and secondary market area;</text> </paragraph> <paragraph num="(f)"> <text>A description of the minimum age, income, and net worth eligibility requirements for the anticipated subscribers of the proposed project;</text> </paragraph> <paragraph num="(g)"> <text>A description of new entrant assumptions by age, sex, and couple ratio;</text> </paragraph> <paragraph num="(h)"> <text>A description of the results of testing the potential demand and acceptance of the proposed project's location, services, and concept characteristics;</text> </paragraph> <paragraph num="(i)"> <text>If the area in which the facility is to be built has limited continuing care experience, a comparison with a demographically similar area that has experience with continuing care communities that shows the:</text> <paragraph num="(i)"> <text>Similarities and dissimilarities of the two markets, and</text> </paragraph> <paragraph num="(ii)"> <text>Experiences of one or more continuing care retirement communities in the comparable market, including their initial utilization experience and the penetration rates of their continuing care units into the eligible population; and</text> </paragraph> </paragraph> <paragraph num="(j)"> <text>A statement describing the estimated presales period, including when the provider projects it will have executed agreements and collected at least 10 percent of the entrance fee for at least 65 percent of the independent living units;</text> </paragraph> </paragraph> <paragraph num="(16)"> <text>A plan demonstrating the financial feasibility of the proposed project including the following:</text> <paragraph num="(a)"> <text>The anticipated costs of constructing or acquiring the proposed project, including all related costs such as land costs, construction costs, architectural and engineering fees, financing expenses, marketing costs, legal and administrative costs, furnishings and equipment costs, fees and permits, and other costs;</text> </paragraph> <paragraph num="(b)"> <text>The anticipated sources and uses of funds to finance the proposed project, including documentation of the financial resources of the provider;</text> </paragraph> <paragraph num="(c)"> <text>A description of the proposed financing, including anticipated terms and costs of financing the proposed project;</text> </paragraph> <paragraph num="(d)"> <text>Projected financial statements that are based on the information required in §(A)(17)(b) of this regulation and prepared in accordance with both §C of this regulation and generally accepted accounting principles;</text> </paragraph> <paragraph num="(e)"> <text>A schedule of anticipated fees for a 10-year period, including any proposed escalator or other automatic adjustment provisions;</text> </paragraph> <paragraph num="(f)"> <text>For each type of unit proposed to be offered, a schedule of the anticipated monthly move-ins until full occupancy is reached;</text> </paragraph> <paragraph num="(g)"> <text>A description of the terms of the lease, if the provider is planning to lease the facility;</text> </paragraph> <paragraph num="(h)"> <text>The estimated start and completion dates for the construction of the proposed project;</text> </paragraph> <paragraph num="(i)"> <text>The initial proposed occupancy date; and</text> </paragraph> <paragraph num="(j)"> <text>A statement indicating compliance with the requirements of Regulation .20 of this chapter;</text> </paragraph> </paragraph> <paragraph num="(17)"> <text>Except as provided in §B of this regulation, an actuarial study, prepared or reviewed by a qualified actuary, which includes:</text> <paragraph num="(a)"> <text>A cohort pricing analysis which demonstrates that for a typical cohort of new subscribers the sum of the entrance fees paid at occupancy plus the actuarial present value at occupancy of periodic fees exceeds the actuarial present value at occupancy of the costs of performing all obligations assumed by the provider, with appropriate provision for surplus;</text> </paragraph> <paragraph num="(b)"> <text>Supporting detailed documentation for the cohort pricing analysis required in §A(17)(a) of this regulation, including:</text> <paragraph num="(i)"> <text>A projection of future population flows and health care bed needs, for the first 20 years, using appropriate inflation factors, mortality, morbidity, withdrawal, and other demographic assumptions, and</text> </paragraph> <paragraph num="(ii)"> <text>A description of the actuarial data, assumptions, and methods used to create the projection;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>Cash flow projections for a 20-year period, which project positive cash balances; and</text> </paragraph> <paragraph num="(d)"> <text>The opinion of the actuary that the data and assumptions used are appropriate, the methods employed are consistent with sound actuarial principles and practices, and provision has been made for all actuarial liabilities and related statement items;</text> </paragraph> </paragraph> <paragraph num="(18)"> <text>A copy of the proposed deposit agreement between the provider and prospective subscribers governing the disposition of the escrowed funds and the interest earned on them;</text> </paragraph> <paragraph num="(19)"> <text>A copy of the proposed escrow agreement between the provider and the depository;</text> </paragraph> <paragraph num="(20)"> <text>Proposed payment arrangements under the agreement for both the shelter and health-related benefits;</text> </paragraph> <paragraph num="(21)"> <text>A copy of a certificate of need, or a letter or exemption from the certificate of need requirement, issued by MHCC for any proposed comprehensive care beds;</text> </paragraph> <paragraph num="(22)"> <text>The form and substance of any advertising campaign or proposed advertisement for the proposed project that is available at the time of filing; and</text> </paragraph> <paragraph num="(23)"> <text>Any further information that the Department requires.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Facilities which offer only domiciliary care or comprehensive care and do not offer independent living units, and facilities which offer, as the only health care, priority admission to a nursing facility, are not subject to §A(17) of this regulation, and shall submit the projection of future population flows and health care bed needs for the first 20 years, using appropriate mortality, morbidity, withdrawal, and other demographic assumptions.</text> </paragraph> <paragraph num="C."> <text>In §A(16)(d) of this regulation, the provider shall submit projected financial statements for a minimum of the first 10 years of operation that include:</text> <paragraph num="(1)"> <text>Balance sheets;</text> </paragraph> <paragraph num="(2)"> <text>Income statements, including separate supplemental income statements for each of the following:</text> <paragraph num="(a)"> <text>Independent living,</text> </paragraph> <paragraph num="(b)"> <text>Assisted living, and</text> </paragraph> <paragraph num="(c)"> <text>Comprehensive care;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>Statements of cash flow; and</text> </paragraph> <paragraph num="(4)"> <text>The key assumptions used in preparing the projected financial statements, including assumptions related to utilization, turnover of units, inflation, debt service, personnel staffing and related salaries, interest rates, depreciation and amortization, amortization of entrance fees, raw food, insurance, and real estate taxes.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Application for a Preliminary Certificate of Registration."> <paragraph num="A."> <text>Application. An application for a preliminary certificate of registration shall include the information described in this regulation.</text> </paragraph> <paragraph num="B."> <text>The names and addresses of the following shall be included:</text> <paragraph num="(1)"> <text>The facility;</text> </paragraph> <paragraph num="(2)"> <text>The provider;</text> </paragraph> <paragraph num="(3)"> <text>Any affiliate, parent, or subsidiary person or business entity; and</text> </paragraph> <paragraph num="(4)"> <text>The chief executive officer of the provider, the facility, and each affiliate, parent, or subsidiary person or business entity.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The application shall describe the organizational structure and management of the provider, including:</text> <paragraph num="(1)"> <text>If the provider is a corporation or limited liability company, the:</text> <paragraph num="(a)"> <text>Name of the corporation or limited liability company, and</text> </paragraph> <paragraph num="(b)"> <text>State in which the corporation is incorporated or the limited liability company is formed;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>If the provider is a partnership, the:</text> <paragraph num="(a)"> <text>Names of the general partners,</text> </paragraph> <paragraph num="(b)"> <text>State governing the formation of the partnership, and</text> </paragraph> <paragraph num="(c)"> <text>Name of the primary individual responsible for managing the partnership;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>If the provider is an unincorporated association, the:</text> <paragraph num="(a)"> <text>Names of the members,</text> </paragraph> <paragraph num="(b)"> <text>State governing the association's activities, and</text> </paragraph> <paragraph num="(c)"> <text>Name of the primary individual responsible for managing the association;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>If the provider is a partnership having a corporation or limited liability company as one or more of its general partners, the:</text> <paragraph num="(a)"> <text>Names of each corporation or limited liability company,</text> </paragraph> <paragraph num="(b)"> <text>State in which each corporation is incorporated or the limited liability company is formed, and</text> </paragraph> <paragraph num="(c)"> <text>Name of the chief executive officer of each;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>If the provider is a trust, the:</text> <paragraph num="(a)"> <text>Name of each trustee,</text> </paragraph> <paragraph num="(b)"> <text>Names of the owners of beneficial interests in the trust,</text> </paragraph> <paragraph num="(c)"> <text>State whose laws govern the trust, and</text> </paragraph> <paragraph num="(d)"> <text>Name of the primary individual responsible for overseeing the trust's activities;</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>The names and occupations of:</text> <paragraph num="(a)"> <text>The provider's officers, directors, trustees, managing or general partners, and non-stock corporation members, and</text> </paragraph> <paragraph num="(b)"> <text>An individual having a 10 percent or greater equity or beneficial interest in the provider;</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>A description of each financial interest in, or occupation with, the provider of each individual identified under §C(6) of this regulation.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Contracts with Related Entities.</text> <paragraph num="(1)"> <text>If it is anticipated that a business entity will provide to either the facility or the provider goods, premises, or services with a value of $10,000 or more within any fiscal year, and if a person identified in §C(6) of this regulation has a financial interest of 10 percent or more in the business entity, the application shall include:</text> <paragraph num="(a)"> <text>The name and address of the business entities;</text> </paragraph> <paragraph num="(b)"> <text>A description of the goods, premises, or services; and</text> </paragraph> <paragraph num="(c)"> <text>The anticipated yearly costs the facility or provider will incur for the goods, premises, or services.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Section D(1) of this regulation does not require the disclosure of salary, age, or benefit information of employees of the provider.</text> </paragraph> </paragraph> <paragraph num="E."> <text>The application shall include a copy of all current documentation concerning the legal organization of the provider, including the corporate charter, bylaws, partnership agreement, articles of association, membership agreement, trust agreement, or similar instruments or agreements.</text> </paragraph> <paragraph num="F."> <text>The application shall include certified financial statements of the provider for the three most recent fiscal years for which certified financial statements are obtainable under generally accepted accounting principles. If the provider's fiscal year ended more than 90 days before the date of the filing, then the application shall also include an income statement, which does not need to be certified, that covers a period that begins on the date the fiscal year ended and ends on a date that is within 90 days of the date of the filing.</text> </paragraph> <paragraph num="G."> <text>The application shall include a statement of any current or prior affiliation with a religious, charitable, or other nonprofit organization, and the extent, if any, to which the affiliate organization will be responsible for the financial and contractual obligations of the provider.</text> </paragraph> <paragraph num="H."> <text>The application shall include a copy of any proposed:</text> <paragraph num="(1)"> <text>Agreements to be entered into between the provider and subscribers for continuing care; and</text> </paragraph> <paragraph num="(2)"> <text>Priority admission agreements between the provider and any health care providers.</text> </paragraph> </paragraph> <paragraph num="I."> <text>A table of the most current fee structure, including escalator or other automatic adjustment provisions, shall accompany the application.</text> </paragraph> <paragraph num="J."> <text>A statement describing the current or proposed use of any insurance program or publicly funded benefit program in the financing of care shall accompany the application.</text> </paragraph> <paragraph num="K."> <text>A description of the physical facility shall accompany the application.</text> </paragraph> <paragraph num="L."> <text>The form and substance of any advertising campaign, advertisement, or other promotional material for the facility that has not been previously filed with the Department shall be submitted with the application.</text> </paragraph> <paragraph num="M."> <text>Any other reasonable and pertinent information that the Department requests in writing shall be submitted with the application.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".07" heading="Department Action on Feasibility Study and Application for a Preliminary Certificate of Registration."> <paragraph num="A."> <text>The Department shall approve a feasibility study when it determines that:</text> <paragraph num="(1)"> <text>Either a certificate of need or an exemption from a certificate of need has been issued by MHCC for the number of comprehensive care beds proposed for the facility for which licenses are required by MDH;</text> </paragraph> <paragraph num="(2)"> <text>The number of licensed assisted living units proposed for the facility is not inconsistent with the State Health Plan;</text> </paragraph> <paragraph num="(3)"> <text>A reasonable financial plan has been submitted for developing and operating the proposed project, which:</text> <paragraph num="(a)"> <text>Includes in the projected financial statements all obligations and liabilities to be undertaken by the provider pursuant to the terms of the proposed continuing care agreement;</text> </paragraph> <paragraph num="(b)"> <text>Demonstrates that the anticipated sources of funds to finance the proposed project are equal to or greater than the anticipated uses of funds to construct or acquire the proposed project; and</text> </paragraph> <paragraph num="(c)"> <text>Demonstrates that the facility is financially feasible;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>A market for the continuing care facility appears to exist, based on reliable data, which:</text> <paragraph num="(a)"> <text>Is community specific;</text> </paragraph> <paragraph num="(b)"> <text>Takes into account competing shelter and health-related providers;</text> </paragraph> <paragraph num="(c)"> <text>Relates the existence of a market to the age, health, sex, marital status, number, population trends, net worth, home values, and income of the potential subscribers; and</text> </paragraph> <paragraph num="(d)"> <text>Demonstrates that the rate of penetration in the proposed market area is within acceptable industry ranges;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>The actuarial study as required in Regulation .05 of this chapter has been submitted and includes:</text> <paragraph num="(a)"> <text>A cohort pricing analysis that demonstrates that, for a typical cohort of new subscribers, the sum of the entrance fees paid at occupancy plus the actuarial present value at occupancy of periodic fees exceeds the actuarial present value at occupancy of the costs of performing all obligations assumed by the provider, with appropriate provision for surplus;</text> </paragraph> <paragraph num="(b)"> <text>Cash flow projections for a 20-year period, which project positive cash balances;</text> </paragraph> <paragraph num="(c)"> <text>Supporting detailed documentation for the cohort pricing analysis which includes a:</text> <paragraph num="(i)"> <text>Projection of future population flows for a 20-year period, which uses appropriate morbidity, mortality, withdrawal, and other demographic assumptions,</text> </paragraph> <paragraph num="(ii)"> <text>Projection of future health care bed needs for a 20-year period, which uses appropriate morbidity, mortality, withdrawal, and other demographic assumptions, and</text> </paragraph> <paragraph num="(iii)"> <text>Descriptions of the actuarial data, assumptions, and methods; and</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>An opinion of a qualified actuary, which states that:</text> <paragraph num="(i)"> <text>The data and assumptions used are appropriate,</text> </paragraph> <paragraph num="(ii)"> <text>The methods employed are consistent with sound actuarial principles and practices, and</text> </paragraph> <paragraph num="(iii)"> <text>Provision has been made for all actuarial liabilities and related statement items;</text> </paragraph> </paragraph> </paragraph> <paragraph num="(6)"> <text>The projection of future population flows and health care bed needs, for the first 20 years, uses appropriate mortality, morbidity, withdrawal, and other demographic assumptions as required in Regulation .05 of this chapter;</text> </paragraph> <paragraph num="(7)"> <text>The feasibility study was prepared by an authority recognized by the Department;</text> </paragraph> <paragraph num="(8)"> <text>The approved escrow agreement and deposit agreement state that all deposits and entrance fees shall be held in escrow in Maryland in a financial institution until:</text> <paragraph num="(a)"> <text>The issuance of an initial certificate of registration;</text> </paragraph> <paragraph num="(b)"> <text>Completion of construction;</text> </paragraph> <paragraph num="(c)"> <text>The issuance of a certificate of occupancy or the equivalent by the appropriate local jurisdiction; and</text> </paragraph> <paragraph num="(d)"> <text>The issuance of appropriate licenses or certificates by MDH, MHCC, and the Department; and</text> </paragraph> </paragraph> <paragraph num="(9)"> <text>A copy of the escrow agreement, executed by the provider and the financial institution, is on file with the Department.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The Department shall issue a preliminary certificate of registration when it determines that the following conditions have been met:</text> <paragraph num="(1)"> <text>The feasibility study has been approved by the Department;</text> </paragraph> <paragraph num="(2)"> <text>The agreement between the provider and the subscriber meets the requirements of Human Services Article, §§10-444—10-449, Annotated Code of Maryland, and Regulations .27—.29 of this chapter;</text> </paragraph> <paragraph num="(3)"> <text>The required financial and organizational materials have been submitted to the Department; and</text> </paragraph> <paragraph num="(4)"> <text>The Department has determined that the form and substance of all advertising and other promotional materials filed are not deceptive, misleading, or likely to mislead.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Until the initial certificate of registration has been issued, the provider shall inform the Department of any changes or additions to the information provided in the feasibility study and in the application for a preliminary certificate of registration.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".08" heading="Advertising Before an Initial Certificate of Registration Has Been Issued."> <paragraph num="A."> <text>If a provider that has submitted a feasibility study desires to advertise a continuing care community before an initial certificate of registration has been issued, the provider shall submit that advertising so it is received by the Department at least 3 working days before the advertising is to be aired, distributed, or otherwise used. The envelope or package in which the submission is delivered shall indicate in prominent type that the contents are proposed advertising materials for a community that does not have an initial certificate of registration.</text> </paragraph> <paragraph num="B."> <text>The Department shall determine within 3 working days of the receipt of the advertising whether it is deceptive, misleading, or likely to mislead. If the Department determines that the advertising is deceptive, misleading, or likely to mislead and should not be used, then the Department shall notify the provider that submitted the advertising materials of its determination. This notice shall be in writing, include the rationale for the determination, and be delivered before the close of business of the third working day after the day upon which the advertising was received for review. The notice may be delivered by facsimile.</text> </paragraph> <paragraph num="C."> <text>If the provider has not received the notice by 5 p.m. on the third working day following receipt of the advertising by the Department, the provider may use the advertising. The lack of notification by the Department does not mean the Department has determined that the advertising is not deceptive, misleading, or likely to mislead.</text> </paragraph> <paragraph num="D."> <text>If a provider is notified that the Department has determined that the advertising, or some part of the advertising, is deceptive, misleading, or likely to mislead, the provider may appeal that determination under Regulation .36 of this chapter. An appeal shall be processed on an accelerated basis if the provider so desires.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".09" heading="Application for an Initial Certificate of Registration."> <paragraph num="A."> <text>A provider shall file an application for an initial certificate of registration on a form provided by the Department.</text> </paragraph> <paragraph num="B."> <text>The application shall include verification that:</text> <paragraph num="(1)"> <text>All licenses and certificates required as of the date of the application from MDH, MHCC, and the Department for the new units have been issued;</text> </paragraph> <paragraph num="(2)"> <text>Agreements have been executed for at least 65 percent of the independent living units and at least 10 percent of the total entrance fees for each contracted unit has been collected;</text> </paragraph> <paragraph num="(3)"> <text>The provider has received a written commitment for permanent long-term financing; and</text> </paragraph> <paragraph num="(4)"> <text>Closing on construction financing has taken place.</text> </paragraph> </paragraph> <paragraph num="C."> <text>A provider may, when the requirements in §B(1)—(3) of this regulation have been met, request the Department to verify to its construction lender that these requirements have been met to the Department's satisfaction, and that an initial certificate of registration for the new units will be issued when closing on the construction loan has taken place.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".10" heading="Action of Department on Application for an Initial Certificate of Registration."> <paragraph num="A."> <text>The Department shall issue an initial certificate of registration when it determines that all of the following conditions have been met:</text> <paragraph num="(1)"> <text>The provider has been issued a preliminary certificate of registration;</text> </paragraph> <paragraph num="(2)"> <text>The provider has received all licenses and certifications and letters of exemption required as of that date from MDH, MHCC, and the Department;</text> </paragraph> <paragraph num="(3)"> <text>The provider has submitted documentation which demonstrates to the satisfaction of the Department that:</text> <paragraph num="(a)"> <text>Agreements have been executed for at least 65 percent of the independent living units, and</text> </paragraph> <paragraph num="(b)"> <text>At least 10 percent of the total entrance fee has been paid as a deposit for each unit for which an agreement has been executed;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>The provider has submitted documentation to the satisfaction of the Department that there is a commitment for permanent long-term financing;</text> </paragraph> <paragraph num="(5)"> <text>The provider has submitted documentation which demonstrates to the satisfaction of the Department that closing on construction financing has taken place; and</text> </paragraph> <paragraph num="(6)"> <text>The form and substance of all advertising and other promotional materials filed are not deceptive, misleading, or likely to mislead.</text> </paragraph> </paragraph> <paragraph num="B."> <text>If requested, a verification letter may be issued to the construction lender by the Department when it is determined that the conditions stated in §A(1)—(4), and (6) of this regulation have been met and that an initial certificate of registration will be issued for the new units when closing on the construction loan has taken place.</text> </paragraph> <paragraph num="C."> <text>If the conditions in §A of this regulation are not met, the Department shall issue a denial of an initial certificate of registration, in writing, which includes the reasons for the denial. The provider may resubmit an amended application within the time limits set forth in §D of this regulation.</text> </paragraph> <paragraph num="D."> <text>If an initial certificate of registration is not issued within 24 months of the issuance of the preliminary certificate of registration, or a longer time allowed by the Department for good cause shown, as defined in §E of this regulation, the Department shall require the provider to refund all deposits and to cease in its attempts to offer continuing care under that application. A further intent to provide continuing care shall require a new application, including a feasibility study.</text> </paragraph> <paragraph num="E."> <text>The Department may not deny a request for an extension of time if the provider demonstrates reasonable progress toward acquiring an initial certificate of registration.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".11" heading="Request for Approval to Use Deposits."> <paragraph num="A."> <text>After the issuance of an initial certificate of registration for any new units, the provider may submit to the Department a request for permission to use deposits.</text> </paragraph> <paragraph num="B."> <text>The request shall include verification that:</text> <paragraph num="(1)"> <text>Construction of the proposed project has been completed as evidenced by a certificate of substantial completion; and</text> </paragraph> <paragraph num="(2)"> <text>The provider has been issued:</text> <paragraph num="(a)"> <text>A certificate of occupancy, or the equivalent, by the appropriate local jurisdiction, and</text> </paragraph> <paragraph num="(b)"> <text>The appropriate licenses or certificates required by MDH, MHCC, and the Department.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".12" heading="Action of the Department on Request for Approval to Use Deposits."> <text>The Department shall issue a written approval to the provider permitting withdrawal of deposits from escrow for use by the provider when the Department determines that the provider has met the following requirements:</text> <paragraph num="A."> <text>Construction of the proposed project has been completed as evidenced by a certificate of substantial completion;</text> </paragraph> <paragraph num="B."> <text>A certificate of occupancy, or its equivalent, has been issued by the appropriate local jurisdiction;</text> </paragraph> <paragraph num="C."> <text>An initial certificate of registration has been issued for any new units; and</text> </paragraph> <paragraph num="D."> <text>Appropriate licenses or certificates required by MDH, MHCC, and the Department have been issued.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".13" heading="Application for Renewal Certificate of Registration."> <paragraph num="A."> <text>The provider shall file an application for a renewal certificate of registration within 120 days of the end of the provider's fiscal year on a form provided by the Department.</text> </paragraph> <paragraph num="B."> <text>A renewal certificate of registration shall be issued for 1 year, which is in effect from 6 months after the end of the provider's most recent fiscal year to 6 months after the close of the provider's current fiscal year.</text> </paragraph> <paragraph num="C."> <text>The application for a renewal certificate of registration shall include the following information and attachments:</text> <paragraph num="(1)"> <text>Any changes or additions to the information submitted on the most recent application;</text> </paragraph> <paragraph num="(2)"> <text>An original certified financial statement for the preceding fiscal year prepared in accordance with generally accepted accounting principles, which include the principles expressed in the American Institute of Certified Public Accounts' “Audit and Accounting Guide for Health Care Organizations”;</text> </paragraph> <paragraph num="(3)"> <text>All exhibits or attachments to the certified financial statements, including:</text> <paragraph num="(a)"> <text>A balance sheet,</text> </paragraph> <paragraph num="(b)"> <text>An income statement,</text> </paragraph> <paragraph num="(c)"> <text>A statement of cash flows,</text> </paragraph> <paragraph num="(d)"> <text>The related notes to the financial statements, and</text> </paragraph> <paragraph num="(e)"> <text>The opinion of an independent certified public accountant;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>An operating budget for the current fiscal year prepared in accordance with generally accepted accounting principles;</text> </paragraph> <paragraph num="(5)"> <text>A projection of the number of subscribers who will require nursing home care and an estimate of the life expectancy of future subscribers;</text> </paragraph> <paragraph num="(6)"> <text>A projected operating budget for the next succeeding fiscal year prepared in accordance with generally accepted accounting principals;</text> </paragraph> <paragraph num="(7)"> <text>An actuarial study which meets the requirements of §E of this regulation;</text> </paragraph> <paragraph num="(8)"> <text>A report specifying:</text> <paragraph num="(a)"> <text>The total current number of units,</text> </paragraph> <paragraph num="(b)"> <text>Whether each unit is occupied or unoccupied, and</text> </paragraph> <paragraph num="(c)"> <text>Changes in unit configurations proposed for the succeeding year;</text> </paragraph> </paragraph> <paragraph num="(9)"> <text>A copy of each current license and certificate required to be issued by MDH or the Department;</text> </paragraph> <paragraph num="(10)"> <text>A copy of the provider's most recent certificate of need or exemption letter from MHCC;</text> </paragraph> <paragraph num="(11)"> <text>The form and substance of any advertising campaign or proposed advertisement and other promotional materials not previously filed with the Department;</text> </paragraph> <paragraph num="(12)"> <text>A renewal fee of $29 per unit;</text> </paragraph> <paragraph num="(13)"> <text>A cash flow projection for the current fiscal year and the next 2 fiscal years prepared in accordance with generally accepted accounting principles;</text> </paragraph> <paragraph num="(14)"> <text>A statement that provides the dates of the meetings held the previous year to comply with Regulation .19 of this chapter;</text> </paragraph> <paragraph num="(15)"> <text>A copy of the disclosure statement prepared in accordance with Regulation .21 of this chapter; and</text> </paragraph> <paragraph num="(16)"> <text>A statement that indicates compliance with the operating reserve requirement in Regulation .20 of this chapter.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Actuarial Study Exceptions.</text> <paragraph num="(1)"> <text>Until January 1, 1999, §E of this regulation does not apply to facilities which offer only domiciliary care or comprehensive care and do not offer independent living units.</text> </paragraph> <paragraph num="(2)"> <text>Section E of this regulation does not apply to a facility:</text> <paragraph num="(a)"> <text>Where the only health care provided to subscribers is either priority admission to an independent nursing facility or paid for on a fee-for-service basis;</text> </paragraph> <paragraph num="(b)"> <text>Where:</text> <paragraph num="(i)"> <text>The provider is in the process of decertifying as a provider; and</text> </paragraph> <paragraph num="(ii)"> <text>Fewer than five of the facility's subscribers have continuing care agreements that promise the provider will provide more than 90 days of nursing care on a basis other than fee-for-service; or</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>Where:</text> <paragraph num="(i)"> <text>The comprehensive care facility is Medicaid certified;</text> </paragraph> <paragraph num="(ii)"> <text>The continuing care agreements presently offered new subscribers only provide nursing care on a fee-for-service basis, and</text> </paragraph> <paragraph num="(iii)"> <text>5 percent or less of the facility's subscribers have continuing care agreements that promise the provider will provide nursing care on a basis other than fee-for-service.</text> </paragraph> </paragraph> </paragraph> </paragraph> <paragraph num="E."> <text>Actuarial Study.</text> <paragraph num="(1)"> <text>Unless exempted by §D of this regulation, every 3 years after occupancy of the facility has begun, a provider shall submit to the Department with its renewal application an actuarial study, prepared or reviewed by a qualified actuary. The actuarial study shall include:</text> <paragraph num="(a)"> <text>An actuarial balance sheet for current subscribers;</text> </paragraph> <paragraph num="(b)"> <text>A cohort pricing analysis for a cohort of new subscribers; and</text> </paragraph> <paragraph num="(c)"> <text>Projected cash and investment balances for a period of 20 years.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The actuarial study required by §E(1) of this regulation shall be performed in accordance with generally accepted actuarial principles and the standards of practice adopted by the Actuarial Standards Board of the American Academy of Actuaries. The actuarial study shall include or be accompanied by a statement of the opinion of a qualified actuary as to whether:</text> <paragraph num="(a)"> <text>The data and assumptions used are appropriate;</text> </paragraph> <paragraph num="(b)"> <text>The methods employed are consistent with sound actuarial principles and practices;</text> </paragraph> <paragraph num="(c)"> <text>Provision has been made for all actuarial liabilities and related statement items; and</text> </paragraph> <paragraph num="(d)"> <text>The provider is in satisfactory actuarial balance.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>The actuarial study shall include supporting detailed documentation, including a projection of future population flows and health care bed needs for 20 years using appropriate inflation factors, mortality, morbidity, withdrawal, and other demographic assumptions.</text> </paragraph> <paragraph num="(4)"> <text>The Department may request the information required in §E(1)—(3) of this regulation more frequently to assist in the determination of possible financial difficulty as provided in Regulation .26 of this chapter.</text> </paragraph> </paragraph> <paragraph num="F."> <text>If the materials required in §C of this regulation are not received in the Department within 120 days after the end of the provider's fiscal year, the Department may charge a late fee of $10 per unit in addition to the renewal fee per unit, unless a written request for an extension is submitted to and approved by the Department within the 120-day period.</text> </paragraph> <paragraph num="G."> <text>Failure to file the annual renewal application or obtain an extension within 120 days after the end of a fiscal year is a violation of the Act and this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".14" heading="Action of the Department on Application for Annual Renewal Certificate of Registration."> <paragraph num="A."> <text>The Department shall approve an application for a renewal certificate of registration when it determines that:</text> <paragraph num="(1)"> <text>The required documents have been filed;</text> </paragraph> <paragraph num="(2)"> <text>Any revised agreements meet the applicable requirements of the Act and this chapter;</text> </paragraph> <paragraph num="(3)"> <text>The provider has not been found to be in financial difficulty;</text> </paragraph> <paragraph num="(4)"> <text>The necessary facilities for providing continuing care are in existence;</text> </paragraph> <paragraph num="(5)"> <text>The provider has received all required licenses and certificates from MDH, MHCC, and the Department;</text> </paragraph> <paragraph num="(6)"> <text>The form and substance of all advertising and other promotional materials filed are not deceptive, misleading, or likely to mislead;</text> </paragraph> <paragraph num="(7)"> <text>If required under Regulation .13 of this chapter, an actuarial study, prepared or reviewed by a qualified actuary, has been submitted which meets the requirements of Regulation .13E of this chapter;</text> </paragraph> <paragraph num="(8)"> <text>The disclosure statement submitted complies with Regulation .21 of this chapter;</text> </paragraph> <paragraph num="(9)"> <text>The operating reserves comply with the requirements of Regulation .20 of this chapter; and</text> </paragraph> <paragraph num="(10)"> <text>All renewal fees and any late fees have been paid.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Upon review of a provider's application for a renewal certificate of registration, the Department may make a finding of possible financial difficulty. The Department may refer the application of a provider found to be in possible financial difficulty to the Financial Review Committee. Applications that are referred to the Committee are subject to Regulations .25 and .26 of this chapter.</text> </paragraph> <paragraph num="C."> <text>If the conditions in §A of this regulation and, if applicable, Regulation .26 of this chapter are not met, the Department may issue in writing a denial of an application for a renewal certificate of registration. The Department shall include the reasons for denying an application in the written denial.</text> </paragraph> <paragraph num="D."> <text>If the actuary responsible for an actuarial study required by Regulation .13E of this chapter does not opine that the provider is in satisfactory actuarial balance, the provider shall submit to the Department with its renewal application a detailed plan that specifies how and when the provider plans to attain satisfactory actuarial balance.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".15" heading="Application for Renovation of Facility."> <paragraph num="A."> <text>Statement of Intent. A provider that intends to undertake a renovation of its facility shall file a statement of intent with the Department at least 30 days before submitting a renovation approval request. If a renovation approval request is not filed by the provider within 60 days after the statement of intent is filed, a new statement of intent shall be filed with the Department at least 30 days before submission of a financial plan described in §B of this regulation. The statement of intent shall describe at a minimum the nature of the renovation.</text> </paragraph> <paragraph num="B."> <text>Renovation Approval Request. A request for renovation approval shall:</text> <paragraph num="(1)"> <text>Be prepared in a form satisfactory to the Department; and</text> </paragraph> <paragraph num="(2)"> <text>Include at least the following information:</text> <paragraph num="(a)"> <text>A statement of the purpose and need for the renovation;</text> </paragraph> <paragraph num="(b)"> <text>A financial plan, prepared by an authority recognized by the Department, that:</text> <paragraph num="(i)"> <text>Meets the requirements of §C of this regulation, and</text> </paragraph> <paragraph num="(ii)"> <text>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 furnish continuing care in accordance with the provider's agreements and the Act at each facility of the provider in the State; and</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Financial Plan. A financial plan shall include:</text> <paragraph num="(1)"> <text>The anticipated costs of the proposed renovation, including:</text> <paragraph num="(a)"> <text>Construction costs,</text> </paragraph> <paragraph num="(b)"> <text>Architect and engineering fees,</text> </paragraph> <paragraph num="(c)"> <text>Financing costs,</text> </paragraph> <paragraph num="(d)"> <text>Legal and administrative costs, and</text> </paragraph> <paragraph num="(e)"> <text>Any other related costs;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The anticipated sources and uses of funds to finance the proposed renovation;</text> </paragraph> <paragraph num="(3)"> <text>A description of any proposed financing, including anticipated terms and costs of financing;</text> </paragraph> <paragraph num="(4)"> <text>Projected 5-year cash flow statements prepared in accordance with generally accepted accounting principles; and</text> </paragraph> <paragraph num="(5)"> <text>The key assumptions underlying the cash flow statements.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".16" heading="Action of the Department on Renovation Approval Request."> <paragraph num="A."> <text>Approval Standards. The Department shall approve a renovation approval request when it determines that a reasonable financial plan, prepared by an authority recognized by the Department, has been submitted for the proposed renovation, and the plan demonstrates that:</text> <paragraph num="(1)"> <text>The anticipated sources of funds to finance the proposed renovation are equal to or greater than the anticipated uses of funds for the proposed renovation; and</text> </paragraph> <paragraph num="(2)"> <text>The proposed renovation will not have an unreasonably adverse effect on the financial ability of the provider to furnish continuing care in accordance with the provider's agreements and the Act at each facility of the provider in the State.</text> </paragraph> </paragraph> <paragraph num="B."> <text>No Construction Before Approval. A provider may not begin construction of a renovation until the provider receives written approval of the renovation approval request from the Department for the proposed renovation.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".17" heading="Application for Expansion of Facility."> <paragraph num="A."> <text>Statement of Intent.</text> <paragraph num="(1)"> <text>A provider that intends to undertake an expansion of its facility shall file a statement of intent with the Department at least 30 days before submission of an expansion approval request.</text> </paragraph> <paragraph num="(2)"> <text>If the expansion approval request is not filed by the provider within 60 days after the statement of intent is filed, a new statement of intent shall be filed with the Department at least 30 days before submission of the financial plan described in §B(3) of this regulation.</text> </paragraph> <paragraph num="(3)"> <text>A statement of intent shall describe at a minimum:</text> <paragraph num="(a)"> <text>The proposed expansion;</text> </paragraph> <paragraph num="(b)"> <text>The types of agreements proposed, such as extensive, modified, or fee-for-service, and whether entrance fees will be refundable or nonrefundable;</text> </paragraph> <paragraph num="(c)"> <text>The number of proposed additional units, if any, by unit type; and</text> </paragraph> <paragraph num="(d)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>Expansion Approval Request.</text> <paragraph num="(1)"> <text>An expansion approval request shall be prepared in a form satisfactory to the Department.</text> </paragraph> <paragraph num="(2)"> <text>A provider's expansion approval request shall include the following information:</text> <paragraph num="(a)"> <text>A statement of the purpose and need for the expansion;</text> </paragraph> <paragraph num="(b)"> <text>A demonstration that a market exists for any proposed additional independent living or assisted living units, which meets the requirements of §C of this regulation; and</text> </paragraph> <paragraph num="(c)"> <text>A financial plan that:</text> <paragraph num="(i)"> <text>Is prepared by an authority recognized by the Department,</text> </paragraph> <paragraph num="(ii)"> <text>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 furnish continuing care in accordance with the provider's agreements and the Act at each facility of the provider in the State, and</text> </paragraph> <paragraph num="(iii)"> <text>Meets the requirements of §D of this regulation.</text> </paragraph> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Demonstration of a Market.</text> <paragraph num="(1)"> <text>For expansions of ten or fewer units, a provider's expansion approval request shall include the following to demonstrate that a market exists for the proposed additional units:</text> <paragraph num="(a)"> <text>The existing wait lists and existing occupancy lists for the facility's independent living and assisted living units, by unit type; or</text> </paragraph> <paragraph num="(b)"> <text>Other documentation of market demand for the proposed additional units that is acceptable to the Department.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>For expansions of more than ten units, a provider's expansion approval request shall include the following to demonstrate that a market exists for the proposed additional units:</text> <paragraph num="(a)"> <text>A description of the primary and secondary market areas as defined by the provider;</text> </paragraph> <paragraph num="(b)"> <text>A table of population information, including the age, sex, number, income distribution, and trends of the total population and of the population of individuals 60 years old and older within the primary and secondary market areas;</text> </paragraph> <paragraph num="(c)"> <text>A calculation of the market penetration rate for the proposed additional units for both the primary and secondary markets;</text> </paragraph> <paragraph num="(d)"> <text>A table of home values in the primary and secondary market areas; and</text> </paragraph> <paragraph num="(e)"> <text>A statement of the minimum age, income, and net worth eligibility standards for a subscriber to the proposed additional living units.</text> </paragraph> </paragraph> </paragraph> <paragraph num="D."> <text>Financial Plan. A financial plan required in §B(2)(c) of this regulation shall include:</text> <paragraph num="(1)"> <text>The anticipated costs of the proposed expansion, including all related costs such as:</text> <paragraph num="(a)"> <text>Financing costs,</text> </paragraph> <paragraph num="(b)"> <text>Marketing costs,</text> </paragraph> <paragraph num="(c)"> <text>Construction costs,</text> </paragraph> <paragraph num="(d)"> <text>Architect and engineering fees,</text> </paragraph> <paragraph num="(e)"> <text>Legal and administrative costs, and</text> </paragraph> <paragraph num="(f)"> <text>Any other costs;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The anticipated sources and uses of funds to finance the proposed expansion and costs of financing;</text> </paragraph> <paragraph num="(3)"> <text>A description of any proposed financing, including anticipated terms;</text> </paragraph> <paragraph num="(4)"> <text>Projected 5-year balance sheets, income statements, cash flow statements, including key assumptions for each, prepared in accordance with generally accepted accounting principles;</text> </paragraph> <paragraph num="(5)"> <text>A schedule of anticipated periodic fees and entrance fees for any additional independent living and assisted living units;</text> </paragraph> <paragraph num="(6)"> <text>A schedule of monthly move-ins, by unit type, for any additional units; and</text> </paragraph> <paragraph num="(7)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> <paragraph num="E."> <text>Filing Fee.</text> <paragraph num="(1)"> <text>A filing fee of $50 per additional unit shall accompany the expansion approval request.</text> </paragraph> <paragraph num="(2)"> <text>The Department may charge an additional fee, not to exceed the original fee, for resubmission of a financial plan to the Department due to:</text> <paragraph num="(a)"> <text>Significant changes in assumptions in the financial plan;</text> </paragraph> <paragraph num="(b)"> <text>Correction of significant errors in the plan; or</text> </paragraph> <paragraph num="(c)"> <text>An incomplete financial plan submission.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".18" heading="Action of the Department on Expansion Approval Request."> <paragraph num="A."> <text>The Department shall approve an expansion approval request and, if applicable, issue a revised certificate of registration that includes the additional units when it determines that:</text> <paragraph num="(1)"> <text>A market for the additional independent living and assisted living units appears to exist, based on reliable data; and</text> </paragraph> <paragraph num="(2)"> <text>A reasonable financial plan, prepared by an authority recognized by the Department, has been submitted for the proposed expansion that demonstrates that the:</text> <paragraph num="(a)"> <text>Anticipated sources of funds to finance the proposed expansion are equal to or greater than the anticipated uses of funds for the proposed expansion, and</text> </paragraph> <paragraph num="(b)"> <text>Proposed expansion will not have an unreasonably adverse effect on the financial ability of the provider to furnish continuing care in accordance with the provider's agreements and the Act at each facility of the provider in the State.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>A provider may not begin construction of the expansion until the provider receives written approval from the Department for the proposed expansion.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".19" heading="Required Information Regarding Governance."> <paragraph num="A."> <text>In General. At least annually, each provider shall conduct a meeting, open to all of the provider's subscribers, at which an authorized officer of the provider shall present a summary of the provider's operations, significant changes from the previous year, and goals and objectives for the next year. The provider shall make provisions to have an authorized officer receive and answer questions from subscribers at the meeting.</text> </paragraph> <paragraph num="B."> <text>Provider that has a Governing Body.</text> <paragraph num="(1)"> <text>A provider that has a governing body shall include at least one of the provider's subscribers as a full and regular member of the governing body.</text> </paragraph> <paragraph num="(2)"> <text>If a provider that has a governing body owns or operates more than three facilities in the State, there shall be at least one of the provider's subscribers as a full and regular member of the governing body for every three facilities in the State.</text> </paragraph> <paragraph num="(3)"> <text>Subscriber Member Selection Requirements.</text> <paragraph num="(a)"> <text>Subject to the provisions of §B(3)(b) of this regulation, a governing body member selected to meet the requirements of §B(1) and (2) of this regulation 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> </paragraph> <paragraph num="(b)"> <text>The governing body shall confer with the subscriber association at each facility of the provider before the subscriber officially joins the governing body.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Provider Without a Governing Body. A provider that does not have a governing body shall appoint a select committee of its officers or partners to meet at least twice annually with the subscriber 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. If a facility does not have an association of subscribers, the committee shall meet with a reasonable number of representatives, not required to exceed 15, elected by the subscribers.</text> </paragraph> <paragraph num="D."> <text>Materials to be Made Available. Copies of all materials that a provider submits to the Department that are required to be disclosed under the Public Information Act shall be made readily available by the provider for its subscribers to review at the facility.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".20" heading="Operating Reserve Requirements."> <paragraph num="A."> <text>Definitions.</text> <paragraph num="(1)"> <text>In this regulation, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="(2)"> <text>Terms Defined.</text> <paragraph num="(a)"> <text>“Binding agreement” means an unconditional, irrevocable letter of credit or line of credit agreement entered into by a provider and a financial institution.</text> </paragraph> <paragraph num="(b)"> <text>“Debt service fund” means one or more special loan funds, established under requirements imposed by a financial institution or under applicable financing documents, into which the provider is required to deposit moneys during the provider's fiscal year to pay the current portion of the principal due and the interest accruing in that year on the provider's debt.</text> </paragraph> <paragraph num="(c)"> <text>“Debt service reserve fund” means moneys required by a financial institution or under applicable financing documents to be deposited in a special loan fund, which are to be used to pay principal and interest payments due on the provider's debt if the provider is unable to pay when due the principal and interest from operating income or other sources.</text> </paragraph> <paragraph num="(d)"> <text>“Market value” means readily determinable fair value.</text> </paragraph> <paragraph num="(e)"> <text>Net Operating Expenses.</text> <paragraph num="(i)"> <text>“Net operating expenses” means a provider's total operating expenses at each facility of the provider, less depreciation, amortization, unusual and infrequent expenses, and changes in the obligation to provide future services.</text> </paragraph> <paragraph num="(ii)"> <text>“Net operating expenses” does not include interest expense if the provider has funded a debt service fund or other interest reserve under requirements imposed by a financial institution or under applicable financing documents, to the extent and in the amount the fund or reserve includes amounts to cover interest for the year in question.</text> </paragraph> </paragraph> <paragraph num="(f)"> <text>“Other interest reserve” means one or more special loan funds other than debt service funds or debt service reserve funds:</text> <paragraph num="(i)"> <text>Established under requirements imposed by a financial institution or under applicable financing documents; and</text> </paragraph> <paragraph num="(ii)"> <text>Into which the provider is required to deposit moneys during the provider's fiscal year to pay interest accruing in that year on the provider's debt.</text> </paragraph> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>Computation of Operating Reserve Requirement.</text> <paragraph num="(1)"> <text>Except as otherwise provided in this regulation, a provider shall set aside for each facility subject to this chapter operating reserves equal to 15 percent of the facility's net operating expenses for the most recent fiscal year for which a certified financial statement is available. The reserves shall be maintained in reasonably liquid form in the judgment of the provider and in accordance with the provider's investment policies.</text> </paragraph> <paragraph num="(2)"> <text>A provider shall compute operating reserves for each facility as of the end of the facility's most recent fiscal year and shall indicate compliance by setting forth the amount actually set aside in a letter to the Department from the provider's certified public accountant or by disclosing the amount in the provider's most recent certified financial statement. The letter or certified financial statements shall be submitted with the provider's application for a renewal certificate.</text> </paragraph> <paragraph num="(3)"> <text>A provider may apply toward the reserve required by this regulation any reserves, other than debt service reserve funds, maintained under applicable financing document requirements if the reserves are available to the provider to meet the facility's operating expenses.</text> </paragraph> <paragraph num="(4)"> <text>For the purpose of calculating the 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> </paragraph> <paragraph num="(5)"> <text>A provider at a community that has not been the subject of a conversion and in which some residents are not parties to continuing care agreements shall set aside as its operating reserves an amount equal to at least 15 percent of the pro rata proportion of the net operating expenses for the community. The pro rata proportion of the net operating expenses shall equal the number of units in the community certified by the Department divided by the total number of accommodations in the community, with the resulting figure multiplied by the net operating expenses for the community for the most recent fiscal year for which a certified financial statement is available.</text> </paragraph> <paragraph num="(6)"> <text>In calculating the community's operating expenses, the provider may deduct depreciation, amortization, unusual and infrequent expenses, and changes in the obligation to provide future services. Interest expense may also be excluded from the calculation of operating expenses if the provider has funded a debt service fund or other interest reserve under requirements imposed by a financial institution or under applicable financing documents, to the extent and in the amount the fund or reserve includes amounts to cover interest for the year in question.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Use of Operating Reserves.</text> <paragraph num="(1)"> <text>A provider shall notify the Department in writing simultaneously with drawing any amount from the funds available to satisfy the operating reserve that is required by §B of this regulation.</text> </paragraph> <paragraph num="(2)"> <text>Within 30 days of any draw, the provider shall submit to the Department a written plan for restoring the funds in the reserve to the level required by §B of this regulation.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Phase-In Period of Operating Reserve Requirement.</text> <paragraph num="(1)"> <text>A provider shall have up to 10 full fiscal years after the later of October 1, 1996, or the date of its first initial certificate of registration for the community, to meet the requirement of §B of this regulation.</text> </paragraph> <paragraph num="(2)"> <text>A provider shall meet the requirement of §B of this regulation at a minimum rate of 10 percent per year as of the end of each fiscal year after the later of October 1, 1996, or the date of its first initial certificate of registration for the community, up to a total of 100 percent as of the end of the tenth fiscal year.</text> </paragraph> <paragraph num="(3)"> <text>The Department may allow a provider to modify the minimum rate or authorize an additional amount of time to meet the requirement of §B of this regulation if the modification is necessary to maintain the financial viability of the facility.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".21" heading="Disclosure Statement."> <paragraph num="A."> <text>General. A provider shall furnish, without cost, a disclosure statement for each facility of the provider holding either a preliminary certificate of registration or a certificate of registration to all prospective subscribers and, upon request, annually to all subscribers. A disclosure statement shall be provided to a prospective subscriber before payment of any part of the entrance fee or, if earlier, the execution of a continuing care agreement. The provider shall submit its initial disclosure statement to the Department for review at least 45 days before distributing the statement to any prospective or existing subscribers.</text> </paragraph> <paragraph num="B."> <text>Disclosure Statement Revisions. A provider shall revise its disclosure statement annually. A provider shall file a revised disclosure statement with the Department within 120 days after the end of the provider's fiscal year and notify current subscribers that the revised disclosure statement is available for review. The Department shall review the disclosure statement solely to ensure compliance with this regulation.</text> </paragraph> <paragraph num="C."> <text>Disclosure Statement Contents. The disclosure statement shall include:</text> <paragraph num="(1)"> <text>The name and address of the facility;</text> </paragraph> <paragraph num="(2)"> <text>A description of the facility;</text> </paragraph> <paragraph num="(3)"> <text>The name and address of any parent or subsidiary person;</text> </paragraph> <paragraph num="(4)"> <text>The organizational structure and management of the provider, including:</text> <paragraph num="(a)"> <text>If the provider is a corporation or limited liability company, the:</text> <paragraph num="(i)"> <text>Name of the corporation or limited liability company,</text> </paragraph> <paragraph num="(ii)"> <text>State in which the corporation is incorporated or the limited liability company is formed, and</text> </paragraph> <paragraph num="(iii)"> <text>Name of the chief executive officer;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>If the provider is a partnership, the:</text> <paragraph num="(i)"> <text>Names of the general partners,</text> </paragraph> <paragraph num="(ii)"> <text>State governing the formation of the partnership, and</text> </paragraph> <paragraph num="(iii)"> <text>Name of the primary individual responsible for managing the partnership;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>If the provider is an unincorporated association, the:</text> <paragraph num="(i)"> <text>Names of the members,</text> </paragraph> <paragraph num="(ii)"> <text>State governing the association's activities, and</text> </paragraph> <paragraph num="(iii)"> <text>Name of the primary individual responsible for managing the association;</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>If the provider is a partnership having a corporation or limited liability company as one or more of its general partners, the:</text> <paragraph num="(i)"> <text>Name of each corporation or limited liability company,</text> </paragraph> <paragraph num="(ii)"> <text>State in which the corporation is incorporated or the limited liability company is formed, and</text> </paragraph> <paragraph num="(iii)"> <text>Name of the chief executive officer;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>If the provider is a trust, the:</text> <paragraph num="(i)"> <text>Name of each trustee,</text> </paragraph> <paragraph num="(ii)"> <text>Names of the owners of beneficial interests in the trust,</text> </paragraph> <paragraph num="(iii)"> <text>State whose law governs the trust, and</text> </paragraph> <paragraph num="(iv)"> <text>Name of the primary individual responsible for overseeing the trust's activities; and</text> </paragraph> </paragraph> <paragraph num="(f)"> <text>A statement regarding whether the provider is qualified, or intends to qualify, as a tax-exempt organization under the Internal Revenue Code;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>A statement regarding any affiliation of the provider with a religious, charitable, or other nonprofit organization, and the extent to which that organization is responsible for the financial and contractual obligations of the provider;</text> </paragraph> <paragraph num="(6)"> <text>A description of all fees collected by the provider that are not optional, including:</text> <paragraph num="(a)"> <text>Entrance fees;</text> </paragraph> <paragraph num="(b)"> <text>Fees for health-related services;</text> </paragraph> <paragraph num="(c)"> <text>Parking fees; and</text> </paragraph> <paragraph num="(d)"> <text>Periodic fees;</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>The date and the amount of any changes in the fees that are not optional imposed in any of the past 5 years during which the facility was in operation;</text> </paragraph> <paragraph num="(8)"> <text>A statement describing provisions that have been, or will be, made to comply with the operating reserve requirements in Regulation .20 of this chapter;</text> </paragraph> <paragraph num="(9)"> <text>A general statement regarding the provider's investment policy related to the required reserves, including how often the reserve fund investment is reviewed and by whom;</text> </paragraph> <paragraph num="(10)"> <text>A copy of the most recent certified financial statement available under generally accepted accounting principles;</text> </paragraph> <paragraph num="(11)"> <text>A description of the long-term financing for the facility;</text> </paragraph> <paragraph num="(12)"> <text>If operations have not begun at the facility, a summary of the most recent feasibility study approved by the Department, which shall include:</text> <paragraph num="(a)"> <text>A description of the anticipated sources and uses of funds for the purchase or construction of the facility, including related costs such as:</text> <paragraph num="(i)"> <text>Land costs,</text> </paragraph> <paragraph num="(ii)"> <text>Construction costs,</text> </paragraph> <paragraph num="(iii)"> <text>Architect and engineering fees,</text> </paragraph> <paragraph num="(iv)"> <text>Financing expenses,</text> </paragraph> <paragraph num="(v)"> <text>Marketing costs,</text> </paragraph> <paragraph num="(vi)"> <text>Legal and administrative costs, and</text> </paragraph> <paragraph num="(vii)"> <text>Furnishing and equipment costs;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>A description of any short-term or long-term financing used in acquiring or constructing the facility, including the terms and costs of the financing or, if the provider leases the facility, a description of the anticipated or actual terms of the lease;</text> </paragraph> <paragraph num="(c)"> <text>The projected balance sheets, income statements, and cash flow statements of the provider contained in the feasibility study approved by the Department or, if there have been revisions to these financial projections since approval was received, then:</text> <paragraph num="(i)"> <text>Include the most current projections, and</text> </paragraph> <paragraph num="(ii)"> <text>Specify that the financial projections have been revised since the feasibility study was approved by the Department;</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>A projected presales schedule for the independent living units;</text> </paragraph> <paragraph num="(e)"> <text>A projected move-in schedule for all of the units of the facility;</text> </paragraph> <paragraph num="(f)"> <text>A statement indicating when the provider expects to have executed agreements for 65 percent of the provider's independent living units;</text> </paragraph> <paragraph num="(g)"> <text>A statement indicating when the provider expects to achieve 95 percent occupancy of the facility's independent living units; and</text> </paragraph> <paragraph num="(h)"> <text>Any further information the Department requires;</text> </paragraph> </paragraph> <paragraph num="(13)"> <text>If operations have begun at the facility and the provider has not reached 85 percent occupancy in the independent living units, a summary of the most recent feasibility study approved by the Department, which shall include:</text> <paragraph num="(a)"> <text>A description of the sources and uses of funds for the purchase or construction of the facility, including related costs such as:</text> <paragraph num="(i)"> <text>Land costs,</text> </paragraph> <paragraph num="(ii)"> <text>Construction costs,</text> </paragraph> <paragraph num="(iii)"> <text>Architect and engineering fees,</text> </paragraph> <paragraph num="(iv)"> <text>Financing expenses,</text> </paragraph> <paragraph num="(v)"> <text>Marketing costs,</text> </paragraph> <paragraph num="(vi)"> <text>Legal and administrative costs, and</text> </paragraph> <paragraph num="(vii)"> <text>Furnishing and equipment costs;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>A description of any short-term or long-term financing used in acquiring or constructing the facility, including the terms and costs of financing, or, if the provider leases the facility, a description of the terms of the lease;</text> </paragraph> <paragraph num="(c)"> <text>The projected balance sheets, income statements and cash flow statements of the provider shown in the feasibility study approved by the Department or, if there have been revisions to these financial projections since approval was received, then:</text> <paragraph num="(i)"> <text>Include the most current projections, and</text> </paragraph> <paragraph num="(ii)"> <text>Specify that the financial projections have been revised since the feasibility study was approved by the Department;</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>A projected presales schedule for the independent living units;</text> </paragraph> <paragraph num="(e)"> <text>A projected move-in schedule for all of the units of the facility;</text> </paragraph> <paragraph num="(f)"> <text>A semiannual schedule which shows actual move-ins for all of the units of the facility since opening;</text> </paragraph> <paragraph num="(g)"> <text>A statement indicating when the provider expects to achieve 95 percent occupancy of the facility's independent living units; and</text> </paragraph> <paragraph num="(h)"> <text>Any further information the Department requires;</text> </paragraph> </paragraph> <paragraph num="(14)"> <text>A cash flow forecast statement for the current and the next 2 fiscal years;</text> </paragraph> <paragraph num="(15)"> <text>The names and occupations of:</text> <paragraph num="(a)"> <text>The provider's officers, directors, trustees, and managing or general partners; and</text> </paragraph> <paragraph num="(b)"> <text>Any person with a 10 percent or greater equity or beneficial interest in the provider;</text> </paragraph> </paragraph> <paragraph num="(16)"> <text>A description of the financial interest in or occupation with the provider of each person identified under §C(15) of this regulation;</text> </paragraph> <paragraph num="(17)"> <text>If it is anticipated that a business entity will provide to either the facility or the provider goods, premises, or services with a value of $10,000 or more within any fiscal year, and if a person identified in §C(15) of this regulation has a financial interest of 10 percent or more in the business entity, then include:</text> <paragraph num="(a)"> <text>The name and address of the business entities;</text> </paragraph> <paragraph num="(b)"> <text>A description of the goods, premises, or services; and</text> </paragraph> <paragraph num="(c)"> <text>The anticipated yearly costs the facility or provider will incur for the goods, premises, or services;</text> </paragraph> </paragraph> <paragraph num="(18)"> <text>If the facility is, or will be, managed on a day-to-day basis by a person other than an individual directly employed by the provider, then include a description of the proposed manager or management company, including the business experience the manager or company has operating or managing similar facilities;</text> </paragraph> <paragraph num="(19)"> <text>A description of any matter in which an individual identified under §C(15) of this regulation has:</text> <paragraph num="(a)"> <text>Been convicted of, or pleaded nolo contendere to, a felony charge involving fraud, embezzlement, fraudulent conversion, or misappropriation of property;</text> </paragraph> <paragraph num="(b)"> <text>Been held liable, or enjoined by a final judgment, in a civil action involving fraud, embezzlement, fraudulent conversion, or misappropriation as a fiduciary;</text> </paragraph> <paragraph num="(c)"> <text>Been subject to an effective injunctive or restrictive order of a court of record arising out of or relating to business activity or health care, including actions affecting a license to operate any facility or service for aging, impaired, or dependent persons; or</text> </paragraph> <paragraph num="(d)"> <text>Had any state or federal license or permit suspended or revoked within the past 10 years, as a result of an action brought by a governmental agency arising out of or relating to business activity or health care, including actions affecting a license to operate any facility or service for aging, impaired, or dependent persons;</text> </paragraph> </paragraph> <paragraph num="(20)"> <text>A description of the form of governance of the provider, including the composition of the governing body;</text> </paragraph> <paragraph num="(21)"> <text>A statement that the provider shall hold the periodic meetings with residents as required under Regulation .19 of this chapter;</text> </paragraph> <paragraph num="(22)"> <text>If applicable, a description of the conditions under which the provider may:</text> <paragraph num="(a)"> <text>Be issued an initial certificate of registration for any new units; and</text> </paragraph> <paragraph num="(b)"> <text>Use escrowed deposits;</text> </paragraph> </paragraph> <paragraph num="(23)"> <text>If applicable, a statement of the amount of a subscriber's deposit that may be used upon issuance of an initial certificate of registration;</text> </paragraph> <paragraph num="(24)"> <text>A summary of the basic services provided, or proposed to be provided, under the continuing care agreements that clearly states which services are to be included in the basic fee or fees and which services are to be made available at an extra charge;</text> </paragraph> <paragraph num="(25)"> <text>A statement that explains:</text> <paragraph num="(a)"> <text>The extent to which health-related services are to be furnished; and</text> </paragraph> <paragraph num="(b)"> <text>Which health-related services are to be included in the basic fee or fees and which are to be made available at an extra charge;</text> </paragraph> </paragraph> <paragraph num="(26)"> <text>A statement that the provider will promptly amend its disclosure statement if, in the opinion of the provider or the Department, an amendment is necessary to prevent the disclosure statement from containing any material misstatement of fact required by this regulation to be stated in the disclosure statement or omission of a material fact required by this regulation to be stated in the disclosure statement;</text> </paragraph> <paragraph num="(27)"> <text>A description of any activity involving a renovation or an expansion, whether or not subject to Department review under Regulation .15 or .17 of this chapter, during the preceding fiscal year or proposed for the current fiscal year;</text> </paragraph> <paragraph num="(28)"> <text>If it is the provider's policy to impose a surcharge on some, but not all, subscribers because of some condition or circumstance, a statement that describes the types of conditions or circumstances that would warrant a surcharge and that a surcharge is not considered part of the entrance fee when calculating a statutory refund under Regulation .31 of this chapter;</text> </paragraph> <paragraph num="(29)"> <text>A description of the existence and role of the resident association;</text> </paragraph> <paragraph num="(30)"> <text>A description of the internal grievance procedure that provides for:</text> <paragraph num="(a)"> <text>The opportunity for a subscriber to submit a written grievance to the provider; and</text> </paragraph> <paragraph num="(b)"> <text>A response from the provider within 45 days after receipt of the written grievance as to the investigation and resolution of the subscriber's grievance; and</text> </paragraph> </paragraph> <paragraph num="(31)"> <text>Any other material information concerning the facility or the provider that the Department requires or that the provider wishes to include.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The disclosure statement shall contain a cover page that states in a prominent location and type face, the following:</text> <paragraph num="(1)"> <text>The date of the disclosure statement;</text> </paragraph> <paragraph num="(2)"> <text>That the issuance of a certificate of registration does not constitute approval, recommendation, or endorsement of the facility by the Department; and</text> </paragraph> <paragraph num="(3)"> <text>That the issuance of a certificate of registration is neither evidence of, nor does it attest to, the accuracy or completeness of the information set out in the disclosure statement.</text> </paragraph> </paragraph> <paragraph num="E."> <text>Any amended disclosure statement shall be:</text> <paragraph num="(1)"> <text>Filed with the Department at the same time that it is delivered to a subscriber or prospective subscriber; and</text> </paragraph> <paragraph num="(2)"> <text>Subject to all the requirements of this chapter.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".22" heading="Sale, Transfer, or Reorganization of Ownership or Control."> <paragraph num="A."> <text>Sale or Transfer of Ownership or Control.</text> <paragraph num="(1)"> <text>Except as provided in §B of this regulation, a provider that holds an initial or renewal certificate of registration or a person with an ownership interest in or right to control that provider through governing body appointments or contractual or similar arrangements may not sell or otherwise transfer, directly or indirectly, more than 50 percent of the provider's ownership of a facility or more than 50 percent of the ownership of, or right to control, a person that owns or controls a facility, unless the provider or person obtains the approval of the Department to the sale or other transfer in accordance with §§C—F of this regulation.</text> </paragraph> <paragraph num="(2)"> <text>Any series of sales or other transfers within a 12-month period shall be aggregated for purposes of this regulation.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Exception for Business Reorganizations.</text> <paragraph num="(1)"> <text>This regulation does not apply if:</text> <paragraph num="(a)"> <text>A transfer of ownership of a facility, or a transfer of ownership or control of a person owning or controlling a facility, is part of a business reorganization; and</text> </paragraph> <paragraph num="(b)"> <text>The same party or parties holding a majority of ownership of, or right to control, the provider before the business reorganization will retain, directly or indirectly, a majority of the ownership of, or right to control, the provider after the business reorganization.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>If a sale or transfer of ownership satisfies the exception of §B(1) of this regulation, the provider shall give written notice to the Department and to the facility's subscribers 30 days before the business reorganization.</text> </paragraph> <paragraph num="(3)"> <text>The written notice to the Department required by §B(2) of this regulation shall include:</text> <paragraph num="(a)"> <text>A statement describing the reorganization in ownership including the new organizational structure;</text> </paragraph> <paragraph num="(b)"> <text>A copy of each corporate charter, articles of incorporation, bylaws, partnership agreements, articles of association, membership agreement, or trust agreement that will govern the legal organization of the provider after the sale or other transfer;</text> </paragraph> <paragraph num="(c)"> <text>A copy of the notice given to, or to be given to, the facility's subscribers; and</text> </paragraph> <paragraph num="(d)"> <text>Any further information the Department requires regarding the structure of the legal entities involved in the reorganization.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Request for Approval of a Sale or Transfer of Ownership or Control.</text> <paragraph num="(1)"> <text>A provider subject to §A of this regulation shall:</text> <paragraph num="(a)"> <text>At least 90 days before the proposed effective date of the sale or other transfer, file with the Department a statement of intent to transfer ownership or control; and</text> </paragraph> <paragraph num="(b)"> <text>At least 65 days before the proposed effective date of the sale or other transfer, give written notice of the proposed sale or other transfer to the subscribers of the affected facility and to the Department.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Along with the written notice to the Department required by §C(1)(b) of this regulation, the provider shall submit a payment to the Department of $20,000.</text> </paragraph> <paragraph num="(3)"> <text>The written notice required by §C(1)(b) of this regulation shall specify the following information, which also shall be provided to any subscriber of the affected facility upon request:</text> <paragraph num="(a)"> <text>The place and time for the meeting specified in §C(4) of this regulation;</text> </paragraph> <paragraph num="(b)"> <text>The address of the provider and the Department to which any comments may be sent;</text> </paragraph> <paragraph num="(c)"> <text>The name and address of the affected facility and the name and address of the new provider;</text> </paragraph> <paragraph num="(d)"> <text>The organizational structure and management of the provider and the facility after the proposed sale or other transfer is completed, including:</text> <paragraph num="(i)"> <text>If the provider is to be a corporation or limited liability company, then the name of the corporation or limited liability company, the state in which the corporation is incorporated or the limited liability company is formed, and the name of the chief executive officer of the provider,</text> </paragraph> <paragraph num="(ii)"> <text>If the provider is to be a partnership, then the names of the general partners, the state governing the formation of the partnership, and the name of the primary individual responsible for managing the partnership,</text> </paragraph> <paragraph num="(iii)"> <text>If the provider is to be an unincorporated association, then the names of the members, the state governing the unincorporated association's activities, and the name of the primary individual responsible for managing the association,</text> </paragraph> <paragraph num="(iv)"> <text>If the provider is to be a trust, then the name of each trustee, the names of the owners of the beneficial interests in the trust, the state whose law governs the trust, and the name of the primary individual responsible for overseeing the trust's activities,</text> </paragraph> <paragraph num="(v)"> <text>If the provider is to be a partnership having a corporation or limited liability company as one or more of its general partners, then the name of each corporation or limited liability company, the state in which the corporation is incorporated or the limited liability company is formed, and the name of the provider's chief executive officer, and</text> </paragraph> <paragraph num="(vi)"> <text>The names and occupations of each person who will be an officer, director, trustee, general partner, principal, or person with a 10 percent or greater equity or beneficial interest in the provider after the sale or other transfer;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>A copy of each corporate charter, articles of incorporation, bylaws, partnership agreement, articles of association, membership agreement, or trust agreement as it will pertain to the legal organization of the provider after the sale or other transfer;</text> </paragraph> <paragraph num="(f)"> <text>A statement as to:</text> <paragraph num="(i)"> <text>Any affiliation with a religious, charitable, or other nonprofit organization that will exist after the proposed sale or other transfer, and</text> </paragraph> <paragraph num="(ii)"> <text>The extent, if any, to which the affiliate organization will be responsible for the financial and contractual obligations of the provider;</text> </paragraph> </paragraph> <paragraph num="(g)"> <text>The name and address of each person that is likely to provide goods, premises, or services to the facility or provider after the sale or other transfer, which goods, premises, or services will have a value of $10,000 or more within any fiscal year;</text> </paragraph> <paragraph num="(h)"> <text>If a person identified in §C(2)(d)(vi) of this regulation has a 10 percent or greater financial interest in a person identified in §C(2)(g) of this regulation, then describe the goods, premises, or services to be provided to the facility or provider;</text> </paragraph> <paragraph num="(i)"> <text>A description of any proposed manager or management company that will manage the day-to-day operations of the facility after the sale or other transfer, including the business experience the manager or company has in operating or managing similar facilities;</text> </paragraph> <paragraph num="(j)"> <text>A description of each matter in which a person identified in §C(2)(d)(vi) of this regulation has:</text> <paragraph num="(i)"> <text>Been convicted of, or pleaded nolo contendere to, a felony charge involving fraud, embezzlement, fraudulent conversion, or misappropriation of property,</text> </paragraph> <paragraph num="(ii)"> <text>Been held liable, or enjoined by a final judgment, in a civil action involving fraud, embezzlement, fraudulent conversion, or misappropriation as a fiduciary,</text> </paragraph> <paragraph num="(iii)"> <text>Been subject to an effective injunctive or restrictive order of a court of record arising out of or relating to business activity or health care, including, actions affecting a license to operate a facility or service for aging, impaired, or dependent persons, or</text> </paragraph> <paragraph num="(iv)"> <text>Had any state or federal license or permit suspended or revoked within the past 10 years, as a result of an action brought by a governmental agency arising out of or relating to business activity or health care, including actions affecting a license to operate a facility or service for aging, impaired, or dependent persons;</text> </paragraph> </paragraph> <paragraph num="(k)"> <text>A financial plan, prepared by an authority recognized by the Department, in a form reasonably acceptable to the Department that:</text> <paragraph num="(i)"> <text>Demonstrates the projected effects of the sale or other transfer on the financial operations of the provider and facility,</text> </paragraph> <paragraph num="(ii)"> <text>Includes any obligations of the provider to make payments in connection with the sale or other transfer from the financial resources of the provider,</text> </paragraph> <paragraph num="(iii)"> <text>Includes projected 10-year balance sheets, income statements, and cash flow statements each prepared in accordance with generally accepted accounting principles, and</text> </paragraph> <paragraph num="(iv)"> <text>Includes the key assumptions underlying the projected 10-year balance sheets, income statements, and cash flow statements;</text> </paragraph> </paragraph> <paragraph num="(l)"> <text>A statement from an authority recognized by the Department that is based on the financial plan and that concludes that the proposed change in ownership is not likely to have an unreasonably adverse effect on the provider's ability to perform its obligations under its agreements; and</text> </paragraph> <paragraph num="(m)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>For the first 15 days after the provider gives the notice specified in §C(1)(b) of this regulation, subscribers may submit to the provider and to the Department written questions and comments on the proposed sale or other transfer.</text> </paragraph> <paragraph num="(5)"> <text>At least 18 days, but not later than the 25th day, after the notice specified in §C(1)(b) of this regulation is given, representatives of the provider shall hold a meeting with representatives of the subscribers of the affected facility to discuss the proposed sale or other transfer. Representatives of the subscribers may not exceed 15 in number. If a community has a resident association, the 15 representatives shall be chosen by the association. If the community does not have a resident association, the representatives shall be elected by the subscribers. The names and addresses of the subscriber representatives shall be given by those representatives to the provider and to the Department. Representatives of the Department may attend the meeting.</text> </paragraph> <paragraph num="(6)"> <text>For 10 days after the meeting specified in §C(4) of this regulation, subscribers may submit to the provider and to the Department additional written comments on the proposed sale or other transfer.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Approval of Sale or Transfer of Ownership or Control. By the 50th day after the date of the notice required by §C(1)(b) of this regulation, the Department shall issue an approval of the sale or other transfer, unless it determines that the sale or transfer is likely to have an unreasonably adverse impact on the financial stability of the provider or is likely to have an unreasonably adverse effect on a provider's capacity to perform its obligations under the continuing care agreements to which it is a party. The Department may extend the date for approval past the 50th day after the date of the notice required by §C(1)(b) of this regulation for good cause. The Department shall notify the provider and subscriber representatives in writing of its determination and rationale.</text> </paragraph> <paragraph num="E."> <text>Appeal of Department Decision. The decision by the Department with respect to the proposed sale or other transfer is subject to appeal only by the provider in accordance with Regulation .36 of this chapter, and no other person shall be deemed to be a party in interest to the proceedings. If an appeal is taken by the provider, the Department shall give prompt notice of the appeal to the subscriber representatives. The Department shall give the subscriber representatives prompt notice of any decision rendered in the appeal.</text> </paragraph> <paragraph num="F."> <text>Effective Date of Sale or Transfer of Ownership or Control. A sale or other transfer of ownership or control may not be completed until after the 15th day following the later of:</text> <paragraph num="(1)"> <text>The date the Department issues an approval specified in §D of this regulation; or</text> </paragraph> <paragraph num="(2)"> <text>If an appeal is taken under §E of this regulation, the day a hearing officer or administrative law judge renders a final decision permitting the sale or other transfer.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".23" heading="Sale, Transfer, or Other Disposition of Assets."> <paragraph num="A."> <text>Definitions.</text> <paragraph num="(1)"> <text>In this regulation, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="(2)"> <text>Terms Defined.</text> <paragraph num="(a)"> <text>“Days cash on hand ratio” means the ratio created by the following calculation: [Unrestricted current cash and investments + Unrestricted noncurrent cash and investments] divided by [(Total operating expenses—Depreciation and amortization) divided by 365].</text> </paragraph> <paragraph num="(b)"> <text>“Debt service coverage ratio” means the ratio created by the following calculation: [Total excess of revenues over expenses + Interest, depreciation and amortization expenses—Amortization of deferred revenue + Net proceeds from the collection of entrance fees] divided by [Maximum annual debt service or annual lease payments].</text> </paragraph> <paragraph num="(c)"> <text>“Future service obligation” means a financial obligation of a provider that equals any positive number resulting from the calculation to determine the amount by which the present value of the net costs of future services and the use of facilities to be provided to the current subscribers exceeds the balance of deferred revenue from entrance fees, which calculation is required to be performed annually by generally accepted accounting principles.</text> </paragraph> <paragraph num="(d)"> <text>“Liquid resources” means an asset that is easily converted to cash.</text> </paragraph> <paragraph num="(e)"> <text>“Maximum annual debt service” means the greatest amount required to pay the debt service requirements of any long-term indebtedness for any fiscal year, excluding any year in which the amount due is defined in the applicable financing documents as a balloon payment.</text> </paragraph> <paragraph num="(f)"> <text>“Operating ratio” means the ratio created by the following calculation: [Total operating expenses—Depreciation and amortization expenses] divided by [Total revenues—Amortization of deferred revenue].</text> </paragraph> <paragraph num="(g)"> <text>“Ordinary course of business” means transactions that occur on a routine basis without the involvement of the board of directors, or other governing body, such as paying employees and vendors, collecting fees, and selling and purchasing investments.</text> </paragraph> <paragraph num="(h)"> <text>“Transfer” means a sale, disposition, donation, lease, or other transaction that diminishes the ownership rights that the provider has in any assets.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>Transactions Not Included. The following transactions are not considered sales, transfers, or other dispositions of assets for purposes of §§C and D of this regulation:</text> <paragraph num="(1)"> <text>Those undertaken under contractual obligations in effect on October 1, 1996;</text> </paragraph> <paragraph num="(2)"> <text>Those made in the ordinary course of business of operating the facility;</text> </paragraph> <paragraph num="(3)"> <text>Refunds of amounts under contracts entered into in the ordinary course of business;</text> </paragraph> <paragraph num="(4)"> <text>Transfers of cash, securities, or other investment properties in connection with ordinary investment transactions;</text> </paragraph> <paragraph num="(5)"> <text>Grants of mortgages, deeds of trust, or security interests to unrelated third parties;</text> </paragraph> <paragraph num="(6)"> <text>Those involving easements, rights-of-way, road widening, and similar conveyances for the benefit of public bodies or utilities; and</text> </paragraph> <paragraph num="(7)"> <text>Those made for an expansion or renovation.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Transfers of 10 Percent or Less of Assets.</text> <paragraph num="(1)"> <text>A provider that holds an initial or renewal certificate of registration may not transfer assets that are equal to or less than 10 percent of the provider's total assets, based on the certified financial statements for the most recent fiscal year for which a certified financial statement is available at the time of the transfer, if the transfer is likely to have an unreasonably adverse:</text> <paragraph num="(a)"> <text>Impact on the financial stability of the provider; or</text> </paragraph> <paragraph num="(b)"> <text>Effect on the provider's capacity to perform its obligations under continuing care agreements to which it is a party.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Unlike a transfer of assets greater than 10 percent of total assets, a transfer of assets equal to or less than 10 percent of total assets does not have to be approved in advance by the Department unless one or more of the following circumstances exists:</text> <paragraph num="(a)"> <text>The transfer would result in insufficient liquid resources to cover the provider's future service obligation after the proposed transfer; or</text> </paragraph> <paragraph num="(b)"> <text>The provider believes that the transfer may have an unreasonably adverse:</text> <paragraph num="(i)"> <text>Impact on its financial stability, or</text> </paragraph> <paragraph num="(ii)"> <text>Effect on its capacity to perform its obligations under its agreements.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(3)"> <text>In order to have a transfer subject to §C(2) of this regulation approved in advance by the Department, the provider shall submit to the Department the following:</text> <paragraph num="(a)"> <text>Identification of the assets or assets to be sold, transferred, or otherwise disposed of;</text> </paragraph> <paragraph num="(b)"> <text>Documentation as to why the proposed transfer is needed to maintain the financial viability of the provider;</text> </paragraph> <paragraph num="(c)"> <text>A 10-year financial plan, prepared in accordance with generally accepted accounting principles by an independent consultant, that demonstrates the effects of the proposed transfer and includes projected balance sheets, income statements, statements of cash flows, and the key assumptions of the plan; and</text> </paragraph> <paragraph num="(d)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>Within 60 days of receipt of the information required by §D(3) of this regulation, the Department shall issue a written determination that either:</text> <paragraph num="(a)"> <text>Approves the transfer;</text> </paragraph> <paragraph num="(b)"> <text>Denies the transfer; or</text> </paragraph> <paragraph num="(c)"> <text>Seeks more information to evaluate the transfer.</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>If the determination of the Department is not to approve the proposed sale, transfer, or other disposition, the Department shall set forth the reasoning supporting its determination in a written communication to the provider.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Transfer of More than 10 Percent of Assets.</text> <paragraph num="(1)"> <text>A provider that holds an initial or renewal certificate of registration may not transfer, in any 12-month period, assets in excess of 10 percent of its total assets, based on its certified financial statements for the most recent fiscal year for which a certified financial statement is available at the time of the transfer, unless the provider obtains the approval of the Department for the transfer in accordance with this regulation.</text> </paragraph> <paragraph num="(2)"> <text>A provider subject to §D(1) of this regulation shall, at least 60 days before the proposed transfer, file with the Department a statement of intent to transfer assets and, at least 30 days before the proposed transfer, give written notice to the Department.</text> </paragraph> <paragraph num="(3)"> <text>A statement of intent required to be filed with the Department under §D(2) of this regulation shall include the following information:</text> <paragraph num="(a)"> <text>Identification of the asset or assets to be sold, transferred, or otherwise disposed of;</text> </paragraph> <paragraph num="(b)"> <text>If the provider is subject to §E(1) of this regulation by reason of a series of transfers that have cumulatively exceeded the 10 percent amount, the provider shall identify all of the assets that resulted in exceeding the 10 percent amount; and</text> </paragraph> <paragraph num="(c)"> <text>The reason for the transfer.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>Along with the written notice to the Department required by §D(2) of this regulation, the provider shall submit a payment to the Department of $10,000.</text> </paragraph> <paragraph num="(5)"> <text>A notice required to be filed with the Department by §D(2) of this regulation shall include the following information:</text> <paragraph num="(a)"> <text>A statement that demonstrates that the proposed transfer is not likely to have an unreasonably adverse:</text> <paragraph num="(i)"> <text>Impact on the financial stability of the provider, or</text> </paragraph> <paragraph num="(ii)"> <text>Effect on the provider's capacity to perform its obligations under the agreements to which it is a party;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>Computations, prepared by an authority recognized by the Department, of the following financial ratios for the 3 fiscal years before and after the proposed transfer:</text> <paragraph num="(i)"> <text>Operating ratio,</text> </paragraph> <paragraph num="(ii)"> <text>Days cash on hand ratio, and</text> </paragraph> <paragraph num="(iii)"> <text>Debt service coverage ratio;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>If the provider is required by generally accepted accounting principles to perform a future service obligation calculation, a statement from an independent consultant that explains why:</text> <paragraph num="(i)"> <text>The provider will have sufficient liquid resources to cover the provider's future service obligation, if one exists, after the proposed transfer, or</text> </paragraph> <paragraph num="(ii)"> <text>The proposed transfer will have a positive impact on the provider's ability to perform its obligations in accordance with the terms of its continuing care agreements; and</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>Any other information the Department requires.</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>If the provider cannot meet the financial standards set forth in §E(2) of this regulation, the notice required by §D(2) of this regulation shall include the following additional information:</text> <paragraph num="(a)"> <text>A 10-year financial plan, prepared in accordance with generally accepted accounting principles by an independent consultant, that demonstrates the effects of the proposed transfer and includes:</text> <paragraph num="(i)"> <text>Projected balance sheets,</text> </paragraph> <paragraph num="(ii)"> <text>Income statements,</text> </paragraph> <paragraph num="(iii)"> <text>Statements of cash flows, and</text> </paragraph> <paragraph num="(iv)"> <text>The key assumptions of the plan;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>A statement from the independent consultant that after taking into account the provider's historic performance and future assumptions, which future assumptions the independent consultant concludes are not unreasonable, the provider will have the financial ability after the transfer to perform its obligations under the provider's agreements; and</text> </paragraph> <paragraph num="(c)"> <text>Any further information that the Department requires.</text> </paragraph> </paragraph> </paragraph> <paragraph num="E."> <text>Approval of Transfer of More than 10 Percent of Assets.</text> <paragraph num="(1)"> <text>The Department shall approve the sale, transfer, or other disposition of assets in excess of 10 percent unless it determines that the sale, transfer, or other disposition is likely to have an unreasonably adverse:</text> <paragraph num="(a)"> <text>Impact on the financial stability of the provider; or</text> </paragraph> <paragraph num="(b)"> <text>Effect on the provider's capacity to perform its obligations under the continuing care agreements to which it is a party.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The Department shall approve a proposed transfer of assets in excess of 10 percent if the information required by §D(4) of this regulation adequately demonstrates that the provider:</text> <paragraph num="(a)"> <text>Will be able to achieve at least one of the following financial ratios by the end of the third fiscal year after the transfer:</text> <paragraph num="(i)"> <text>An operating ratio less than or equal to 0.95,</text> </paragraph> <paragraph num="(ii)"> <text>A days cash on hand ratio of greater than 90 days, or</text> </paragraph> <paragraph num="(iii)"> <text>A debt service coverage ratio greater than or equal to 1.25; and</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>Meets one of the following standards if the provider is required by generally accepted accounting principles to perform a future service obligation calculation:</text> <paragraph num="(i)"> <text>Will have sufficient liquid resources to cover the provider's future service obligation after the proposed transfer, or</text> </paragraph> <paragraph num="(ii)"> <text>The proposed transfer will have a positive impact on the provider's ability to perform its obligations in accordance with the terms of its agreements.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(3)"> <text>The Department shall communicate its determination in writing to the provider by the 25th day after the date the Department receives the written notice required by §D(2) of this regulation, unless extended by the Department for good cause. If the determination of the Department is not to approve the proposed sale, transfer, or other disposition, the Department shall set forth the reasons supporting its determination in the written communication to the provider.</text> </paragraph> </paragraph> <paragraph num="F."> <text>Appeal of an Department Decision. The determination by the Department with respect to a proposed transfer of assets is subject to appeal only by the provider in accordance with Regulation .36 of this chapter. No other person may be deemed to be a party in interest to the proceedings.</text> </paragraph> <paragraph num="G."> <text>Effective Date of a Transfer of Assets. A transfer of assets subject to review by the Department under this regulation may not be completed until after the fifth day following the later of:</text> <paragraph num="(1)"> <text>The day on which the Department issues a determination approving the transfer; or</text> </paragraph> <paragraph num="(2)"> <text>If an appeal is taken under §F of this regulation, the day a hearing officer or administrative law judge renders a final decision permitting the transfer of assets.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".24" heading="Financial Review Committee."> <paragraph num="A."> <text>The Financial Review Committee shall review providers' financial matters referred to it by the Department.</text> </paragraph> <paragraph num="B."> <text>The Secretary shall appoint seven members to the Committee from qualified applicants. The seven members shall consist of:</text> <paragraph num="(1)"> <text>Two persons knowledgeable in the field of continuing care;</text> </paragraph> <paragraph num="(2)"> <text>Two certified public accountants;</text> </paragraph> <paragraph num="(3)"> <text>One member of the financial community; and</text> </paragraph> <paragraph num="(4)"> <text>Two consumer members, preferably subscribers of continuing care facilities.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The term of a member is 3 years. The terms of members are staggered as required by the terms provided for members of the Committee on July 1, 1985. A member may serve consecutive terms.</text> </paragraph> <paragraph num="D."> <text>The Committee shall elect its chairperson.</text> </paragraph> <paragraph num="E."> <text>Committee members do not receive compensation, but are entitled to reimbursement for expenses incurred in the performance of their official duties as provided for in the State budget.</text> </paragraph> <paragraph num="F."> <text>A Committee member, acting in good faith and within the scope of the duties of a Committee member, is immune from civil liability as a result of those acts.</text> </paragraph> <paragraph num="G."> <text>A Committee member may not participate in a review of a continuing care provider's financial condition if that member has an interest in the provider as defined by the Maryland Public Ethics Law, State Government Article, Title 15, Annotated Code of Maryland.</text> </paragraph> <paragraph num="H."> <text>The deliberations of the Committee and communications between the Department and the Committee, including but not limited to recommendations of the Committee, are confidential.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".25" heading="Referrals to the Financial Review Committee."> <paragraph num="A."> <text>The Department may refer to the Committee for its consideration:</text> <paragraph num="(1)"> <text>A provider's application for a renewal certificate after review by the Department; or</text> </paragraph> <paragraph num="(2)"> <text>A finding of possible financial difficulty, at any time.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Upon receipt of a referral from the Department, the Committee shall:</text> <paragraph num="(1)"> <text>Request from the Department any additional material which the Committee may require;</text> </paragraph> <paragraph num="(2)"> <text>Review the material to determine:</text> <paragraph num="(a)"> <text>Whether or not it recommends finding the provider in financial difficulty; and</text> </paragraph> <paragraph num="(b)"> <text>Whether or not it recommends identifying the financial difficulty as including a significant risk of financial failure in accordance with Human Services Article, §10-469, Annotated Code of Maryland;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>Notify the Department in writing of its recommendations and the reason or reasons for its recommendations, within 45 days of receipt of the referral; and</text> </paragraph> <paragraph num="(4)"> <text>Provide consultation to the Department regarding corrective financial plans for providers in financial difficulty when requested by the Department.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The Committee may request one 30-day extension under §B(3) of this regulation. The Secretary may grant or deny the extension.</text> </paragraph> <paragraph num="D."> <text>Upon notification of the recommendations of the Committee, the Department shall consider the recommendations of the Committee and, within 25 days of receipt of the Committee's recommendations, make a final determination of whether financial difficulty exists, including whether the Department finds a significant risk of financial failure in accordance with Human Services Article, §10-469, Annotated Code of Maryland.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".26" heading="Findings of Financial Difficulty."> <paragraph num="A."> <text>Upon a final determination by the Department that a provider is in financial difficulty, the Department shall notify the provider, by certified mail, return receipt requested, of the determination, including whether the Department has determined that there is a significant risk of financial failure.</text> </paragraph> <paragraph num="B."> <text>The Department may:</text> <paragraph num="(1)"> <text>Consult with the Financial Review Committee to review the findings and possible corrective financial plans; and</text> </paragraph> <paragraph num="(2)"> <text>Assist the provider to develop an adequate corrective financial plan.</text> </paragraph> </paragraph> <paragraph num="C."> <text>A provider notified of a determination of financial difficulty shall:</text> <paragraph num="(1)"> <text>Advise its subscribers of the Department's determination in a meeting to be held by the provider with representatives of the subscribers within 10 days of the provider's receipt of notice from the Department;</text> </paragraph> <paragraph num="(2)"> <text>Notify the Department in advance of the date, time, and location of the meeting;</text> </paragraph> <paragraph num="(3)"> <text>Cooperate with the Department to develop a corrective financial plan;</text> </paragraph> <paragraph num="(4)"> <text>Prepare a 5-year financial plan to correct the causes of the financial difficulty;</text> </paragraph> <paragraph num="(5)"> <text>Submit the corrective plan to the Department for approval within 60 days of receipt of notification from the Department;</text> </paragraph> <paragraph num="(6)"> <text>Make available to its subscribers copies of its approved 5-year plan;</text> </paragraph> <paragraph num="(7)"> <text>Amend the financial plan as the Department may advise to enable a finding of no financial difficulty;</text> </paragraph> <paragraph num="(8)"> <text>Implement the corrective financial plan;</text> </paragraph> <paragraph num="(9)"> <text>Submit to the Department within 60 days of the close of each fiscal year an annual progress report on the implementation of its approved financial plan; and</text> </paragraph> <paragraph num="(10)"> <text>At the direction of the Department, revise and update its corrective financial plan if the Department finds that revisions are necessary based on review of the annual progress report or other investigation.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The provider may request from the Secretary a 30-day extension of the 60-day time period specified in §C(5) of this regulation. The Secretary may grant the extension.</text> </paragraph> <paragraph num="E."> <text>After a provider has been found to be in financial difficulty, the Department may withhold a renewal certificate of registration or withdraw a current certificate of registration if the Department determines that the provider:</text> <paragraph num="(1)"> <text>Did not prepare a corrective financial plan within 60 days of notification (or 90 days, if the Secretary granted an extension);</text> </paragraph> <paragraph num="(2)"> <text>Is unwilling or unable to prepare a corrective financial plan;</text> </paragraph> <paragraph num="(3)"> <text>Prepared a financial plan which is found by the Department to be inadequate to correct the current or impending financial difficulty; or</text> </paragraph> <paragraph num="(4)"> <text>Failed to implement the approved corrective plan, which is demonstrated by the annual progress report or an interim investigation by the Department.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".27" heading="Deposit Agreement and Processing Fee."> <paragraph num="A."> <text>A deposit agreement used for a deposit on a unit for which the provider has not received written approval to withdraw deposits under Regulation .12 of this chapter shall:</text> <paragraph num="(1)"> <text>State that all deposits and entrance fees shall be held in escrow until:</text> <paragraph num="(a)"> <text>The issuance of an initial certificate of registration for the unit,</text> </paragraph> <paragraph num="(b)"> <text>Construction is completed,</text> </paragraph> <paragraph num="(c)"> <text>A certificate of occupancy, or its equivalent, has been issued by the local jurisdiction, and</text> </paragraph> <paragraph num="(d)"> <text>The provider has been issued appropriate licenses or certificates by MDH, MHCC, and the Department;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Describe the disposition of any interest earned on deposits and entrance fees;</text> </paragraph> <paragraph num="(3)"> <text>State the amount of any processing fee and whether it will be refunded if the deposit agreement is canceled; and</text> </paragraph> <paragraph num="(4)"> <text>State that the deposit will be refunded within not more than 60 days of the cancellation, if the deposit agreement is canceled before the continuing care agreement is executed.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A deposit agreement that is used for a deposit on a unit for which the provider has received written approval to withdraw deposits under Regulation .12 of this chapter shall:</text> <paragraph num="(1)"> <text>State that the provider may use all deposits and entrance fees at any time; or</text> </paragraph> <paragraph num="(2)"> <text>Describe any applicable limitations on the use of deposits and entrance fees.</text> </paragraph> </paragraph> <paragraph num="C."> <text>A processing fee may only be assessed against a subscriber one time and may not exceed $300 per individual.</text> </paragraph> <paragraph num="D."> <text>If a deposit agreement does not precede a continuing care agreement, the provider shall ensure that the continuing care agreement referred to in Regulation .28 of this chapter meets the requirements of §A of this regulation.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".28" heading="Continuing Care Agreement."> <paragraph num="A."> <text>Each continuing care agreement shall, in a form acceptable to the Department:</text> <paragraph num="(1)"> <text>List the total consideration paid, or to be paid, by the subscriber for continuing care, including a schedule or inventory that sets forth in one place the value of all entrance fees, subscription fees, property transferred, surcharges, periodic fees, donations, and other fees;</text> </paragraph> <paragraph num="(2)"> <text>Describe in detail all items of service to be provided to the subscriber, such as food, shelter, medical or nursing care, and other health-related services;</text> </paragraph> <paragraph num="(3)"> <text>State whether the items described for §A(2) of this regulation are to be provided for a designated time period or for life;</text> </paragraph> <paragraph num="(4)"> <text>If a subscriber is offered a priority for nursing home admission, state:</text> <paragraph num="(a)"> <text>The name of the nursing home or homes with which the provider has a formal priority arrangement;</text> </paragraph> <paragraph num="(b)"> <text>What provisions for care will be made if a nursing home bed is not available at a facility identified in §A(4)(a) of this regulation at the time the bed is needed;</text> </paragraph> <paragraph num="(c)"> <text>What the payment provisions will be for care at a facility identified in §A(4)(a) of this regulation; and</text> </paragraph> <paragraph num="(d)"> <text>That the provider shall promptly notify the subscriber and the Department of any change in the formal priority arrangement between the provider and the nursing home;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>Designate the categories of subscribers at the facility according to the types of entrance fee plans offered;</text> </paragraph> <paragraph num="(6)"> <text>State that a subscriber may not be relocated from the subscriber's unit except to protect the health or safety of the subscriber or for the general and economic welfare of other subscribers of the facility;</text> </paragraph> <paragraph num="(7)"> <text>While recognizing the constraints of §A(6) of this regulation, describe the procedures the parties to the agreement are to follow in order to temporarily transfer a subscriber:</text> <paragraph num="(a)"> <text>From the unit in which the subscriber resides to another unit within the facility; or</text> </paragraph> <paragraph num="(b)"> <text>To an accommodation outside of the facility;</text> </paragraph> </paragraph> <paragraph num="(8)"> <text>Describe the procedures the parties to the agreement are to follow in order to return a subscriber to the unit in which the subscriber resided before a temporary change;</text> </paragraph> <paragraph num="(9)"> <text>While recognizing the constraints of §A(6) of this regulation, describe the procedures the parties to the agreement are to follow in order to permanently transfer a subscriber:</text> <paragraph num="(a)"> <text>From the unit in which the subscriber resides to another unit within the facility; or</text> </paragraph> <paragraph num="(b)"> <text>To an accommodation outside of the facility;</text> </paragraph> </paragraph> <paragraph num="(10)"> <text>If the agreement is an extensive contract or modified contract, as defined in Human Services Article, §10-447, Annotated Code of Maryland, include provisions in accordance with the applicable requirements of Human Services Article, §10-447, Annotated Code of Maryland;</text> </paragraph> <paragraph num="(11)"> <text>Describe how the procedures for changes, transfers, and returns, whether temporary or permanent, will operate if a unit is occupied by more than one subscriber;</text> </paragraph> <paragraph num="(12)"> <text>State whether there will be a partial refund of an entrance fee, an additional fee, or any increase or decrease in a periodic fee in the event of an increase or decrease in the number of people occupying a unit;</text> </paragraph> <paragraph num="(13)"> <text>Describe the policies of the facility regarding subscribers unable to meet the periodic charges;</text> </paragraph> <paragraph num="(14)"> <text>State in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, the terms governing the refund of any portion of the entrance fee in the event of:</text> <paragraph num="(a)"> <text>Discharge by the provider; or</text> </paragraph> <paragraph num="(b)"> <text>Termination by the subscriber;</text> </paragraph> </paragraph> <paragraph num="(15)"> <text>Include provisions governing contractual entrance fee refunds in accordance with the applicable requirements of Human Services Article, §10-449, Annotated Code of Maryland;</text> </paragraph> <paragraph num="(16)"> <text>State the terms under which an agreement is canceled by the death of a subscriber;</text> </paragraph> <paragraph num="(17)"> <text>State in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, whether or not periodic fees, if charged, will be subject to periodic increases;</text> </paragraph> <paragraph num="(18)"> <text>If periodic fees are subject to increase, state in clear and understandable language, and in all capital, underlined, and bold letters of the largest type used in the body of the agreement, the number of days of notice that will be given by the provider before an increase becomes effective;</text> </paragraph> <paragraph num="(19)"> <text>State that the charges for prepaid care may not be increased, if the agreement provides that care is paid for in advance, in one lump sum;</text> </paragraph> <paragraph num="(20)"> <text>State whether funeral and burial services are furnished by the provider;</text> </paragraph> <paragraph num="(21)"> <text>Identify the specific living unit initially assigned to the subscriber;</text> </paragraph> <paragraph num="(22)"> <text>State whether the subscriber may assign the use of a unit to another and, if so, under what conditions;</text> </paragraph> <paragraph num="(23)"> <text>If any additional costs or charges will be incurred by the subscriber for any modifications to the unit requested by the subscriber, provide a separate, written addendum to the agreement that:</text> <paragraph num="(a)"> <text>Describes the costs or charges;</text> </paragraph> <paragraph num="(b)"> <text>Is signed by the subscriber;</text> </paragraph> <paragraph num="(c)"> <text>States whether the additional costs or charges will be refunded in the event of cancellation or termination; and</text> </paragraph> <paragraph num="(d)"> <text>States whether there will be charges or costs assessed against the subscriber or the subscriber's estate for restoration when the subscriber permanently releases the unit;</text> </paragraph> </paragraph> <paragraph num="(24)"> <text>Describe any religious or charitable affiliations of the provider;</text> </paragraph> <paragraph num="(25)"> <text>Describe the extent to which an affiliate organization will be responsible for the financial and contractual obligations of the provider;</text> </paragraph> <paragraph num="(26)"> <text>State the subscriber's and provider's respective rights and obligations as to any real and personal property of the subscriber transferred to or placed in the custody of the provider;</text> </paragraph> <paragraph num="(27)"> <text>State the rights and obligations a subscriber has regarding the use of the facility, including common areas;</text> </paragraph> <paragraph num="(28)"> <text>State the rights and obligations a provider has regarding its use of the facility, including what, if any, rights the provider has to enter a subscriber's unit;</text> </paragraph> <paragraph num="(29)"> <text>State that subscribers have the right to:</text> <paragraph num="(a)"> <text>Organize and operate a subscriber's association at the facility; and</text> </paragraph> <paragraph num="(b)"> <text>Meet privately at the facility to conduct business;</text> </paragraph> </paragraph> <paragraph num="(30)"> <text>State that there is an internal grievance procedure to investigate the grievances of subscribers;</text> </paragraph> <paragraph num="(31)"> <text>State what fee adjustments, if any, will be made by the provider in the event of a subscriber's voluntary absence from the facility for an extended period of time;</text> </paragraph> <paragraph num="(32)"> <text>Specify the circumstances, if any, under which a subscriber will be required to apply for Medicaid, Medicare, public assistance, or any public benefit program;</text> </paragraph> <paragraph num="(33)"> <text>State whether the facility is or plans to be a participant in Medicare or Medicaid;</text> </paragraph> <paragraph num="(34)"> <text>In a separate paragraph, signed by each subscriber, state: “I have received a copy of the provider's latest certified financial statement at least 2 weeks before signing this agreement, and I have reviewed the certified financial statement provided.”;</text> </paragraph> <paragraph num="(35)"> <text>State that the provider will make available to each subscriber, upon request, any certified financial statement or disclosure statement submitted to the Department;</text> </paragraph> <paragraph num="(36)"> <text>If an agreement is executed before the provider has received an initial certificate for the unit identified in the agreement, state:</text> <paragraph num="(a)"> <text>The conditions that the provider must meet to be issued an initial certificate of registration by the Department; and</text> </paragraph> <paragraph num="(b)"> <text>That all deposits and entrance fees shall be held in an escrow account in Maryland in a financial institution until:</text> <paragraph num="(i)"> <text>An initial certificate of registration is issued,</text> </paragraph> <paragraph num="(ii)"> <text>A certificate of occupancy is received,</text> </paragraph> <paragraph num="(iii)"> <text>Construction is complete, and</text> </paragraph> <paragraph num="(iv)"> <text>The provider has been issued appropriate licenses or certificates by MDH, MHCC, and the Department;</text> </paragraph> </paragraph> </paragraph> <paragraph num="(37)"> <text>State that fees collected by a provider under the terms of a continuing care agreement may not be used for purposes other than those set forth in the agreement;</text> </paragraph> <paragraph num="(38)"> <text>Allow a subscriber to designate a beneficiary for receipt of any refundable portion of the entrance fee, if:</text> <paragraph num="(a)"> <text>The designation is in writing;</text> </paragraph> <paragraph num="(b)"> <text>The designation is witnessed by two or more competent witnesses;</text> </paragraph> <paragraph num="(c)"> <text>The designation is noncontingent; and</text> </paragraph> <paragraph num="(d)"> <text>The designation is specified in percentages and accounts for 100 percent of the refund due;</text> </paragraph> </paragraph> <paragraph num="(39)"> <text>State in boldface type of the largest font used in the body of the contract: “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> </paragraph> <paragraph num="(40)"> <text>State the legal remedies available to a subscriber in the event of injury caused by a provider's violation of the Act;</text> </paragraph> <paragraph num="(41)"> <text>In a separate paragraph, signed by each subscriber, state: “I have received a copy of the provider's latest disclosure statement, and I have reviewed the disclosure statement provided.”; and</text> </paragraph> <paragraph num="(42)"> <text>State that if there are differences between the requirements for continuing care certification and the licensure requirements for assisted living and comprehensive care facilities, the applicable requirements most favorable to the subscriber will prevail while the subscriber is residing in an assisted living or comprehensive care unit.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Each continuing care agreement may contain any other provisions which are:</text> <paragraph num="(1)"> <text>Agreed upon by the provider and the subscriber to effectuate the purpose of the contract; and</text> </paragraph> <paragraph num="(2)"> <text>Not in conflict with the Act or this chapter, as determined by the Department.</text> </paragraph> </paragraph> <paragraph num="C."> <text>A preliminary certificate of registration may not be issued by the Department if the agreement submitted with the application does not contain all of the provisions of §A of this regulation. The Department shall return to the provider for revision any agreement which it finds in violation of the applicable requirements of the Act or this chapter. The provider shall submit the agreement to an attorney for legal sufficiency as to content and form before resubmission to the Department.</text> </paragraph> <paragraph num="D."> <text>The provider shall request approval from the Department for any modification, addition, or deletion to the terms of a continuing care agreement, before the agreement is offered to or used with subscribers.</text> </paragraph> <paragraph num="E."> <text>Except as provided in §A(38) of this regulation, agreements are governed by the version of this regulation that was in effect at the time the agreement was executed by the parties.</text> </paragraph> <paragraph num="F."> <text>If changes to the form of any continuing care agreement currently in use are proposed for implementation, the provider or its attorney shall submit a separate cover letter to the Department with the following:</text> <paragraph num="(1)"> <text>Two clean copies of the entire proposed continuing care agreement or such portion of the proposed continuing care agreement as is acceptable to the Department under the circumstances;</text> </paragraph> <paragraph num="(2)"> <text>Two redlined copies that highlight all proposed additions, deletions, and other changes, by underlining, italic type, blacklining, or such other method or symbols that indicate clearly any changes, to:</text> <paragraph num="(a)"> <text>If applicable, the last version of the document in question that was approved by the Department;</text> </paragraph> <paragraph num="(b)"> <text>If requested by the Department, the provider's prior draft of the document in question; and</text> </paragraph> <paragraph num="(c)"> <text>If requested by the Department, the provider's other similar version of the document in question; and</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>If the continuing care agreement is being substantially revised, a completed copy of a contract worksheet form issued by the Department.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".29" heading="Withdrawal of Application or Rescission of Agreement Before Occupancy Date."> <paragraph num="A."> <text>Withdrawal of Application. A person seeking admission to a continuing care facility may withdraw an application at any time before execution of the continuing care agreement. A provider shall refund within not more than 60 days of the withdrawal all money paid, less any nonrefundable processing fee that was specified in the deposit agreement, to a prospective subscriber who withdraws an application before signing a continuing care agreement.</text> </paragraph> <paragraph num="B."> <text>Rescission of Agreement Before the Occupancy Date.</text> <paragraph num="(1)"> <text>If the subscriber rescinds the agreement before the date of occupancy, and the rescission either occurs within 90 days after entering into the agreement or because of a substantial change in the subscriber's physical, mental, or financial condition, the provider shall, within 30 days of rescission, refund all moneys paid by the subscriber except:</text> <paragraph num="(a)"> <text>Any processing fee previously specified as nonrefundable; and</text> </paragraph> <paragraph num="(b)"> <text>Special additional costs incurred by the provider due to modifications in the structure or furnishings of the unit specifically requested by the subscriber, but only if the:</text> <paragraph num="(i)"> <text>Costs do not exceed the costs of modification or the reasonable costs of restoration actually incurred by the provider, and</text> </paragraph> <paragraph num="(ii)"> <text>Modification was described in writing in a separate addendum to the agreement as required by Regulation .28A(23) of this chapter.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(2)"> <text>If the subscriber rescinds the agreement before the date of occupancy, but more than 90 days after entering into the agreement, for any reason other than a substantial change in the subscriber's physical, mental, or financial condition, the provider shall refund the same amount specified in §B(1) of this regulation, except that the provider may require that the subscriber forfeit part of the refund. The forfeiture amount may not exceed 25 percent of any deposit paid by the subscriber.</text> </paragraph> <paragraph num="(3)"> <text>If a subscriber rescinds an agreement before the date of occupancy because of a substantial change in the subscriber's physical, mental, or financial condition, the provider shall refund the same amount specified in §B(1) of this regulation.</text> </paragraph> <paragraph num="(4)"> <text>If a provider rescinds an agreement before occupancy because it determines that the subscriber is not eligible for entrance into the facility, the provider shall refund the same amount specified in §B(1) of this regulation.</text> </paragraph> <paragraph num="(5)"> <text>If a subscriber dies before the date of occupancy, the agreement is automatically canceled, and the provider shall refund to the subscriber's legal representative the same amount specified in §B(1) of this regulation, except that the cancellation is not automatic and is at the option of the surviving subscriber if the agreement is in the name of two subscribers.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".30" heading="Rescissions for Violation of the Act."> <text>If the terms of an agreement are in violation of the terms of the Act and a subscriber is injured by the violation, the subscriber may rescind the agreement at any time. The subscriber is entitled to treble damages for extensive injuries arising from a violation.</text> </regulation> <regulation prefix="Regulation" num=".31" heading="Termination of the Agreement After the Occupancy Date."> <paragraph num="A."> <text>Termination by a Subscriber. If the subscriber elects to terminate the agreement after the date of occupancy, refund of the entrance fee is governed by the terms of the agreement.</text> </paragraph> <paragraph num="B."> <text>Dismissal or Discharge by the Provider.</text> <paragraph num="(1)"> <text>An agreement may not permit dismissal or discharge of a subscriber from a facility, including by involuntary transfer to an accommodation outside the facility, before expiration of the agreement for any reason, unless the:</text> <paragraph num="(a)"> <text>Dismissal or discharge is for just cause; and</text> </paragraph> <paragraph num="(b)"> <text>Subscriber is given advance notice of at least 60 days.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Just cause can exist only when there is:</text> <paragraph num="(a)"> <text>Nonpayment;</text> </paragraph> <paragraph num="(b)"> <text>Material breach of:</text> <paragraph num="(i)"> <text>The agreement, or</text> </paragraph> <paragraph num="(ii)"> <text>Written reasonable rules of the provider that contractually bind the subscriber; or</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>Health status or behavior that constitutes a substantial threat to the health or safety of the subscriber or other subscribers.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>A notice of dismissal or discharge shall include at least the following:</text> <paragraph num="(a)"> <text>A statement of the intent to dismiss or discharge;</text> </paragraph> <paragraph num="(b)"> <text>A statement of each reason for dismissing or discharging, which shall include at least one of the reasons stated in §B(2) of this regulation;</text> </paragraph> <paragraph num="(c)"> <text>The facts that serve as the basis for the provider's decision to dismiss or discharge; and</text> </paragraph> <paragraph num="(d)"> <text>The effective date of dismissal or discharge, which shall be at least 60 days from the date the subscriber receives the notice.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>An agreement may recognize that a subscriber may have to be moved in the event of an emergency. A move or transfer of a subscriber to an accommodation outside the facility because of an emergency may not, in and of itself, establish just cause for a dismissal or discharge.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Permissible Dismissal or Discharge.</text> <paragraph num="(1)"> <text>In the event of a permissible dismissal or discharge, the provider shall pay to the discharged subscriber a refund equal to the subscriber's total entrance fee divided by the subscriber's years of expected life at admission multiplied by the subscriber's years of expected life at discharge or dismissal. Years of expected life at admission and at dismissal or discharge shall be computed at the time of discharge or dismissal. The computations shall be based upon the appropriate life tables in the most recently published version of the United States Decennial Life Tables published by the U.S. Department of Health and Human Services.</text> </paragraph> <paragraph num="(2)"> <text>A refund paid after a permissible dismissal or discharge shall be paid within 60 days of the later of the:</text> <paragraph num="(a)"> <text>Effective date of the discharge or dismissal; or</text> </paragraph> <paragraph num="(b)"> <text>Subscriber's vacating the unit.</text> </paragraph> </paragraph> </paragraph> <paragraph num="D."> <text>In the event of a discharge or dismissal of one subscriber from a unit occupied by two or more subscribers, the subscriber not discharged from the unit has the option to terminate the agreement and receive a refund based on the formula described in §C of this regulation.</text> </paragraph> <paragraph num="E."> <text>In the event of a discharge of two subscribers who contracted for a single two-subscriber unit, or in cases where the option in §D of this regulation is selected, the refund shall be calculated based on the assumption that the entrance fee is attributable in equal shares to each subscriber. One half of the entrance fee is multiplied and divided by the appropriate life expectancy of each subscriber, and the results added to determine the total refund.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".32" heading="Public Information."> <paragraph num="A."> <text>The Department shall:</text> <paragraph num="(1)"> <text>Make the information required to be provided under this chapter available to all interested persons; and</text> </paragraph> <paragraph num="(2)"> <text>Publicize the availability of this information.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Information will be made available for review to all interested persons under COMAR 32.01.02.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".33" heading="Inspection by the Department."> <paragraph num="A."> <text>The Department may:</text> <paragraph num="(1)"> <text>Inspect any facility offering continuing care;</text> </paragraph> <paragraph num="(2)"> <text>Examine the records of a provider or person that controls a provider; and</text> </paragraph> <paragraph num="(3)"> <text>Audit or observe any service rendered under a continuing care agreement.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A provider shall cooperate with the Department in all reasonable requests to inspect, examine, audit, or observe the provider, the facility, the services, and the records of the provider.</text> </paragraph> <paragraph num="C."> <text>If a continuing care facility or a portion of a facility is subject to licensure by MDH, the Department shall coordinate any inspection of the facility or portion of the facility with MDH to avoid duplication.</text> </paragraph> <paragraph num="D."> <text>Failure of the provider to permit reasonable requests for inspection, examination, or audit is a violation of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".34" heading="Removal of Records and Accounts."> <paragraph num="A."> <text>A provider may not remove from the State records or assets of the provider related to the operation of the facility or the provision of services under continuing care agreements without the written consent of the Department.</text> </paragraph> <paragraph num="B."> <text>A provider may request from the Department approval to remove records or assets from the State by submitting the verification that the Department requires to establish that removal of records or assets will:</text> <paragraph num="(1)"> <text>Facilitate the operations of the provider and make the operations more economical; and</text> </paragraph> <paragraph num="(2)"> <text>Not diminish the service or protection given to the provider's subscribers.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The Department may not consent to the removal until the Secretary determines that the removal of records and assets meets the conditions of §B of this regulation.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".35" heading="Administrative Sanctions."> <paragraph num="A."> <text>The Secretary may deny, suspend, or revoke a preliminary, initial, or renewal certificate of registration for cause. Cause for denial, suspension, or revocation includes, but is not limited to the following:</text> <paragraph num="(1)"> <text>Violations of the provisions of the Act;</text> </paragraph> <paragraph num="(2)"> <text>Violations of regulations in this chapter;</text> </paragraph> <paragraph num="(3)"> <text>Misrepresentations of fact to the Department or to subscribers;</text> </paragraph> <paragraph num="(4)"> <text>Submission of false financial information to the Department;</text> </paragraph> <paragraph num="(5)"> <text>Failure to prepare or implement an adequate corrective financial plan when found to be in financial difficulty; or</text> </paragraph> <paragraph num="(6)"> <text>Agreement terms or provisions that:</text> <paragraph num="(a)"> <text>Violate the Act,</text> </paragraph> <paragraph num="(b)"> <text>Violate regulations in this chapter, or</text> </paragraph> <paragraph num="(c)"> <text>Are not approved by the Department.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>The denial, suspension, or revocation of a certificate of registration is an action of the Secretary that may be appealed in accordance with Regulation .36 of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".36" heading="Appeals."> <text>An applicant for, or a holder of, a feasibility study approval, preliminary certificate, initial certificate, or renewal certificate that is aggrieved by a denial of a certificate of registration, by a revocation of a certificate of registration, or by any other action of the Department or Secretary under this chapter, may file a written appeal. An appeal of any action taken by the Department or Secretary under this chapter shall be conducted in accordance with the Maryland Administrative Procedure Act, State Government Article, Title 10, Subtitles 2 and 3, Annotated Code of Maryland, and COMAR 32.01.01.</text> </regulation> <annotations> <annotation type="Authority">Human Services Article, §10-403, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: December 26, 1980 (7:26 Md. R. 2423)</annotation> <annotation type="History" subtype="Administrative History">Regulations .02B, .04A, .08, .10, and .14 amended effective March 28, 1983 (10:6 Md. R. 559)</annotation> <annotation type="History" subtype="Administrative History">Regulations .04A, .05A, .06, and .09 amended effective December 31, 1984 (11:26 Md. R. 2280)</annotation> <annotation type="History" subtype="Administrative History">Regulation .07 repealed and new Regulation .07 adopted effective December 31, 1984 (11:26 Md. R. 2280)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01—.22 repealed and new Regulations .01—.22 adopted effective June 2, 1986 (13:11 Md. R. 1274)</annotation> <annotation type="History" subtype="Administrative History">Regulation .01B amended effective December 1, 1989 (16:23 Md. R. 2506); November 25, 1991 (18:23 Md. R. 2491)</annotation> <annotation type="History" subtype="Administrative History">Regulation .03A amended effective December 1, 1989 (16:23 Md. R. 2506); September 23, 1996 (23:19 Md. R. 1377)</annotation> <annotation type="History" subtype="Administrative History">Regulation .03B and C amended effective November 25, 1991 (18:23 Md. R. 2491)</annotation> <annotation type="History" subtype="Administrative History">Regulation .04A amended effective November 25, 1991 (18:23 Md. R. 2491)</annotation> <annotation type="History" subtype="Administrative History">Regulation .09 amended effective November 25, 1991 (18:23 Md. R. 2491)</annotation> <annotation type="History" subtype="Administrative History">Regulation .09C amended effective December 1, 1989 (16:23 Md. R. 2506); June 22, 1992 (19:12 Md. R. 1136); September 23, 1996 (23:19 Md. R. 1377)</annotation> <annotation type="History" subtype="Administrative History">Regulation .09E amended effective December 1, 1989 (16:23 Md. R. 2506)</annotation> <annotation type="History" subtype="Administrative History">Regulation .09G amended effective June 22, 1992 (19:12 Md. R. 1136)</annotation> <annotation type="History" subtype="Administrative History">Regulation .10A amended effective November 25, 1991 (18:23 Md. R. 2491)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01—.22 repealed and new Regulations .01—.36 adopted effective July 27, 1998 (25:15 Md. R. 1192)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.02 to COMAR 32.02.01, October 2000</annotation> <annotation type="History" subtype="Administrative History">Regulation .01B amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .02B amended effective October 6, 2008 (35:20 Md. R. 1777)</annotation> <annotation type="History" subtype="Administrative History">Regulation .02B, E amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .03B amended effective March 1, 2004 (31:4 Md. R. 318)</annotation> <annotation type="History" subtype="Administrative History">Regulation .04 amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .05A amended effective November 6, 2006 (33:22 Md. R. 1734); March 22, 2010 (37:6 Md. R. 481)</annotation> <annotation type="History" subtype="Administrative History">Regulation .06L, M amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .07A amended effective March 22, 2010 (37:6 Md. R. 481)</annotation> <annotation type="History" subtype="Administrative History">Regulation .07A, B amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .09B amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .10A amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .11B amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .12D amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .13 amended effective October 6, 2008 (35:20 Md. R. 1777); March 22, 2010 (37:6 Md. R. 481)</annotation> <annotation type="History" subtype="Administrative History">Regulation .13C amended effective March 1, 2004 (31:4 Md. R. 318); March 4, 2013 (40:4 Md. R. 348); August 29, 2016 (43:17 Md. R. 959)</annotation> <annotation type="History" subtype="Administrative History">Regulation .13C, F amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .13D amended effective December 25, 2000 (27:25 Md. R. 2283)</annotation> <annotation type="History" subtype="Administrative History">Regulation .14 amended effective March 22, 2010 (37:6 Md. R. 481)</annotation> <annotation type="History" subtype="Administrative History">Regulation .17E amended effective March 1, 2004 (31:4 Md. R. 318); June 20, 2016 (43:12 Md. R. 668)</annotation> <annotation type="History" subtype="Administrative History">Regulation .19 amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .20 amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .21C amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .22C amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .23D amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .23G amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .24B, H amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .25 amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .26 amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .27A, C amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .28C amended effective March 22, 2010 (37:6 Md. R. 481)</annotation> <annotation type="History" subtype="Administrative History">Regulation .28A, E amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .28F adopted effective March 22, 2010 (37:6 Md. R. 481)</annotation> <annotation type="History" subtype="Administrative History">Regulation .29 amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .32B amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .34C amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .35B amended effective November 6, 2006 (33:22 Md. R. 1734)</annotation> <annotation type="History" subtype="Administrative History">Regulation .36 amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> </annotations> </chapter> <chapter num="02" heading="Certificate of Registration for Continuing Care at Home Providers"> <regulation prefix="Regulation" num=".01" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Act” means the portion of Human Services Article, Title 10, Subtitle 4,, Annotated Code of Maryland, as specified in §10-402(a).</text> </paragraph> <paragraph num="(2)"> <text>“Actuarial balance sheet” means a balance sheet that uses actuarial principles and practices to determine the value of certain items in the balance sheet based on actuarial techniques involving reasonable assumptions about contingencies, inflation, and the time value of money as applied to current subscribers, which items include the present value of:</text> <paragraph num="(a)"> <text>Future periodic fees;</text> </paragraph> <paragraph num="(b)"> <text>The costs of providing promised future services; and</text> </paragraph> <paragraph num="(c)"> <text>The obligation for refundable entrance fees.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>“Agreement” means an agreement between a provider and subscriber that is a contract to provide continuing care at home.</text> </paragraph> <paragraph num="(4)"> <text>“Assisted living unit” means a unit in which the services rendered will require the provider to be licensed as an assisted living program under Health-General Article, §19-1805, Annotated Code of Maryland.</text> </paragraph> <paragraph num="(5)"> <text>Authority Recognized by the Department.</text> <paragraph num="(a)"> <text>"Authority recognized by the Department" means a person whom the Department determines has the knowledge and experience of the continuing care industry necessary to produce the particular materials required by a given regulation in this chapter.</text> </paragraph> <paragraph num="(b)"> <text>"Authority recognized by the Department" includes an independent consultant or an employee of a provider or related entity.</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>“Authorized officer” means an individual holding one of the following positions with a provider:</text> <paragraph num="(a)"> <text>An officer;</text> </paragraph> <paragraph num="(b)"> <text>A general partner;</text> </paragraph> <paragraph num="(c)"> <text>Any individual who serves on the governing body; and</text> </paragraph> <paragraph num="(d)"> <text>A trustee of the provider.</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>“Break-even point” means the projected point at which a provider's total revenue from continuing care at home agreements will begin to equal or exceed the provider's total expenses.</text> </paragraph> <paragraph num="(8)"> <text>“Certified financial statement” means a financial statement, prepared in accordance with generally accepted accounting principles by an independent certified public accountant, that includes an audit opinion, balance sheet, income statement, statement of cash flows, and the related notes to the financial statement.</text> </paragraph> <paragraph num="(9)"> <text>“Certified financial statement for the most recent fiscal year for which a certified financial statement is available” means:</text> <paragraph num="(a)"> <text>For providers who annually receive a certified financial statement within 120 days of the end of their fiscal year, the most recently dated financial statement; and</text> </paragraph> <paragraph num="(b)"> <text>For any other providers, assuming that a certified financial statement is obtainable under generally accepted auditing standards, a certified financial statement that is not greater than 120 days old.</text> </paragraph> </paragraph> <paragraph num="(10)"> <text>“Chief executive officer” means the individual whose primary responsibility is to oversee all aspects of the operation of the provider.</text> </paragraph> <paragraph num="(11)"> <text>“Committee” means Financial Review Committee.</text> </paragraph> <paragraph num="(12)"> <text>“Continuing care at home” means furnishing services, either directly or by contractual arrangement, to the public where:</text> <paragraph num="(a)"> <text>The services include health services and assistance with the maintenance of a subscriber's dwelling;</text> </paragraph> <paragraph num="(b)"> <text>The health services include:</text> <paragraph num="(i)"> <text>Medical services,</text> </paragraph> <paragraph num="(ii)"> <text>Nursing services,</text> </paragraph> <paragraph num="(iii)"> <text>Assisted living or comprehensive care services in an assisted living or comprehensive care facility, or</text> </paragraph> <paragraph num="(iv)"> <text>Assistance with the activities of daily living, other than the provision of meals, in a subscriber's dwelling;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>The services are offered to individuals who are:</text> <paragraph num="(i)"> <text>60 years old or older, and</text> </paragraph> <paragraph num="(ii)"> <text>Not related to the provider by blood or marriage;</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>The services are offered for:</text> <paragraph num="(i)"> <text>The life of the subscriber, or</text> </paragraph> <paragraph num="(ii)"> <text>A period in excess of 1 year; and</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>The services are offered under a written agreement that requires:</text> <paragraph num="(i)"> <text>A transfer of assets from the subscriber to the provider,</text> </paragraph> <paragraph num="(ii)"> <text>An entrance fee, or</text> </paragraph> <paragraph num="(iii)"> <text>Both a transfer of assets and an entrance fee.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(13)"> <text>Control.</text> <paragraph num="(a)"> <text>“Control” means the power to direct, or cause the direction of, the management and policies of a provider through the ownership of voting securities, by contract, or otherwise.</text> </paragraph> <paragraph num="(b)"> <text>“Control” includes a parent or sole corporate member of a corporation directly participating in the initiation or approval of policies directly affecting the operations, including approval of budgets or approval of the chief executive officer of the provider.</text> </paragraph> </paragraph> <paragraph num="(14)"> <text>“Department” means the Maryland Department of Aging.</text> </paragraph> <paragraph num="(15)"> <text>“Deposit” means a portion of the entrance fee.</text> </paragraph> <paragraph num="(16)"> <text>Deposit Agreement.</text> <paragraph num="(a)"> <text>“Deposit agreement” means a preliminary agreement between the subscriber and the provider by which the provider reserves for the subscriber the right to contract for continuing care at home in return for payment by the subscriber of a deposit.</text> </paragraph> <paragraph num="(b)"> <text>“Deposit agreement” includes any agreement of similar form and use, regardless of title, including priority agreement and reservation agreement.</text> </paragraph> </paragraph> <paragraph num="(17)"> <text>Entrance Fee.</text> <paragraph num="(a)"> <text>“Entrance fee” means a sum of money or other consideration, other than a surcharge, paid initially or in deferred payments, that:</text> <paragraph num="(i)"> <text>Assures a subscriber continuing care at home for a term of more than 1 year or for life; and</text> </paragraph> <paragraph num="(ii)"> <text>Is at least equal to the greater of either 12 times the monthly cost of the basic periodic fees charged under an agreement or $5,000.</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>“Entrance fee” includes a fee of similar form and application, regardless of title.</text> </paragraph> </paragraph> <paragraph num="(18)"> <text>“Escrow agreement” means an agreement between the provider and a financial institution by which deposits and entrance fees are held in Maryland by the financial institution until release is permitted by law or regulation.</text> </paragraph> <paragraph num="(19)"> <text>“Facility” means a physical plant and related grounds, other than a subscriber's dwelling, used to provide assisted living or comprehensive care services to continuing care at home subscribers, in accordance with this chapter.</text> </paragraph> <paragraph num="(20)"> <text>“Financial difficulty” means the current or impending financial condition of a provider which currently impairs or may impair the ability of the provider to meet existing or future obligations to subscribers or other creditors.</text> </paragraph> <paragraph num="(21)"> <text>“Fiscal year” means the fiscal year of the provider.</text> </paragraph> <paragraph num="(22)"> <text>“Generally accepted accounting principles” means those accounting principles and practices adopted by the Financial Accounting Standards Board and the American Institute of Certified Public Accountants, which include the principles expressed in the American Institute of Certified Public Accountants' “Audit and Accounting Guide for Health Care Organizations”.</text> </paragraph> <paragraph num="(23)"> <text>“Governing body” means an individual or group of individuals with authority to direct, control, and manage the policies and business affairs of the provider, including groups such as boards of directors, boards of trustees, management committees, and executive committees.</text> </paragraph> <paragraph num="(24)"> <text>“MDH” means the Maryland Department of Health.</text> </paragraph> <paragraph num="(25)"> <text>“MHCC” means the Maryland Health Care Commission.</text> </paragraph> <paragraph num="(26)"> <text>“Person” means an individual, firm, association, corporation, company, trust, partnership, limited liability company, public body, or other business or nonprofit entity.</text> </paragraph> <paragraph num="(27)"> <text>“Processing fee” means a one-time fee charged by the provider to determine the financial, mental, and physical eligibility of an individual who seeks to enter a continuing care at home agreement.</text> </paragraph> <paragraph num="(28)"> <text>“Provider” means a person who is an applicant for, or the holder of, a certificate of registration to provide continuing care at home.</text> </paragraph> <paragraph num="(29)"> <text>“Qualified actuary” means a member in good standing of the American Academy of Actuaries.</text> </paragraph> <paragraph num="(30)"> <text>“Records” means the information, books, and data maintained for the operation of a provider in accordance with this chapter.</text> </paragraph> <paragraph num="(31)"> <text>“Renewal” means the renewal of a certificate of registration required annually to permit the provider to continue to offer continuing care at home to the public.</text> </paragraph> <paragraph num="(32)"> <text>“Secretary” means the Secretary of Aging.</text> </paragraph> <paragraph num="(33)"> <text>“Subscriber” means an individual for whom continuing care at home is purchased under an agreement.</text> </paragraph> <paragraph num="(34)"> <text>Subscriber's Dwelling.</text> <paragraph num="(a)"> <text>“Subscriber's dwelling” means a house, apartment, condominium, cooperative, or other place where a subscriber lives and has agreed to live while receiving continuing care at home services.</text> </paragraph> <paragraph num="(b)"> <text>“Subscriber's dwelling” does not include facilities licensed by the Maryland Department of Health as an assisted living program or a comprehensive care facility or by the Department as a continuing care facility under COMAR 32.02.01.</text> </paragraph> </paragraph> <paragraph num="(35)"> <text>“Surcharge” means a separate and additional charge, other than a second-person entrance fee, imposed simultaneously with the entrance fee, that may be required of some, but not all, subscribers because of a condition or circumstance that applies only to those subscribers.</text> </paragraph> <paragraph num="(36)"> <text>Unit.</text> <paragraph num="(a)"> <text>“Unit” means a suite, room, cottage, apartment, or any other type of quarters that is located at a facility in which a subscriber is to reside while receiving assisted living or comprehensive care benefits under a continuing care at home agreement.</text> </paragraph> <paragraph num="(b)"> <text>“Unit” includes individual beds licensed for assisted living and comprehensive care so that each assisted living bed and comprehensive care bed constitutes a unit.</text> </paragraph> <paragraph num="(c)"> <text>“Unit” does not include a subscriber's dwelling.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".02" heading="General Requirements to Offer Continuing Care at Home."> <paragraph num="A."> <text>A provider may not offer continuing care at home or collect deposits for continuing care at home without having secured the necessary feasibility study approval.</text> </paragraph> <paragraph num="B."> <text>A provider may not provide continuing care at home without having secured an initial certificate of registration from the Department.</text> </paragraph> <paragraph num="C."> <text>Submissions.</text> <paragraph num="(1)"> <text>The submissions described in this section shall be filed with and approved by the Department.</text> </paragraph> <paragraph num="(2)"> <text>Statement of Intent. An entity which intends to offer continuing care at home agreements shall file a statement of intent with the Department at least 30 days before submission of the feasibility study.</text> </paragraph> <paragraph num="(3)"> <text>Application for Approval of Feasibility Study. A provider shall obtain approval by the Department of a feasibility study before a provider may collect deposits for continuing care at home. Deposits collected for continuing care at home shall be maintained in an escrow account held in Maryland in a federally insured depository under an escrow agreement approved by the Department.</text> </paragraph> <paragraph num="(4)"> <text>Application for Preliminary Certificate. A preliminary certificate of registration is required before a provider may offer or enter into continuing care at home agreements.</text> </paragraph> <paragraph num="(5)"> <text>Application for Initial Certificate. An initial certificate of registration is required before a provider may provide services under a continuing care at home agreement.</text> </paragraph> <paragraph num="(6)"> <text>Application for Renewal of Certificate of Registration. A current certificate of registration or provisional renewal certificate of registration is required to continue to operate as a continuing care at home provider.</text> </paragraph> </paragraph> <paragraph num="D."> <text>A provider may not offer or enter into a deposit agreement or an agreement, unless the terms of the agreements have been approved by the Department.</text> </paragraph> <paragraph num="E."> <text>Basic Services. A provider shall, at a minimum, provide the following services to all the provider's subscribers as needed:</text> <paragraph num="(1)"> <text>Care coordination services that assist subscribers to:</text> <paragraph num="(a)"> <text>Determine what services they need and when they need them,</text> </paragraph> <paragraph num="(b)"> <text>Access all the services provided or coordinated by the provider,</text> </paragraph> <paragraph num="(c)"> <text>Identify other entities that can assist subscribers with their needs, and</text> </paragraph> <paragraph num="(d)"> <text>Apply for and access services in addition to the basic services described in this section;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The number of home inspections required by §F of this regulation, which shall be conducted by an occupational therapist to:</text> <paragraph num="(a)"> <text>Assess a subscriber's functioning and safety in the subscriber's dwelling, and</text> </paragraph> <paragraph num="(b)"> <text>Recommend any modifications to the dwelling that would help the subscriber overcome or minimize any safety issues or functional limitations;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>Assistance with activities of daily living in the subscriber's dwelling;</text> </paragraph> <paragraph num="(4)"> <text>Skilled nursing services in the subscriber's dwelling;</text> </paragraph> <paragraph num="(5)"> <text>The routine services of a licensed assisted living facility;</text> </paragraph> <paragraph num="(6)"> <text>The routine services of a licensed comprehensive care facility; and</text> </paragraph> <paragraph num="(7)"> <text>The amount of assistance with the maintenance of a subscriber's dwelling required by §H of this regulation.</text> </paragraph> </paragraph> <paragraph num="F."> <text>Home Inspections by Occupational Therapist. The minimum number of home inspections by an occupational therapist that a provider shall pay for is at least:</text> <paragraph num="(1)"> <text>An initial inspection upon entering the agreement and an additional inspection every other year after that; or</text> </paragraph> <paragraph num="(2)"> <text>Five inspections during the term of the agreement, which shall be provided when requested by the subscriber.</text> </paragraph> </paragraph> <paragraph num="G."> <text>Required Amounts of Assistance with Activities of Daily Living and Nursing Services.</text> <paragraph num="(1)"> <text>A provider may include in its agreement a lifetime maximum dollar amount it will pay for the services required by §E(3)—(6) of this regulation. If a maximum dollar amount is used, it shall be at least $150,000. Provision of either assistance with activities of daily living or nursing services, whether delivered in the subscriber's dwelling, an assisted living facility, or a comprehensive care facility, may be counted toward the maximum.</text> </paragraph> <paragraph num="(2)"> <text>Assistance with activities of daily living services shall be provided whenever a subscriber needs assistance with two or more activities of daily living. The threshold for when assistance with activities of daily living services will be provided may be set lower as long as the threshold standard is applied uniformly to all subscribers using consistent assessment practices.</text> </paragraph> <paragraph num="(3)"> <text>A provider may include in an agreement a daily, weekly, or monthly benefit amount it will pay for particular services required by §E(3)—(6) of this regulation. If it does include amounts in an agreement, the amount for assistance with activities of daily living services shall be at least 50 percent of the amount specified for services of a licensed comprehensive care facility.</text> </paragraph> <paragraph num="(4)"> <text>A provider may exclude services covered by Medicare from the services for which it otherwise would be required to pay. If a provider includes an exclusion in its agreement, services covered by Medicare may not be counted towards the lifetime maximum dollar amount permitted by §G(1) of this regulation.</text> </paragraph> </paragraph> <paragraph num="H."> <text>Assistance with Dwelling Maintenance.</text> <paragraph num="(1)"> <text>In order to provide assistance with the maintenance of a subscriber's dwelling, a provider shall, at a minimum, provide a referral service that refers subscribers to vendors and suppliers who will contract with a subscriber to perform repair and maintenance services.</text> </paragraph> <paragraph num="(2)"> <text>The provider shall:</text> <paragraph num="(a)"> <text>Check the liability insurance coverage and any applicable licenses; and</text> </paragraph> <paragraph num="(b)"> <text>Review the referral list for any changes in insurance coverage, licenses, or quality of service every 2 years.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>A provider may also directly provide repair and maintenance services to subscribers through its employees or contractual arrangements with third parties.</text> </paragraph> </paragraph> <paragraph num="I."> <text>Payment for Basic Services.</text> <paragraph num="(1)"> <text>The minimum basic services required by §E of this regulation shall be paid for by the following methods:</text> <paragraph num="(a)"> <text>An entrance fee paid in advance of the receipt of the basic services;</text> </paragraph> <paragraph num="(b)"> <text>Regular periodic charges that guarantee basic services when needed;</text> </paragraph> <paragraph num="(c)"> <text>For some or all of the basic services required by §E(2)—(7) of this regulation, a copayment from the subscriber of 30 percent or less of the actual cost; or</text> </paragraph> <paragraph num="(d)"> <text>A combination of the arrangements described in §I(1)(a)—(c).</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>A subscriber may not be charged for the minimum amount of basic services required by §§E—H of this regulation on a fee-for-service basis.</text> </paragraph> <paragraph num="(3)"> <text>Services in excess of the minimum amount of basic services required by §§E—H of this regulation may be charged for on a fee-for-service basis.</text> </paragraph> <paragraph num="(4)"> <text>A provider may charge on a fee-for-service basis for services other than those required by §E of this regulation.</text> </paragraph> </paragraph> <paragraph num="J."> <text>A provider may not disseminate advertising or circulars which are deceptive, misleading, or likely to mislead.</text> </paragraph> <paragraph num="K."> <text>Special Conditions.</text> <paragraph num="(1)"> <text>A provider applying for a certificate of registration whose personal, professional, or financial history causes the Secretary to question the provider's financial or administrative ability to provide continuing care at home in compliance with this chapter, shall submit to the Department evidence demonstrating financial or administrative soundness, or both, as the Secretary considers appropriate. This information may only be sought in special circumstances and may not be required as a matter of course.</text> </paragraph> <paragraph num="(2)"> <text>The Secretary shall:</text> <paragraph num="(a)"> <text>Approve the application unconditionally;</text> </paragraph> <paragraph num="(b)"> <text>Require the provider to use the services of a management firm; or</text> </paragraph> <paragraph num="(c)"> <text>Deny the application.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>A management firm required by §K(2)(b) of this regulation shall be selected by the provider subject to the approval of the Department. Approval of a management firm that currently does business in Maryland, has projects in good standing under the Act, and which has not had a fiduciary or consultant relationship with the Department may not be denied without cause. The management firm shall assume full operational and financial responsibilities. The Secretary may not require utilization of a management firm for a period that exceeds 24 months.</text> </paragraph> </paragraph> <paragraph num="L."> <text>A party aggrieved by a decision of the Secretary under this regulation has the right to appeal under Regulation .31 of this chapter.</text> </paragraph> <paragraph num="M."> <text>A provider who is denied approval of submissions required by §C(3) or (4) of this regulation may reapply 1 year after the date of denial.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Preliminary Certificate of Registration."> <paragraph num="A."> <text>Process to Obtain a Preliminary Certificate of Registration. A person shall file a:</text> <paragraph num="(1)"> <text>Statement of intent under Regulation .04 of this chapter;</text> </paragraph> <paragraph num="(2)"> <text>A feasibility study under Regulation .05 of this chapter; and</text> </paragraph> <paragraph num="(3)"> <text>An application under Regulation .06 of this chapter.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Forms and Fees for Feasibility Study and Application.</text> <paragraph num="(1)"> <text>A feasibility study and an application for a preliminary certificate of registration shall be submitted with forms provided by the Department.</text> </paragraph> <paragraph num="(2)"> <text>A fee of $20,000 shall accompany a feasibility study.</text> </paragraph> <paragraph num="(3)"> <text>The Department may charge an additional fee, not to exceed the original fee, if resubmission of a feasibility study to the Department is required due to:</text> <paragraph num="(a)"> <text>Significant changes in the assumptions upon which the feasibility study was based;</text> </paragraph> <paragraph num="(b)"> <text>Correction of significant errors in the feasibility study; or</text> </paragraph> <paragraph num="(c)"> <text>A significant omission in the original feasibility study submission.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Statement of Intent to Apply for a Preliminary Certificate."> <paragraph num="A."> <text>Statement of Intent. An entity that intends to offer continuing care at home agreements shall file a statement of intent with the Department at least 30 days before submission of a feasibility study. If a feasibility study is not filed by the provider within 60 days after the statement of intent is filed, a new statement of intent shall be filed with the Department at least 30 days before submission of a feasibility study.</text> </paragraph> <paragraph num="B."> <text>Contents. A statement of intent shall contain, at a minimum, the following information:</text> <paragraph num="(1)"> <text>The name of the provider;</text> </paragraph> <paragraph num="(2)"> <text>Whether entrance fees will be refundable or nonrefundable;</text> </paragraph> <paragraph num="(3)"> <text>The types of agreements proposed to generate the required contract reserves;</text> </paragraph> <paragraph num="(4)"> <text>Whether the provider is proposed to be for-profit or nonprofit;</text> </paragraph> <paragraph num="(5)"> <text>The name of the management company, if any, that will manage the day-to-day operations;</text> </paragraph> <paragraph num="(6)"> <text>If applicable, the name of the:</text> <paragraph num="(a)"> <text>Person proposing to create or finance the provider,</text> </paragraph> <paragraph num="(b)"> <text>Marketing consultant,</text> </paragraph> <paragraph num="(c)"> <text>Provider's attorney, and</text> </paragraph> <paragraph num="(d)"> <text>Preparer of the feasibility study, along with the preparer's qualifications;</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>A statement indicating whether any proposed comprehensive care beds will need a new certificate of need from MHCC;</text> </paragraph> <paragraph num="(8)"> <text>Whether the provider plans to build a facility; and</text> </paragraph> <paragraph num="(9)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Feasibility Study."> <paragraph num="A."> <text>The feasibility study shall be prepared in a form satisfactory to the Department, by an authority recognized by the Department, and shall include at least the following information:</text> <paragraph num="(1)"> <text>A statement of the purpose for the proposed continuing care at home project;</text> </paragraph> <paragraph num="(2)"> <text>A summary of the proposed continuing care at home project, which shall include the following information:</text> <paragraph num="(a)"> <text>A description of the proposed geographic area in which the continuing care at home project will operate;</text> </paragraph> <paragraph num="(b)"> <text>A statement regarding any affiliation of the provider with a religious, charitable, or other nonprofit organization, and the extent to which the organization will be responsible for the financial and contractual obligations of the provider;</text> </paragraph> <paragraph num="(c)"> <text>The number of subscribers projected to be enrolled in 10 years;</text> </paragraph> <paragraph num="(d)"> <text>The number of proposed assisted living units or comprehensive care units the provider plans to use; and</text> </paragraph> <paragraph num="(e)"> <text>A description of any community spaces to be provided, such as doctor's offices, craft centers, meeting rooms, or exercise centers;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>A summary of the organizational structure of the proposed provider and development team, which shall include the following information:</text> <paragraph num="(a)"> <text>The ownership of the provider, including whether it is for-profit;</text> </paragraph> <paragraph num="(b)"> <text>A description of the qualifications of the proposed manager or management company if the project is, or will be, managed on a day-to-day basis by a person other than an individual directly employed by the provider, including the business experience the manager or management company has operating or managing similar projects; and</text> </paragraph> <paragraph num="(c)"> <text>A description of the qualifications of any other person who is significantly involved in the development of the continuing care at home project;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>A summary of plans to provide for assisted living and comprehensive care units, which shall include the following:</text> <paragraph num="(a)"> <text>A schedule showing the number of assisted living and comprehensive care units the provider anticipates needing as the subscriber population grows and ages;</text> </paragraph> <paragraph num="(b)"> <text>A statement describing whether the provider plans to:</text> <paragraph num="(i)"> <text>Operate its own assisted living or comprehensive care facilities,</text> </paragraph> <paragraph num="(ii)"> <text>Contract with other facilities to provide assisted living or comprehensive care services to subscribers, or</text> </paragraph> <paragraph num="(iii)"> <text>Create some other arrangement to provide facility-based assisted living and comprehensive care services to its subscribers;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>If the provider plans to be licensed for and operate its own assisted living and nursing home facilities, a general description of the anticipated square footage of each type of unit; and</text> </paragraph> <paragraph num="(d)"> <text>If the provider plans to be licensed for and operate its own assisted living and nursing home facilities, the number of anticipated assisted living and comprehensive care units categorized as:</text> <paragraph num="(i)"> <text>Private,</text> </paragraph> <paragraph num="(ii)"> <text>Semiprivate, and</text> </paragraph> <paragraph num="(iii)"> <text>Suites;</text> </paragraph> </paragraph> </paragraph> <paragraph num="(5)"> <text>A summary of the services that will be included in the periodic service fee;</text> </paragraph> <paragraph num="(6)"> <text>A summary of the ancillary services that will not be included in the periodic service fee;</text> </paragraph> <paragraph num="(7)"> <text>A statement describing any plans the provider has to require a subscriber to have long-term care insurance or supplemental health insurance coverage;</text> </paragraph> <paragraph num="(8)"> <text>A statement describing any plans the provider has to become Medicare or Medicaid certified;</text> </paragraph> <paragraph num="(9)"> <text>A statement describing any plans the provider has to offer priority access to assisted living or comprehensive care facilities;</text> </paragraph> <paragraph num="(10)"> <text>A study that demonstrates a market exists for the proposed project, which study shall include:</text> <paragraph num="(a)"> <text>A description of the market area as defined by the provider;</text> </paragraph> <paragraph num="(b)"> <text>A table of population information including age, sex, number, income distribution, and trends of the total population and individuals 60 years old and older within the market area;</text> </paragraph> <paragraph num="(c)"> <text>A calculation of the potential impact on the proposed project of existing continuing care at home providers, continuing care at home projects for which letters of intent have been filed with the Department, and other ventures that offer similar services in the market area, which calculation shall include the following information for each provider, project, or venture in the market:</text> <paragraph num="(i)"> <text>The number of continuing care subscribers,</text> </paragraph> <paragraph num="(ii)"> <text>The number of assisted living units and comprehensive care units,</text> </paragraph> <paragraph num="(iii)"> <text>If services are not yet being provided, the proposed start date,</text> </paragraph> <paragraph num="(iv)"> <text>The area marketed to,</text> </paragraph> <paragraph num="(v)"> <text>The amount and type of entrance fees and monthly service fees, and</text> </paragraph> <paragraph num="(vi)"> <text>The services offered;</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>A calculation of the potential impact on the proposed project of existing continuing care retirement communities, continuing care retirement communities for which letters of intent have been filed with the Department, and other ventures that offer similar services in the market area, which calculation shall include the following information for each community, provider, project, or venture in the market:</text> <paragraph num="(i)"> <text>The number of independent living units, assisted living units, and comprehensive care units,</text> </paragraph> <paragraph num="(ii)"> <text>The number of continuing care subscribers,</text> </paragraph> <paragraph num="(iii)"> <text>If services are not yet being provided, the proposed start date, and</text> </paragraph> <paragraph num="(iv)"> <text>The area marketed to;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>A calculation of the market penetration rate for the proposed market;</text> </paragraph> <paragraph num="(f)"> <text>A table of home values in the market area;</text> </paragraph> <paragraph num="(g)"> <text>A description of the minimum age, income, and net worth eligibility requirements for the anticipated subscribers of the proposed project;</text> </paragraph> <paragraph num="(h)"> <text>A description of new entrant assumptions by age, sex, and couple ratio;</text> </paragraph> <paragraph num="(i)"> <text>A description of the results of testing the potential demand and acceptance of the proposed project's services and concept characteristics;</text> </paragraph> <paragraph num="(j)"> <text>If the area in which the project is to be marketed has limited continuing care at home experience and a demographically similar area exists that has had experience with continuing care at home, a comparison that shows the:</text> <paragraph num="(i)"> <text>Similarities and dissimilarities of the two markets, and</text> </paragraph> <paragraph num="(ii)"> <text>Experiences of one or more continuing care at home providers in the comparable market, including their initial utilization experience and their penetration rates into the eligible population; and</text> </paragraph> </paragraph> <paragraph num="(k)"> <text>A statement describing the estimated presales period, including when the provider projects it will have executed agreements and collected at least 10 percent of the entrance fee for at least the greater of 10 percent of the number of subscribers needed for the provider to reach its break-even point or 30 subscribers;</text> </paragraph> </paragraph> <paragraph num="(11)"> <text>A plan demonstrating the financial feasibility of the proposed project including the following:</text> <paragraph num="(a)"> <text>The anticipated costs of the project, including financing expenses, marketing costs, legal and administrative costs, fees and permits, and other costs;</text> </paragraph> <paragraph num="(b)"> <text>The anticipated sources and uses of funds to finance the project, including documentation of the financial resources of the provider;</text> </paragraph> <paragraph num="(c)"> <text>A description of the proposed financing, including anticipated terms and costs of financing the project;</text> </paragraph> <paragraph num="(d)"> <text>Projected financial statements that are based on the information required in §(A)(12)(b) of this regulation and prepared in accordance with:</text> <paragraph num="(i)"> <text>§B of this regulation,</text> </paragraph> <paragraph num="(ii)"> <text>Generally accepted accounting principles, and</text> </paragraph> <paragraph num="(iii)"> <text>Regulation .14 of this chapter;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>A schedule of anticipated fees for a 10-year period, including any proposed escalator or other automatic adjustment provisions;</text> </paragraph> <paragraph num="(f)"> <text>A schedule of the anticipated number of new agreements to be signed each month up to the month in which the break-even point is reached;</text> </paragraph> <paragraph num="(g)"> <text>The proposed start date for providing services under the agreements;</text> </paragraph> <paragraph num="(h)"> <text>A statement indicating compliance with the requirements of Regulation .14 of this chapter; and</text> </paragraph> <paragraph num="(i)"> <text>A calculation that demonstrates the minimum number of subscribers that need to be enrolled in order for the provider to reach its break-even point;</text> </paragraph> </paragraph> <paragraph num="(12)"> <text>An actuarial study, prepared or reviewed by a qualified actuary, which includes:</text> <paragraph num="(a)"> <text>An actuarial balance sheet that demonstrates that, for a typical cohort of new subscribers, the sum of the entrance fees paid plus the actuarial present value of the periodic fees expected at the beginning of the agreement exceeds the actuarial present value of the costs of performing all obligations assumed by the provider, with appropriate provision for surplus;</text> </paragraph> <paragraph num="(b)"> <text>Supporting detailed documentation for the actuarial balance sheet required in §A(12)(a) of this regulation, including a:</text> <paragraph num="(i)"> <text>Projection of future population flows and service needs covered by the provider's agreements for the first 20 years, using appropriate mortality, morbidity, withdrawal, and other demographic assumptions, and</text> </paragraph> <paragraph num="(ii)"> <text>Description of the actuarial data, assumptions, inflation factors, and methods used to create the projection;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>Cash flow projection for a 20-year period, which project positive cash balances; and</text> </paragraph> <paragraph num="(d)"> <text>The opinion of the actuary that the data and assumptions used are appropriate, the methods employed are consistent with sound actuarial principles and practices, and provision has been made for all actuarial liabilities and related statement items;</text> </paragraph> </paragraph> <paragraph num="(13)"> <text>A copy of the proposed deposit agreement between the provider and prospective subscribers governing the disposition of the escrowed funds and the interest earned on them;</text> </paragraph> <paragraph num="(14)"> <text>A copy of the proposed escrow agreement between the provider and the depository;</text> </paragraph> <paragraph num="(15)"> <text>Proposed payment arrangements under the agreement for:</text> <paragraph num="(a)"> <text>The assistance with the maintenance of the subscriber's dwelling; and</text> </paragraph> <paragraph num="(b)"> <text>The health-related benefits;</text> </paragraph> </paragraph> <paragraph num="(16)"> <text>A copy of a certificate of need issued by MHCC for any proposed comprehensive care beds the provider plans to operate for its subscribers;</text> </paragraph> <paragraph num="(17)"> <text>The form and substance of any advertising campaign or proposed advertisement for the proposed project that is available at the time of filing; and</text> </paragraph> <paragraph num="(18)"> <text>Any further information that the Department requires.</text> </paragraph> </paragraph> <paragraph num="B."> <text>In §A(11)(d) of this regulation, the provider shall submit projected financial statements for a minimum of the first 10 years of operation that include:</text> <paragraph num="(1)"> <text>Balance sheets;</text> </paragraph> <paragraph num="(2)"> <text>Income statements, including separate supplemental income statements for each group of subscribers in each of the following environments:</text> <paragraph num="(a)"> <text>Subscriber's dwelling,</text> </paragraph> <paragraph num="(b)"> <text>Assisted living, and</text> </paragraph> <paragraph num="(c)"> <text>Comprehensive care;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>Statements of cash flow; and</text> </paragraph> <paragraph num="(4)"> <text>The key assumptions used in preparing the projected financial statements, including, when applicable, assumptions related to utilization, turnover, inflation, debt service, personnel staffing and related salaries, interest rates, depreciation and amortization, amortization of entrance fees, raw food, insurance, real estate taxes, and reserve assumptions.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Application for a Preliminary Certificate of Registration."> <paragraph num="A."> <text>Application. An application for a preliminary certificate of registration shall include the information described in this regulation.</text> </paragraph> <paragraph num="B."> <text>The names and addresses of the following shall be included:</text> <paragraph num="(1)"> <text>The provider;</text> </paragraph> <paragraph num="(2)"> <text>Any affiliate, parent, or subsidiary person or business entity; and</text> </paragraph> <paragraph num="(3)"> <text>The chief executive officer of the provider, and each affiliate, parent, or subsidiary person or business entity.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The application shall describe the organizational structure and management of the provider, including:</text> <paragraph num="(1)"> <text>If the provider is a corporation or limited liability company, the:</text> <paragraph num="(a)"> <text>Name of the corporation or limited liability company, and</text> </paragraph> <paragraph num="(b)"> <text>State in which the corporation is incorporated or the limited liability company is formed;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>If the provider is a partnership, the:</text> <paragraph num="(a)"> <text>Names of the general partners,</text> </paragraph> <paragraph num="(b)"> <text>State governing the formation of the partnership, and</text> </paragraph> <paragraph num="(c)"> <text>Name of the primary individual responsible for managing the partnership;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>If the provider is an unincorporated association, the:</text> <paragraph num="(a)"> <text>Names of the members,</text> </paragraph> <paragraph num="(b)"> <text>State governing the association's activities, and</text> </paragraph> <paragraph num="(c)"> <text>Name of the primary individual responsible for managing the association;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>If the provider is a partnership having a corporation or limited liability company as one or more of its general partners, the:</text> <paragraph num="(a)"> <text>Names of each corporation or limited liability company,</text> </paragraph> <paragraph num="(b)"> <text>State in which each corporation is incorporated or the limited liability company is formed, and</text> </paragraph> <paragraph num="(c)"> <text>Name of the chief executive officer of each;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>If the provider is a trust, the:</text> <paragraph num="(a)"> <text>Name of each trustee,</text> </paragraph> <paragraph num="(b)"> <text>Names of the owners of beneficial interests in the trust,</text> </paragraph> <paragraph num="(c)"> <text>State whose laws govern the trust, and</text> </paragraph> <paragraph num="(d)"> <text>Name of the primary individual responsible for overseeing the trust's activities;</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>The names and occupations of:</text> <paragraph num="(a)"> <text>The provider's officers, directors, trustees, managing or general partners, and non-stock corporation members, and</text> </paragraph> <paragraph num="(b)"> <text>An individual having a 10 percent or greater equity or beneficial interest in the provider;</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>A description of each financial interest in, or occupation with, the provider of each individual identified under §C(6) of this regulation.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Contracts with Related Entities.</text> <paragraph num="(1)"> <text>If it is anticipated that a business entity will provide to the provider goods, premises, or services with a value of $10,000 or more within any fiscal year, and if a person identified in §C(6) of this regulation has a financial interest of 10 percent or more in the business entity, the application shall include:</text> <paragraph num="(a)"> <text>The name and address of the business entities;</text> </paragraph> <paragraph num="(b)"> <text>A description of the goods, premises, or services; and</text> </paragraph> <paragraph num="(c)"> <text>The anticipated yearly costs the provider will incur for the goods, premises, or services.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Section D(1) of this regulation does not require the disclosure of salary, age, or benefit information of employees of the provider.</text> </paragraph> </paragraph> <paragraph num="E."> <text>The application shall include a copy of all current documentation concerning the legal organization of the provider, including the corporate charter, bylaws, partnership agreement, articles of association, membership agreement, trust agreement, or similar instruments or agreements.</text> </paragraph> <paragraph num="F."> <text>The application shall include certified financial statements of the provider for the 3 most recent fiscal years for which certified financial statements are obtainable under generally accepted accounting principles. If the provider's fiscal year ended more than 90 days before the date of the filing, then the application shall also include an income statement, which does not need to be certified, that covers a period that begins on the date the fiscal year ended and ends on a date that is within 90 days of the date of the filing.</text> </paragraph> <paragraph num="G."> <text>The application shall include a statement of any current or prior affiliation with a religious, charitable, or other nonprofit organization, and the extent, if any, to which the affiliate organization will be responsible for the financial and contractual obligations of the provider.</text> </paragraph> <paragraph num="H."> <text>The application shall include a copy of any proposed:</text> <paragraph num="(1)"> <text>Agreements to be entered into between the provider and subscribers for continuing care at home; and</text> </paragraph> <paragraph num="(2)"> <text>Contractual arrangement between the provider and any assisted living or comprehensive care providers.</text> </paragraph> </paragraph> <paragraph num="I."> <text>A table of the most current fee structure, including escalator or other automatic adjustment provisions, shall accompany the application.</text> </paragraph> <paragraph num="J."> <text>A statement describing the current or proposed use of any insurance program or publicly funded benefit program in the financing of care shall accompany the application.</text> </paragraph> <paragraph num="K."> <text>A description of the arrangements that have been or will be made to obtain the personnel or outside services necessary to provide continuing care at home shall accompany the application.</text> </paragraph> <paragraph num="L."> <text>The form and substance of any advertising campaign, advertisement, or other promotional material that has not been previously approved by the Department shall be submitted with the application.</text> </paragraph> <paragraph num="M."> <text>Any other reasonable and pertinent information that the Department requests in writing shall be submitted with the application.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".07" heading="Department Action on Feasibility Study and Application for a Preliminary Certificate of Registration."> <paragraph num="A."> <text>The Department shall approve a feasibility study when it determines that:</text> <paragraph num="(1)"> <text>A certificate of need has been issued by MHCC for any new comprehensive care beds proposed by the provider for the continuing care at home project;</text> </paragraph> <paragraph num="(2)"> <text>The construction of any new assisted living units proposed by the provider for the continuing care at home project is not inconsistent with the State Health Plan;</text> </paragraph> <paragraph num="(3)"> <text>A reasonable financial plan has been submitted for developing and operating the proposed project, which:</text> <paragraph num="(a)"> <text>Includes in the projected financial statements for all obligations and liabilities to be undertaken by the provider pursuant to the terms of the proposed continuing care at home agreement; and</text> </paragraph> <paragraph num="(b)"> <text>Demonstrates that the project is financially feasible;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>A market for the continuing care at home project appears to exist, based on reliable data, which:</text> <paragraph num="(a)"> <text>Is specific to the area in which the provider intends to operate;</text> </paragraph> <paragraph num="(b)"> <text>Takes into account competing health-related providers;</text> </paragraph> <paragraph num="(c)"> <text>Relates the existence of a market to the age, health, sex, marital status, number, population trends, net worth, home values, and income of the potential subscribers; and</text> </paragraph> <paragraph num="(d)"> <text>Demonstrates that the rate of penetration in the proposed market area is acceptable;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>The actuarial study as required in Regulation .05 of this chapter has been submitted and includes:</text> <paragraph num="(a)"> <text>An actuarial balance sheet that demonstrates that, for a typical cohort of new subscribers, the sum of the entrance fees paid plus the actuarial present value, at the beginning of the agreement, of periodic fees exceeds the actuarial present value of the costs of performing all obligations assumed by the provider, with appropriate provision for surplus;</text> </paragraph> <paragraph num="(b)"> <text>Cash flow statements for a 20-year period, which project positive cash balances;</text> </paragraph> <paragraph num="(c)"> <text>Supporting detailed documentation for the actuarial balance sheet which includes:</text> <paragraph num="(i)"> <text>A projection of future population flows for a 20-year period, which uses appropriate morbidity, mortality, withdrawal, and other demographic assumptions,</text> </paragraph> <paragraph num="(ii)"> <text>A projection of future service needs covered by the provider's agreements, for a 20-year period, which uses appropriate morbidity, mortality, withdrawal, and other demographic assumptions, and</text> </paragraph> <paragraph num="(iii)"> <text>Descriptions of the actuarial data, assumptions, and methods; and</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>An opinion of a qualified actuary, which states that:</text> <paragraph num="(i)"> <text>The data and assumptions used are appropriate,</text> </paragraph> <paragraph num="(ii)"> <text>The methods employed are consistent with sound actuarial principles and practices, and</text> </paragraph> <paragraph num="(iii)"> <text>Provision has been made for all actuarial liabilities and related statement items;</text> </paragraph> </paragraph> </paragraph> <paragraph num="(6)"> <text>The projection of future population flows and health care bed needs, for the first 20 years, uses appropriate mortality, morbidity, withdrawal, and other demographic assumptions as required in Regulation .05 of this chapter;</text> </paragraph> <paragraph num="(7)"> <text>The feasibility study was prepared by an authority recognized by the Department;</text> </paragraph> <paragraph num="(8)"> <text>The approved escrow agreement and deposit agreement state that all deposits and entrance fees shall be held in escrow in Maryland in a financial institution until:</text> <paragraph num="(a)"> <text>The issuance of an initial certificate of registration; and</text> </paragraph> <paragraph num="(b)"> <text>The issuance of appropriate licenses or certificates by MDH and MHCC; and</text> </paragraph> </paragraph> <paragraph num="(9)"> <text>A copy of the escrow agreement, executed by the provider and the financial institution, is on file with the Department.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The Department shall issue a preliminary certificate of registration when it determines that the following conditions have been met:</text> <paragraph num="(1)"> <text>The feasibility study has been approved by the Department;</text> </paragraph> <paragraph num="(2)"> <text>The agreement between the provider and the subscriber meets the requirements of Human Services Article, §§10-444 and 10-445, Annotated Code of Maryland, and Regulations .21—.23 of this chapter;</text> </paragraph> <paragraph num="(3)"> <text>The required financial and organizational materials have been submitted to the Department; and</text> </paragraph> <paragraph num="(4)"> <text>The Department has determined that the form and substance of all advertising and other promotional materials filed are not deceptive, misleading, or likely to mislead.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Until an initial certificate of registration has been issued, the provider shall inform the Department of any changes or additions to the information provided in the feasibility study and in the application for a preliminary certificate of registration.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".08" heading="Advertising Before an Initial Certificate of Registration Has Been Issued."> <text>If a provider that has submitted a feasibility study desires to advertise a continuing care at home project before an initial certificate of registration has been issued, the provider shall submit that advertising so it is received by the Department at least 3 working days before the advertising is to be aired, distributed, or otherwise used. The envelope or package in which the submission is delivered shall indicate in prominent type that the contents are proposed advertising materials for a project that does not have an initial certificate of registration.</text> </regulation> <regulation prefix="Regulation" num=".09" heading="Application for an Initial Certificate of Registration."> <paragraph num="A."> <text>A provider shall file an application for an initial certificate of registration on a form provided by the Department.</text> </paragraph> <paragraph num="B."> <text>The application shall include verification that:</text> <paragraph num="(1)"> <text>All licenses and certificates required as of the date of the application from MDH and MHCC have been issued;</text> </paragraph> <paragraph num="(2)"> <text>Agreements have been executed for at least the greater of either:</text> <paragraph num="(a)"> <text>10 percent of the number of subscribers needed for the provider to reach its break-even point, or</text> </paragraph> <paragraph num="(b)"> <text>30 subscribers;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>At least 10 percent of the total entrance fee has been collected for each agreement counted towards the requirement of §B(2) of this regulation;</text> </paragraph> <paragraph num="(4)"> <text>The provider has received a written commitment for any planned long-term financing; and</text> </paragraph> <paragraph num="(5)"> <text>Arrangements have been made to obtain the personnel and services necessary to provide continuing care at home.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".10" heading="Action of Department on Application for an Initial Certificate of Registration."> <paragraph num="A."> <text>The Department shall issue an initial certificate of registration when it determines that all of the following conditions have been met:</text> <paragraph num="(1)"> <text>The provider has been issued a preliminary certificate of registration;</text> </paragraph> <paragraph num="(2)"> <text>The provider has received all licenses and certifications required as of that date from MDH and MHCC;</text> </paragraph> <paragraph num="(3)"> <text>The provider has submitted documentation which demonstrates to the satisfaction of the Department that:</text> <paragraph num="(a)"> <text>Agreements have been executed for at least the greater of either:</text> <paragraph num="(i)"> <text>10 percent of the number of subscribers needed for the provider to reach its break-even point, or</text> </paragraph> <paragraph num="(ii)"> <text>30 subscribers; and</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>At least 10 percent of the total entrance fee has been paid as a deposit for each of the executed agreements;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>The provider has submitted documentation that demonstrates to the satisfaction of the Department that there is a commitment for any planned long-term financing;</text> </paragraph> <paragraph num="(5)"> <text>The provider has submitted documentation that demonstrates to the satisfaction of the Department that arrangements have been made for care coordination services consistent with Regulation .02E(1) of this chapter;</text> </paragraph> <paragraph num="(6)"> <text>The provider has submitted proposed agreements that will be entered into with respect to future health care services consistent with Regulation .02E(3—(6) of this chapter; and</text> </paragraph> <paragraph num="(7)"> <text>The form and substance of all advertising and other promotional materials filed are not deceptive, misleading, or likely to mislead.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Upon receipt of an initial certificate of registration, the provider may withdraw escrowed deposits and use them to fulfill its obligations to the subscribers, as long as all required reserves are in place.</text> </paragraph> <paragraph num="C."> <text>If the conditions in §A of this regulation are not met, the Department shall issue a denial of an initial certificate of registration, in writing, which includes the reasons for the denial. The provider may resubmit an amended application within the time limits set forth in §D of this regulation.</text> </paragraph> <paragraph num="D."> <text>If an initial certificate of registration is not issued within 24 months of the issuance of the preliminary certificate of registration, or a longer time allowed by the Department for good cause shown, as defined in §E of this regulation, the Department shall require the provider to refund all deposits and to cease in its attempts to offer continuing care at home under that application. A further intent to provide continuing care at home shall require a new application, including a feasibility study.</text> </paragraph> <paragraph num="E."> <text>The Department may not deny a request for an extension of time if the provider demonstrates reasonable progress toward acquiring an initial certificate of registration.</text> </paragraph> <paragraph num="F."> <text>If the Department issues an initial certificate of registration to a provider, the provider need not re-apply to the Department to certify additional geographic territories within the State of Maryland and shall instead notify the Department in writing in advance that the provider seeks to service additional geographic territories in the State of Maryland.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".11" heading="Application for Renewal Certificate of Registration."> <paragraph num="A."> <text>The provider shall file an application for a renewal certificate of registration within 120 days of the end of the provider's fiscal year on a form provided by the Department.</text> </paragraph> <paragraph num="B."> <text>A renewal certificate of registration shall be issued for 1 year, which is in effect from 6 months after the end of the provider's most recent fiscal year to 6 months after the close of the provider's current fiscal year.</text> </paragraph> <paragraph num="C."> <text>The application for a renewal certificate of registration shall include the following information and attachments:</text> <paragraph num="(1)"> <text>Any changes or additions to the information submitted on the most recent application;</text> </paragraph> <paragraph num="(2)"> <text>An original certified financial statement for the preceding fiscal year prepared in accordance with generally accepted accounting principles, which include the principles expressed in the American Institute of Certified Public Accounts' “Audit and Accounting Guide for Health Care Organizations”;</text> </paragraph> <paragraph num="(3)"> <text>All exhibits or attachments to the certified financial statements, including:</text> <paragraph num="(a)"> <text>A balance sheet,</text> </paragraph> <paragraph num="(b)"> <text>An income statement,</text> </paragraph> <paragraph num="(c)"> <text>A statement of cash flows,</text> </paragraph> <paragraph num="(d)"> <text>The related notes to the financial statements, and</text> </paragraph> <paragraph num="(e)"> <text>The opinion of an independent certified public accountant;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>An operating budget for the current fiscal year prepared in accordance with generally accepted accounting principles;</text> </paragraph> <paragraph num="(5)"> <text>A projection of the life expectancy and the number of subscribers who will require care in an assisted living or nursing home facility;</text> </paragraph> <paragraph num="(6)"> <text>A projected operating budget for the next succeeding fiscal year prepared in accordance with generally accepted accounting principles;</text> </paragraph> <paragraph num="(7)"> <text>An actuarial opinion that meets the requirements of Regulation .14F and G of this chapter;</text> </paragraph> <paragraph num="(8)"> <text>A copy of any new continuing care at home agreement proposed for implementation in the succeeding year, and a demonstration of how the proposed agreement differs from current agreements in use;</text> </paragraph> <paragraph num="(9)"> <text>A description of the arrangements that have been made to obtain the personnel and services necessary to continue providing continuing care at home;</text> </paragraph> <paragraph num="(10)"> <text>A copy of each current license and certificate, if any, required to be issued by MDH;</text> </paragraph> <paragraph num="(11)"> <text>A copy of the provider's most recent certificate of need, if any, required to be issued by MHCC;</text> </paragraph> <paragraph num="(12)"> <text>The form and substance of any advertising campaign or proposed advertisement and other promotional materials not previously filed with the Department;</text> </paragraph> <paragraph num="(13)"> <text>A renewal fee equal to the greater of $5,000 or $18 per subscriber enrolled at the end of the provider's previous fiscal year;</text> </paragraph> <paragraph num="(14)"> <text>A cash flow projection for the current fiscal year and the next 2 fiscal years prepared in accordance with generally accepted accounting principles;</text> </paragraph> <paragraph num="(15)"> <text>A statement that provides the dates of the meetings held the previous year to comply with Regulation .13 of this chapter;</text> </paragraph> <paragraph num="(16)"> <text>A copy of the disclosure statement prepared in accordance with Regulation .15 of this chapter; and</text> </paragraph> <paragraph num="(17)"> <text>A statement that indicates compliance with the operating reserve requirement in Regulation .14 of this chapter.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Actuarial Study.</text> <paragraph num="(1)"> <text>Every 3 years after beginning continuing care at home operations, a provider shall submit an actuarial study, including an actuarial balance sheet, prepared or reviewed by a qualified actuary, which:</text> <paragraph num="(a)"> <text>Demonstrates that the resources available for current and replacement subscribers, including the actuarial present value of periodic fees expected to be paid in the future by present subscribers, are equal to the actuarial present value of the expected costs of performing all remaining obligations to the subscribers under the subscribers' agreements, with appropriate provision for surplus;</text> </paragraph> <paragraph num="(b)"> <text>Includes cash flow statements for 20 years which demonstrate that cash balances are projected to remain positive;</text> </paragraph> <paragraph num="(c)"> <text>Includes a statement of the opinion of a qualified actuary as to whether:</text> <paragraph num="(i)"> <text>The data and assumptions used are appropriate,</text> </paragraph> <paragraph num="(ii)"> <text>The methods employed are consistent with sound actuarial principles and practices, and</text> </paragraph> <paragraph num="(iii)"> <text>Provision has been made for all actuarial liabilities and related statement items; and</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>Includes supporting detailed documentation for the actuarial balance sheet including a projection of future population flows and service needs covered by the provider's agreements for 20 years, which projection shall use appropriate inflation factors, mortality, morbidity, withdrawal, and other demographic assumptions.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The Department may request the information required in §D(1) of this regulation more frequently to assist in the determination of possible financial difficulty as provided in Regulation .20 of this chapter.</text> </paragraph> </paragraph> <paragraph num="E."> <text>If the materials required in §C of this regulation are not received in the Department within 120 days after the end of the provider's fiscal year, the Department shall charge a late fee equal to the greater of $1,000 or $10 per subscriber. The late fee shall be in addition to the renewal fee per subscriber, unless a written request for an extension is submitted to and approved by the Department within the 120-day period.</text> </paragraph> <paragraph num="F."> <text>The Department may issue a provisional renewal certificate of registration for a period not to exceed 6 months, if a provider is found to be in possible financial difficulty as defined in Regulation .01 of this chapter, or subject to Regulation .20 of this chapter. The provisional certificate of registration may be renewed for additional periods, each period not to exceed 6 months, at the discretion of the Department.</text> </paragraph> <paragraph num="G."> <text>Failure to file the annual renewal application or obtain an extension within 120 days after the end of a fiscal year is a violation of the Act and this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".12" heading="Action of the Department on Application for Renewal Certificate of Registration."> <paragraph num="A."> <text>The Department shall approve an application for a renewal certificate of registration when it determines that:</text> <paragraph num="(1)"> <text>The required documents have been filed;</text> </paragraph> <paragraph num="(2)"> <text>The proposed and existing agreements meet the requirements of the Act and this chapter;</text> </paragraph> <paragraph num="(3)"> <text>The provider has not been found to be in financial difficulty;</text> </paragraph> <paragraph num="(4)"> <text>The provider has the necessary resources for providing continuing care at home;</text> </paragraph> <paragraph num="(5)"> <text>The provider has received all required licenses and certificates from MDH and MHCC;</text> </paragraph> <paragraph num="(6)"> <text>The form and substance of all advertising and other promotional materials filed are not deceptive, misleading, or likely to mislead;</text> </paragraph> <paragraph num="(7)"> <text>If required under Regulation .11D of this chapter, an actuarial study, prepared or reviewed by a qualified actuary, has been submitted which:</text> <paragraph num="(a)"> <text>Includes an actuarial balance sheet;</text> </paragraph> <paragraph num="(b)"> <text>Demonstrates that the resources available for current and replacement subscribers, including the actuarial present value of periodic fees expected to be paid in the future by present subscribers, are equal to the actuarial present value of the expected costs of performing all remaining obligations to the subscribers under the subscribers' agreements, with appropriate provision for surplus;</text> </paragraph> <paragraph num="(c)"> <text>Projects positive cash balances for a 20-year period;</text> </paragraph> <paragraph num="(d)"> <text>Includes a statement of the opinion of a qualified actuary as to whether:</text> <paragraph num="(i)"> <text>The data and assumptions used are appropriate and reasonable,</text> </paragraph> <paragraph num="(ii)"> <text>The methods employed are consistent with sound actuarial principles and practices, and</text> </paragraph> <paragraph num="(iii)"> <text>Provision has been made for all actuarial liabilities and related statement items;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>Includes supporting detailed documentation for the actuarial balance sheet including a projection of future population flows and service needs covered by the provider's agreements, which projection shall use appropriate inflation factors, mortality, morbidity, withdrawal, and other demographic assumptions; and</text> </paragraph> <paragraph num="(f)"> <text>Includes a cash flow projection for the next 20 years;</text> </paragraph> </paragraph> <paragraph num="(8)"> <text>The disclosure statement submitted complies with Regulation .15 of this chapter;</text> </paragraph> <paragraph num="(9)"> <text>The operating reserves comply with the requirements of Regulation .14 of this chapter; and</text> </paragraph> <paragraph num="(10)"> <text>All renewal fees and any late fees have been paid.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Upon review of a provider's application for a renewal certificate of registration, the Department may make a finding of possible financial difficulty. The Department shall refer the application of a provider found to be in possible financial difficulty to the Financial Review Committee. Applications that are referred to the Committee are subject to Regulations .19 and .20 of this chapter.</text> </paragraph> <paragraph num="C."> <text>If the conditions in §A of this regulation and, if applicable, Regulation .20 of this chapter are not met, the Department shall issue in writing a denial of an application for a renewal certificate of registration. The Department shall include the reasons for denying the application in the written denial.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".13" heading="Required Information Regarding Governance."> <paragraph num="A."> <text>In General.</text> <paragraph num="(1)"> <text>At least annually, each provider shall conduct a meeting, open to all of the provider's subscribers, at which an authorized officer of the provider shall present a summary of:</text> <paragraph num="(a)"> <text>The provider's operations;</text> </paragraph> <paragraph num="(b)"> <text>Significant changes from the previous year's operations; and</text> </paragraph> <paragraph num="(c)"> <text>The provider's goals and objectives for the next year.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The governing body of the provider shall make provisions to receive and answer questions from subscribers at the meeting.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Committee to Meet with Subscribers.</text> <paragraph num="(1)"> <text>Each governing body of a provider that does not have at least one subscriber as a member or as a regular attendee at its meetings with a right to address the governing body shall appoint a select committee of its members to meet at least twice annually with the subscriber association to address concerns of the subscribers and to ensure that the opinions of subscribers are relayed to the governing body. If the provider's subscribers do not have an association, the committee shall meet with a reasonable number of representatives, not required to exceed 15 elected by the subscribers.</text> </paragraph> <paragraph num="(2)"> <text>In the absence of a subscriber association, the provider shall:</text> <paragraph num="(a)"> <text>Mail a notice to its subscribers stating that subscribers who want to serve as a representative for all the subscribers in meetings with the governing body should submit their names to the provider so they can stand for election; and</text> </paragraph> <paragraph num="(b)"> <text>Arrange for an election conducted by mail to elect up to 15 of those subscribers who submit their names.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".14" heading="Reserve Requirements."> <paragraph num="A."> <text>Definitions.</text> <paragraph num="(1)"> <text>In this regulation, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="(2)"> <text>Terms Defined.</text> <paragraph num="(a)"> <text>“Binding agreement” means an unconditional, irrevocable letter of credit or line of credit agreement entered into by a provider and a financial institution.</text> </paragraph> <paragraph num="(b)"> <text>“Debt service fund” means one or more special loan funds, established under requirements imposed by a financial institution or under applicable financing documents, into which the provider is required to deposit moneys during the provider's fiscal year to pay the current portion of the principal due and the interest accruing in that year on the provider's debt.</text> </paragraph> <paragraph num="(c)"> <text>“Debt service reserve fund” means moneys required by a financial institution or under applicable financing documents to be deposited in a special loan fund, which are to be used to pay principal and interest payments due on the provider's debt if the provider is unable to pay when due the principal and interest from operating income or other sources.</text> </paragraph> <paragraph num="(d)"> <text>“Market value” means readily determinable fair value.</text> </paragraph> <paragraph num="(e)"> <text>Net Operating Expenses.</text> <paragraph num="(i)"> <text>“Net operating expenses” means a provider's total operating expenses related to furnishing continuing care at home, less depreciation, amortization, unusual and infrequent expenses, and changes in the obligation to provide future services.</text> </paragraph> <paragraph num="(ii)"> <text>“Net operating expenses” does not include interest expense if the provider has funded a debt service fund or other interest reserve under requirements imposed by a financial institution or under applicable financing documents, to the extent and in the amount the fund or reserve includes amounts to cover interest for the year in question.</text> </paragraph> </paragraph> <paragraph num="(f)"> <text>“Other interest reserve” means one or more special loan funds other than debt service funds or debt service reserve funds:</text> <paragraph num="(i)"> <text>Established under requirements imposed by a financial institution or under applicable financing documents; and</text> </paragraph> <paragraph num="(ii)"> <text>Into which the provider is required to deposit moneys during the provider's fiscal year to pay interest accruing in that year on the provider's debt.</text> </paragraph> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>Operating Reserve Requirement.</text> <paragraph num="(1)"> <text>Except as otherwise provided in this regulation, a provider shall set aside operating reserves equal to 15 percent of the provider's net continuing care at home operating expenses for the most recent fiscal year for which a certified financial statement is available.</text> </paragraph> <paragraph num="(2)"> <text>A provider shall compute the operating reserves as of the end of its most recent fiscal year and shall indicate compliance by setting forth the amount actually set aside in a letter to the Department from the provider's certified public accountant or by disclosing the amount in the provider's most recent certified financial statement. The letter or certified financial statements shall be submitted with the provider's application for a renewal certificate.</text> </paragraph> <paragraph num="(3)"> <text>A provider may apply toward the reserve required by this regulation any reserves, other than debt service reserve funds, maintained under applicable financing document requirements if the reserves are available to the provider to meet operating expenses.</text> </paragraph> <paragraph num="(4)"> <text>For the purpose of calculating the 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> </paragraph> </paragraph> <paragraph num="C."> <text>Capital Reserves. In addition to the operating reserve required under this chapter, a provider shall have a capital reserve of unencumbered, surplus assets of at least $500,000 before beginning operations and shall maintain an equal amount in reserve in order to maintain itself in good standing.</text> </paragraph> <paragraph num="D."> <text>Contract Reserves.</text> <paragraph num="(1)"> <text>Calculation. Annually a provider shall calculate a contract reserve amount to cover all its continuing care at home agreements. This calculation:</text> <paragraph num="(a)"> <text>Shall place a sound value on the provider's liabilities under its continuing care at home agreements;</text> </paragraph> <paragraph num="(b)"> <text>In the aggregate, may not be less than the pro rata gross unearned periodic and entrance fees paid pursuant to the subscribers' agreements;</text> </paragraph> <paragraph num="(c)"> <text>May not use an interest rate greater than the maximum allowable interest rate established annually by the National Association of Insurance Commissioners for calculating reserves for whole life insurance policies, with maturities 20 or more years after issue;</text> </paragraph> <paragraph num="(d)"> <text>May not assume an inflation rate of benefits:</text> <paragraph num="(i)"> <text>Greater than the interest rate used, or</text> </paragraph> <paragraph num="(ii)"> <text>Less than the interest rate used minus two percentage points;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>Shall use the 1994 Annuitant Table published by the American Society of Actuaries and adjust it accordingly for expected mortality improvements; and</text> </paragraph> <paragraph num="(f)"> <text>Shall:</text> <paragraph num="(i)"> <text>Subtract the future administrative and claim expenses from the future periodic fees for each year for each subscriber,</text> </paragraph> <paragraph num="(ii)"> <text>Discount the result back to the current year, and</text> </paragraph> <paragraph num="(iii)"> <text>Sum the results for each subscriber.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(2)"> <text>Funding. A provider shall fund and maintain a reserve account that equals or exceeds:</text> <paragraph num="(a)"> <text>50 percent of the calculated contract reserve amount by the end of its first year of operation;</text> </paragraph> <paragraph num="(b)"> <text>60 percent of the calculated contract reserve amount by the end of its second year of operation;</text> </paragraph> <paragraph num="(c)"> <text>70 percent of the calculated contract reserve amount by the end of its third year of operation;</text> </paragraph> <paragraph num="(d)"> <text>80 percent of the calculated contract reserve amount by the end of its fourth year of operation;</text> </paragraph> <paragraph num="(e)"> <text>90 percent of the calculated contract reserve amount by the end of its fifth year of operation;</text> </paragraph> <paragraph num="(f)"> <text>100 percent of the calculated contract reserve amount by the end of its sixth year of operation; and</text> </paragraph> <paragraph num="(g)"> <text>100 percent of the calculated contract reserve amount for every year after the provider's sixth year of operation.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>Funds in the capital reserve may be counted towards satisfying the contract reserve requirements. Funds in the operating reserve may not be counted towards the contract reserve requirements.</text> </paragraph> </paragraph> <paragraph num="E."> <text>Aggregate Reserves. The aggregate reserves for all continuing care at home may not be less than the aggregate reserves that a qualified actuary determines to be necessary under §G of this regulation.</text> </paragraph> <paragraph num="F."> <text>Actuarial Opinions. Each provider shall submit annually the opinion of a qualified actuary as to whether the reserves and related actuarial items held in support of the providers' agreements are:</text> <paragraph num="(1)"> <text>Computed appropriately;</text> </paragraph> <paragraph num="(2)"> <text>Based on reasonable assumptions that satisfy contractual provisions;</text> </paragraph> <paragraph num="(3)"> <text>Consistent with prior reported amounts; and</text> </paragraph> <paragraph num="(4)"> <text>In compliance with applicable laws of the State.</text> </paragraph> </paragraph> <paragraph num="G."> <text>Adequacy of Aggregate Reserves.</text> <paragraph num="(1)"> <text>Each provider shall include with the opinion required by §F of this regulation an additional opinion of the same qualified actuary, stating whether the reserves and related actuarial items that are held in support of the agreements by the provider appear on their face to be adequate to meet its obligations under its agreements. The obligations of a provider under its agreements include benefits to be provided and associated expenses that may reasonably be expected.</text> </paragraph> <paragraph num="(2)"> <text>A memorandum acceptable to the Secretary shall be prepared to support each opinion required under this section, and submitted to the Secretary annually.</text> </paragraph> <paragraph num="(3)"> <text>The memorandum shall also include a statement from the actuary:</text> <paragraph num="(a)"> <text>That all assumptions contained in the reserve calculations are reasonable and are calculated net of all, if any, reinsurance agreements that limit the provider's exposure to risk;</text> </paragraph> <paragraph num="(b)"> <text>That the assumptions contained in the reserve calculation are supported by an actuarial balance sheet and a pricing analysis prepared within the past 3 years; and</text> </paragraph> <paragraph num="(c)"> <text>Setting forth the underlying morbidity assumptions.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>The Secretary may engage a qualified actuary at the expense of the provider to review each opinion and prepare a supporting memorandum if:</text> <paragraph num="(a)"> <text>The provider fails to provide a supporting memorandum within the period specified by regulation; or</text> </paragraph> <paragraph num="(b)"> <text>The Secretary determines that the supporting memorandum that the provider provides fails to meet necessary standards or is unacceptable.</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>Each opinion and memorandum required by this section shall be submitted with the annual renewal application required by this chapter and reflect the valuation of the reserve liabilities of the provider and be based on standards adopted by the Actuarial Standards Board.</text> </paragraph> </paragraph> <paragraph num="H."> <text>Use of Reserves.</text> <paragraph num="(1)"> <text>A provider shall notify the Department in writing simultaneously with withdrawing any amount from the funds available to satisfy the reserves required by this regulation.</text> </paragraph> <paragraph num="(2)"> <text>Within 30 days of any draw, the provider shall submit to the Department a written plan for restoring promptly and prudently the funds in the reserve to the level required by this regulation.</text> </paragraph> </paragraph> <paragraph num="I."> <text>Phase-In Period of Operating Reserve Requirement.</text> <paragraph num="(1)"> <text>Except as provided under §I(2) of this regulation, a provider shall meet the requirements of §B of this regulation by the end of the second full fiscal year after the fiscal year in which the provider obtains its initial certificate of registration.</text> </paragraph> <paragraph num="(2)"> <text>For the time specified in §I(3) of this regulation, a provider may meet the operating reserve requirements in §B of this regulation if the provider has a binding agreement with a financial institution that unconditionally obligates the financial institution to furnish the provider credit in the amount of the reserve required by §B of this regulation.</text> </paragraph> <paragraph num="(3)"> <text>A provider may use the exception allowed by §I(2) of this regulation only until the earlier of the:</text> <paragraph num="(a)"> <text>End of the tenth full fiscal year after the fiscal year in which the provider obtains its initial certificate of registration; or</text> </paragraph> <paragraph num="(b)"> <text>Date on which the binding agreement with a financial institution expires.</text> </paragraph> </paragraph> </paragraph> <paragraph num="J."> <text>Semi-Annual Reporting. For the first 5 years following the issuance of an initial certificate, a provider shall submit to the Department on a semi-annual basis a financial statement that specifies and describes the status of each reserve required by the regulation. The submission for a renewal certificate under Regulation .11 of this chapter shall count toward such reporting requirement so that the provider need only submit one additional report per year.</text> </paragraph> <paragraph num="K."> <text>Investment Reserves. Reserves shall be maintained in reasonably liquid form in the judgment of the provider and in accordance with the provider's investment policies. For assets held to satisfy the reserves required by this regulation, the provider shall list the assets by type, number, and value. The list shall be disclosed in the provider's most recent certified financial statement or in a letter to the Department from the provider's certified public accountant. The certified financial statement or letter shall be submitted with the provider's application for a renewal certificate of registration.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".15" heading="Disclosure Statement."> <paragraph num="A."> <text>General. A provider holding either a preliminary, initial, or renewal certificate of registration shall furnish, without cost, a disclosure statement to all prospective subscribers and, upon request, annually to all subscribers. A disclosure statement shall be provided to a prospective subscriber before payment of any part of the entrance fee or, if earlier, the execution of a continuing care at home agreement. The provider shall submit its initial disclosure statement to the Department for review at least 45 days before distributing the statement to any prospective or existing subscribers.</text> </paragraph> <paragraph num="B."> <text>Disclosure Statement Revisions. A provider shall revise its disclosure statement annually. A provider shall file a revised disclosure statement with the Department within 120 days after the end of the provider's fiscal year and notify current subscribers that the revised disclosure statement is available for review. The Department shall review the disclosure statement solely to ensure compliance with this regulation.</text> </paragraph> <paragraph num="C."> <text>Disclosure Statement Contents. The disclosure statement shall include:</text> <paragraph num="(1)"> <text>The name and address of the provider;</text> </paragraph> <paragraph num="(2)"> <text>The name and address of any parent or subsidiary person;</text> </paragraph> <paragraph num="(3)"> <text>The organizational structure and management of the provider, including:</text> <paragraph num="(a)"> <text>If the provider is a corporation or limited liability company, the:</text> <paragraph num="(i)"> <text>Name of the corporation or limited liability company,</text> </paragraph> <paragraph num="(ii)"> <text>State in which the corporation is incorporated or the limited liability company is formed, and</text> </paragraph> <paragraph num="(iii)"> <text>Name of the chief executive officer;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>If the provider is a partnership, the:</text> <paragraph num="(i)"> <text>Names of the general partners,</text> </paragraph> <paragraph num="(ii)"> <text>State governing the formation of the partnership, and</text> </paragraph> <paragraph num="(iii)"> <text>Name of the primary individual responsible for managing the partnership;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>If the provider is an unincorporated association, the:</text> <paragraph num="(i)"> <text>Names of the members,</text> </paragraph> <paragraph num="(ii)"> <text>State governing the association's activities, and</text> </paragraph> <paragraph num="(iii)"> <text>Name of the primary individual responsible for managing the association;</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>If the provider is a partnership having a corporation or limited liability company as one or more of its general partners, the:</text> <paragraph num="(i)"> <text>Name of each corporation or limited liability company,</text> </paragraph> <paragraph num="(ii)"> <text>State in which the corporation is incorporated or the limited liability company is formed, and</text> </paragraph> <paragraph num="(iii)"> <text>Name of the chief executive officer;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>If the provider is a trust, the:</text> <paragraph num="(i)"> <text>Name of each trustee,</text> </paragraph> <paragraph num="(ii)"> <text>Names of the owners of beneficial interests in the trust,</text> </paragraph> <paragraph num="(iii)"> <text>State whose law governs the trust, and</text> </paragraph> <paragraph num="(iv)"> <text>Name of the primary individual responsible for overseeing the trust's activities; and</text> </paragraph> </paragraph> <paragraph num="(f)"> <text>A statement regarding whether the provider is qualified, or intends to qualify, as a tax-exempt organization under the Internal Revenue Code;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>A statement regarding any affiliation of the provider with a religious, charitable, or other nonprofit organization, and the extent to which that organization is responsible for the financial and contractual obligations of the provider;</text> </paragraph> <paragraph num="(5)"> <text>A description of all fees collected by the provider that are not optional, including:</text> <paragraph num="(a)"> <text>Entrance fees;</text> </paragraph> <paragraph num="(b)"> <text>Additional periodic fees; and</text> </paragraph> <paragraph num="(c)"> <text>Any additional fees for health care services that are not covered by the entrance fee and periodic fee;</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>The date and the amount of any changes in the fees that are not optional imposed in any of the past 5 years during which the provider was providing continuing care at home;</text> </paragraph> <paragraph num="(7)"> <text>A statement describing provisions that have been, or will be, made to comply with the reserve requirements in Regulation .14 of this chapter;</text> </paragraph> <paragraph num="(8)"> <text>A general statement regarding the provider's investment policy related to the required reserves, including how often the reserve funds' investments are reviewed and by whom;</text> </paragraph> <paragraph num="(9)"> <text>A copy of the most recent certified financial statement available under generally accepted accounting principles;</text> </paragraph> <paragraph num="(10)"> <text>A description of any long-term financing for the provider;</text> </paragraph> <paragraph num="(11)"> <text>If operations have not begun, a summary of the most recent feasibility study approved by the Department, which shall include:</text> <paragraph num="(a)"> <text>A description of the anticipated sources and uses of funds to finance the project, including related costs such as:</text> <paragraph num="(i)"> <text>Financing expenses,</text> </paragraph> <paragraph num="(ii)"> <text>Marketing costs, and</text> </paragraph> <paragraph num="(iii)"> <text>Legal and administrative costs;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>The projected balance sheets, income statements, and cash flow statements of the provider contained in the most recent feasibility study approved by the Department or, if there have been revisions to these financial projections since approval was received, then:</text> <paragraph num="(i)"> <text>Include the most current projections, and</text> </paragraph> <paragraph num="(ii)"> <text>Specify that the financial projections have been revised since the feasibility study was approved by the Department;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>A projected presales schedule;</text> </paragraph> <paragraph num="(d)"> <text>A statement indicating when the provider expects to have executed agreements for 30 percent of the number of subscribers needed for the provider to reach its break-even point;</text> </paragraph> <paragraph num="(e)"> <text>A statement indicating when the provider plans to begin operations;</text> </paragraph> <paragraph num="(f)"> <text>A statement indicating when the provider expects to enroll the number of subscribers needed for the provider to reach its break-even point; and</text> </paragraph> <paragraph num="(g)"> <text>Any further information the Department requires;</text> </paragraph> </paragraph> <paragraph num="(12)"> <text>If operations have begun and the provider has not enrolled the number of subscribers needed for the provider to reach its break-even point, a summary of the most recent feasibility study approved by the Department, which shall include:</text> <paragraph num="(a)"> <text>A description of the sources and uses of funds to finance the project, including related costs such as:</text> <paragraph num="(i)"> <text>Financing expenses,</text> </paragraph> <paragraph num="(ii)"> <text>Marketing costs, and</text> </paragraph> <paragraph num="(iii)"> <text>Legal and administrative costs;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>The projected balance sheets, income statements, and cash flow statements of the provider shown in the most recent feasibility study approved by the Department or, if there have been revisions to these financial projections since approval was received, then:</text> <paragraph num="(i)"> <text>Include the most current projections, and</text> </paragraph> <paragraph num="(ii)"> <text>Specify that the financial projections have been revised since the feasibility study was approved by the Department;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>A projected presales schedule;</text> </paragraph> <paragraph num="(d)"> <text>A semiannual schedule which shows actual presales since operations began;</text> </paragraph> <paragraph num="(e)"> <text>A statement indicating when the provider expects to enroll the number of subscribers needed for the provider to reach its break-even point; and</text> </paragraph> <paragraph num="(f)"> <text>Any further information the Department requires;</text> </paragraph> </paragraph> <paragraph num="(13)"> <text>A cash flow forecast statement for the current and the next 2 fiscal years;</text> </paragraph> <paragraph num="(14)"> <text>The names and occupations of:</text> <paragraph num="(a)"> <text>The provider's officers, directors, trustees, and managing or general partners; and</text> </paragraph> <paragraph num="(b)"> <text>Any person with a 10 percent or greater equity or beneficial interest in the provider;</text> </paragraph> </paragraph> <paragraph num="(15)"> <text>A description of the financial interest in or occupation with the provider of each person identified under §C(14) of this regulation;</text> </paragraph> <paragraph num="(16)"> <text>If it is anticipated that a business entity will provide to the provider goods, premises, or services with a value of $10,000 or more within any fiscal year, and if a person identified in §C(14) of this regulation has a financial interest of 10 percent or more in the business entity, then include:</text> <paragraph num="(a)"> <text>The name and address of the business entities;</text> </paragraph> <paragraph num="(b)"> <text>A description of the goods, premises, or services; and</text> </paragraph> <paragraph num="(c)"> <text>The anticipated yearly costs the provider will incur for the goods, premises, or services;</text> </paragraph> </paragraph> <paragraph num="(17)"> <text>If the continuing care at home operations are, or will be, managed on a day-to-day basis by a person other than an individual directly employed by the provider, then include a description of the proposed manager or management company, including the business experience the manager or company has operating or managing similar operations;</text> </paragraph> <paragraph num="(18)"> <text>A description of any matter in which an individual identified under §C(14) of this regulation has:</text> <paragraph num="(a)"> <text>Been convicted of, or pleaded nolo contendere to, a felony charge involving fraud, embezzlement, fraudulent conversion, or misappropriation of property;</text> </paragraph> <paragraph num="(b)"> <text>Been held liable, or enjoined by a final judgment, in a civil action involving fraud, embezzlement, fraudulent conversion, or misappropriation as a fiduciary;</text> </paragraph> <paragraph num="(c)"> <text>Been subject to an effective injunctive or restrictive order of a court of record arising out of or relating to business activity or health care, including actions affecting a license to operate any facility or service for aging, impaired, or dependent persons; or</text> </paragraph> <paragraph num="(d)"> <text>Had any state or federal license or permit suspended or revoked within the past 10 years, as a result of an action brought by a governmental agency arising out of or relating to business activity or health care, including actions affecting a license to operate any facility or service for aging, impaired, or dependent persons;</text> </paragraph> </paragraph> <paragraph num="(19)"> <text>A description of the form of governance of the provider, including the composition of the governing body;</text> </paragraph> <paragraph num="(20)"> <text>A statement that the provider shall hold the periodic meetings with subscribers as required under Regulation .13 of this chapter;</text> </paragraph> <paragraph num="(21)"> <text>If applicable, a description of the conditions under which the provider may:</text> <paragraph num="(a)"> <text>Be issued an initial certificate of registration; and</text> </paragraph> <paragraph num="(b)"> <text>Use escrowed deposits;</text> </paragraph> </paragraph> <paragraph num="(22)"> <text>If applicable, a statement of the amount of a subscriber's deposit that may be used upon issuance of an initial certificate of registration;</text> </paragraph> <paragraph num="(23)"> <text>A summary of the basic services provided or proposed to be provided under the provider's agreements;</text> </paragraph> <paragraph num="(24)"> <text>For each basic service a provider is required to provide by Regulation .02E of this chapter, a statement that explains:</text> <paragraph num="(a)"> <text>Any limits on the amount of the basic service that will be provided to a subscriber in exchange for the entrance fee and periodic fee; and</text> </paragraph> <paragraph num="(b)"> <text>If there is a limit, the methodology used to measure the amount of services, such as hours of service, calendar months, or the dollar value of services rendered;</text> </paragraph> </paragraph> <paragraph num="(25)"> <text>A summary of any services in addition to the basic services that are provided or proposed to be provided under the provider's agreements;</text> </paragraph> <paragraph num="(26)"> <text>For each additional service described under §C(25) of this regulation, a statement that describes which of those additional services are to be covered by the entrance fee and any periodic fees and which additional services will be made available at an extra charge;</text> </paragraph> <paragraph num="(27)"> <text>The names of facilities with which the provider has a formal arrangement to provide services to subscribers;</text> </paragraph> <paragraph num="(28)"> <text>A statement describing which, if any, services are portable and may be used outside the geographic service area;</text> </paragraph> <paragraph num="(29)"> <text>A statement describing any procedures a subscriber must follow to use a benefit outside the geographic service area;</text> </paragraph> <paragraph num="(30)"> <text>If it is the provider's policy that a subscriber maintain certain insurance, a statement describing each type of insurance required and, if applicable, the amounts of coverage required;</text> </paragraph> <paragraph num="(31)"> <text>A statement that the provider will promptly amend its disclosure statement if, in the opinion of the provider or the Department, an amendment is necessary to prevent the disclosure statement from containing any material misstatement of fact required by this regulation to be stated in the disclosure statement or omission of a material fact required by this regulation to be stated in the disclosure statement;</text> </paragraph> <paragraph num="(32)"> <text>If it is the provider's policy to impose a surcharge on some, but not all, subscribers because of some condition or circumstance, a statement that describes the types of conditions or circumstances that would warrant a surcharge and that a surcharge is not considered part of the entrance fee when calculating a refund under Regulation .25 of this chapter; and</text> </paragraph> <paragraph num="(33)"> <text>Any other material information concerning the provider that the Department requires or that the provider wishes to include.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The disclosure statement shall contain a cover page that states in a prominent location and type face, the following:</text> <paragraph num="(1)"> <text>The date of the disclosure statement;</text> </paragraph> <paragraph num="(2)"> <text>That the issuance of a certificate of registration does not constitute approval, recommendation, or endorsement of the provider by the Department; and</text> </paragraph> <paragraph num="(3)"> <text>That the issuance of a certificate of registration is neither evidence of, nor does it attest to, the accuracy or completeness of the information set out in the disclosure statement.</text> </paragraph> </paragraph> <paragraph num="E."> <text>Any amended disclosure statement shall be:</text> <paragraph num="(1)"> <text>Filed with the Department at the same time that it is delivered to a subscriber or prospective subscriber; and</text> </paragraph> <paragraph num="(2)"> <text>Subject to all the requirements of this chapter.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".16" heading="Sale, Transfer, or Reorganization of Ownership or Control."> <paragraph num="A."> <text>Sale or Transfer of Ownership or Control.</text> <paragraph num="(1)"> <text>Except as provided in §B of this regulation, a provider that holds an initial or renewal certificate of registration, or a person with an ownership interest in or right to control that provider through governing body appointments or contractual or similar arrangements, may not sell or otherwise transfer, directly or indirectly, more than 50 percent of the ownership of, or right to control, the provider or a person that owns or controls a provider, unless the provider or person obtains the approval of the Department to the sale or other transfer in accordance with §§C—F of this regulation.</text> </paragraph> <paragraph num="(2)"> <text>Any series of sales or other transfers within a 12-month period shall be aggregated for purposes of this regulation.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Exception for Business Reorganizations.</text> <paragraph num="(1)"> <text>This regulation does not apply if:</text> <paragraph num="(a)"> <text>A transfer of ownership of a provider, or a transfer of ownership or control of a person owning or controlling a provider, is part of a business reorganization; and</text> </paragraph> <paragraph num="(b)"> <text>The same party or parties holding a majority of ownership of, or right to control, the provider before the business reorganization will retain, directly or indirectly, a majority of the ownership of, or right to control, the provider after the business reorganization.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>If a sale or transfer of ownership satisfies the exception of §B(1) of this regulation, the provider shall give written notice to the Department and to the provider's subscribers 30 days before the business reorganization.</text> </paragraph> <paragraph num="(3)"> <text>The written notice to the Department required by §B(2) of this regulation shall include:</text> <paragraph num="(a)"> <text>A statement describing the reorganization in ownership including the new organizational structure;</text> </paragraph> <paragraph num="(b)"> <text>A copy of each corporate charter, articles of incorporation, bylaws, partnership agreements, articles of association, membership agreement, or trust agreement that will govern the legal organization of the provider after the sale or other transfer;</text> </paragraph> <paragraph num="(c)"> <text>A copy of the notice given to, or to be given to, the provider's subscribers; and</text> </paragraph> <paragraph num="(d)"> <text>Any further information the Department requires regarding the structure of the legal entities involved in the reorganization.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Request for Approval of a Sale or Transfer of Ownership or Control.</text> <paragraph num="(1)"> <text>A provider subject to §A of this regulation shall:</text> <paragraph num="(a)"> <text>At least 90 days before the proposed effective date of the sale or other transfer, file with the Department a statement of intent to transfer ownership or control; and</text> </paragraph> <paragraph num="(b)"> <text>At least 65 days before the proposed effective date of the sale or other transfer, give written notice of the proposed sale or other transfer to the continuing care at home subscribers of the provider and to the Department.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Along with the written notice to the Department required by §C(1)(b) of this regulation, the provider shall submit a payment to the Department of $8,000.</text> </paragraph> <paragraph num="(3)"> <text>The written notice required by §C(1)(b) of this regulation shall specify the following information, which also shall be provided to any continuing care at home subscriber of the provider upon request:</text> <paragraph num="(a)"> <text>The place and time for the meeting specified in §C(4) of this regulation;</text> </paragraph> <paragraph num="(b)"> <text>The address of the provider and the Department to which any comments may be sent;</text> </paragraph> <paragraph num="(c)"> <text>The name and address of affected facilities and the name and address of the new provider;</text> </paragraph> <paragraph num="(d)"> <text>The organizational structure and management of the provider and affected facilities after the proposed sale or other transfer is completed, including:</text> <paragraph num="(i)"> <text>If the provider is to be a corporation or limited liability company, then the name of the corporation or limited liability company, the state in which the corporation is incorporated or the limited liability company is formed, and the name of the chief executive officer of the provider,</text> </paragraph> <paragraph num="(ii)"> <text>If the provider is to be a partnership, then the names of the general partners, the state governing the formation of the partnership, and the name of the primary individual responsible for managing the partnership,</text> </paragraph> <paragraph num="(iii)"> <text>If the provider is to be an unincorporated association, then the names of the members, the state governing the unincorporated association's activities, and the name of the primary individual responsible for managing the association,</text> </paragraph> <paragraph num="(iv)"> <text>If the provider is to be a trust, then the name of each trustee, the names of the owners of the beneficial interests in the trust, the state whose law governs the trust, and the name of the primary individual responsible for overseeing the trust's activities,</text> </paragraph> <paragraph num="(v)"> <text>If the provider is to be a partnership having a corporation or limited liability company as one or more of its general partners, then the name of each corporation or limited liability company, the state in which the corporation is incorporated or the limited liability company is formed, and the name of the provider's chief executive officer, and</text> </paragraph> <paragraph num="(vi)"> <text>The names and occupations of each person who will be an officer, director, trustee, general partner, principal, or person with a 10 percent or greater equity or beneficial interest in the provider after the sale or other transfer;</text> </paragraph> </paragraph> <paragraph num="(e)"> <text>A copy of each corporate charter, articles of incorporation, bylaws, partnership agreement, articles of association, membership agreement, or trust agreement as it will pertain to the legal organization of the provider after the sale or other transfer;</text> </paragraph> <paragraph num="(f)"> <text>A statement as to:</text> <paragraph num="(i)"> <text>Any affiliation with a religious, charitable, or other nonprofit organization that will exist after the proposed sale or other transfer, and</text> </paragraph> <paragraph num="(ii)"> <text>The extent, if any, to which the affiliate organization will be responsible for the financial and contractual obligations of the provider;</text> </paragraph> </paragraph> <paragraph num="(g)"> <text>The name and address of each person that is likely to provide goods, premises, or services to the provider after the sale or other transfer, which goods, premises, or services will have a value of $10,000 or more within any fiscal year;</text> </paragraph> <paragraph num="(h)"> <text>If a person identified in §C(2)(d)(vi) of this regulation has a 10 percent or greater financial interest in a person identified in §C(2)(g) of this regulation, then describe the goods, premises, or services to be provided to the provider;</text> </paragraph> <paragraph num="(i)"> <text>A description of any proposed manager or management company that will manage the day-to-day operations of the provider after the sale or other transfer, including the business experience the manager or company has in operating or managing similar operations;</text> </paragraph> <paragraph num="(j)"> <text>A description of each matter in which a person identified in §C(2)(d)(vi) of this regulation has:</text> <paragraph num="(i)"> <text>Been convicted of, or pleaded nolo contendere to, a felony charge involving fraud, embezzlement, fraudulent conversion, or misappropriation of property,</text> </paragraph> <paragraph num="(ii)"> <text>Been held liable, or enjoined by a final judgment, in a civil action involving fraud, embezzlement, fraudulent conversion, or misappropriation as a fiduciary,</text> </paragraph> <paragraph num="(iii)"> <text>Been subject to an effective injunctive or restrictive order of a court of record arising out of or relating to business activity or health care, including actions affecting a license to operate a facility or service for aging, impaired, or dependent persons, or</text> </paragraph> <paragraph num="(iv)"> <text>Had any state or federal license or permit suspended or revoked within the past 10 years, as a result of an action brought by a governmental agency arising out of or relating to business activity or health care, including actions affecting a license to operate a facility or service for aging, impaired, or dependent persons;</text> </paragraph> </paragraph> <paragraph num="(k)"> <text>A financial plan, prepared by an authority recognized by the Department, in a form reasonably acceptable to the Department that:</text> <paragraph num="(i)"> <text>Demonstrates the projected effects of the sale or other transfer on the financial operations of the provider,</text> </paragraph> <paragraph num="(ii)"> <text>Includes any obligations of the provider to make payments in connection with the sale or other transfer from the financial resources of the provider,</text> </paragraph> <paragraph num="(iii)"> <text>Includes projected 10-year balance sheets, income statements, and cash flow statements each prepared in accordance with generally accepted accounting principles, and</text> </paragraph> <paragraph num="(iv)"> <text>Includes the key assumptions underlying the projected 10-year balance sheets, income statements, and cash flow statements;</text> </paragraph> </paragraph> <paragraph num="(l)"> <text>A statement from an authority recognized by the Department that is based on the financial plan and that concludes that the proposed change in ownership is not likely to have an unreasonably adverse effect on the provider's ability to perform its obligations under its agreements; and</text> </paragraph> <paragraph num="(m)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>For the first 15 days after the provider gives the notice specified in §C(1)(b) of this regulation, subscribers may submit to the provider and to the Department written questions and comments on the proposed sale or other transfer.</text> </paragraph> <paragraph num="(5)"> <text>At least 18 days, but not later than the 25th day, after the notice specified in §C(1)(b) of this regulation is given, representatives of the provider shall hold a meeting with representatives of the subscribers to discuss the proposed sale or other transfer. Representatives of the Department may attend the meeting. Representatives of the subscribers may not exceed 15 in number. If there is a subscriber association, up to 15 representatives shall be chosen by the association. The names and addresses of the subscriber representatives shall be given by those elected representatives to the provider and to the Department. If a subscriber association does not exist, the provider shall include in the notice to subscribers required by §C(1)(b) of this regulation a statement that up to 15 subscribers can be elected to represent the subscribers in a meeting with the provider to discuss the proposed sale or transfer and that subscribers desiring to be elected should submit their names to the provider by a particular date and time. Immediately after the date and time established in the notice, the provider shall conduct an election by mail to select the subscribers receiving the most votes as representatives of the subscribers. The provider shall provide the names and addresses of the elected representatives to the Department.</text> </paragraph> <paragraph num="(6)"> <text>For 10 days after the meeting specified in §C(4) of this regulation, subscribers may submit to the provider and to the Department additional written comments on the proposed sale or other transfer.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Approval of Sale or Transfer of Ownership or Control. By the 50th day after the date of the notice required by §C(1)(b) of this regulation, the Department shall issue an approval of the sale or other transfer, unless it determines that the sale or transfer is likely to have an unreasonably adverse impact on the financial stability of the provider or is likely to have an unreasonably adverse effect on a provider's capacity to perform its obligations under the continuing care at home agreements to which it is a party. The Department may extend the date for approval past the 50th day after the date of the notice required by §C(1)(b) of this regulation for good cause. The Department shall notify the provider and subscriber representatives in writing of its determination and rationale.</text> </paragraph> <paragraph num="E."> <text>Appeal of Department Decision. The decision by the Department with respect to the proposed sale or other transfer is subject to appeal only by the provider in accordance with Regulation .31 of this chapter, and no other person shall be deemed to be a party in interest to the proceedings. If an appeal is taken by the provider, the Department shall give prompt notice of the appeal to the subscriber representatives. The Department shall give the subscriber representatives prompt notice of any decision rendered in the appeal.</text> </paragraph> <paragraph num="F."> <text>Effective Date of Sale or Transfer of Ownership or Control. A sale or other transfer of ownership or control may not be completed until after the 15th day following the later of:</text> <paragraph num="(1)"> <text>The date the Department issues an approval specified in §D of this regulation; or</text> </paragraph> <paragraph num="(2)"> <text>If an appeal is taken under §E of this regulation, the day a hearing officer or administrative law judge renders a final decision permitting the sale or other transfer.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".17" heading="Sale, Transfer, or Other Disposition of Assets."> <paragraph num="A."> <text>Definitions.</text> <paragraph num="(1)"> <text>In this regulation, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="(2)"> <text>Terms Defined.</text> <paragraph num="(a)"> <text>“Days cash on hand ratio” means the ratio created by the following calculation: [Unrestricted current cash and investments + Unrestricted noncurrent cash and investments] / [(Total operating expenses - depreciation and amortization) / 365].</text> </paragraph> <paragraph num="(b)"> <text>“Debt service coverage ratio” means the ratio created by the following calculation: [Total excess of revenues over expenses + Interest, lease, depreciation, and amortization expenses / Amortization of deferred revenue + Net proceeds from the collection of entrance fees] / [Maximum annual debt service or annual lease payments].</text> </paragraph> <paragraph num="(c)"> <text>“Future service obligation” means a financial obligation of a provider that equals any positive number resulting from the calculation to determine the amount by which the present value of the net costs of future services to be provided to the current subscribers exceeds the balance of deferred revenue from entrance fees, which calculation is required to be performed annually by generally accepted accounting principles.</text> </paragraph> <paragraph num="(d)"> <text>“Liquid resources” means an asset that is easily converted to cash.</text> </paragraph> <paragraph num="(e)"> <text>“Maximum annual debt service” means the greatest amount required to pay the debt service requirements of any long-term indebtedness for any fiscal year, excluding any year in which the amount due is defined in the applicable financing documents as a balloon payment.</text> </paragraph> <paragraph num="(f)"> <text>“Operating ratio” means the ratio created by the following calculation: [Total operating expenses - Depreciation and amortization expenses] / [Total revenues - amortization of deferred revenue].</text> </paragraph> <paragraph num="(g)"> <text>“Ordinary course of business” means transactions that occur on a routine basis without the involvement of the board of directors, or other governing body, such as paying employees and vendors, collecting fees, and selling and purchasing investments.</text> </paragraph> <paragraph num="(h)"> <text>“Transfer” means a sale, disposition, donation, lease, or other transaction that diminishes the ownership rights that the provider has in any assets.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>Transactions Not Included. The following transactions are not considered sales, transfers, or other dispositions of assets for purposes of §§C and D of this regulation:</text> <paragraph num="(1)"> <text>Those undertaken under contractual obligations in effect on April 1, 2000;</text> </paragraph> <paragraph num="(2)"> <text>Those made in the ordinary course of business;</text> </paragraph> <paragraph num="(3)"> <text>Refunds of amounts under contracts entered into in the ordinary course of business;</text> </paragraph> <paragraph num="(4)"> <text>Transfers of cash, securities, or other investment properties in connection with ordinary investment transactions;</text> </paragraph> <paragraph num="(5)"> <text>Grants of mortgages, deeds of trust, or security interests to unrelated third parties;</text> </paragraph> <paragraph num="(6)"> <text>Those involving easements, rights-of-way, road widening, and similar conveyances for the benefit of public bodies or utilities; and</text> </paragraph> <paragraph num="(7)"> <text>Those made for an expansion or renovation.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Transfers of 10 Percent or Less of Assets.</text> <paragraph num="(1)"> <text>Except as provided by §C(3) of this regulation, a provider that holds an initial or renewal certificate of registration may not transfer assets that are equal to or less than 10 percent of the provider's total assets, based on the certified financial statements for the most recent fiscal year for which a certified financial statement is available at the time of the transfer, if the transfer is likely to have an unreasonably adverse:</text> <paragraph num="(a)"> <text>Impact on the financial stability of the provider; or</text> </paragraph> <paragraph num="(b)"> <text>Effect on the provider's capacity to perform its obligations under continuing care at home agreements to which it is a party.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Unlike a transfer of assets greater than 10 percent of total assets, a transfer of assets equal to or less than 10 percent of total assets does not have to be approved in advance by the Department unless one or more of the following circumstances exists:</text> <paragraph num="(a)"> <text>The transfer would result in insufficient liquid resources to cover the provider's future service obligation after the proposed transfer; or</text> </paragraph> <paragraph num="(b)"> <text>The provider believes that the transfer may have an unreasonably adverse:</text> <paragraph num="(i)"> <text>Impact on its financial stability, or</text> </paragraph> <paragraph num="(ii)"> <text>Effect on its capacity to perform its obligations under its agreements.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(3)"> <text>In order to have a transfer subject to §C of this regulation approved in advance by the Department, the provider shall submit to the Department the following:</text> <paragraph num="(a)"> <text>Identification of all assets to be sold, transferred, or otherwise disposed of;</text> </paragraph> <paragraph num="(b)"> <text>Documentation as to why the proposed transfer is needed to maintain the financial viability of the provider;</text> </paragraph> <paragraph num="(c)"> <text>A 10-year financial plan, prepared in accordance with generally accepted accounting principles by an independent consultant, that demonstrates the effects of the proposed transfer and includes projected balance sheets, income statements, statements of cash flows, and the key assumptions of the plan; and</text> </paragraph> <paragraph num="(d)"> <text>Any further information the Department requires.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>Within 60 days of receipt of the information required by §D(3) of this regulation, the Department shall issue a written determination that either:</text> <paragraph num="(a)"> <text>Approves the transfer;</text> </paragraph> <paragraph num="(b)"> <text>Denies the transfer; or</text> </paragraph> <paragraph num="(c)"> <text>Seeks more information to evaluate the transfer.</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>If the determination of the Department is not to approve the proposed sale, transfer, or other disposition, the Department shall set forth the reasoning supporting its determination in a written communication to the provider.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Transfer of More than 10 Percent of Assets.</text> <paragraph num="(1)"> <text>A provider that holds an initial or renewal certificate of registration may not transfer, in any 12-month period, assets in excess of 10 percent of its total assets, based on its certified financial statements for the most recent fiscal year for which a certified financial statement is available at the time of the transfer, unless the provider obtains the approval of the Department for the transfer in accordance with this regulation.</text> </paragraph> <paragraph num="(2)"> <text>A provider subject to §D(1) of this regulation shall, at least 60 days before the proposed transfer, file with the Department a statement of intent to transfer assets and, at least 30 days before the proposed transfer, give written notice to the Department.</text> </paragraph> <paragraph num="(3)"> <text>A statement of intent required to be filed with the Department under §D(2) of this regulation shall include the following information:</text> <paragraph num="(a)"> <text>Identification of all the assets to be sold, transferred, or otherwise disposed of;</text> </paragraph> <paragraph num="(b)"> <text>If the provider is subject to §E(1) of this regulation by reason of a series of transfers that have cumulatively exceeded the 10 percent amount, the provider shall identify all of the assets that resulted in exceeding the 10 percent amount; and</text> </paragraph> <paragraph num="(c)"> <text>The reason for the transfer.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>Along with the written notice to the Department required by §D(2) of this regulation, the provider shall submit a payment to the Department of $5,000.</text> </paragraph> <paragraph num="(5)"> <text>A notice required to be filed with the Department by §D(2) of this regulation shall include the following information:</text> <paragraph num="(a)"> <text>A statement that demonstrates that the proposed transfer is not likely to have an unreasonably adverse:</text> <paragraph num="(i)"> <text>Impact on the financial stability of the provider, or</text> </paragraph> <paragraph num="(ii)"> <text>Effect on the provider's capacity to perform its obligations under the agreements to which it is a party;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>Computations, prepared by an authority recognized by the Department, of the following financial ratios for the 3 fiscal years before and after the proposed transfer:</text> <paragraph num="(i)"> <text>Operating ratio,</text> </paragraph> <paragraph num="(ii)"> <text>Day's cash on hand ratio, and</text> </paragraph> <paragraph num="(iii)"> <text>Debt service coverage ratio;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>If the provider is required by generally accepted accounting principles to perform a future service obligation calculation, a statement from an independent consultant that explains why:</text> <paragraph num="(i)"> <text>The provider will have sufficient liquid resources to cover the provider's future service obligation, if one exists, after the proposed transfer, or</text> </paragraph> <paragraph num="(ii)"> <text>The proposed transfer will have a positive impact on the provider's ability to perform its obligations in accordance with the terms of its continuing care at home agreements; and</text> </paragraph> </paragraph> <paragraph num="(d)"> <text>Any other information the Department requires.</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>If the provider cannot meet the financial standards set forth in §E(2) of this regulation, the notice required by §D(2) of this regulation shall include the following additional information:</text> <paragraph num="(a)"> <text>A 10-year financial plan, prepared in accordance with generally accepted accounting principles by an independent consultant, that demonstrates the effects of the proposed transfer and includes:</text> <paragraph num="(i)"> <text>Projected balance sheets,</text> </paragraph> <paragraph num="(ii)"> <text>Income statements,</text> </paragraph> <paragraph num="(iii)"> <text>Statements of cash flows, and</text> </paragraph> <paragraph num="(iv)"> <text>The key assumptions of the plan;</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>A statement from the independent consultant that after taking into account the provider's historic performance and future assumptions, which future assumptions the independent consultant concludes are not unreasonable, the provider will have the financial ability after the transfer to perform its obligations under the provider's agreements; and</text> </paragraph> <paragraph num="(c)"> <text>Any further information that the Department requires.</text> </paragraph> </paragraph> </paragraph> <paragraph num="E."> <text>Approval of Transfer of More than 10 Percent of Assets.</text> <paragraph num="(1)"> <text>The Department shall approve the sale, transfer, or other disposition of assets in excess of 10 percent unless it determines that the sale, transfer, or other disposition is likely to have an unreasonably adverse:</text> <paragraph num="(a)"> <text>Impact on the financial stability of the provider; or</text> </paragraph> <paragraph num="(b)"> <text>Effect on the provider's capacity to perform its obligations under the continuing care at home agreements to which it is a party.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The Department shall approve a proposed transfer of assets in excess of 10 percent if the information required by §D(4) of this regulation adequately demonstrates that the provider:</text> <paragraph num="(a)"> <text>Will be able to achieve at least one of the following financial ratios by the end of the third fiscal year after the transfer:</text> <paragraph num="(i)"> <text>An operating ratio less than or equal to 0.95,</text> </paragraph> <paragraph num="(ii)"> <text>A day's cash on hand ratio of greater than 90 days, or</text> </paragraph> <paragraph num="(iii)"> <text>A debt service coverage ratio greater than or equal to 1.25; and</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>Meets one of the following standards if the provider is required by generally accepted accounting principles to perform a future service obligation calculation:</text> <paragraph num="(i)"> <text>Will have sufficient liquid resources to cover the provider's future service obligation after the proposed transfer, or</text> </paragraph> <paragraph num="(ii)"> <text>The proposed transfer will have a positive impact on the provider's ability to perform its obligations in accordance with the terms of its agreements.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(3)"> <text>The Department shall communicate its determination in writing to the provider by the 25th day after the date the Department receives the written notice required by §D(2) of this regulation, unless extended by the Department for good cause. If the determination of the Department is not to approve the proposed sale, transfer, or other disposition, the Department shall set forth the reasons supporting its determination in the written communication to the provider.</text> </paragraph> </paragraph> <paragraph num="F."> <text>Appeal of a Department Decision. The determination by the Department with respect to a proposed transfer of assets is subject to appeal only by the provider in accordance with Regulation .31 of this chapter. No other person may be deemed to be a party in interest to the proceedings.</text> </paragraph> <paragraph num="G."> <text>Effective Date of a Transfer of Assets. A transfer of assets subject to review by the Department under this regulation may not be completed until after the fifth day following the later of:</text> <paragraph num="(1)"> <text>The day on which the Department issues a determination approving the transfer; or</text> </paragraph> <paragraph num="(2)"> <text>If an appeal is taken under §F of this regulation, the day a hearing officer or administrative law judge renders a final decision permitting the transfer of assets.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".18" heading="Financial Review Committee."> <text>The Financial Review Committee authorized by Human Services Article, §§10-464—10-469, Annotated Code of Maryland, shall review providers' financial matters referred to it by the Department in accordance with the provisions of COMAR 32.02.01.24.</text> </regulation> <regulation prefix="Regulation" num=".19" heading="Referrals to the Financial Review Committee."> <paragraph num="A."> <text>The Department may refer to the Committee for its consideration:</text> <paragraph num="(1)"> <text>A provider's application for a renewal certificate after review by the Department; or</text> </paragraph> <paragraph num="(2)"> <text>A finding of possible financial difficulty, at any time.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Upon receipt of a referral from the Department, the Committee shall:</text> <paragraph num="(1)"> <text>Request from the Department any additional material which the Committee may require;</text> </paragraph> <paragraph num="(2)"> <text>Review the material to determine whether or not it finds the provider in financial difficulty;</text> </paragraph> <paragraph num="(3)"> <text>Notify the Department in writing of its findings and reasons for its findings, within 45 days of receipt of the referral; and</text> </paragraph> <paragraph num="(4)"> <text>Provide consultation to the Department regarding corrective financial plans for providers in financial difficulty when requested by the Department.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The Committee may request one 30-day extension if the 45-day time limit cannot be met. The Secretary may grant the extension.</text> </paragraph> <paragraph num="D."> <text>Upon notification of a finding by the Committee, the Department shall consider the finding of the Committee and, within 25 days of receipt of the Committee's finding, make a final determination whether the provider is in financial difficulty.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".20" heading="Findings of Financial Difficulty."> <paragraph num="A."> <text>Upon final determination by the Department that a provider is in financial difficulty, the Department shall notify the provider of the determination by certified mail, return receipt requested.</text> </paragraph> <paragraph num="B."> <text>The Department may:</text> <paragraph num="(1)"> <text>Consult with the Financial Review Committee to review the findings and possible corrective financial plans; and</text> </paragraph> <paragraph num="(2)"> <text>Assist the provider to develop an adequate corrective financial plan.</text> </paragraph> </paragraph> <paragraph num="C."> <text>A provider notified of a determination of financial difficulty shall:</text> <paragraph num="(1)"> <text>Cooperate with the Department to develop a corrective financial plan;</text> </paragraph> <paragraph num="(2)"> <text>Prepare a 5-year financial plan to correct the causes of the financial difficulty;</text> </paragraph> <paragraph num="(3)"> <text>Submit the corrective plan to the Department for approval within 60 days of receipt of notification from the Department;</text> </paragraph> <paragraph num="(4)"> <text>Amend the financial plan as the Department may advise to enable a finding of no financial difficulty;</text> </paragraph> <paragraph num="(5)"> <text>Implement the corrective financial plan;</text> </paragraph> <paragraph num="(6)"> <text>Submit to the Department within 60 days of the close of each fiscal year an annual progress report on the implementation of its approved financial plan; and</text> </paragraph> <paragraph num="(7)"> <text>At the direction of the Department, revise and update its corrective financial plan if the Department finds that revisions are necessary based on review of the annual progress report or other investigation.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The provider may request from the Secretary a 30-day extension of the 60-day time period specified in §C(3) of this regulation. The Secretary may grant the extension.</text> </paragraph> <paragraph num="E."> <text>After a provider has been found to be in financial difficulty, the Department may withhold a renewal certificate of registration or withdraw a current certificate of registration if the Department determines that the provider:</text> <paragraph num="(1)"> <text>Did not prepare a corrective financial plan within 60 days of notification (or 90 days, if the Secretary granted an extension);</text> </paragraph> <paragraph num="(2)"> <text>Is unwilling or unable to prepare a corrective financial plan;</text> </paragraph> <paragraph num="(3)"> <text>Prepared a financial plan which is found by the Department to be inadequate to correct the current or impending financial difficulty; or</text> </paragraph> <paragraph num="(4)"> <text>Failed to implement the approved corrective plan, which is demonstrated by the annual progress report or an interim investigation by the Department.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".21" heading="Deposit Agreement and Processing Fee."> <paragraph num="A."> <text>A deposit agreement used before the provider has received an initial certificate of registration shall:</text> <paragraph num="(1)"> <text>State that all deposits and entrance fees shall be held in escrow until the:</text> <paragraph num="(a)"> <text>Issuance of an initial certificate of registration, and</text> </paragraph> <paragraph num="(b)"> <text>Provider has been issued appropriate licenses or certificates by MDH and MHCC;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Describe the disposition of any interest earned on deposits and entrance fees;</text> </paragraph> <paragraph num="(3)"> <text>State the amount of any processing fee and whether it will be refunded if the deposit agreement is canceled; and</text> </paragraph> <paragraph num="(4)"> <text>Describe the disposition of the deposit if the deposit agreement is canceled before the continuing care at home agreement is executed.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A deposit agreement that is used after the provider has received an initial certificate of registration shall:</text> <paragraph num="(1)"> <text>State that the provider may use all deposits and entrance fees at any time; or</text> </paragraph> <paragraph num="(2)"> <text>Describe any applicable limitations on the use of deposits and entrance fees.</text> </paragraph> </paragraph> <paragraph num="C."> <text>A processing fee may only be assessed against a subscriber one time and may not exceed $300.</text> </paragraph> <paragraph num="D."> <text>If a deposit agreement does not precede a continuing care at home agreement, the provider shall ensure that the continuing care at home agreement referred to in Regulation .22 of this chapter meets the requirements of §A of this regulation.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".22" heading="Continuing Care At Home Agreement."> <paragraph num="A."> <text>Each continuing care at home agreement shall:</text> <paragraph num="(1)"> <text>List the total consideration paid, or to be paid, by the subscriber for continuing care at home, including a schedule or inventory that sets forth in one place the value of all entrance fees, subscription fees, property transferred, surcharges, periodic fees, donations, and other fees;</text> </paragraph> <paragraph num="(2)"> <text>Describe in detail:</text> <paragraph num="(a)"> <text>All items of service required to be provided to a subscriber by Regulation .02E of this chapter; and</text> </paragraph> <paragraph num="(b)"> <text>Any additional services to be provided;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>For each item described in §A(2) of this regulation, state whether:</text> <paragraph num="(a)"> <text>There are any limits on the amount of the services to be provided; and</text> </paragraph> <paragraph num="(b)"> <text>If there are limits, the methodology by which they will be measured or capped;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>If adult day care or respite care are not provided, specifically state that they are not;</text> </paragraph> <paragraph num="(5)"> <text>State:</text> <paragraph num="(a)"> <text>Whether the provider has a formal arrangement with a facility owned or operated by another person to provide services to a subscriber;</text> </paragraph> <paragraph num="(b)"> <text>What provisions for care will be made if an assisted living or nursing home bed is not available at a facility with which the provider has a formal arrangement, as described in §A(5)(a) of this regulation, at the time a bed is needed by a subscriber;</text> </paragraph> <paragraph num="(c)"> <text>What the payment provisions will be for care at a facility with which the provider has a formal arrangement as described in §A(5)(a) of this regulation; and</text> </paragraph> <paragraph num="(d)"> <text>That the provider shall promptly notify the subscriber and the Department of any change in a formal arrangement described in §A(5)(a);</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>Designate the categories of subscribers according to the types of entrance fee plans offered;</text> </paragraph> <paragraph num="(7)"> <text>State that a subscriber may not be relocated except to protect the health or safety of the subscriber or for the general and economic welfare of other subscribers;</text> </paragraph> <paragraph num="(8)"> <text>While recognizing the constraints of §A(7) of this regulation, describe the procedures the parties to the agreement are to follow in order to temporarily transfer a subscriber;</text> </paragraph> <paragraph num="(9)"> <text>Describe the procedures the parties to the agreement are to follow in order to return a subscriber to the location where the subscriber resided before a temporary change;</text> </paragraph> <paragraph num="(10)"> <text>While recognizing the constraints of §A(7) of this regulation, describe the procedures the parties to the agreement are to follow in order to permanently transfer a subscriber;</text> </paragraph> <paragraph num="(11)"> <text>Describe how the procedures for changes, transfers, and returns, whether temporary or permanent, will operate if the subscriber lives with another subscriber;</text> </paragraph> <paragraph num="(12)"> <text>State whether there will be a partial refund of an entrance fee, an additional fee, or any increase or decrease in a periodic fee in the event of an increase or decrease in the number of subscribers living together;</text> </paragraph> <paragraph num="(13)"> <text>Describe the policies of the provider regarding subscribers unable to meet the periodic charges;</text> </paragraph> <paragraph num="(14)"> <text>State in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, the terms governing the refund of any portion of the entrance fee in the event of:</text> <paragraph num="(a)"> <text>Discharge by the provider; or</text> </paragraph> <paragraph num="(b)"> <text>Termination by the subscriber;</text> </paragraph> </paragraph> <paragraph num="(15)"> <text>State the terms under which an agreement is canceled by the death of a subscriber;</text> </paragraph> <paragraph num="(16)"> <text>State in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, whether or not periodic fees, if charged, will be subject to periodic increases;</text> </paragraph> <paragraph num="(17)"> <text>If periodic fees are subject to increase, state in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, the number of days of notice that will be given by the provider before an increase becomes effective;</text> </paragraph> <paragraph num="(18)"> <text>State that the charges for prepaid care may not be increased, if the agreement provides that care is paid for in advance, in one lump sum;</text> </paragraph> <paragraph num="(19)"> <text>State whether funeral and burial services are furnished by the provider;</text> </paragraph> <paragraph num="(20)"> <text>State the address of subscriber's dwelling;</text> </paragraph> <paragraph num="(21)"> <text>Describe any procedures a subscriber must follow to amend the agreement to change the address of the subscriber's dwelling;</text> </paragraph> <paragraph num="(22)"> <text>State whether the subscriber may assign the dwelling or agreement to another and, if so, under what conditions;</text> </paragraph> <paragraph num="(23)"> <text>Describe what, if any, assistance with the maintenance of the subscriber's dwelling will be performed if the subscriber is not residing in the dwelling;</text> </paragraph> <paragraph num="(24)"> <text>Describe any religious or charitable affiliations of the provider;</text> </paragraph> <paragraph num="(25)"> <text>Describe the extent to which an affiliate organization will be responsible for the financial and contractual obligations of the provider;</text> </paragraph> <paragraph num="(26)"> <text>State the subscriber's and provider's respective rights and obligations as to any real and personal property of the subscriber transferred to or placed in the custody of the provider;</text> </paragraph> <paragraph num="(27)"> <text>State the rights and obligations a subscriber has regarding the use of the provider's facilities, if any, including common areas;</text> </paragraph> <paragraph num="(28)"> <text>State the rights and obligations a provider has regarding its use of its facilities, if any, and what, if any, rights the provider has to enter a subscriber's dwelling;</text> </paragraph> <paragraph num="(29)"> <text>State that subscribers have the right to organize and operate a subscriber's association;</text> </paragraph> <paragraph num="(30)"> <text>State what fee adjustments, if any, will be made by the provider in the event of a subscriber's voluntary absence from the provider's geographic service area or the subscriber's dwelling for an extended period of time;</text> </paragraph> <paragraph num="(31)"> <text>Specify the circumstances, if any, under which a subscriber will be required to apply for Medicaid, Medicare, public assistance, or any public benefit program;</text> </paragraph> <paragraph num="(32)"> <text>State whether the provider is, or plans to be, a participant in Medicare or Medicaid;</text> </paragraph> <paragraph num="(33)"> <text>In a separate paragraph, signed by each subscriber, state: “I have received a copy of the provider's latest certified financial statement at least 2 weeks before signing this agreement, and I have reviewed the certified financial statement provided.”;</text> </paragraph> <paragraph num="(34)"> <text>State that the provider will make available to each subscriber, upon request, any certified financial statement or disclosure statement submitted to the Department;</text> </paragraph> <paragraph num="(35)"> <text>If an agreement is executed before the provider has received an initial certificate, state:</text> <paragraph num="(a)"> <text>The conditions that the provider must meet to be issued an initial certificate of registration by the Department; and</text> </paragraph> <paragraph num="(b)"> <text>That all deposits and entrance fees shall be held in an escrow account in Maryland in a financial institution until:</text> <paragraph num="(i)"> <text>An initial certificate of registration is issued, and</text> </paragraph> <paragraph num="(ii)"> <text>The provider has been issued appropriate licenses or certificates by MDH and MHCC;</text> </paragraph> </paragraph> </paragraph> <paragraph num="(36)"> <text>State that fees collected by a provider under the terms of a continuing care at home agreement may not be used for purposes other than those set forth in the agreement;</text> </paragraph> <paragraph num="(37)"> <text>State in boldface type of the largest font used in the body of the agreement: “A preliminary certificate of registration or certificate of registration is not an endorsement or guarantee of this provider 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> </paragraph> <paragraph num="(38)"> <text>State in boldface type of the largest font used in the body of the agreement: “The provider has estimated it needs x subscribers before it will be fully financially viable. A provider may begin operating before it is fully financially viable. The provider's financial viability depends on enrolling x subscribers.”;</text> </paragraph> <paragraph num="(39)"> <text>State in boldface type of the largest font used in the body of the agreement: “Continuing care at home is a new concept in delivering services to the elderly. While it promises certain future health services, it is not an insurance product and is not as regulated or secure as an insurance policy. However, it does offer services that typically are not available through an insurance policy.”;</text> </paragraph> <paragraph num="(40)"> <text>State which, if any, benefits are portable if the subscriber moves out of the geographic service area and which are not portable;</text> </paragraph> <paragraph num="(41)"> <text>Describe the procedures the parties to the agreement are to follow in order for a subscriber to use portable benefits outside the geographic service area;</text> </paragraph> <paragraph num="(42)"> <text>State the legal remedies available to a subscriber in the event of injury caused by a provider's violation of the Act;</text> </paragraph> <paragraph num="(43)"> <text>In a separate paragraph, signed by each subscriber, state: “I have received a copy of the provider's latest disclosure statement, and I have reviewed the disclosure statement provided.”; and</text> </paragraph> <paragraph num="(44)"> <text>State that if there are differences between the requirements for continuing care at home certification and the licensure requirements for assisted living and comprehensive care facilities, the applicable requirements most favorable to the subscriber will prevail while the subscriber is residing in an assisted living or comprehensive care facility.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Each continuing care at home agreement may contain any other provisions which are:</text> <paragraph num="(1)"> <text>Agreed upon by the provider and the subscriber to effectuate the purpose of the contract; and</text> </paragraph> <paragraph num="(2)"> <text>Not in conflict with the Act or this chapter, as determined by the Department.</text> </paragraph> </paragraph> <paragraph num="C."> <text>A preliminary certificate of registration may not be issued by the Department if the agreement submitted with the application does not contain all of the provisions of §A of this regulation. The Department shall return to the provider for amendment any agreement which it finds in violation of this chapter. The provider shall submit the agreement to an attorney for legal sufficiency as to content and form before resubmission to the Department.</text> </paragraph> <paragraph num="D."> <text>The provider shall request approval from the Department for any modification, addition, or deletion to the terms of a continuing care at home agreement, before the agreement is offered to or used with subscribers. If a proposed change would significantly alter an agreement, the Department may require the submission of an actuarial pricing analysis, performed by a qualified actuary, to support the financial viability of the proposed agreement.</text> </paragraph> <paragraph num="E."> <text>Agreements are governed by the version of this regulation that was in effect at the time the agreement was executed by the parties.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".23" heading="Withdrawal of Application or Rescission of Agreement."> <paragraph num="A."> <text>Withdrawal of Application. A person seeking admission to a continuing care at home program may withdraw an application at any time before execution of the continuing care at home agreement. A provider shall refund all money paid, less any nonrefundable processing fee that was specified in the deposit agreement, to a prospective subscriber who withdraws an application before signing a continuing care at home agreement.</text> </paragraph> <paragraph num="B."> <text>Rescission of Agreement before Services Commence.</text> <paragraph num="(1)"> <text>If a subscriber rescinds an agreement by giving written notice of the rescission to the provider before the provider begins to provide continuing care at home services to the subscriber, and the rescission either occurs within 90 days after entering into the agreement or because of a substantial change in the subscriber's physical, mental, or financial condition, the provider shall, within 30 days of rescission, refund all moneys paid by the subscriber except any processing fee previously specified as nonrefundable.</text> </paragraph> <paragraph num="(2)"> <text>If a subscriber rescinds an agreement by giving written notice of the rescission to the provider before the provider begins to provide continuing care at home services to the subscriber, but more than 90 days after entering into the agreement, for any reason other than a substantial change in the subscriber's physical, mental, or financial condition, the provider shall refund the same amount specified in §B(1) of this regulation, except that the provider may require that the subscriber forfeit part of the refund. The forfeiture amount may not exceed 25 percent of any deposit paid by the subscriber.</text> </paragraph> <paragraph num="(3)"> <text>If a subscriber rescinds an agreement by giving written notice of the rescission to the provider before the provider begins to provide continuing care at home services to the subscriber, because of a substantial change in the subscriber's physical, mental, or financial condition, the provider shall refund the same amount specified in §B(1) of this regulation.</text> </paragraph> <paragraph num="(4)"> <text>If a subscriber dies before the date the provider begins to provide continuing care at home services to the subscriber, the agreement is automatically canceled, and the provider shall refund to the subscriber's legal representative the same amount specified in §B(1) of this regulation, except that the cancellation is not automatic and is at the option of the surviving subscriber if the agreement is in the name of two subscribers.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".24" heading="Rescissions for Violation of the Act."> <text>If the terms of an agreement are in violation of the terms of the Act and a subscriber is injured by the violation, the subscriber may rescind the agreement at any time. The subscriber is entitled to treble damages for extensive injuries arising from a violation of the Act.</text> </regulation> <regulation prefix="Regulation" num=".25" heading="Termination of the Agreement after Services Commence."> <paragraph num="A."> <text>Termination by a Subscriber. If a subscriber elects to terminate the agreement after the provider begins to provide continuing care at home services, any refund of the entrance fee is governed by the terms of the agreement.</text> </paragraph> <paragraph num="B."> <text>Termination, Dismissal, or Discharge by the Provider.</text> <paragraph num="(1)"> <text>An agreement may not permit termination of the agreement or dismissal or discharge of a subscriber from the continuing care at home program, including by involuntary transfer to a health care or mental health facility, before expiration of the agreement for any reason, unless the:</text> <paragraph num="(a)"> <text>Dismissal or discharge is for just cause; and</text> </paragraph> <paragraph num="(b)"> <text>Subscriber is given advance notice of at least 60 days.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Just cause can exist only when there is:</text> <paragraph num="(a)"> <text>Nonpayment;</text> </paragraph> <paragraph num="(b)"> <text>Material breach of:</text> <paragraph num="(i)"> <text>The agreement, or</text> </paragraph> <paragraph num="(ii)"> <text>Written reasonable rules of the provider that contractually bind the subscriber; or</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>Health status or behavior that constitutes a substantial threat to the health or safety of the subscriber, other subscribers, or employees or contractors of the provider.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>A notice of termination, dismissal, or discharge shall include at least the following:</text> <paragraph num="(a)"> <text>A statement of the intent to terminate, dismiss, or discharge;</text> </paragraph> <paragraph num="(b)"> <text>A statement of each reason for terminating, dismissing, or discharging, which shall include at least one of the reasons stated in §B(2) of this regulation;</text> </paragraph> <paragraph num="(c)"> <text>The facts that serve as the basis for the provider's decision to terminate, dismiss, or discharge; and</text> </paragraph> <paragraph num="(d)"> <text>The effective date of termination, dismissal, or discharge, which shall be at least 60 days from the date the subscriber receives the notice.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>An agreement may recognize that a subscriber may have to be moved without the subscriber's consent in the event of an emergency. A move or transfer of a subscriber because of an emergency may not, in and of itself, establish just cause for a termination, dismissal, or discharge.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Permissible Termination, Dismissal, or Discharge. In the event of a termination, discharge, or dismissal of a subscriber who lived with or signed an agreement with another subscriber, who was not terminated, then the subscriber not terminated has the option to:</text> <paragraph num="(1)"> <text>Remain as a subscriber under his or her agreement; or</text> </paragraph> <paragraph num="(2)"> <text>Terminate his or her agreement.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".26" heading="Individuals Employed or Contracted by Provider."> <paragraph num="A."> <text>If a provider employs an individual or contracts with an individual to provide services to the provider's subscribers and the individual will enter a subscriber's dwelling or any combination of subscribers' dwellings more than four times in a year to deliver those services, then the provider shall:</text> <paragraph num="(1)"> <text>Make sure the individual meets the requirements of §B of this regulation;</text> </paragraph> <paragraph num="(2)"> <text>Check at least two character references for the individual to confirm the individual meets the requirements of §B(1)—(5) of this regulation; and</text> </paragraph> <paragraph num="(3)"> <text>Have the individual submit the necessary forms and fingerprints needed to conduct a criminal history records check through the Criminal Justice Information System operated by the Department of Public Safety and Correctional Services.</text> </paragraph> </paragraph> <paragraph num="B."> <text>An individual who is employed by or contracted by a provider to provide services to a subscriber in the subscriber's dwelling and who will enter a subscriber's dwelling or any combination of subscribers' dwellings more than four times in a year to deliver those services shall:</text> <paragraph num="(1)"> <text>Be 18 years old or older;</text> </paragraph> <paragraph num="(2)"> <text>Have adequate training, education, or experience to perform the duties assigned;</text> </paragraph> <paragraph num="(3)"> <text>Have sufficient physical, emotional, and mental capacity to perform the duties assigned;</text> </paragraph> <paragraph num="(4)"> <text>Have no convictions for crimes that have a bearing on the individual's ability to provide services consistent with the well-being of the subscribers;</text> </paragraph> <paragraph num="(5)"> <text>Have sufficient moral character to be entrusted with providing services to elderly people who may be physically or mentally infirm;</text> </paragraph> <paragraph num="(6)"> <text>Provide the names, addresses, and telephone numbers of at least three references attesting to the individual's meeting the requirements of §B(1)—(5) of this regulation; and</text> </paragraph> <paragraph num="(7)"> <text>Be free from communicable diseases, as evidenced by a physician's statement.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".27" heading="Public Information."> <paragraph num="A."> <text>The Department shall:</text> <paragraph num="(1)"> <text>Make the information required to be provided under this chapter available to all interested persons; and</text> </paragraph> <paragraph num="(2)"> <text>Publicize the availability of this information.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Information will be made available for review to all interested persons under COMAR 32.01.02.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".28" heading="Inspection by the Department."> <paragraph num="A."> <text>The Department may:</text> <paragraph num="(1)"> <text>Inspect any facility used to provide services under a continuing care at home agreement;</text> </paragraph> <paragraph num="(2)"> <text>Examine the records of a provider or person that controls a provider; and</text> </paragraph> <paragraph num="(3)"> <text>Audit or observe any service rendered under a continuing care at home agreement.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A provider shall cooperate with the Department in all reasonable requests to inspect, examine, audit, or observe the provider, a facility, the services, and the records of the provider.</text> </paragraph> <paragraph num="C."> <text>If a facility is subject to licensure by MDH, the Department shall coordinate any inspection of a facility with MDH to avoid duplication.</text> </paragraph> <paragraph num="D."> <text>Failure of the provider to permit reasonable requests for inspection, examination, or audit is a violation of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".29" heading="Removal of Records and Accounts."> <paragraph num="A."> <text>A provider may not remove from the State records or assets of the provider related to the operation of a facility or the provision of services under continuing care at home agreements without the written consent of the Department.</text> </paragraph> <paragraph num="B."> <text>A provider may request from the Department approval to remove records or assets from the State by submitting the verification that the Department requires to establish that removal of records or assets will:</text> <paragraph num="(1)"> <text>Facilitate the operations of the provider and make the operations more economical; and</text> </paragraph> <paragraph num="(2)"> <text>Not diminish the service or protection given to the provider's subscribers.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The Department may not consent to the removal until the Secretary determines that the removal of records and assets meets the conditions of §B of this regulation.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".30" heading="Administrative Sanctions."> <paragraph num="A."> <text>The Secretary may deny, suspend, or revoke a preliminary, initial, or renewal certificate of registration for cause. Cause for denial, suspension, or revocation includes, but is not limited to the following:</text> <paragraph num="(1)"> <text>Violations of the provisions of the Act;</text> </paragraph> <paragraph num="(2)"> <text>Violations of regulations in this chapter;</text> </paragraph> <paragraph num="(3)"> <text>Misrepresentations of fact to the Department or to subscribers;</text> </paragraph> <paragraph num="(4)"> <text>Submission of false financial information to the Department;</text> </paragraph> <paragraph num="(5)"> <text>Failure to prepare or implement an adequate corrective financial plan when found to be in financial difficulty; or</text> </paragraph> <paragraph num="(6)"> <text>Agreement terms or provisions that:</text> <paragraph num="(a)"> <text>Violate the Act,</text> </paragraph> <paragraph num="(b)"> <text>Violate regulations in this chapter, or</text> </paragraph> <paragraph num="(c)"> <text>Are not approved by the Department.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>The denial, suspension, or revocation of a certificate of registration is an action of the Secretary that may be appealed in accordance with Regulation .31 of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".31" heading="Appeals."> <text>An applicant for, or a holder of, a feasibility study approval, preliminary certificate, initial certificate, or renewal certificate that is aggrieved by a denial of a certificate of registration, by a revocation of a certificate of registration, or by any other action of the Department or Secretary under this chapter, may file a written appeal. An appeal of any action taken by the Department or Secretary under this chapter shall be conducted in accordance with the Maryland Administrative Procedure Act, State Government Article, Title 10, Subtitles 2 and 3, Annotated Code of Maryland, and COMAR 32.01.01.</text> </regulation> <annotations> <annotation type="Authority">Human Services Article, §10-454, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: May 15, 2000 (27:9 Md. R. 859)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.09 to COMAR 32.02.02, October 2000</annotation> <annotation type="History" subtype="Administrative History">Regulation .02H amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .10A amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .10F adopted effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .11C amended effective March 1, 2004 (31:4 Md. R. 319)</annotation> <annotation type="History" subtype="Administrative History">Regulation .14J amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .16C amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .17D amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> <annotation type="History" subtype="Administrative History">Regulation .31 amended effective March 17, 2025 (52:5 Md. R. 239)</annotation> </annotations> </chapter> <chapter num="03" heading="Approval of Burial Arrangements for Unclaimed Deceased Nursing Home Residents"> <regulation prefix="Regulation" num=".01" heading="Purpose."> <text>This chapter provides guidelines and procedures for carrying out the intent of Human Services Article, §10-214, Annotated Code of Maryland, requiring nursing home administrators to obtain the prior approval of the Department of Aging for burial arrangements for unclaimed deceased nursing home residents.</text> </regulation> <regulation prefix="Regulation" num=".02" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Anatomy Board” means the Anatomy Board of the Maryland Department of Health.</text> </paragraph> <paragraph num="(2)"> <text>“Department” means the Maryland Department of Aging.</text> </paragraph> <paragraph num="(3)"> <text>“Nursing home” means comprehensive care facilities or extended care facilities.</text> </paragraph> <paragraph num="(4)"> <text>“Nursing home administrator” means the individual licensed by the Board of Examiners of Nursing Home Administrators and responsible for the operation of the nursing home, or the individual authorized to act for the administrator for the purpose of these regulations.</text> </paragraph> <paragraph num="(5)"> <text>“Unclaimed deceased nursing home resident” means a resident of a nursing home who has not pre-arranged and prepaid for the disposal of his body and for whom no person has claimed the body and assumed funeral or burial responsibility upon the death of the resident.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Nursing Home Records."> <paragraph num="A."> <text>Each nursing home shall ascertain and record upon admission of the resident, or as soon after as possible:</text> <paragraph num="(1)"> <text>Any arrangements (financial, religious, name of preferred funeral director, if any, etc.) the resident has made, or wishes to make, with regard to burial; and</text> </paragraph> <paragraph num="(2)"> <text>The name, address, and relationship of any person who has agreed to claim the body upon death of the resident and to assume funeral or burial responsibility.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Each nursing home shall make reasonable efforts to keep their records current to reflect any subsequent changes in the information in §A of this regulation.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Notification Upon Death."> <paragraph num="A."> <text>Upon the death of an individual who appears to be an unclaimed deceased nursing home resident, the nursing home administrator should contact any person who, although not having been identified in advance as being responsible for the burial arrangements, might nevertheless at the time of death be willing to claim the body and assume responsibility. A nursing home administrator may wish to initiate contact with potentially responsible persons when death appears imminent.</text> </paragraph> <paragraph num="B."> <text>The nursing home administrator shall promptly notify the Department of the death of an unclaimed deceased nursing home resident.</text> </paragraph> <paragraph num="C."> <text>In addition to this notification, the nursing home administrator shall furnish the Department with information with respect to:</text> <paragraph num="(1)"> <text>The burial arrangements, if any, made, or any preferences for the arrangements expressed, by the resident before death;</text> </paragraph> <paragraph num="(2)"> <text>The nature of the documentation of the pre-arrangements or preferences;</text> </paragraph> <paragraph num="(3)"> <text>The name, address, and relationship of any individual who was predesignated as willing to assume responsibility for the burial arrangements and the reason they are not assuming the responsibility;</text> </paragraph> <paragraph num="(4)"> <text>The name, address, and relationship of other known relatives or friends of the deceased and the results of efforts, if any, made by the nursing home administrator to have them assume responsibility for the burial arrangements;</text> </paragraph> <paragraph num="(5)"> <text>The funds or sources of funds, if any, known to the nursing home administrator that are or could be available to pay the costs of burial;</text> </paragraph> <paragraph num="(6)"> <text>The arrangements, if any, the nursing home administrator proposes to make for the burial of the individual, including financial arrangements, that take into account any pre-arrangements or preferences stated in §C(1) of this regulation; and</text> </paragraph> <paragraph num="(7)"> <text>Any other information requested by the Department for proper administration of the law and these regulations.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The nursing home administrator shall furnish the required information to the Department as soon as possible after death of the resident or, if possible, when death is imminent, to enable the Department to expedite its approval of burial arrangements.</text> </paragraph> <paragraph num="E."> <text>A nursing home administrator shall, whenever possible, plan arrangements for the burial of an unclaimed deceased nursing home resident if there are sufficient funds or resources (including Social Security, Veterans' Administration, or Social Services burial assistance benefits) available to pay the burial costs. These arrangements shall be consistent with the criteria in Regulation .05B of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Prior Approval of the Department."> <paragraph num="A."> <text>A nursing home administrator shall obtain the approval of the Department for the burial and funeral arrangements of an unclaimed deceased nursing home resident before the arrangements may be carried out.</text> </paragraph> <paragraph num="B."> <text>The Department will approve a nursing home administrator's proposed arrangements for burial of an unclaimed deceased nursing home resident if:</text> <paragraph num="(1)"> <text>The proposed arrangements take into account any pre-arrangements or preferences of the deceased resident;</text> </paragraph> <paragraph num="(2)"> <text>Sufficient funds (including Social Security, VA, or Social Services burial assistance benefits) are available to pay the burial costs; and</text> </paragraph> <paragraph num="(3)"> <text>The total burial costs would meet one of the following financial criteria:</text> <paragraph num="(a)"> <text>The total burial costs would not exceed $650, exclusive of cemetery charges, or</text> </paragraph> <paragraph num="(b)"> <text>If the total costs would exceed $650, exclusive of cemetery charges, the additional costs are reasonably required in order to comply with the deceased resident's burial pre-arrangements or preferences.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Upon approval by the Department of the nursing home administrator's proposed arrangements, the Department will issue a certification of approval for burial arrangements to the nursing home administrator. Following the burial, the nursing home administrator shall file with the Department a report of the completed burial arrangements and costs. The report shall be filed on a prescribed form within 10 calendar days after burial.</text> </paragraph> <paragraph num="D."> <text>If a nursing home administrator's proposed arrangements are not approved by the Department or the nursing home administrator does not propose to make arrangements for burial of the unclaimed deceased resident, the Department will arrange, with the Anatomy Board when appropriate, for the prompt removal of the body from the nursing home and burial.</text> </paragraph> <paragraph num="E."> <text>A nursing home administrator may make the initial report of the required information to the Department by telephone, if necessary to expedite burial of the deceased nursing home resident. Similarly, a request for approval of burial arrangements may be made by telephone.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Estates and Trusts Article."> <text>Nothing in these regulations shall be construed to modify the requirements of the Estates and Trusts Article, Annotated Code of Maryland, regarding the administration of estates.</text> </regulation> <annotations> <annotation type="Authority">Human Services Article, §10-214, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: March 29, 1982 (9:6 Md. R. 615)</annotation> <annotation type="History" subtype="Administrative History">Regulation .05B amended effective October 31, 1988 (15:22 Md. R. 2559)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.04 to COMAR 32.02.03, October 2000</annotation> </annotations> </chapter> </subtitle> <subtitle num="03" heading="Grants and Subsidies"> <chapter num="01" heading="Senior Citizen Activities Centers Capital Improvement Grants"> <regulation prefix="Regulation" num=".01" heading="Preface."> <paragraph num="A."> <text>This chapter governs the administration of grants to local government agencies to develop and improve elderly citizen activities centers under the Elderly Citizen Activities Centers Loan Act of 1987 and previous and subsequent similar acts.</text> </paragraph> <paragraph num="B."> <text>The terms of previous Authorization Acts continue to govern the administration of funds for facilities which have received, or after this may receive, State funds under previous Elderly Citizen Activities Centers Acts.</text> </paragraph> <paragraph num="C."> <text>These regulations provide rules for the administration of grants under the following Authorization Acts:</text> <paragraph num="(1)"> <text>Chapter 910, Laws of Maryland, 1978, as amended;</text> </paragraph> <paragraph num="(2)"> <text>Chapter 680, Laws of Maryland, 1983;</text> </paragraph> <paragraph num="(3)"> <text>Chapter 472, Laws of Maryland, 1984;</text> </paragraph> <paragraph num="(4)"> <text>Chapter 541, Laws of Maryland, 1985, as amended;</text> </paragraph> <paragraph num="(5)"> <text>Chapter 471, Laws of Maryland, 1986;</text> </paragraph> <paragraph num="(6)"> <text>Chapter 366, Laws of Maryland, 1987; and</text> </paragraph> <paragraph num="(7)"> <text>Subsequent similar acts.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The definition of work eligible to be funded by State grants is more restricted under some Acts than others. The applicant for grant funds shall be provided, at its request, with a list of funds available under prior Acts. However, the applicant need not apply for funds under a certain Act. The Department will award grants under the Act from which funds are available and for which the project work meets the Act's definition of eligible work.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".02" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Acquisition” means purchasing or obtaining ownership of all or part of an existing facility for use as an elderly citizen activities center.</text> </paragraph> <paragraph num="(2)"> <text>“Area agency on aging” means the agency designated by the Maryland Department of Aging in a geographical area of the State to develop and administer the area plan for a comprehensive and coordinated system of services for older persons under the authority of the Older Americans Act, 42 U.S.C. §3001 et seq.</text> </paragraph> <paragraph num="(3)"> <text>“Board of Public Works” means the Board established by Article XII of the Constitution of Maryland, consisting of the Governor, the Treasurer, and the Comptroller of Maryland.</text> </paragraph> <paragraph num="(4)"> <text>“Building” means:</text> <paragraph num="(a)"> <text>All or part of an existing elderly citizen activities center and its surrounding real property; or</text> </paragraph> <paragraph num="(b)"> <text>A facility proposed to be constructed or converted for use as an elderly citizen activities center, and its surrounding real property.</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>“Capital equipment” means essential fixed equipment and furnishings that have an expected useful life of at least 15 years.</text> </paragraph> <paragraph num="(6)"> <text>“Construction” means all work necessary to build an elderly citizen activities center including, but not limited to:</text> <paragraph num="(a)"> <text>Acquisition of real property;</text> </paragraph> <paragraph num="(b)"> <text>Architectural/engineering services;</text> </paragraph> <paragraph num="(c)"> <text>Site development and improvement;</text> </paragraph> <paragraph num="(d)"> <text>Construction; and</text> </paragraph> <paragraph num="(e)"> <text>Equipment for completed buildings.</text> </paragraph> </paragraph> <paragraph num="(7)"> <text>“Conversion” means the work required to transform a building or part of a building for effective use as an elderly citizen activities center.</text> </paragraph> <paragraph num="(8)"> <text>“Department” means the Maryland Department of Aging.</text> </paragraph> <paragraph num="(9)"> <text>“Design” means the work required to prepare architectural/engineering plans and specifications to construct an elderly citizen activities center.</text> </paragraph> <paragraph num="(10)"> <text>“Elderly citizen” means a person 60 years old or older or a spouse of a person 60 years old or older.</text> </paragraph> <paragraph num="(11)"> <text>“Elderly citizen activities center” means a community or neighborhood facility for the organization and provision of a broad spectrum of services, which include such services as health, social, nutritional, educational, and recreational programs, to elderly citizens.</text> </paragraph> <paragraph num="(12)"> <text>“Eligible work” means that work for which the use of State funds is authorized under the applicable Authorization Act.</text> </paragraph> <paragraph num="(13)"> <text>“Grant” means a State grant provided under the Elderly Citizen Activities Centers Capital Improvement Grants Program, unless the context clearly implies otherwise.</text> </paragraph> <paragraph num="(14)"> <text>“Local government” means a political subdivision of Maryland.</text> </paragraph> <paragraph num="(15)"> <text>“Master plan” means a comprehensive plan for a local government's projected need for funds for elderly citizen activities centers for a period of 15 years.</text> </paragraph> <paragraph num="(16)"> <text>“Operating costs” means costs associated with the operation of an elderly citizen activities center, including costs for rent, maintenance, utilities, personnel, and expendable supplies and equipment.</text> </paragraph> <paragraph num="(17)"> <text>“Planning” means the work necessary to prepare preliminary and final plans and specifications for construction of a new elderly citizen activities center and related activity.</text> </paragraph> <paragraph num="(18)"> <text>“Project” means:</text> <paragraph num="(a)"> <text>An existing elderly citizen activities center which receives or has received a State grant for eligible work;</text> </paragraph> <paragraph num="(b)"> <text>A proposed elderly citizen activities center which receives or has received a State grant for eligible work; or</text> </paragraph> <paragraph num="(c)"> <text>The development of a comprehensive master plan for elderly citizen activities centers in a political subdivision which receives or has received a State grant.</text> </paragraph> </paragraph> <paragraph num="(19)"> <text>“Renovation” means the work required to restore and modernize a facility in order that the facility may be effectively used for its designated functional purpose as an elderly citizen activities center or to comply with current code requirements.</text> </paragraph> <paragraph num="(20)"> <text>“Secretary” means the Secretary of Aging, or the Secretary's designee.</text> </paragraph> <paragraph num="(21)"> <text>“Senior center” means an elderly citizen activities center.</text> </paragraph> <paragraph num="(22)"> <text>“Site development and improvement” means the work required to develop the exterior of a facility and its surrounding real property.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Eligibility of an Applicant for Grant Funds."> <paragraph num="A."> <text>A local government agency may apply for State funds under the Elderly Citizen Activities Centers Capital Improvement Grants Program, if the applicant is eligible to receive funding under Title III of the Older Americans Act, 42 U.S.C. §3001 et seq.</text> </paragraph> <paragraph num="B."> <text>A local government agency may apply for a grant to subgrant to a nonprofit organization.</text> </paragraph> <paragraph num="C."> <text>Before submitting the application, an applicant which is not an area agency on aging shall have its proposed project reviewed by the area agency on aging, and shall submit a letter of recommendation from that agency with its proposal.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Eligibility of a Senior Center for Grant Funds."> <paragraph num="A."> <text>Except as provided in §C of this regulation, to receive a State grant, a senior center shall meet the following mandatory requirements:</text> <paragraph num="(1)"> <text>Population.</text> <paragraph num="(a)"> <text>An urban senior center shall serve a catchment area which has a population of at least 10,000 elderly citizens.</text> </paragraph> <paragraph num="(b)"> <text>A rural senior center shall serve a catchment area which has a population of at least 2,000 elderly citizens.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Hours of Operation. The senior center shall operate at least 6 hours a day.</text> </paragraph> <paragraph num="(3)"> <text>Days of Operation.</text> <paragraph num="(a)"> <text>An urban senior center shall operate at least 250 days per year.</text> </paragraph> <paragraph num="(b)"> <text>A rural senior center shall operate at least 150 days per year.</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>Proximity of Proposed Center to Existing Center. The senior center may not be located within a 3-mile radius of another senior center, unless the centers are under the jurisdiction of different local governments.</text> </paragraph> </paragraph> <paragraph num="B."> <text>At the discretion of the Director, one or more of the mandatory requirements in §A of this regulation may be waived, if the applicant provides evidence that the type of work proposed is classified as a priority project under Regulation .05 of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Priority of Eligible Projects."> <paragraph num="A."> <text>Eligible projects shall be classified according to the type of work proposed. Projects classified under the following types of work will receive priority:</text> <paragraph num="(1)"> <text>Projects to renovate or replace senior centers in order to make life safety corrections;</text> </paragraph> <paragraph num="(2)"> <text>Projects to renovate or open senior centers in areas of high concentration of low-income, frail, or minority elderly citizens;</text> </paragraph> <paragraph num="(3)"> <text>Projects to renovate obsolete buildings that have been in use for more than 40 years;</text> </paragraph> <paragraph num="(4)"> <text>Projects to renovate senior centers that have been in use for more than 25 years; and</text> </paragraph> <paragraph num="(5)"> <text>Projects which have not previously received grants under this program.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The Office shall consider the total unallocated State funds available at the time applications are submitted in determining priority of projects.</text> </paragraph> <paragraph num="C."> <text>The Office shall also consider the following criteria in regards to grants for senior centers:</text> <paragraph num="(1)"> <text>The conformity of the senior center with Statewide objectives for elderly citizen activities centers;</text> </paragraph> <paragraph num="(2)"> <text>The practical and economic feasibilities of the proposed work;</text> </paragraph> <paragraph num="(3)"> <text>The physical environment, location, demographic characteristics, and transportation accessibility of the proposed senior center; and</text> </paragraph> <paragraph num="(4)"> <text>The availability of operating funds for the proposed senior center.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Use of Grant."> <paragraph num="A."> <text>A State grant under this program may be used by a local government for the following eligible work:</text> <paragraph num="(1)"> <text>Conversion of a public building or part of a public building for use as a senior center;</text> </paragraph> <paragraph num="(2)"> <text>Acquisition of an existing building or part of an existing building for use as a senior center;</text> </paragraph> <paragraph num="(3)"> <text>Renovation of a senior center;</text> </paragraph> <paragraph num="(4)"> <text>Purchase of capital equipment for a senior center;</text> </paragraph> <paragraph num="(5)"> <text>Planning, design, and construction of a senior center;</text> </paragraph> <paragraph num="(6)"> <text>Architects' and engineers' fees in connection with §A(1)—(5) of this regulation;</text> </paragraph> <paragraph num="(7)"> <text>A subgrant by a local government agency to a nonprofit organization for a purpose stated in §A(1)—(6) of this regulation; and</text> </paragraph> <paragraph num="(8)"> <text>Development of a comprehensive master plan for elderly citizen activities centers in a political subdivision.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Funds available under Authorization Acts of certain years are restricted to certain of the purposes listed in §A of this regulation. The Department will apply funds available under those Acts for the purposes authorized by the Acts.</text> </paragraph> <paragraph num="C."> <text>Use of Part of a Building as a Senior Center.</text> <paragraph num="(1)"> <text>If an existing or proposed senior center shares or will share a building with any other group or agency, the grant may be used only to perform eligible work for that area of the building designated for use as a senior center.</text> </paragraph> <paragraph num="(2)"> <text>After completion of a project, the senior center may be used by other agencies or groups, if that use does not interfere with the operation of the senior center and is otherwise permissible under federal and State law.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".07" heading="Amount of Grant."> <paragraph num="A."> <text>A grant for conversion, acquisition, renovation, equipment, or construction may not exceed $600,000.</text> </paragraph> <paragraph num="B."> <text>A grant for the development of a master plan may not exceed $15,000.</text> </paragraph> <paragraph num="C."> <text>Except as provided in §E of this regulation:</text> <paragraph num="(1)"> <text>A State grant may not exceed 50 percent of the total cost of eligible work;</text> </paragraph> <paragraph num="(2)"> <text>At least 50 percent of the cost of eligible work shall be provided from local contributions.</text> </paragraph> </paragraph> <paragraph num="D."> <text>If a federal grant is available for the project, unless federal law is to the contrary, the federal grant shall be applied to the costs of the project before a grant under this program is applied. If a federal grant is applied, a grant under this program may not exceed 50 percent of the total cost of eligible work remaining after the federal grant has been applied, except as provided in §F of this regulation.</text> </paragraph> <paragraph num="E."> <text>At the discretion of the Board of Public Works, a grant may exceed 50 percent of the cost of eligible work, if:</text> <paragraph num="(1)"> <text>The grant is for conversion, renovation or planning, design and construction of an elderly citizens activity center;</text> </paragraph> <paragraph num="(2)"> <text>The value of property and improvements made available by the local government, including but not limited to eligible work, or the value of the center to be renovated, equals or exceeds the amount of the State grant;</text> </paragraph> <paragraph num="(3)"> <text>State funds have not been used for the acquisition, construction, or maintenance of any real property or improvements made available by the applicant, or for the building to be converted or renovated; and</text> </paragraph> <paragraph num="(4)"> <text>The State is not responsible for any bonded indebtedness in connection with any real property or improvements made available by the applicant, or in connection with the building to be converted, acquired, or renovated.</text> </paragraph> </paragraph> <paragraph num="F."> <text>A grantee that has in the past received funds in a total amount of less than $300,000 for an eligible project under this program may receive a grant for additional eligible work in an amount equal to the difference between the prior grant and $300,000, if the project meets the other requirements of this chapter.</text> </paragraph> <paragraph num="G."> <text>In determining the amount of the grant, the Department shall also consider:</text> <paragraph num="(1)"> <text>The senior citizen population density of the area for which the project is proposed;</text> </paragraph> <paragraph num="(2)"> <text>The proximity of the project to existing senior centers; and</text> </paragraph> <paragraph num="(3)"> <text>Localities eligible for funding that have not received funds in the past.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".08" heading="Applications for Conversion, Acquisition, Renovation, Purchase of Capital Equipment, and Construction."> <paragraph num="A."> <text>The applicant may apply for a grant to be used for conversion, acquisition, renovation, construction, or the purchase of capital equipment by filing with the Department an original application and seven copies, on a form provided by the Department.</text> </paragraph> <paragraph num="B."> <text>The application shall include all of the following information:</text> <paragraph num="(1)"> <text>Program statement, briefly describing the proposed project.</text> </paragraph> <paragraph num="(2)"> <text>Overview of project, including major aspects and justification for the proposed project.</text> </paragraph> <paragraph num="(3)"> <text>Project considerations, detailing needs to be met, services to be provided, and the scope of the project.</text> </paragraph> <paragraph num="(4)"> <text>Physical characteristics, describing the specific physical features of the project.</text> </paragraph> <paragraph num="(5)"> <text>Financial projections, detailing all estimated costs and sources of capital funds for the project.</text> </paragraph> <paragraph num="(6)"> <text>A written opinion of legal counsel certifying the applicant's interest in the project site.</text> </paragraph> <paragraph num="(7)"> <text>If the project involves an existing facility, certification from the local government that the project has been inspected, and that all major capital improvements necessary to insure life safety have been identified in the application. The certification shall include:</text> <paragraph num="(a)"> <text>A written assessment from a local public facilities agency such as a local department of public works, that identifies all State and local building, health, and safety code deficiencies that will require correction;</text> </paragraph> <paragraph num="(b)"> <text>A written assessment from the local fire authority that identifies all State and local fire code deficiencies that will require correction.</text> </paragraph> </paragraph> <paragraph num="(8)"> <text>Written assurance in the following language: “The proposed project shall be operated as a senior center for a period of 15 years after its completion and may not be sold, bargained, or transferred to any person, agency, or organization not qualified as an applicant under these regulations, without the prior express written approval of the Secretary and the Board of Public Works”.</text> </paragraph> <paragraph num="(9)"> <text>If, at the time of application, the applicant:</text> <paragraph num="(a)"> <text>Owns property to be used as part of the project, a copy of the deed evidencing the applicant's interest in that property;</text> </paragraph> <paragraph num="(b)"> <text>Rents property to be used as part of the project:</text> <paragraph num="(i)"> <text>Certification that the applicant will continue to rent the property for at least 15 years,</text> </paragraph> <paragraph num="(ii)"> <text>Certification that the applicant has recorded the written lease in the land records of the political subdivision in which the proposed project will be located, and</text> </paragraph> <paragraph num="(iii)"> <text>A copy of the lease;</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>Does not own or rent property to be used as part of the project:</text> <paragraph num="(i)"> <text>A letter from the potential grantor or lessor that evidences an intent by the potential grantor or lessor to convey the property or to lease the property for 15 years, and</text> </paragraph> <paragraph num="(ii)"> <text>After the property has been conveyed or leased to the applicant, a copy of the deed or lease, and certification that the deed or lease has been recorded in the land records of the political subdivision in which the proposed project will be located.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(10)"> <text>If the application is for the acquisition of a building or part of a building for use as a senior center, both of the following apply:</text> <paragraph num="(a)"> <text>An appraisal performed by appraisers selected from the Department of General Services' list of independent fee appraisers. If the property is to be acquired from private owners, two appraisals are required. If the property is to be acquired from a unit of government, one appraisal is required.</text> </paragraph> <paragraph num="(b)"> <text>Certification by the local government that no public building appropriate for use as a senior center exists in the area where the proposed project will be located.</text> </paragraph> </paragraph> <paragraph num="(11)"> <text>If the application is for construction of a new building or part of a building for use as a senior center, certification by the local government that no public building appropriate for use as a senior center exists in the area where the proposed project will be located.</text> </paragraph> <paragraph num="(12)"> <text>If the applicant intends to use the value of real property as a local matching contribution under Regulation .09 of this chapter, an appraisal of the real property performed in accordance with §B(9)(c) of this regulation.</text> </paragraph> <paragraph num="(13)"> <text>Other information required by the application form.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".09" heading="Applications for Development of Master Plans for Elderly Citizen Activities Centers."> <paragraph num="A."> <text>A local government agency may apply for a grant to be used for development of a master plan by filing with the Department an original application and seven copies, on a form provided by the Department.</text> </paragraph> <paragraph num="B."> <text>The application shall include all of the following information:</text> <paragraph num="(1)"> <text>Program statement, briefly describing the proposed project, an explanation of the need for a master plan, and a description of the methodology to be used in development of a master plan. The methodology shall include:</text> <paragraph num="(a)"> <text>An analysis of demographic characteristics and trends in the jurisdiction which demonstrate a need for future senior centers; and</text> </paragraph> <paragraph num="(b)"> <text>An analysis of the geographic location of the area and how the location affects the area's need for senior centers.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The total cost of the proposed project.</text> </paragraph> <paragraph num="(3)"> <text>Alternative and supplementary sources of funding for the proposed project, including the source of funds that the applicant will provide.</text> </paragraph> <paragraph num="(4)"> <text>Other information required by the application.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The applicant shall insure that upon the completion of the project, the master plan shall include the following:</text> <paragraph num="(1)"> <text>A summary of findings and conclusions;</text> </paragraph> <paragraph num="(2)"> <text>A description of the agency that developed the master plan and its involvement with implementing the plan;</text> </paragraph> <paragraph num="(3)"> <text>Background data on each senior center in the project area, including:</text> <paragraph num="(a)"> <text>An overview of each senior center,</text> </paragraph> <paragraph num="(b)"> <text>User data for each senior center, and</text> </paragraph> <paragraph num="(c)"> <text>Programs, services, or operations provided at each senior center;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>Evaluation of each senior center, including:</text> <paragraph num="(a)"> <text>Coordination with other aging services and programs, and</text> </paragraph> <paragraph num="(b)"> <text>Adequacy of service provision;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>Master plan proposal for senior centers; and</text> </paragraph> <paragraph num="(6)"> <text>Recommendations based on goals and objectives established by the local government.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".10" heading="Allowable Types of Local Contributions."> <paragraph num="A."> <text>Except when the application is for the development of a master plan, the applicant may apply the following types of contributions toward the applicant's required share of the cost of eligible work:</text> <paragraph num="(1)"> <text>Cash;</text> </paragraph> <paragraph num="(2)"> <text>The value of real property and improvements made available by the applicant for use as part of the project; and</text> </paragraph> <paragraph num="(3)"> <text>If the applicant proposes to contribute leased property for use as part of the project, the 15-year net retail rental value of that property.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The total value of allowable local contributions shall equal or exceed the amount of the requested State grant, except as provided in Regulation .07E of this chapter.</text> </paragraph> <paragraph num="C."> <text>If the application is for the development of a master plan, the applicant shall contribute at least 50 percent of the cost of eligible work in cash.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".11" heading="Application Procedure."> <paragraph num="A."> <text>The applicant shall comply with the application procedures required by the Department at the time of application.</text> </paragraph> <paragraph num="B."> <text>Applications shall be filed with the Secretary.</text> </paragraph> <paragraph num="C."> <text>The Secretary shall establish a reasonable date each year by which all applications for grants during that fiscal year are to be received. The Secretary shall provide a copy of each application to the Maryland State Clearinghouse for Intergovernmental Assistance and the Department of General Services for review and comments.</text> </paragraph> <paragraph num="D."> <text>After the Secretary approves an application, the Secretary shall promptly report the application to the Board of Public Works, together with a written report that includes:</text> <paragraph num="(1)"> <text>A statement that:</text> <paragraph num="(a)"> <text>The project has been reviewed by the Maryland State Clearinghouse for Intergovernmental Assistance and the Department of General Services,</text> </paragraph> <paragraph num="(b)"> <text>Indicates that all costs identified in the project application are determined to be reasonably sufficient to bring the facility into conformity with all existing building, fire, handicapped accessibility, and all other applicable State and local codes,</text> </paragraph> <paragraph num="(c)"> <text>The project has been approved by the Secretary; and</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>A recommendation that the Board of Public Works make a grant to the applicant, and a recommendation as to the amount of the grant.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".12" heading="Award of Contracts by the Grantee."> <paragraph num="A."> <text>In awarding a contract for the performance of eligible work under a grant, a grantee shall comply with regulations or guidelines adopted by the Board of Public Works regarding the use of State funds.</text> </paragraph> <paragraph num="B."> <text>If a grantee proposes to award a contract for the performance of eligible work under the grant, and if competitive bidding is required, the grantee shall comply with each of the following requirements before a contract is awarded:</text> <paragraph num="(1)"> <text>The grantee shall advertise for competitive bids in appropriate trade publications, including appropriate publications used by the Department of General Services;</text> </paragraph> <paragraph num="(2)"> <text>The grantee may select and recommend as the contractor the bidder whose offer, in the opinion of the applicant, best combines economy and quality;</text> </paragraph> <paragraph num="(3)"> <text>The grantee shall submit the bid tabulation and the name of the recommended contractor to the Department.</text> </paragraph> </paragraph> <paragraph num="C."> <text>In a case covered by §B of this regulation, the Department shall forward all bid and proposed contract documents to the Department of General Services for review, submission, and recommendation to the Board of Public Works.</text> </paragraph> <paragraph num="D."> <text>After a grantee has awarded a contract in accordance with this regulation, the grantee shall submit the following information:</text> <paragraph num="(1)"> <text>If the contract is for architectural services, the grantee shall submit to the Department copies of all preliminary and final architectural plans and specifications, including all architectural contract documents to insure consistency with the approved application and compliance with all State and other applicable requirements;</text> </paragraph> <paragraph num="(2)"> <text>If the contract is for construction, the grantee shall submit copies of the executed contract to insure compliance with the approved grant application and all other State requirements;</text> </paragraph> <paragraph num="(3)"> <text>If the contract is for the purchase of equipment, the grantee shall submit copies of all equipment price lists for evaluation of compliance with the approved grant application and all other State requirements.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".13" heading="Additional Requirements Applicable to Grantee."> <paragraph num="A."> <text>Completion of Eligible Work.</text> <paragraph num="(1)"> <text>Except as otherwise provided in this regulation, a grantee shall complete eligible work within 2 years after receiving notification from the Secretary that its application has been approved by the Board of Public Works.</text> </paragraph> <paragraph num="(2)"> <text>When eligible work has been completed, the grantee shall submit to the Department a certification from qualified personnel of the grantee or of a contractor that the work has been completed according to approved plans.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Extension of Time for Completion; Other Changes.</text> <paragraph num="(1)"> <text>If the grantee is unable to complete eligible work in the manner initially approved or within 2 years, the grantee shall promptly notify the Secretary.</text> </paragraph> <paragraph num="(2)"> <text>The Secretary may grant a request by the applicant for a change in the manner or time of completion of eligible work, including an extension of time, for good cause.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Insurance Requirements.</text> <paragraph num="(1)"> <text>The grantee shall provide fire and extended coverage insurance during the entire period of work on the project. The policy shall be endorsed to protect the State to the extent of the State's interest. The grantee shall submit evidence of this insurance to the Department.</text> </paragraph> <paragraph num="(2)"> <text>Upon completion of the project, the grantee shall maintain, for a period of 15 years, fire insurance in an amount at least equal to the State's contribution to the project. The grantee shall submit evidence of this insurance annually to the Department and to the State Treasurer's Office.</text> </paragraph> <paragraph num="(3)"> <text>If the eligible work is acquisition, the grantee shall provide fire insurance for its interests in the property to be acquired from the time the contract of sale is signed until the time of settlement. The grantee shall submit evidence of this insurance to the Department.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Information and Inspection.</text> <paragraph num="(1)"> <text>The Department may require the grantee to keep and submit to the Department, in the manner the Department determines, information on any subject relevant to the acquisition, renovation, equipping, conversion, construction, and operation of the senior center.</text> </paragraph> <paragraph num="(2)"> <text>The Secretary may inspect a senior center during reasonable business hours.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".14" heading="Recovery of State Grant Funds."> <paragraph num="A."> <text>Under the conditions of §B of this regulation, the State may recover State grant funds.</text> </paragraph> <paragraph num="B."> <text>The State may recover State grant funds if, within 15 years of the completion of a project:</text> <paragraph num="(1)"> <text>An interest in property with respect to which funds have been paid under this program is assigned, transferred, or conveyed:</text> <paragraph num="(a)"> <text>To any person, agency, or organization which has not been approved by the Board of Public Works as a transferee, or</text> </paragraph> <paragraph num="(b)"> <text>For use other than as a senior center; or</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Property with respect to which funds have been paid under this program ceases to be operated as a senior center.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The amount of State recovery shall be:</text> <paragraph num="(1)"> <text>An amount bearing the same ratio to the then current value of so much of the property as constituted a project, as the amount of the State funds bore to the total cost of all eligible work; and</text> </paragraph> <paragraph num="(2)"> <text>All costs and reasonable attorney fees incurred by the State in recovery proceedings.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Notice Recordation.</text> <paragraph num="(1)"> <text>Before the payment of State funds under this program, the grantee shall record the notice of the State's right to recovery required by the Authorization Act under which the grant has been made.</text> </paragraph> <paragraph num="(2)"> <text>The notice shall be recorded in the land records of the jurisdiction in which the senior center or proposed senior center is or will be located.</text> </paragraph> <paragraph num="(3)"> <text>The grantee shall provide evidence of the recordation to the Department.</text> </paragraph> </paragraph> </regulation> <annotations> <annotation type="Authority">Human Services Article, §10-510, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date:</annotation> <annotation type="History" subtype="Administrative History">Chapter adopted as an emergency provision effective August 18, 1978 (5:18 Md. R. 1384); adopted permanently effective January 6, 1979 (5:26 Md. R. 1931)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01, .02B, .04A, .10, and .13 amended effective December 14, 1979 (6:25 Md. R. 1984)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01, .02B, .03, .04A, .06, .10A, and .13 amended effective May 15, 1981 (8:10 Md. R. 879)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01, .02B, .08, and .13A amended effective June 16, 1986 (13:12 Md. R. 1374)</annotation> <annotation type="History" subtype="Administrative History">Regulation .02-1 adopted effective June 17, 1985 (12:12 Md. R. 1166)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01—.13 amended effective June 17, 1985 (12:12 Md. R. 1166)</annotation> <annotation type="History" subtype="Administrative History">Regulation .10-1 adopted effective May 15, 1981 (8:10 Md. R. 879); repealed effective June 17, 1985 (12:12 Md. R. 1166)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01—.13 repealed and new Regulations .01—.14 adopted under a new chapter, Elderly Citizen Activities Centers Capital Improvement Grants, as an emergency provision effective June 14, 1987 (14:14 Md. R. 1565); emergency status extended at 14:22 Md. R. 2336; emergency status expired January 7, 1988 (Emergency provisions are temporary and not printed in COMAR)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01—.13, Conversion of Surplus Public Schools and Other Public Buildings Into Elderly Citizen Activities Centers, repealed effective May 2, 1988 (15:9 Md. R. 1113)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01—.14, Senior Citizen Activities Centers Capital Improvement Grants, adopted effective May 2, 1988 (15:9 Md. R. 1113)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.01 to COMAR 32.03.01, October 2000</annotation> <annotation type="History" subtype="Administrative History">Regulation .07A amended effective February 12, 2007 (34:3 Md. R. 303)</annotation> </annotations> </chapter> <chapter num="02" heading="Nursing Home Ombudsman Program"> <regulation prefix="Regulation" num=".01" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Legal representative” means a person acting under a power of attorney, as a representative payee (unless the facility is the representative payee), or as a guardian of the person or property.</text> </paragraph> <paragraph num="(2)"> <text>“Local ombudsman” means the Director of the local Nursing Home Ombudsman Program.</text> </paragraph> <paragraph num="(3)"> <text>“Patient advocate” means the director of the local Nursing Home Ombudsman Program, the Director of the State Nursing Home Ombudsman Program, or the professional staff and volunteers working in those programs.</text> </paragraph> <paragraph num="(4)"> <text>“Related Institution”.</text> <paragraph num="(a)"> <text>“Related institution” means an organized institution, environment, or home that:</text> <paragraph num="(i)"> <text>Maintains conditions or facilities and equipment to provide domiciliary, personal, or nursing care for two or more unrelated individuals who are dependent on the administrator, operator, or proprietor for nursing care or the subsistence of daily living in a safe, sanitary, and healthful environment; and</text> </paragraph> <paragraph num="(ii)"> <text>Admits or retains the individuals for overnight care.</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>“Related institution” does not include:</text> <paragraph num="(i)"> <text>An adult residential environment or home that is certified by the Department of Human Services; or</text> </paragraph> <paragraph num="(ii)"> <text>A nursing facility or visiting nurse service that is conducted only by or for adherents of a recognized church or religious denomination, in accordance with tenets and practices that include reliance on treatment by spiritual means alone for healing.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(5)"> <text>“Secretary” means the Secretary of Aging.</text> </paragraph> <paragraph num="(6)"> <text>“State ombudsman” means the Director of the State Nursing Home Ombudsman Program.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".02" heading="Delegation."> <paragraph num="A."> <text>The Secretary has the authority to receive, investigate, and seek to resolve complaints concerning the operations of related institutions and the authority to make on-site visits to related institutions on his own motion, to determine if these facilities are in compliance with applicable laws, rules, and regulations.</text> </paragraph> <paragraph num="B."> <text>The Secretary may delegate the powers specified in §A of this regulation to the director of a local office on aging if:</text> <paragraph num="(1)"> <text>The local office on aging has established a local nursing home ombudsman program within the agency or by grant, or contract; and</text> </paragraph> <paragraph num="(2)"> <text>The local nursing home ombudsman program complies with these regulations.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Training."> <paragraph num="A."> <text>The State ombudsman shall provide, and the local ombudsman shall participate in, the following training for local ombudsman:</text> <paragraph num="(1)"> <text>At least 14 hours of orientation to provide a working knowledge of the long-term care system and the Statewide Ombudsman Program;</text> </paragraph> <paragraph num="(2)"> <text>At least quarterly in-service meetings, each at least 1 day in duration;</text> </paragraph> <paragraph num="(3)"> <text>Technical assistance on a continuing, as-needed basis.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The local ombudsman shall provide, and the patient advocates shall participate in, the following training for patient advocates:</text> <paragraph num="(1)"> <text>At least 20 hours of initial training to provide a working knowledge of the long-term care system and the Statewide Ombudsman Program;</text> </paragraph> <paragraph num="(2)"> <text>At least quarterly in-service meetings, each at least 3 hours in duration;</text> </paragraph> <paragraph num="(3)"> <text>Technical assistance on a continuing, as-needed basis.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Training shall cover at least the following subjects:</text> <paragraph num="(1)"> <text>Physical, mental, and emotional aspects of aging;</text> </paragraph> <paragraph num="(2)"> <text>History, purpose, objectives of local ombudsman program, and relationship to State Ombudsman Program;</text> </paragraph> <paragraph num="(3)"> <text>Volunteer policies, procedures, and skills for handling complaints;</text> </paragraph> <paragraph num="(4)"> <text>Confidentiality;</text> </paragraph> <paragraph num="(5)"> <text>Overview of nursing home system;</text> </paragraph> <paragraph num="(6)"> <text>Patients' Bill of Rights—State and federal;</text> </paragraph> <paragraph num="(7)"> <text>Regulatory system—federal/State/local laws and regulations;</text> </paragraph> <paragraph num="(8)"> <text>Health care system profile and interrelationships between agencies;</text> </paragraph> <paragraph num="(9)"> <text>Family/resident council;</text> </paragraph> <paragraph num="(10)"> <text>Reading and understanding medical records.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Complaint Investigation Procedures."> <paragraph num="A."> <text>The Ombudsman Program is responsible for investigating complaints made by or on behalf of residents of related institutions concerning the provision of services to residents.</text> </paragraph> <paragraph num="B."> <text>Investigation responsibilities shall include but not be limited to:</text> <paragraph num="(1)"> <text>Personal contact with the resident who has made the complaint or on whose behalf the complaint was made;</text> </paragraph> <paragraph num="(2)"> <text>Interviews with appropriate officials and staff of the related institution and other appropriate resource people;</text> </paragraph> <paragraph num="(3)"> <text>Visits with residents other than the resident who has complained or on whose behalf the complaint has been made if it is necessary to verify the complaint or to protect the confidentiality of the complaint or resident;</text> </paragraph> <paragraph num="(4)"> <text>Documentation of the complaint and investigation;</text> </paragraph> <paragraph num="(5)"> <text>Periodic communication with the complainant and resident to keep them informed of the status of the investigation.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The patient advocate shall visit related institutions between 9 a.m. and 5 p.m. and during regular visiting hours except when the nature of the complaint requires visitation at other hours.</text> </paragraph> <paragraph num="D."> <text>Upon entering a related institution, the patient advocate shall comply with any reasonable policy of the facility with regard to the identification of visitors and shall carry an identification card.</text> </paragraph> <paragraph num="E."> <text>The patient advocate shall knock on a resident's room door before entering and identify himself/herself and the program immediately. A resident shall have the right to refuse to communicate with the patient advocate. Any refusal shall be made directly to the patient advocate and not through an intermediary.</text> </paragraph> <paragraph num="F."> <text>The patient advocate may not disclose the identity of any complainant or resident unless:</text> <paragraph num="(1)"> <text>The complainant or resident, or a legal representative of either, consents in writing to the disclosure and specifies to whom the identity may be disclosed; or</text> </paragraph> <paragraph num="(2)"> <text>A court orders the disclosure.</text> </paragraph> </paragraph> <paragraph num="G."> <text>If the resident's room does not permit private consultation between the patient advocate and the resident or if the consultation infringes on the rights of roommates, the facility shall provide a private place for a consultation.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Complaint Resolution."> <paragraph num="A."> <text>After an investigation, if the patient advocate and the local ombudsman determine that the complaint has no merit, the patient advocate shall explain the situation fully to the complainant, and educate the complainant as to his rights and responsibilities.</text> </paragraph> <paragraph num="B."> <text>After an investigation, if the complaint is fully or partially verified, the patient advocate shall seek to resolve the problem.</text> </paragraph> <paragraph num="C."> <text>Complaint resolution responsibilities shall include but not be limited to:</text> <paragraph num="(1)"> <text>Development of a plan for corrective action through discussions with the complainant, resident, and appropriate officials and staff of the related institution;</text> </paragraph> <paragraph num="(2)"> <text>Establishment of a timetable for resolution;</text> </paragraph> <paragraph num="(3)"> <text>Follow-up within 30 days to determine if the problem giving rise to the complaint has been resolved.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Complaints of conditions adversely affecting residents that cannot be resolved shall be referred by the State or local ombudsman to the appropriate governmental agency.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Cooperation with the Maryland Department of Health."> <paragraph num="A."> <text>The Maryland Department of Health shall designate an employee of the Division of Licensing and Certification to serve as a liaison between the Ombudsman Program and the Maryland Department of Health.</text> </paragraph> <paragraph num="B."> <text>If a local or State ombudsman has reason to believe that a related institution is in violation of any statute or regulation which is enforced by the Maryland Department of Health, and the patient advocate is unable to resolve the situation, the local or State ombudsman shall refer the matter to the Maryland Department of Health designated liaison for investigation and appropriate enforcement.</text> </paragraph> <paragraph num="C."> <text>The State ombudsman shall provide the Maryland Department of Health with an annual statistical summary of the complaints handled by the Nursing Home Ombudsman Program.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".07" heading="Record-Keeping System."> <paragraph num="A."> <text>The respective local and State ombudsman shall maintain records related to complaints received by or on behalf of residents of related institutions which shall include:</text> <paragraph num="(1)"> <text>Name, address, and phone number of the complainant;</text> </paragraph> <paragraph num="(2)"> <text>Name of the resident;</text> </paragraph> <paragraph num="(3)"> <text>Relationship of the complainant to the resident;</text> </paragraph> <paragraph num="(4)"> <text>Name of the facility;</text> </paragraph> <paragraph num="(5)"> <text>Nature of the complaint;</text> </paragraph> <paragraph num="(6)"> <text>Steps taken to investigate the complaint;</text> </paragraph> <paragraph num="(7)"> <text>Outcome of the investigation;</text> </paragraph> <paragraph num="(8)"> <text>Resolution and follow-up.</text> </paragraph> </paragraph> <paragraph num="B."> <text>If the complainant refuses to identify himself or the resident, it should be so indicated in the record.</text> </paragraph> <paragraph num="C."> <text>The local and State ombudsman shall store complaint records in file cabinets which are locked when not in use. Access to these file cabinets shall be limited to the patient advocates and project staff authorized by the local or State ombudsman.</text> </paragraph> <paragraph num="D."> <text>In accordance with federal statutes, information or records maintained by the Ombudsman Program may not be disclosed unless authorized by the respective State or local ombudsman.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".08" heading="Access to Medical Records."> <paragraph num="A."> <text>A related institution shall grant access to a resident's medical record or provide a copy of a medical record to a patient advocate if:</text> <paragraph num="(1)"> <text>The patient advocate presents written authorization from the resident on whom the record is kept;</text> </paragraph> <paragraph num="(2)"> <text>In the event that the resident has been adjudicated a disabled person, the patient advocate presents written authorization from the court appointed guardian; or</text> </paragraph> <paragraph num="(3)"> <text>In the event that the resident has not been adjudicated disabled but is unable to communicate with others or is found to be medically incompetent by the attending physician of the resident, the patient advocate presents written authorization from the next of kin of the resident, the sponsoring agency of the resident, or, unless the facility is the representative payee, the representative payee that the Social Security Administration designates for the resident.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".09" heading="Annual Review."> <paragraph num="A."> <text>The Department of Aging shall conduct an annual review of each local ombudsman program.</text> </paragraph> <paragraph num="B."> <text>The annual review shall be conducted to ensure local program compliance with all applicable federal and State statutes and regulations.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".10" heading="Family and Resident Council Requirements."> <paragraph num="A."> <text>The Long Term Care Ombudsman Program shall support the organization and development of family and resident councils in nursing homes.</text> </paragraph> <paragraph num="B."> <text>Organizing a Resident or Family Council.</text> <paragraph num="(1)"> <text>The Ombudsman Program shall promote the development of family and resident councils in nursing homes in their local jurisdictions.</text> </paragraph> <paragraph num="(2)"> <text>If a nursing home does not have a resident council, the local ombudsman shall provide assistance to the residents and the facility in developing an active resident council.</text> </paragraph> <paragraph num="(3)"> <text>If a nursing home does not have an active family council, the local ombudsman shall provide assistance and make recommendations to the family members and facility in developing an active family council.</text> </paragraph> <paragraph num="(4)"> <text>Local ombudsman involvement in the development of resident or family councils may include:</text> <paragraph num="(a)"> <text>Providing information about resident or family councils to residents, family members, or the nursing home;</text> </paragraph> <paragraph num="(b)"> <text>Referring residents, family members, or the nursing home to appropriate resources for assistance;</text> </paragraph> <paragraph num="(c)"> <text>Speaking to groups on the role of the Ombudsman Program, family councils; or resident councils; and</text> </paragraph> <paragraph num="(d)"> <text>When invited, participating in organizational meetings for family councils and resident councils.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Involvement in Existing Resident or Family Councils.</text> <paragraph num="(1)"> <text>The local ombudsman shall inform the head of each resident and family council in the service area of:</text> <paragraph num="(a)"> <text>The role of the Ombudsman Program;</text> </paragraph> <paragraph num="(b)"> <text>The availability of the Program to assist resident and family councils; and</text> </paragraph> <paragraph num="(c)"> <text>The topics or subject matter on which the local ombudsman is able to provide training.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The local ombudsman shall make every effort to attend a resident or family council meeting to which the ombudsman has been invited.</text> </paragraph> </paragraph> </regulation> <annotations> <annotation type="Authority">Human Services Article, §10-213, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: May 9, 1983 (10:9 Md. R. 792)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.05 to COMAR 32.03.02, October 2000</annotation> <annotation type="History" subtype="Administrative History">Regulation .10 adopted effective February 26, 2007 (34:4 Md. R. 404)</annotation> </annotations> </chapter> <chapter num="03" heading="Senior Assisted Living Subsidy Program"> <regulation prefix="Regulation" num=".01" heading="Purpose."> <text>The purpose of the Senior Assisted Living Subsidy Program is to provide subsidies on behalf of eligible elderly residents of facilities that are licensed as an assisted living program pursuant to COMAR 10.07.14, and enrolled in the Program.</text> </regulation> <regulation prefix="Regulation" num=".02" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Applicant” means an individual who has applied for a subsidy or a current participant whose eligibility is being redetermined in accordance with Regulation .06C of this chapter.</text> </paragraph> <paragraph num="(2)"> <text>“Assets” means real and personal property.</text> </paragraph> <paragraph num="(3)"> <text>“Assisted living program” has the meaning stated in COMAR 10.07.14.02B(11).</text> </paragraph> <paragraph num="(4)"> <text>“Burial funds” means a revocable burial contract, burial trust, or other burial or funeral arrangement or any other separately identifiable fund which is clearly designated as set aside for a person's burial or funeral expenses.</text> </paragraph> <paragraph num="(5)"> <text>“Burial spaces” means conventional gravesites, crypts, mausoleums, urns, and other repositories which are customarily and traditionally used for the remains of deceased persons.</text> </paragraph> <paragraph num="(6)"> <text>“Consumer Price Index” means the Consumer Price Index for all urban consumers (CPI-U), U.S. City Average, All Items (1982—84=100) published by the United States Department of Labor for each calendar year, January through December.</text> </paragraph> <paragraph num="(7)"> <text>“Department” means the Maryland Department of Aging.</text> </paragraph> <paragraph num="(8)"> <text>“Earned subsidy” means the amount of subsidy that a subsidized resident qualified for during a reporting period.</text> </paragraph> <paragraph num="(9)"> <text>“Elderly” means an individual who is 62 years old or older.</text> </paragraph> <paragraph num="(10)"> <text>“Enrolled provider” means a licensee who has entered into a service agreement with a local office.</text> </paragraph> <paragraph num="(11)"> <text>“Facility” means the physical plant in which a licensee provides assisted living services.</text> </paragraph> <paragraph num="(12)"> <text>“Functional assessment” means an evaluation of an applicant's physical, mental, and functional status conducted by a geriatric evaluation service or its equivalent.</text> </paragraph> <paragraph num="(13)"> <text>“Immediate family” means an individual's:</text> <paragraph num="(a)"> <text>Spouse or minor and adult children, including adopted children and stepchildren; or</text> </paragraph> <paragraph num="(b)"> <text>Brothers, sisters, parents, adoptive parents, aunts, uncles, and their spouses.</text> </paragraph> </paragraph> <paragraph num="(14)"> <text>“Income" means the gross amount of all earned and unearned income received from all sources, including employment, annuities, Social Security benefits, workers' compensation, pensions or disability payments, alimony, interest, dividends, and net income from a business or profession.</text> </paragraph> <paragraph num="(15)"> <text>“Irrevocable burial fund” means an irrevocable burial contract, an irrevocable burial trust, or other irrevocable arrangement, the assets of which are only available for funeral or burial expenses or both.</text> </paragraph> <paragraph num="(16)"> <text>“License” means a license issued by the Maryland Department of Health to operate an assisted living program in Maryland.</text> </paragraph> <paragraph num="(17)"> <text>“Licensee” means an entity that has been issued a license to operate an assisted living program.</text> </paragraph> <paragraph num="(18)"> <text>“Local office” means the public or private nonprofit agency designated by the Department as the area agency on aging for a specific geographic area of the State.</text> </paragraph> <paragraph num="(19)"> <text>“Monthly allowance for personal expenses” equals $130 per month. Subject to the limitations of the State budget, the amount shall increase on July 1 of each year beginning July 1, 2021, by the percentage, if any, by which the Consumer Price Index for the most recent calendar year exceeds the Consumer Price Index for the previous calendar year, rounded to the nearest dollar. The Department shall publish annually the monthly allowance for personal expenses.</text> </paragraph> <paragraph num="(20)"> <text>“Net annual income” means net monthly income multiplied by 12.</text> </paragraph> <paragraph num="(21)"> <text>“Net monthly income” means total monthly income from all sources, minus:</text> <paragraph num="(a)"> <text>Monthly recurring nonreimbursable medical expenses greater than 3 percent of total monthly income; and</text> </paragraph> <paragraph num="(b)"> <text>The monthly allowance for personal expenses.</text> </paragraph> </paragraph> <paragraph num="(22)"> <text>“Program” means the Senior Assisted Living Subsidy Program.</text> </paragraph> <paragraph num="(23)"> <text>“Representative” means an agent, guardian of the person, guardian of the property, or any other person referred to in COMAR 10.07.14.34.</text> </paragraph> <paragraph num="(24)"> <text>“Resident” means an elderly individual who resides in an assisted living facility for the purpose of obtaining assisted living services.</text> </paragraph> <paragraph num="(25)"> <text>“Resident agreement” has the meaning stated in COMAR 10.07.14.02B(65).</text> </paragraph> <paragraph num="(26)"> <text>“Service agreement” means an agreement between a licensee and the local office that specifies the obligations of both parties, including the types of services to be provided, the fees to be charged, and the amount of subsidy to be paid on behalf of eligible residents.</text> </paragraph> <paragraph num="(27)"> <text>“Subsidy” means funds paid or approved to be paid by the local office to a licensee on behalf of a subsidized resident.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Enrollment of Assisted Living Facility Licensee."> <paragraph num="A."> <text>If an assisted living facility wants to participate in the Program and receive subsidies on behalf of eligible residents, the licensee shall:</text> <paragraph num="(1)"> <text>Obtain an enrollment form from the local office;</text> </paragraph> <paragraph num="(2)"> <text>Complete the enrollment form; and</text> </paragraph> <paragraph num="(3)"> <text>Submit the enrollment form to the local office, along with:</text> <paragraph num="(a)"> <text>A copy of its license or its application for a license, and</text> </paragraph> <paragraph num="(b)"> <text>A sample copy of its resident agreement.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>In addition to other routine information, the enrollment form shall require the licensee to demonstrate that it has:</text> <paragraph num="(1)"> <text>The bookkeeping services needed to assure the proper handling of any subsidy funds;</text> </paragraph> <paragraph num="(2)"> <text>A manager who is literate, able to communicate in English, and is:</text> <paragraph num="(a)"> <text>A licensed physician;</text> </paragraph> <paragraph num="(b)"> <text>A licensed registered nurse;</text> </paragraph> <paragraph num="(c)"> <text>A licensed practical nurse; or</text> </paragraph> <paragraph num="(d)"> <text>An individual with at least 3 years' experience in direct patient care in a private home, certified home, or health-related establishment; and</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>Had no deficiencies in the previous 12 months that presented an imminent danger to the residents' health and safety.</text> </paragraph> </paragraph> <paragraph num="C."> <text>If the local office determines that the information submitted on the enrollment form is accurate and satisfactory, and the resident agreement is consistent with COMAR 10.07.14.24 and .25, it shall:</text> <paragraph num="(1)"> <text>Prepare a service agreement that contains the agreed upon monthly fee; and</text> </paragraph> <paragraph num="(2)"> <text>Send the service agreement to the licensee to execute.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Unless some reason for denying enrollment in the subsidy program came to the local office's attention after sending the service agreement to the licensee, the local office shall execute the service agreement upon its return.</text> </paragraph> <paragraph num="E."> <text>When the service agreement is executed by the local office, the licensee is an enrolled provider.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Application for Subsidy."> <paragraph num="A."> <text>If a resident's or prospective resident's net monthly income is less than the approved monthly fee at the facility, the resident or prospective resident may apply to the local office for a subsidy on an application provided by the Department.</text> </paragraph> <paragraph num="B."> <text>An application for a subsidy shall include:</text> <paragraph num="(1)"> <text>Basic personal information;</text> </paragraph> <paragraph num="(2)"> <text>Income, expense, and asset information, including the amount and type of regular medical expenses; and</text> </paragraph> <paragraph num="(3)"> <text>A release signed by the applicant authorizing the local office to verify the medical and financial information in the application.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Resident Eligibility for Subsidy."> <paragraph num="A."> <text>An applicant is eligible to receive a subsidy paid to the licensee on the applicant's behalf when the following conditions are met:</text> <paragraph num="(1)"> <text>The applicant is a resident 62 years old or older, or has been accepted for admission as a resident, in a facility operated by a licensee, which has enrolled in the Program and executed a service agreement with the local office;</text> </paragraph> <paragraph num="(2)"> <text>The applicant is determined to be functionally eligible for a subsidy, based on a functional assessment;</text> </paragraph> <paragraph num="(3)"> <text>The applicant is determined to be financially eligible for a subsidy, based on a review and verification of the financial information provided; and</text> </paragraph> <paragraph num="(4)"> <text>Unless the licensee is a nonprofit corporation, the applicant is not a parent, child, spouse, aunt, uncle, niece, nephew, first cousin, or in-law of:</text> <paragraph num="(a)"> <text>The licensee, or</text> </paragraph> <paragraph num="(b)"> <text>Any partner or officer of the licensee.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>To be functionally eligible for a subsidy, an applicant shall be:</text> <paragraph num="(1)"> <text>Physically or mentally impaired; and</text> </paragraph> <paragraph num="(2)"> <text>In need of assistance with the activities of daily living provided by the assisted living program.</text> </paragraph> </paragraph> <paragraph num="C."> <text>To be financially eligible for a subsidy, an applicant shall meet the following conditions:</text> <paragraph num="(1)"> <text>The applicant's net monthly income is less than the approved monthly fee for the services provided;</text> </paragraph> <paragraph num="(2)"> <text>The applicant's net annual income is not higher than 60 percent of the State median income as determined by the U.S. Department of Housing and Urban Development;</text> </paragraph> <paragraph num="(3)"> <text>Subject to §H of this regulation, the applicant's resources are not greater than $19,000 if single, or $25,000 if married; and</text> </paragraph> <paragraph num="(4)"> <text>The applicant may not have disposed of or transferred more than 5 percent of such applicant’s net worth in the previous 5 years for less than fair market value unless the transfer was into a:</text> <paragraph num="(a)"> <text>Trust for an immediate family member who was medically dependent; or</text> </paragraph> <paragraph num="(b)"> <text>Special needs trust that meets the requirements of COMAR 10.09.24.08-2C.</text> </paragraph> </paragraph> </paragraph> <paragraph num="D."> <text>Calculation of Resources.</text> <paragraph num="(1)"> <text>When calculating the amount of an applicant's or subsidized resident's resources, the net fair market value of all assets owned by the applicant or subsidized resident shall be totaled, with the exception of the following:</text> <paragraph num="(a)"> <text>One personal automobile;</text> </paragraph> <paragraph num="(b)"> <text>Customary household goods;</text> </paragraph> <paragraph num="(c)"> <text>Personal effects;</text> </paragraph> <paragraph num="(d)"> <text>Life insurance policies with a total cash surrender value of not more than $5,000, including available accrued dividends and interest;</text> </paragraph> <paragraph num="(e)"> <text>Real property that satisfies the exclusion requirements of §§E—G of this regulation;</text> </paragraph> <paragraph num="(f)"> <text>Burial spaces for a person and the person’s immediate family;</text> </paragraph> <paragraph num="(g)"> <text>An irrevocable burial fund of any amount, which has been set aside for the burial or funeral of the individual or the individual's spouse; and</text> </paragraph> <paragraph num="(h)"> <text>Amounts in burial funds that satisfy the requirements of §D(2) of this regulation.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Burial Funds.</text> <paragraph num="(a)"> <text>In determining the resources of a person and the person's spouse, if any, there shall be excluded an amount up to $5,000 per person of funds specifically set aside in a burial fund for the person or the person's spouse.</text> </paragraph> <paragraph num="(b)"> <text>Interest earned on excluded burial funds and appreciation on the value of excluded burial arrangements shall be excluded from resources if left to accumulate and become a part of the burial fund.</text> </paragraph> <paragraph num="(c)"> <text>Funds or interest earned on funds and appreciation in the value of burial arrangements, which have been excluded from resources because they are burial funds, shall be used solely for that purpose.</text> </paragraph> <paragraph num="(d)"> <text>An individual's $5,000 exclusion as described under §D(2)(a) of this regulation shall be reduced by amounts in an irrevocable burial fund as described under §D(1)(g) of this regulation.</text> </paragraph> </paragraph> </paragraph> <paragraph num="E."> <text>Real property that was the primary residence of the applicant at the time of admission to a facility is excluded from the calculation of the applicant's resources for 1 year from the date of admission. After 1 year, the value of the applicant’s interest in the property shall be counted as part of an applicant's or subsidized resident's resources, unless the:</text> <paragraph num="(1)"> <text>Secretary grants an extension under §G of this regulation; or</text> </paragraph> <paragraph num="(2)"> <text>Residence is occupied by the applicant's or subsidized resident's:</text> <paragraph num="(a)"> <text>Spouse;</text> </paragraph> <paragraph num="(b)"> <text>Unmarried child younger than 21 years old; or</text> </paragraph> <paragraph num="(c)"> <text>An immediate family member who is medically or financially dependent.</text> </paragraph> </paragraph> </paragraph> <paragraph num="F."> <text>For the purposes of §§C and E of this regulation, an unmarried child younger than 21 years old shall be considered financially dependent without documentation other than age, and an immediate family member who has been determined to be blind or disabled by the Social Security Administration or by the State Medical Review Team as a part of determining their eligibility for Medical Assistance, shall be considered medically dependent.</text> </paragraph> <paragraph num="G."> <text>The Secretary may grant an extension of the 1-year period specified in §E of this regulation if the applicant demonstrates why the property could not be sold within the year despite timely and good faith efforts.</text> </paragraph> <paragraph num="H."> <text>The resource limits for applicants shall increase on July 1 of each year beginning July 1, 2021, by the percentage, if any, by which the Consumer Price Index for the most recent calendar year exceeds the Consumer Price Index for the previous calendar year, rounded to the nearest dollar. The Department shall publish annually the resource limits.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Determination of Eligibility for Subsidy."> <paragraph num="A."> <text>If subsidy funds are available, the local office, upon receipt of an application for a subsidy, shall:</text> <paragraph num="(1)"> <text>Arrange for a functional assessment of the applicant; and</text> </paragraph> <paragraph num="(2)"> <text>Determine if the applicant is functionally and financially eligible to receive a subsidy.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The local office shall award a subsidy on behalf of an applicant when subsidy funds are available and the applicant has been determined to be eligible to receive a subsidy according to the requirements of Regulation .05 of this chapter.</text> </paragraph> <paragraph num="C."> <text>When a subsidy is awarded, the local office shall annually redetermine each subsidized resident's eligibility to receive a subsidy.</text> </paragraph> <paragraph num="D."> <text>If the local office determines that an applicant or a subsidized resident is ineligible for a Program subsidy, the local office shall notify the applicant in writing of the determination. The notice shall include the:</text> <paragraph num="(1)"> <text>Decision;</text> </paragraph> <paragraph num="(2)"> <text>Reason for denial;</text> </paragraph> <paragraph num="(3)"> <text>Specific regulation supporting the denial;</text> </paragraph> <paragraph num="(4)"> <text>Applicant's right to appeal the decision; and</text> </paragraph> <paragraph num="(5)"> <text>Method for obtaining a hearing.</text> </paragraph> </paragraph> <paragraph num="E."> <text>Appeal of Decision.</text> <paragraph num="(1)"> <text>An individual whose application is denied may appeal the determination of ineligibility to the Department in accordance with COMAR 32.01.01.</text> </paragraph> <paragraph num="(2)"> <text>The local office shall provide an individual who wishes to appeal a decision the required forms and a list of resources in the community available to assist the individual.</text> </paragraph> </paragraph> <paragraph num="F."> <text>If subsidy funds are not available, the local office shall maintain a waiting list of interested applicants with names listed in chronological order according to the date on which the application was received.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".07" heading="Amount of Subsidy."> <paragraph num="A."> <text>Maximum Monthly Subsidy Amount.</text> <paragraph num="(1)"> <text>The monthly subsidy amount paid by the local office to a licensee on behalf of a subsidized resident is equal to the lesser of:</text> <paragraph num="(a)"> <text>The difference between the subsidized resident's net monthly income and the facility's approved monthly fee; or</text> </paragraph> <paragraph num="(b)"> <text>The maximum monthly subsidy amount set forth in writing annually by the local office, which amount shall be between the minimum rate of $650 and the maximum rate of $1,000 per month, inclusive.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>The maximum rate shall increase on July 1 of each year beginning July 1, 2021, by the percentage, if any, by which the Consumer Price Index for the most recent calendar year exceeds the Consumer Price Index for the previous calendar year, rounded to the nearest dollar.</text> </paragraph> <paragraph num="(3)"> <text>The Department shall publish annually the maximum subsidy amount limit.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A local office may limit the amount of the monthly fees that providers may charge subsidized residents within the local office's jurisdiction, subject to the approval of the Department.</text> </paragraph> <paragraph num="C."> <text>If a subsidized resident stayed in an enrolled provider's facility for less than a full month, the amount of subsidy paid by the local office on behalf of the subsidized resident shall be proportionate to the number of days in the month the subsidized resident stayed in the facility.</text> </paragraph> <paragraph num="D."> <text>A resident is considered to be staying at a facility even if absent for up to 14 days if, during the period of absence:</text> <paragraph num="(1)"> <text>The subsidized resident was hospitalized on an in-patient basis; and</text> </paragraph> <paragraph num="(2)"> <text>The subsidized resident's bed was held open for the resident by the enrolled provider.</text> </paragraph> </paragraph> <paragraph num="E."> <text>The amount of the subsidy shall be recalculated annually according to the date of the initial eligibility determination. The recalculation shall be based on the most recent financial information.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".08" heading="Administration of Subsidies."> <paragraph num="A."> <text>The Department shall designate, in writing, a local office to:</text> <paragraph num="(1)"> <text>Administer the Program’s subsidies;</text> </paragraph> <paragraph num="(2)"> <text>Execute subsidy agreements with licensees; and</text> </paragraph> <paragraph num="(3)"> <text>Make monthly subsidy payments to licensees on behalf of subsidized residents.</text> </paragraph> </paragraph> <paragraph num="B."> <text>To receive a subsidy on behalf of an eligible resident, a licensee shall be an enrolled provider and have a service agreement with the local office.</text> </paragraph> <paragraph num="C."> <text>An enrolled provider may not charge a:</text> <paragraph num="(1)"> <text>Subsidized resident more than the monthly fee indicated in the resident agreement that has been executed by the enrolled provider and the subsidized resident; and</text> </paragraph> <paragraph num="(2)"> <text>Non-subsidized resident less than the approved monthly fee charged to a subsidized resident, unless the non-subsidized resident has a subsidy application pending.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The local office shall pay subsidies to an enrolled provider on a monthly basis for services provided during the previous month to residents who were approved for subsidy payments.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".09" heading="Responsibilities of a Local Office."> <paragraph num="A."> <text>A local office shall execute a subsidy administration agreement with the Department to administer Program subsidies.</text> </paragraph> <paragraph num="B."> <text>A subsidy administration agreement shall include the:</text> <paragraph num="(1)"> <text>Time period of the agreement;</text> </paragraph> <paragraph num="(2)"> <text>Monitoring and reporting requirements for facilities in the local office's jurisdiction;</text> </paragraph> <paragraph num="(3)"> <text>Responsibilities of the local office for administering subsidies, including:</text> <paragraph num="(a)"> <text>Executing service agreements with licensees who receive subsidies on behalf of subsidized residents,</text> </paragraph> <paragraph num="(b)"> <text>Determining an applicant's eligibility to receive subsidies,</text> </paragraph> <paragraph num="(c)"> <text>Identifying applicants or residents who may be eligible for subsidies,</text> </paragraph> <paragraph num="(d)"> <text>Determining and annually recalculating the amount of subsidy that an enrolled provider may receive for a subsidized resident,</text> </paragraph> <paragraph num="(e)"> <text>Issuing monthly payments to enrolled providers on behalf of subsidized residents, and</text> </paragraph> <paragraph num="(f)"> <text>Filing required reports with the Department concerning subsidies paid;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>Total amount of subsidy funds allocated by the Department to the area served by the local office; and</text> </paragraph> <paragraph num="(5)"> <text>Portion of the total amount that the local office may use for its administrative costs.</text> </paragraph> </paragraph> <paragraph num="C."> <text>If an emergency prevents a local office from carrying out its responsibilities under a subsidy administration agreement, the Department may assume operation of all or part of the subsidy program.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".10" heading="Service Agreement Requirements."> <paragraph num="A."> <text>A service agreement between a local office and an enrolled provider shall:</text> <paragraph num="(1)"> <text>Specify the number of beds for which the enrolled provider is licensed or for which the enrolled provider has applied for a license;</text> </paragraph> <paragraph num="(2)"> <text>Specify the level of care for which the enrolled provider is licensed or for which the enrolled provider has applied for a license;</text> </paragraph> <paragraph num="(3)"> <text>Specify the approved monthly fee, which is the maximum amount the enrolled provider can charge a subsidized resident;</text> </paragraph> <paragraph num="(4)"> <text>Require the enrolled provider to notify the local office immediately if the enrolled provider decides to surrender its license, or if any actions are taken by others to revoke or restrict the license;</text> </paragraph> <paragraph num="(5)"> <text>Specify that the enrolled provider is obligated to maintain its license and operate in compliance with COMAR 10.07.14;</text> </paragraph> <paragraph num="(6)"> <text>Specify the minimum services the enrolled provider shall provide to all subsidized residents;</text> </paragraph> <paragraph num="(7)"> <text>Require the local office to approve any contracts the enrolled provider uses for subsidized residents;</text> </paragraph> <paragraph num="(8)"> <text>Specify that the enrolled provider may not charge a resident who is not subsidized less than the approved monthly fee, unless the non-subsidized resident has a subsidy application pending;</text> </paragraph> <paragraph num="(9)"> <text>Require the enrolled provider to keep a record of all payments received on behalf of a subsidized resident, which records shall be maintained so that they can be examined by the local office or Department with 24 hours notice;</text> </paragraph> <paragraph num="(10)"> <text>Require the enrolled provider to keep information and records regarding a subsidized resident's subsidy confidential from anyone other than the local office or Department, unless:</text> <paragraph num="(a)"> <text>Authorized to release the information or records by the subsidized resident or the subsidized resident's representative, or</text> </paragraph> <paragraph num="(b)"> <text>Compelled by a subpoena to release the information or records;</text> </paragraph> </paragraph> <paragraph num="(11)"> <text>Specify the maximum monthly subsidy that will be available for payment;</text> </paragraph> <paragraph num="(12)"> <text>Specify how and when payment requests shall be made to the local office;</text> </paragraph> <paragraph num="(13)"> <text>Specify the term of the agreement;</text> </paragraph> <paragraph num="(14)"> <text>Contain the enrolled provider's Federal Employer Identification number or Social Security number;</text> </paragraph> <paragraph num="(15)"> <text>Specify that the subsidized residents are third-party beneficiaries of the service agreement;</text> </paragraph> <paragraph num="(16)"> <text>Require that any amendments to the service agreement be in writing and executed by all parties to the agreement or their authorized representatives; and</text> </paragraph> <paragraph num="(17)"> <text>Specify that if an emergency prevents a local office from carrying out its responsibilities under a service agreement, the Department may enforce and administer the service agreement.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A local office shall send a copy of the service agreement format to the Department.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".11" heading="Denial or Rescission of Licensee Enrollment."> <paragraph num="A."> <text>A local office may deny enrollments in the subsidy program, refuse to subsidize additional residents at an enrolled provider, or rescind a licensee's service agreement or provider enrollment if:</text> <paragraph num="(1)"> <text>Conditions in the facility present an imminent danger to the life, safety, health, or welfare of the residents;</text> </paragraph> <paragraph num="(2)"> <text>A licensee fails to meet the licensure requirements of COMAR 10.07.14;</text> </paragraph> <paragraph num="(3)"> <text>An ongoing pattern exists of violations of COMAR 10.07.14 involving the licensee or facility;</text> </paragraph> <paragraph num="(4)"> <text>There is a violation involving the licensee or facility of COMAR 10.07.14 that presents a threat to the health, safety, or welfare of a resident;</text> </paragraph> <paragraph num="(5)"> <text>A licensee fails to correct cited violations of this chapter within the time specified in writing by the Department or local office;</text> </paragraph> <paragraph num="(6)"> <text>A licensee obtains, or attempts to obtain or retain, its assisted living program license by fraudulent means, misrepresentation, or the submission of false information to the Department, a local office, or the Maryland Department of Health;</text> </paragraph> <paragraph num="(7)"> <text>A licensee surrenders its license;</text> </paragraph> <paragraph num="(8)"> <text>A licensee fails to comply with the requirements for renewal of the license;</text> </paragraph> <paragraph num="(9)"> <text>A licensee fails to abide by the terms of its service agreement or its resident agreements; or</text> </paragraph> <paragraph num="(10)"> <text>A licensee or one of its principals:</text> <paragraph num="(a)"> <text>Has been cited for one or more deficiencies in the past 24 months which presented serious danger to a resident's health or safety; or</text> </paragraph> <paragraph num="(b)"> <text>Has failed to demonstrate substantial, sustained compliance for at least 24 months after any cited deficiency which presented serious danger to a resident's health or safety.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>The local office shall notify the licensee in writing at least 15 days in advance of a proposed action to rescind the service agreement or to refuse to subsidize additional residents.</text> </paragraph> <paragraph num="C."> <text>A notice of denial of enrollment, refusal to subsidize additional residents, or rescission of the service agreement shall:</text> <paragraph num="(1)"> <text>State concisely and simply:</text> <paragraph num="(a)"> <text>The facts that are asserted; or</text> </paragraph> <paragraph num="(b)"> <text>The issues that are involved, if the facts cannot be stated in detail when the notice is given;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>State the pertinent statutory and regulatory sections under which the local office is taking its action;</text> </paragraph> <paragraph num="(3)"> <text>State the sanction proposed, if any, as a result of the local office's action;</text> </paragraph> <paragraph num="(4)"> <text>State that the licensee has an opportunity to request a hearing, including:</text> <paragraph num="(a)"> <text>What, if anything, the licensee has to do to receive a hearing; and</text> </paragraph> <paragraph num="(b)"> <text>All relevant time requirements;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>State the direct consequences, sanction, potential penalty, if any, or remedy of the licensee's failure to exercise in a timely manner the opportunity for a hearing or to appear for a scheduled hearing; and</text> </paragraph> <paragraph num="(6)"> <text>Be sent to the enrolled provider and the Department.</text> </paragraph> </paragraph> <paragraph num="D."> <text>The local office shall notify the subsidized residents and the subsidized residents' representatives of any rescission of a licensee's enrollment in the subsidy program. The notice shall include the information listed in §C of this regulation, and a list of community resources available to assist the subsidized residents to relocate. A copy of the notice shall be sent to the Department.</text> </paragraph> <paragraph num="E."> <text>The Department shall send notice of a rescission of a licensee's enrollment in the subsidy program to the Maryland Department of Health.</text> </paragraph> <paragraph num="F."> <text>Actions taken against an enrolled provider under this chapter are not in lieu of and do not preclude the Maryland Department of Health from taking any action against a licensee under COMAR 10.07.14.</text> </paragraph> </regulation> <annotations> <annotation type="Authority">Human Services Article, §10-211, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: January 14, 1988 (15:1 Md. R. 20)</annotation> <annotation type="History" subtype="Administrative History">Regulation .24C amended effective June 6, 1994 (21:11 Md. R. 953)</annotation> <annotation type="History" subtype="Administrative History">Regulation .26 amended effective June 6, 1994 (21:11 Md. R. 953)</annotation> <annotation type="History" subtype="Administrative History">Regulations .01—.32, Group Sheltered Housing for the Elderly, repealed and new Regulations .01—.11, Senior Assisted Living Group Home Subsidy Program, adopted effective August 23, 1999 (26:17 Md. R. 1325)</annotation> <annotation type="History" subtype="Administrative History">Chapter recodified from COMAR 14.11.07 to COMAR 32.03.03, October 2000</annotation> <annotation type="History" subtype="Administrative History">Regulation .01 amended effective July 27, 2020 (47:15 Md. R. 713)</annotation> <annotation type="History" subtype="Administrative History">Regulation .02B amended as an emergency provision effective January 10, 2002 (29:6 Md. R. 565); emergency status extended at 29:9 Md. R. 743; amended permanently effective May 27, 2002 (29:10 Md. R. 827)</annotation> <annotation type="History" subtype="Administrative History">Regulation .02B amended effective February 13, 2006 (33:3 Md. R. 244); July 27, 2020 (47:15 Md. R. 713)</annotation> <annotation type="History" subtype="Administrative History">Regulation .03 amended effective July 27, 2020 (47:15 Md. R. 713)</annotation> <annotation type="History" subtype="Administrative History">Regulation .05 amended as an emergency provision effective January 10, 2002 (29:6 Md. R. 565); emergency status extended at 29:9 Md. R. 743; amended permanently effective May 27, 2002 (29:10 Md. R. 827)</annotation> <annotation type="History" subtype="Administrative History">Regulation .05 amended effective July 27, 2020 (47:15 Md. R. 713)</annotation> <annotation type="History" subtype="Administrative History">Regulation .07A amended as an emergency provision effective October 1, 2002 (29:20 Md. R. 1585); amended permanently effective January 20, 2003 (30:1 Md. R. 30)</annotation> <annotation type="History" subtype="Administrative History">Regulation .07A amended effective July 27, 2020 (47:15 Md. R. 713)</annotation> <annotation type="History" subtype="Administrative History">Regulation .08 amended effective July 27, 2020 (47:15 Md. R. 713)</annotation> <annotation type="History" subtype="Administrative History">Regulation .11A amended effective February 13, 2006 (33:3 Md. R. 244)</annotation> </annotations> </chapter> <chapter num="04" heading="Congregate Housing Services Program"> <regulation prefix="Regulation" num=".01" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>Allowable Medical Expenses.</text> <paragraph num="(a)"> <text>“Allowable medical expenses” means the total recurring, nonreimbursable medical expenses an individual or a couple reasonably expects to pay out-of-pocket during the 12 months following the date on which a calculation is made to determine a subsidy amount.</text> </paragraph> <paragraph num="(b)"> <text>“Allowable medical expenses” does not include expenses:</text> <paragraph num="(i)"> <text>Paid by a source other than the participant, such as insurance, Medicare, grants, or charitable organizations; or</text> </paragraph> <paragraph num="(ii)"> <text>For medical day care or attendant care, unless prescribed by a physician.</text> </paragraph> </paragraph> <paragraph num="(c)"> <text>“Allowable medical expenses” may include recurring, nonreimbursable expenses for:</text> <paragraph num="(i)"> <text>Services of physicians and other health care professionals;</text> </paragraph> <paragraph num="(ii)"> <text>Hospital expenses;</text> </paragraph> <paragraph num="(iii)"> <text>Medical insurance premiums;</text> </paragraph> <paragraph num="(iv)"> <text>Prescription and nonprescription medicines;</text> </paragraph> <paragraph num="(v)"> <text>Dental expenses;</text> </paragraph> <paragraph num="(vi)"> <text>Eyeglasses; and</text> </paragraph> <paragraph num="(vii)"> <text>Payments on accumulated medical bills.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(2)"> <text>Assets.</text> <paragraph num="(a)"> <text>“Assets” means all real and personal property, including:</text> <paragraph num="(i)"> <text>Checking and savings account balances;</text> </paragraph> <paragraph num="(ii)"> <text>Any automobiles in excess of one per family;</text> </paragraph> <paragraph num="(iii)"> <text>Certificates of deposit;</text> </paragraph> <paragraph num="(iv)"> <text>Stocks;</text> </paragraph> <paragraph num="(v)"> <text>Bonds; and</text> </paragraph> <paragraph num="(vi)"> <text>Revocable trusts.</text> </paragraph> </paragraph> <paragraph num="(b)"> <text>“Assets” does not include:</text> <paragraph num="(i)"> <text>Customary household goods;</text> </paragraph> <paragraph num="(ii)"> <text>Personal effects;</text> </paragraph> <paragraph num="(iii)"> <text>One automobile per family;</text> </paragraph> <paragraph num="(iv)"> <text>Irrevocable funeral trusts;</text> </paragraph> <paragraph num="(v)"> <text>Personal burial space; or</text> </paragraph> <paragraph num="(vi)"> <text>Life insurance with a cash surrender value of not more than $5,000.</text> </paragraph> </paragraph> </paragraph> <paragraph num="(3)"> <text>“Certificate” means a certificate issued by the Maryland Department of Aging authorizing a named provider to operate a congregate housing services program at a specified location.</text> </paragraph> <paragraph num="(4)"> <text>“Congregate housing services” means congregate meals, housekeeping, laundry, personal assistance services, and service management provided in an apartment building, which services are to promote independent living for:</text> <paragraph num="(a)"> <text>An individual 62 years old or older who has temporary or periodic difficulty with one more essential activities of daily living such as feeding, bathing, grooming, dressing, or transferring; and</text> </paragraph> <paragraph num="(b)"> <text>The spouse of an individual described in §B(4)(a) of this regulation who is 55 years old or older and who has temporary or periodic difficulty with one or more essential activities of daily living such as feeding, bathing, grooming, dressing, or transferring.</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>“Congregate Housing Services Program” means the Program operated by the Department under the authority of Human Services Article, §10-209, Annotated Code of Maryland, which, among other activities, certifies providers willing to provide congregate housing services to participants and subsidizes congregate housing services for low income seniors under:</text> <paragraph num="(a)"> <text>The Standard Congregate Housing Services Plan; and</text> </paragraph> <paragraph num="(b)"> <text>The Individualized Congregate Housing Services Plan.</text> </paragraph> </paragraph> <paragraph num="(6)"> <text>“Contact person” means an individual designated by a participant to receive information about the participant's needs or health.</text> </paragraph> <paragraph num="(7)"> <text>“Department” means the Maryland Department of Aging.</text> </paragraph> <paragraph num="(8)"> <text>“Elderly” means an individual who is 62 years old or older.</text> </paragraph> <paragraph num="(9)"> <text>“Emergency” means conditions that:</text> <paragraph num="(a)"> <text>Present a substantial risk of death or serious physical harm; and</text> </paragraph> <paragraph num="(b)"> <text>Require immediate action.</text> </paragraph> </paragraph> <paragraph num="(10)"> <text>“Essential activities of daily living” means the normal daily activities associated with independent living including feeding, bathing, grooming, dressing, and transferring.</text> </paragraph> <paragraph num="(11)"> <text>“Facility” means a specific senior housing building in which:</text> <paragraph num="(a)"> <text>A provider furnishes congregate housing services; or</text> </paragraph> <paragraph num="(b)"> <text>An applicant for a certificate intends to furnish congregate housing services.</text> </paragraph> </paragraph> <paragraph num="(12)"> <text>“Fee for service” means a single congregate housing service offered by a provider, the cost of which has been approved but not subsidized by the Department.</text> </paragraph> <paragraph num="(13)"> <text>“Feeding” means providing meals.</text> </paragraph> <paragraph num="(14)"> <text>“Fiscal year” means the 12-month period that constitutes the State fiscal year, beginning July 1 and ending on June 30.</text> </paragraph> <paragraph num="(15)"> <text>“Income” means the gross amount of all earned and unearned income from all sources, including:</text> <paragraph num="(a)"> <text>Employment;</text> </paragraph> <paragraph num="(b)"> <text>Annuities;</text> </paragraph> <paragraph num="(c)"> <text>Social Security benefits;</text> </paragraph> <paragraph num="(d)"> <text>Workers' Compensation;</text> </paragraph> <paragraph num="(e)"> <text>Pensions;</text> </paragraph> <paragraph num="(f)"> <text>Disability payments;</text> </paragraph> <paragraph num="(g)"> <text>Alimony;</text> </paragraph> <paragraph num="(h)"> <text>Interest;</text> </paragraph> <paragraph num="(i)"> <text>Dividends; and</text> </paragraph> <paragraph num="(j)"> <text>Net income from a business or profession.</text> </paragraph> </paragraph> <paragraph num="(16)"> <text>“Individualized Congregate Housing Services Plan” means a plan that offers participants a choice of different service packages, which may contain fewer, or more, services than the complete set of congregate housing services a Standard Congregate Housing Services Plan provider is required to provide.</text> </paragraph> <paragraph num="(17)"> <text>“Instrumental activities of daily living” means:</text> <paragraph num="(a)"> <text>Using the telephone;</text> </paragraph> <paragraph num="(b)"> <text>Interpreting and responding to mail;</text> </paragraph> <paragraph num="(c)"> <text>Shopping for personal needs;</text> </paragraph> <paragraph num="(d)"> <text>Remembering to take medication;</text> </paragraph> <paragraph num="(e)"> <text>Arranging for prescription refills;</text> </paragraph> <paragraph num="(f)"> <text>Making transportation arrangements; and</text> </paragraph> <paragraph num="(g)"> <text>Performing chores.</text> </paragraph> </paragraph> <paragraph num="(18)"> <text>“Net annual income” means total income projected to be received by an individual or couple in the 12 months after submission of an application for a program subsidy, minus any recurring, nonreimbursable medical expenses projected for the 12-month period that exceed 3 percent of the total income.</text> </paragraph> <paragraph num="(19)"> <text>“Net monthly income” means net annual income divided by 12.</text> </paragraph> <paragraph num="(20)"> <text>“Participant” means an individual who:</text> <paragraph num="(a)"> <text>Lives in an apartment in a facility; and</text> </paragraph> <paragraph num="(b)"> <text>Receives congregate housing services from a provider.</text> </paragraph> </paragraph> <paragraph num="(21)"> <text>“Personal assistance services” means services that assist a participant with feeding, bathing, grooming, or dressing.</text> </paragraph> <paragraph num="(22)"> <text>“Physically or mentally impaired” means having a physical or mental condition that prevents an individual from performing one or more essential activities of daily living.</text> </paragraph> <paragraph num="(23)"> <text>“Program” means the Congregate Housing Services Program.</text> </paragraph> <paragraph num="(24)"> <text>“Projected monthly income” means 1/12 of the income an individual or couple reasonably expects to receive during the 12 months after the date on which a subsidy calculation is made for the individual or couple.</text> </paragraph> <paragraph num="(25)"> <text>“Provider” means an individual or other legal entity certified by the Department to provide congregate housing services at a facility.</text> </paragraph> <paragraph num="(26)"> <text>“Secretary” means the Secretary of the Department.</text> </paragraph> <paragraph num="(27)"> <text>“Senior housing” means a multiple-family apartment building that:</text> <paragraph num="(a)"> <text>Provides housing under a landlord-tenant arrangement; and</text> </paragraph> <paragraph num="(b)"> <text>Is specifically designed to meet the physical or social needs of elderly individuals.</text> </paragraph> </paragraph> <paragraph num="(28)"> <text>“Service management” means the administrative services needed to insure an individual's access to congregate housing services including:</text> <paragraph num="(a)"> <text>Assessing participant needs;</text> </paragraph> <paragraph num="(b)"> <text>Determining eligibility;</text> </paragraph> <paragraph num="(c)"> <text>Documenting services received;</text> </paragraph> <paragraph num="(d)"> <text>Billing for services;</text> </paragraph> <paragraph num="(e)"> <text>Communicating with families and the contact person;</text> </paragraph> <paragraph num="(f)"> <text>Generally supervising participants;</text> </paragraph> <paragraph num="(g)"> <text>Discharge planning; and</text> </paragraph> <paragraph num="(h)"> <text>Supervising services provided by staff.</text> </paragraph> </paragraph> <paragraph num="(29)"> <text>“Service package” means a group of congregate housing services offered as a package by an Individualized Congregate Housing Services Plan provider that may include fewer, or more, services than the complete set of congregate housing services a Standard Congregate Housing Services Plan provider is required to provide.</text> </paragraph> <paragraph num="(30)"> <text>“Service plan” means a written plan developed by a provider in conjunction with an Individualized Congregate Housing Services Plan participant that identifies:</text> <paragraph num="(a)"> <text>The particular congregate housing services, and any optional services under Regulation .14F of this chapter, that the provider will provide to the participant;</text> </paragraph> <paragraph num="(b)"> <text>When the services will be provided; and</text> </paragraph> <paragraph num="(c)"> <text>Who will provide the services.</text> </paragraph> </paragraph> <paragraph num="(31)"> <text>“Standard Congregate Housing Services Plan” means a single plan that includes the complete set of congregate housing services including:</text> <paragraph num="(a)"> <text>Congregate meals;</text> </paragraph> <paragraph num="(b)"> <text>Housekeeping;</text> </paragraph> <paragraph num="(c)"> <text>Laundry;</text> </paragraph> <paragraph num="(d)"> <text>Personal assistance services; and</text> </paragraph> <paragraph num="(e)"> <text>Service management.</text> </paragraph> </paragraph> <paragraph num="(32)"> <text>“Subsidy” means the State funds paid by the Department to a provider for providing congregate housing services to a participant in accordance with a subsidy services agreement and this chapter.</text> </paragraph> <paragraph num="(33)"> <text>“Subsidy services agreement” means a grant agreement between a provider and the Department that specifies the obligations of both parties.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".02" heading="Congregate Housing Services Certificate."> <paragraph num="A."> <text>Certificate Required. An individual or other legal entity shall obtain a certificate from the Department before representing that it is a part of the Program or a Department-approved congregate housing services provider. The requirements of this chapter shall be met in order for a provider to obtain a certificate.</text> </paragraph> <paragraph num="B."> <text>Application. In order to obtain a certificate, an individual or legal entity that wants to be certified as a provider shall apply to the Department for a certificate on a form provided by the Department.</text> </paragraph> <paragraph num="C."> <text>Separate Certificate Required. A separate certificate is required for each facility.</text> </paragraph> <paragraph num="D."> <text>Term of Certificate. A certificate is valid for the period specified on the certificate.</text> </paragraph> <paragraph num="E."> <text>Owner of Certificate. If a certificate is issued, it shall be:</text> <paragraph num="(1)"> <text>For a specific facility; and</text> </paragraph> <paragraph num="(2)"> <text>In the name of the individual or legal entity that made the application.</text> </paragraph> </paragraph> <paragraph num="F."> <text>Posting of Certificate. A provider shall post its certificate conspicuously in a public area of the facility at all times.</text> </paragraph> <paragraph num="G."> <text>Certificate Contents.</text> <paragraph num="(1)"> <text>A certificate shall state:</text> <paragraph num="(a)"> <text>The name and address of the provider;</text> </paragraph> <paragraph num="(b)"> <text>The name and address of the facility; and</text> </paragraph> <paragraph num="(c)"> <text>The expiration date of the certificate.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>For each facility, a certificate shall identify whether the provider is certified as a Standard Congregate Housing Services Plan or an Individualized Congregate Housing Services Plan. A provider may not be certified as both for a single facility.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Certificate Requirements."> <paragraph num="A."> <text>An applicant for a certificate shall submit to the Department:</text> <paragraph num="(1)"> <text>Documentation that verifies that:</text> <paragraph num="(a)"> <text>The facility in which the applicant proposes to provide congregate housing services is owned, leased, or otherwise under the control of the applicant; or</text> </paragraph> <paragraph num="(b)"> <text>The applicant has entered into a written agreement with the owner or management of the facility that specifies that the applicant is to be the sole congregate housing services provider for residents in the facility; and</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>A statement under oath from the owner or manager of the facility stating that:</text> <paragraph num="(a)"> <text>The facility is in compliance with applicable local laws and regulations that govern housing, life safety, zoning, and environmental health; and</text> </paragraph> <paragraph num="(b)"> <text>The facility's structural systems, heating, hot and cold water, electricity, plumbing, artificial and natural lighting, sewage, ventilation, and any other physical components governed by law or regulation, are safe, sanitary, functional, adequate, and in compliance with State and local law.</text> </paragraph> </paragraph> </paragraph> <paragraph num="B."> <text>A facility shall conform to all of the applicable rules, regulations, and standards of any government agency through which it is financed, insured, or subsidized, including the U. S. Department of Housing and Urban Development, Rural Housing Service, or the Maryland Department of Housing and Community Development.</text> </paragraph> <paragraph num="C."> <text>An applicant shall also submit evidence to the Department that demonstrates that the applicant has the capacity to deliver the services required by this chapter.</text> </paragraph> <paragraph num="D."> <text>Evidence submitted to meet the requirements of §C of this regulation shall include:</text> <paragraph num="(1)"> <text>A statement of the mission, goals, and objectives of the applicant;</text> </paragraph> <paragraph num="(2)"> <text>Information about the applicant's experience providing services to the elderly;</text> </paragraph> <paragraph num="(3)"> <text>A description of:</text> <paragraph num="(a)"> <text>All the services to be provided; and</text> </paragraph> <paragraph num="(b)"> <text>A proposed fee schedule;</text> </paragraph> </paragraph> <paragraph num="(4)"> <text>An operating budget that supports the proposed fee schedule and identifies:</text> <paragraph num="(a)"> <text>The anticipated sources of revenue; and</text> </paragraph> <paragraph num="(b)"> <text>Service utilization assumptions;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>A proposed weekly staffing pattern;</text> </paragraph> <paragraph num="(6)"> <text>Proposed salary schedules;</text> </paragraph> <paragraph num="(7)"> <text>A sample 4-week menu cycle that has been reviewed and approved in writing by a registered dietician;</text> </paragraph> <paragraph num="(8)"> <text>A statement of the applicant's goals and objectives for providing services at the facility; and</text> </paragraph> <paragraph num="(9)"> <text>Any other relevant information requested by the Department.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Issuance of a Certificate."> <text>The Department may not issue a certificate until:</text> <paragraph num="A."> <text>A completed application for certification has been submitted to the Department;</text> </paragraph> <paragraph num="B."> <text>The Department has verified that the requirements in Regulation .03 of this chapter have been met; and</text> </paragraph> <paragraph num="C."> <text>The Department has inspected and approved the facility.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".05" heading="Waiver."> <paragraph num="A."> <text>The Department may waive any requirement in this chapter if a waiver request from a provider:</text> <paragraph num="(1)"> <text>Is submitted to the Department in writing and contains specific facts upon which the waiver is requested;</text> </paragraph> <paragraph num="(2)"> <text>Demonstrates that:</text> <paragraph num="(a)"> <text>Compliance with the regulation for which a waiver is requested will impose a hardship; or</text> </paragraph> <paragraph num="(b)"> <text>The waiver, if granted, will improve the operation of the Program;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>Demonstrates that an alternative procedure proposed by the provider will meet or produce the intended effect of each regulation for which a waiver is requested; and</text> </paragraph> <paragraph num="(4)"> <text>Demonstrates that the issuance of a waiver will not adversely affect the health and safety of a participant.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Within 60 days after the date a request for a waiver is received by the Department, the Department shall inform the applicant in writing whether the waiver request will be granted. If granted, the waiver shall remain in effect for the term specified in the notification.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Annual Renewal of Certificate."> <paragraph num="A."> <text>A provider with a certificate, including a certificate issued before the adoption of these regulations, may apply to have the certificate renewed. An updated application for renewal shall be submitted on forms approved by the Department.</text> </paragraph> <paragraph num="B."> <text>An application for renewal shall be filed with the Department by a date specified annually by the Department.</text> </paragraph> <paragraph num="C."> <text>The Department shall renew a certificate if:</text> <paragraph num="(1)"> <text>The provider is in compliance with this chapter; and</text> </paragraph> <paragraph num="(2)"> <text>The Department has verified that the requirements of Regulation .03 of this chapter have been met.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".07" heading="Change of Provider During Term of Subsidy Services Agreement."> <paragraph num="A."> <text>A certificate is not transferable. An entity other than the current provider may become the certificate holder and the new provider for a facility, only if:</text> <paragraph num="(1)"> <text>The Department agrees to the change; and</text> </paragraph> <paragraph num="(2)"> <text>The proposed new provider obtains a certificate for the facility.</text> </paragraph> </paragraph> <paragraph num="B."> <text>An existing provider seeking to have a new entity become the provider for a facility shall notify the Department at least 90 days before the proposed effective date of the change. The entity seeking to be the new provider shall apply for a certificate at least 60 days before the proposed date for the change.</text> </paragraph> <paragraph num="C."> <text>A provider shall remain responsible for the operation of the Program at the facility until the Department approves the proposed change by:</text> <paragraph num="(1)"> <text>Rescinding the provider's certificate; and</text> </paragraph> <paragraph num="(2)"> <text>Issuing a new certificate to a new provider.</text> </paragraph> </paragraph> <paragraph num="D."> <text>A provider shall notify its participants in writing of a proposed change to a new provider at least 60 days prior to the proposed effective date of the change. The notification shall contain at least:</text> <paragraph num="(1)"> <text>A proposed date of the change;</text> </paragraph> <paragraph num="(2)"> <text>A name, address, and telephone number of the proposed new provider; and</text> </paragraph> <paragraph num="(3)"> <text>A name and telephone number of an individual in the Department or local agency on aging that a participant may call with questions.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".08" heading="Qualifications of Provider or Supervisor."> <paragraph num="A."> <text>An individual employed by a provider to work in a supervisory position in a facility and, if the provider is an individual, the provider, shall have at least the minimum qualifications set forth in §B of this regulation.</text> </paragraph> <paragraph num="B."> <text>To qualify to work in a supervisory position for a provider, an individual:</text> <paragraph num="(1)"> <text>Shall be 21 years old or older;</text> </paragraph> <paragraph num="(2)"> <text>Shall be literate and able to communicate effectively with participants;</text> </paragraph> <paragraph num="(3)"> <text>Shall have sufficient skills, education, training, and experience to perform the required services;</text> </paragraph> <paragraph num="(4)"> <text>Shall have sufficient physical, emotional, and mental capacity to perform the duties required;</text> </paragraph> <paragraph num="(5)"> <text>Shall be of good moral character;</text> </paragraph> <paragraph num="(6)"> <text>Shall fully cooperate with a provider's efforts to comply with Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland (Adult Dependent Care Programs—Criminal History Records Checks and Background Checks);</text> </paragraph> <paragraph num="(7)"> <text>May not have been convicted of, received a probation before judgment for, or entered a plea of nolo contendere to a felony or any crime involving moral turpitude or theft, or have any other criminal history that indicates behavior which is potentially harmful to participants;</text> </paragraph> <paragraph num="(8)"> <text>May not be cited on the Maryland Geriatric Nursing Assistants Registry under COMAR 10.07.02.42 with a determination of:</text> <paragraph num="(a)"> <text>Abuse;</text> </paragraph> <paragraph num="(b)"> <text>Misappropriation of resident property; or</text> </paragraph> <paragraph num="(c)"> <text>Neglect; and</text> </paragraph> </paragraph> <paragraph num="(9)"> <text>May not have violated any State or local law regulating residential care facilities, which violation resulted in revocation or nonrenewal of a license or certificate.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".09" heading="Staffing."> <paragraph num="A."> <text>A provider shall have a staff-to-participant ratio which is adequate to provide the services required in Regulation .14 of this chapter.</text> </paragraph> <paragraph num="B."> <text>The provider shall provide or assure that its staff participates in training, as necessary, to ensure that each participant obtains quality congregate housing services consistent with the participant's needs.</text> </paragraph> <paragraph num="C."> <text>If a provider provides services to individuals with Alzheimer's disease or related disorders:</text> <paragraph num="(1)"> <text>The provider shall provide annual education to staff on the care of individuals with dementia; and</text> </paragraph> <paragraph num="(2)"> <text>Employees shall complete an in-service training on dementia that addresses the physical, intellectual, and behavioral manifestations of dementia and techniques to assist and manage dementia participants before the later of:</text> <paragraph num="(a)"> <text>180 days from the beginning of staff member's employment; or</text> </paragraph> <paragraph num="(b)"> <text>December 31, 2005.</text> </paragraph> </paragraph> </paragraph> <paragraph num="D."> <text>Employees of a provider whose jobs require them to enter a participant's apartment or have physical contact with a participant:</text> <paragraph num="(1)"> <text>Shall be 18 years old or older;</text> </paragraph> <paragraph num="(2)"> <text>Shall be of good moral character;</text> </paragraph> <paragraph num="(3)"> <text>Shall be literate if job responsibilities require reading or writing;</text> </paragraph> <paragraph num="(4)"> <text>Shall be able to communicate effectively with the participant;</text> </paragraph> <paragraph num="(5)"> <text>Shall have sufficient skills, education, training, and experience to perform the required services;</text> </paragraph> <paragraph num="(6)"> <text>Shall have sufficient physical, emotional, and mental capacity to perform the duties required;</text> </paragraph> <paragraph num="(7)"> <text>Shall fully cooperate with a provider's efforts to comply with Health-General Article, Title 19, Subtitle 19, Annotated Code of Maryland (Adult Dependent Care Programs — Criminal History Records Checks and Background Checks);</text> </paragraph> <paragraph num="(8)"> <text>May not have been convicted of, received a probation before judgment for, or entered a plea of nolo contendere to a felony or any crime involving moral turpitude or theft, or have any other criminal history that indicates behavior which is potentially harmful to participants;</text> </paragraph> <paragraph num="(9)"> <text>May not be cited on the Maryland Geriatric Nursing Assistant Registry under COMAR 10.07.02.42 with a determination of:</text> <paragraph num="(a)"> <text>Abuse;</text> </paragraph> <paragraph num="(b)"> <text>Misappropriation of resident property; or</text> </paragraph> <paragraph num="(c)"> <text>Neglect; and</text> </paragraph> </paragraph> <paragraph num="(10)"> <text>May not have violated any State or local law regulating residential care facilities that resulted in revocation or nonrenewal of a license or certificate.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".10" heading="Participant Rights."> <paragraph num="A."> <text>In addition to any other rights, a participant shall have the right to:</text> <paragraph num="(1)"> <text>Be treated with consideration, respect, and full recognition of human dignity and individuality;</text> </paragraph> <paragraph num="(2)"> <text>Receive care and services that are adequate and appropriate;</text> </paragraph> <paragraph num="(3)"> <text>Privacy;</text> </paragraph> <paragraph num="(4)"> <text>Be free from emotional and physical abuse;</text> </paragraph> <paragraph num="(5)"> <text>Practice the religion of the participant's choice or to abstain from religious practice;</text> </paragraph> <paragraph num="(6)"> <text>Be free from discrimination, as provided by State and federal law; and</text> </paragraph> <paragraph num="(7)"> <text>Refuse or consent to medical treatment.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A provider shall:</text> <paragraph num="(1)"> <text>Conspicuously post at all times the list of participant rights identified in §A of this regulation:</text> <paragraph num="(a)"> <text>In the facility; and</text> </paragraph> <paragraph num="(b)"> <text>In the provider's office; and</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Give a copy of the list of participant rights to each participant at the time of admission.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".11" heading="Provider-Participant Service Agreement."> <paragraph num="A."> <text>A provider shall enter into a written agreement with a participant on a form provided or approved by the Department that specifies the obligations of both parties, including:</text> <paragraph num="(1)"> <text>The services to be provided;</text> </paragraph> <paragraph num="(2)"> <text>The fees to be charged by the provider;</text> </paragraph> <paragraph num="(3)"> <text>If applicable, the amount of subsidy to be paid on behalf of the participant; and</text> </paragraph> <paragraph num="(4)"> <text>That the provider give at least 30 days notice of any proposed change in a fee charged by the provider for a particular service.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The provider shall give one copy of the executed agreement to the participant and keep a second copy on file for 3 years after the termination date of the agreement. Any modifications to the agreement shall be reflected in an addendum signed and dated by both parties.</text> </paragraph> <paragraph num="C."> <text>A change in the amount of a participant's required contribution following a reassessment of the participant's financial eligibility:</text> <paragraph num="(1)"> <text>May be imposed immediately; and</text> </paragraph> <paragraph num="(2)"> <text>Is not subject to the 30 day notice requirement of §A(4) of this regulation.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".12" heading="Termination of Provider-Participant Service Agreement."> <paragraph num="A."> <text>A provider-participant service agreement shall allow termination by a provider only for the following reasons:</text> <paragraph num="(1)"> <text>A change in the health status or behavior of the participant that constitutes a substantial threat to the health or safety of a participant, other residents, or the provider's staff;</text> </paragraph> <paragraph num="(2)"> <text>Chronic disruptive behavior that is offensive and threatens participants' peaceful enjoyment of their apartments;</text> </paragraph> <paragraph num="(3)"> <text>Nonpayment of fees by the participant;</text> </paragraph> <paragraph num="(4)"> <text>Termination of the Program at the facility through no fault of the provider; or</text> </paragraph> <paragraph num="(5)"> <text>The participant's health has improved sufficiently so that the participant no longer needs congregate housing services.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A provider shall give at least 30 days' written notice of termination to a participant. The notice shall include:</text> <paragraph num="(1)"> <text>A statement of intent to terminate;</text> </paragraph> <paragraph num="(2)"> <text>The reason for termination;</text> </paragraph> <paragraph num="(3)"> <text>The proposed termination date, which may not be less than 30 days from the date of the notification;</text> </paragraph> <paragraph num="(4)"> <text>Assurance that services will be provided up to the proposed termination date; and</text> </paragraph> <paragraph num="(5)"> <text>A list of resources in the community that may be able to assist the participant to relocate.</text> </paragraph> </paragraph> <paragraph num="C."> <text>The existence of an emergency does not necessarily mean that any of the standards in §A of this regulation have been met.</text> </paragraph> <paragraph num="D."> <text>If an emergency involving a participant arises, including one that may require a participant to be transferred to a hospital, the participant's provider shall:</text> <paragraph num="(1)"> <text>Take immediate steps to obtain necessary care for the participant by calling 9-1-1;</text> </paragraph> <paragraph num="(2)"> <text>Notify the participant's contact person within 1 hour of learning of the emergency;</text> </paragraph> <paragraph num="(3)"> <text>Notify the participant and the participant's contact person of the conditions or behavior that created the emergency and, if applicable, the reasons why a transfer was necessary; and</text> </paragraph> <paragraph num="(4)"> <text>Record the appropriate information in an incident report.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".13" heading="Record Keeping."> <paragraph num="A."> <text>A provider shall maintain on-site an accurate and current file for each participant.</text> </paragraph> <paragraph num="B."> <text>A participant's file shall contain the following:</text> <paragraph num="(1)"> <text>A completed copy of the following forms prescribed by the Department:</text> <paragraph num="(a)"> <text>Participant assessment form;</text> </paragraph> <paragraph num="(b)"> <text>Application form;</text> </paragraph> <paragraph num="(c)"> <text>Provider-participant service agreement and any addenda; and</text> </paragraph> <paragraph num="(d)"> <text>Subsidy application, if any;</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>Personal data of participant including:</text> <paragraph num="(a)"> <text>Name;</text> </paragraph> <paragraph num="(b)"> <text>Date of birth;</text> </paragraph> <paragraph num="(c)"> <text>Admission date and, if applicable, termination date;</text> </paragraph> <paragraph num="(d)"> <text>The type of housing the participant lived in before admission into the Program;</text> </paragraph> <paragraph num="(e)"> <text>Name, address, and telephone number of the participant's physician;</text> </paragraph> <paragraph num="(f)"> <text>Name, address, and telephone number of the participant's contact person;</text> </paragraph> <paragraph num="(g)"> <text>If obtained by the provider, relevant medical history of the participant, including physicians' health reports and information on recent hospitalizations; and</text> </paragraph> <paragraph num="(h)"> <text>A copy of any advance health care directive the participant voluntarily provides in response to the provider's inquiring whether it may have a copy of any advance health care directive of participant;</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>For participants in an Individualized Congregate Housing Services Plan, a service plan;</text> </paragraph> <paragraph num="(4)"> <text>Incident reports related to the participant;</text> </paragraph> <paragraph num="(5)"> <text>Documentation verifying on a weekly basis the housekeeping, laundry, and personal assistance services received by the participant during the prior month;</text> </paragraph> <paragraph num="(6)"> <text>Reasons for any termination or transfer and, if applicable, the location to which the participant was transferred;</text> </paragraph> <paragraph num="(7)"> <text>Any assessments or recommendations concerning the participant which were made by the local health department and received by the provider; and</text> </paragraph> <paragraph num="(8)"> <text>If the participant receives a subsidy, a completed copy of the subsidy calculation form and written documentation of the participant's:</text> <paragraph num="(a)"> <text>Net annual income;</text> </paragraph> <paragraph num="(b)"> <text>Assets; and</text> </paragraph> <paragraph num="(c)"> <text>Allowable medical expenses.</text> </paragraph> </paragraph> </paragraph> <paragraph num="C."> <text>Incident Reports.</text> <paragraph num="(1)"> <text>A provider shall record on an incident report a description of each accident, injury, or other incident that occurs at the facility and impacts the amount of congregate housing services needed by a participant.</text> </paragraph> <paragraph num="(2)"> <text>All incident reports shall include the following information:</text> <paragraph num="(a)"> <text>The time, date, and place of the incident;</text> </paragraph> <paragraph num="(b)"> <text>The identity of individuals present at the incident;</text> </paragraph> <paragraph num="(c)"> <text>A complete description of the incident;</text> </paragraph> <paragraph num="(d)"> <text>The response of the staff; and</text> </paragraph> <paragraph num="(e)"> <text>Any appropriate follow-up action taken, including notifying the participant's contact person and licensing or law enforcement authorities.</text> </paragraph> </paragraph> </paragraph> <paragraph num="D."> <text>Confidentiality. A provider shall protect the confidentiality of a participant's file. A provider may not disclose information contained in a participant's file to any person or agency other than the participant, the participant's contact person or legal representative, or the Department's authorized employees unless:</text> <paragraph num="(1)"> <text>The participant consents in writing to the disclosure; or</text> </paragraph> <paragraph num="(2)"> <text>State or federal law or a court order otherwise requires or permits the disclosure.</text> </paragraph> </paragraph> <paragraph num="E."> <text>During ordinary business hours and at other reasonable times, a participant shall have the right to inspect and obtain a copy of the file referred to in §B of this regulation. Upon request by a participant, a provider shall make a copy for the participant of any portion of the file and may charge the participant a reasonable cost for making a copy, not to exceed 30 cents per page.</text> </paragraph> <paragraph num="F."> <text>A provider shall keep a participant's file for at least 3 years after the participant stops participating in the Program at the provider's facility.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".14" heading="Mandatory and Optional Services."> <paragraph num="A."> <text>A provider shall elect to participate in either the Standard Congregate Housing Services Plan or the Individualized Congregate Housing Services Plan.</text> </paragraph> <paragraph num="B."> <text>Meals.</text> <paragraph num="(1)"> <text>A Standard Congregate Housing Services Plan provider shall provide at least two nutritionally balanced meals daily.</text> </paragraph> <paragraph num="(2)"> <text>An Individualized Congregate Housing Services Plan provider shall offer a service package that includes at least one nutritionally balanced meal daily.</text> </paragraph> <paragraph num="(3)"> <text>All meals served to participants shall be prepared by a licensed food service establishment in an approved food preparation facility that complies with the requirements of COMAR 10.15.03.</text> </paragraph> <paragraph num="(4)"> <text>At least one meal a day shall be offered in a congregate setting.</text> </paragraph> <paragraph num="(5)"> <text>If a participant requests that a meal be delivered to the participant's apartment, the provider shall deliver it at no additional charge if the provider determines that the participant is unable to participate in a congregate meal due to a temporary mental or physical condition.</text> </paragraph> <paragraph num="(6)"> <text>A provider or its food service contractor shall prepare in advance a weekly menu of the meals to be serviced.</text> </paragraph> <paragraph num="(7)"> <text>If more than one food service contractor is retained by a provider to prepare meals for participants in a facility, the provider shall assure that menus are coordinated to avoid duplication and to maintain overall nutritional balance.</text> </paragraph> <paragraph num="(8)"> <text>A provider shall retain copies of weekly menus at the facility for a period of 1 year and shall have the menus available during monitoring visits conducted by the Department. If a substitution is made for an item on the approved menu, the substitution shall be documented on the menu.</text> </paragraph> <paragraph num="(9)"> <text>A provider shall keep a record of participants' attendance at each congregate meal provided, investigate a participant's failure to attend a meal, and document why the participant did not attend. Records of meal attendance and documentation of why a participant did not attend shall be kept for at least 3 months.</text> </paragraph> <paragraph num="(10)"> <text>If a provider contracts with another entity to provide meal services for the participants, the provider shall solicit competitive bids from qualified food service establishments at least once every 3 years. Competitive bidding may be waived by the Department if the meals are provided by a food service establishment that is under contract with:</text> <paragraph num="(a)"> <text>The owner or management of the facility, if the provider is not the owner or manager; or</text> </paragraph> <paragraph num="(b)"> <text>The local area agency on aging to provide congregate or home-delivered meals pursuant to Title III C of the federal Older Americans Act, 42 U.S.C. §§3030e — 3030g-22.</text> </paragraph> </paragraph> <paragraph num="(11)"> <text>If a provider contracts with another entity to provide meals to participants, the provider shall arrange for participants to meet periodically with the other entity to discuss menus and other concerns.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Housekeeping and Laundry.</text> <paragraph num="(1)"> <text>A provider shall provide the supplies and equipment necessary for housekeeping required by this regulation.</text> </paragraph> <paragraph num="(2)"> <text>A provider may require that its participants provide laundry supplies and pay for the cost of operating laundry equipment to clean the participants' laundry.</text> </paragraph> <paragraph num="(3)"> <text>A Standard Congregate Housing Services Plan provider shall provide a minimum of 1.5 hours per week of general housekeeping and laundry services for each participant.</text> </paragraph> <paragraph num="(4)"> <text>A Standard Congregate Housing Services Plan provider shall clean a participant's apartment and change the bed linens at least weekly. If a temporary condition requires cleaning an apartment or changing bed linens more often than weekly in order to maintain a clean, safe, and sanitary living environment, a provider shall do so on a temporary basis.</text> </paragraph> <paragraph num="(5)"> <text>A Standard Congregate Housing Services Plan provider shall provide laundry services to participants at least weekly.</text> </paragraph> <paragraph num="(6)"> <text>An Individualized Congregate Housing Services Plan provider shall offer at least one service package that includes at least 1.5 hours per week of assistance with housekeeping and laundry.</text> </paragraph> <paragraph num="(7)"> <text>An Individualized Congregate Housing Services Plan provider may offer service packages that provide 3, 6, or 9 hours per week of any combination of personal assistance services and weekly housekeeping and laundry services.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Personal Assistance Services.</text> <paragraph num="(1)"> <text>If a participant needs and wants personal assistance services, a Standard Congregate Housing Services Plan provider shall provide the services. At a minimum a Standard Congregate Housing Services Plan provider shall have staff available at a facility to provide 1.5 hours per week of personal assistance services for each participant at the facility.</text> </paragraph> <paragraph num="(2)"> <text>An Individualized Congregate Housing Services Plan provider shall offer at least one service package that includes at least 3 hours of personal assistance services weekly.</text> </paragraph> </paragraph> <paragraph num="E."> <text>Service Management.</text> <paragraph num="(1)"> <text>A Standard Congregate Housing Services Plan provider shall provide service management as part of the services provided to participants.</text> </paragraph> <paragraph num="(2)"> <text>An Individualized Congregate Housing Services Program provider shall offer at least one service package that includes service management.</text> </paragraph> </paragraph> <paragraph num="F."> <text>Optional Services. A provider may provide:</text> <paragraph num="(1)"> <text>Assistance with instrumental activities of daily living;</text> </paragraph> <paragraph num="(2)"> <text>Assistance with arrangements for regular health care appointments;</text> </paragraph> <paragraph num="(3)"> <text>A service to escort a participant to a health care appointment;</text> </paragraph> <paragraph num="(4)"> <text>Meal delivery to a participant's apartment, for a nominal fee, if:</text> <paragraph num="(a)"> <text>A participant elects not to participate in the congregate meal program; and</text> </paragraph> <paragraph num="(b)"> <text>The provider has sufficient staff to provide this service;</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>Opportunities for individual or group activities in accordance with participants' interests, abilities, and needs;</text> </paragraph> <paragraph num="(6)"> <text>Assistance with completing and submitting benefit applications;</text> </paragraph> <paragraph num="(7)"> <text>Assistance with securing additional services needed;</text> </paragraph> <paragraph num="(8)"> <text>Subject to the prior approval of the Department and in accordance with §G of this regulation, medication reminders or administration; and</text> </paragraph> <paragraph num="(9)"> <text>Subject to the prior approval of the Department, other services participants may need if a provider has an adequate number of staff with the qualifications necessary to provide the proposed services.</text> </paragraph> </paragraph> <paragraph num="G."> <text>Medications.</text> <paragraph num="(1)"> <text>Medication shall be self-administered by a participant unless a provider successfully demonstrates to the Department that the provider and its staff have the qualifications to offer medication reminders or administer medications.</text> </paragraph> <paragraph num="(2)"> <text>A provider approved by the Department to offer as an optional service medication reminders may:</text> <paragraph num="(a)"> <text>Remind a participant to take medication; or</text> </paragraph> <paragraph num="(b)"> <text>Provide physical assistance with opening and removing medications from a container.</text> </paragraph> </paragraph> <paragraph num="(3)"> <text>A provider approved by the Department to offer as an optional service the administration of medications shall:</text> <paragraph num="(a)"> <text>Assure that staff who administer medications do so under the supervision of a registered nurse pursuant to COMAR 10.27.11;</text> </paragraph> <paragraph num="(b)"> <text>Assure that all staff responsible for medication administration complete a Medication Administration Training Program approved by the Board of Nursing pursuant to Health-General Article, §8-6A-01(f), Annotated Code of Maryland;</text> </paragraph> <paragraph num="(c)"> <text>Assure that every 2 years all staff responsible for medication administration complete a clinical update refresher course; and</text> </paragraph> <paragraph num="(d)"> <text>For each participant whose medication is administered by staff of the provider, arrange for an on-site review by a delegating registered nurse at least every 45 days pursuant to COMAR 10.27.11.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".15" heading="Award of Subsidies to a Provider."> <paragraph num="A."> <text>The Department may award subsidies to a provider if:</text> <paragraph num="(1)"> <text>The Department has certified the facility;</text> </paragraph> <paragraph num="(2)"> <text>Sufficient State funds for congregate housing service subsidies are available in the Department's budget;</text> </paragraph> <paragraph num="(3)"> <text>The cost of services to be provided and the amount of subsidies required per participant are consistent with costs in comparable facilities; and</text> </paragraph> <paragraph num="(4)"> <text>The provider and the Department have entered into a purchase of services agreement for the applicable fiscal year.</text> </paragraph> </paragraph> <paragraph num="B."> <text>If a provider desires subsidies for its participants beyond the initial fiscal year that subsidies are awarded, the provider shall request annually that the Department renew the subsidy award.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".16" heading="Renewal of Subsidy Award."> <text>A subsidy award may be renewed annually if:</text> <paragraph num="A."> <text>Sufficient State funds for subsidies are available in the Department's budget;</text> </paragraph> <paragraph num="B."> <text>The provider's budget for the next fiscal year has been approved by the Department;</text> </paragraph> <paragraph num="C."> <text>The Department and the provider have executed a subsidy services agreement for the next fiscal year; and</text> </paragraph> <paragraph num="D."> <text>The provider and facility are in compliance with this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".17" heading="Award of Subsidies to New Sites."> <text>If funds are made available in the Department’s budget to award subsidies to more facilities than the budget supported in the past, the Department shall issue a request for proposals to persons who want to be providers that are eligible to receive subsidies.</text> </regulation> <regulation prefix="Regulation" num=".18" heading="Subsidy Services Agreement."> <paragraph num="A."> <text>A provider that is approved by the Department to receive State subsidies shall enter into a written subsidy services agreement with the Department.</text> </paragraph> <paragraph num="B."> <text>The Department shall give a copy of the executed agreement to the provider.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".19" heading="Administration of Subsidy Award."> <paragraph num="A."> <text>If funds are available the Department shall advance subsidy payments to a provider in good standing on a quarterly basis.</text> </paragraph> <paragraph num="B."> <text>For the term of a subsidy services agreement, the Department shall:</text> <paragraph num="(1)"> <text>During the first quarter, advance to the provider a subsidy payment equal to 1/4 of the total subsidy award; and</text> </paragraph> <paragraph num="(2)"> <text>During each subsequent quarter, advance an amount equal to the total amount of subsidies earned during the previous quarter.</text> </paragraph> </paragraph> <paragraph num="C."> <text>At the end of each quarter, the provider shall submit the following to the Department on forms provided by the Department:</text> <paragraph num="(1)"> <text>A report of subsidies earned; and</text> </paragraph> <paragraph num="(2)"> <text>A request for funds for the next quarter.</text> </paragraph> </paragraph> <paragraph num="D."> <text>By January 30 of each year, a provider shall submit to the Department a year-to-date report covering the first 6 months of the provider's actual revenues and expenses allocable to the operation of the Program.</text> </paragraph> <paragraph num="E."> <text>At the end of a fiscal year in which subsidies are awarded, or at any time the Department believes that the amount of subsidies advanced significantly exceeds the amount of subsidies earned, the Department shall reconcile:</text> <paragraph num="(1)"> <text>The amount of subsidies advanced to the provider by the Department during the fiscal year; and</text> </paragraph> <paragraph num="(2)"> <text>The amount of subsidies earned by the provider during the fiscal year.</text> </paragraph> </paragraph> <paragraph num="F."> <text>If the subsidies advanced to a provider during a fiscal year are projected to be significantly greater than the subsidies earned, the Department may withhold from the provider an amount equal to the projected overpayment from the next quarterly advance.</text> </paragraph> <paragraph num="G."> <text>If the subsidies advanced to a provider during a fiscal year are greater than the amount of subsidies earned, the provider shall refund the subsidy overpayment to the Department within 60 days of a request by the Department for reimbursement. If a provider does not refund the overpayment within 60 days, the Department may offset the overpayment against any future subsidies earned by the provider.</text> </paragraph> <paragraph num="H."> <text>If the subsidies advanced to a provider during a fiscal year are less than the amount of subsidies earned, the Department shall pay the subsidy amount due the provider, up to the maximum grant amount of the subsidy services agreement.</text> </paragraph> <paragraph num="I."> <text>Not later than 10 days after the end of the third quarter of a fiscal year, a provider may request an amendment to its subsidy services agreement if it projects that the amount of subsidies earned will exceed the maximum grant amount of the subsidy services agreement. If funds are available, the Department may agree to amend the subsidy services agreement for all or part of the projected amount.</text> </paragraph> <paragraph num="J."> <text>If the total subsidy awards received by a provider in a fiscal year are equal to or greater than $25,000, the provider shall submit to the Department, within 90 days of the last day of the fiscal year, an annual audit report, prepared in accordance with generally accepted accounting principles. Providers that receive in any one fiscal year $25,000 or more in subsidies and that have a certificate for more than one facility shall maintain their financial records so that revenues and expenses can be tracked on a facility-by-facility basis.</text> </paragraph> <paragraph num="K."> <text>If the total subsidy awards for a fiscal year are less than $25,000, the provider shall submit to the Department, within 90 days of the last day of the fiscal year, an annual report of the provider's actual revenue and expenditures allocable to its operation under the Program.</text> </paragraph> <paragraph num="L."> <text>The Department shall review a report required by §J or K of this regulation and reconcile the report with the amount of subsidy payments made to the provider during the fiscal year. After the Department has reconciled the subsidy payments, it shall pay any subsidy amount due to the provider, up to the maximum grant amount in the provider’s subsidy services agreement.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".20" heading="Eligibility for Services."> <paragraph num="A."> <text>To be eligible to be a participant and receive congregate housing services, an individual shall:</text> <paragraph num="(1)"> <text>Be 62 years old or older;</text> </paragraph> <paragraph num="(2)"> <text>Be physically or mentally impaired;</text> </paragraph> <paragraph num="(3)"> <text>Need assistance with one or more of the essential activities of daily living;</text> </paragraph> <paragraph num="(4)"> <text>Need one or more of the congregate housing services available in the facility; and</text> </paragraph> <paragraph num="(5)"> <text>Be able to function in the facility if provided with those services.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The spouse of a participant is eligible to be a participant and receive congregate housing services if the spouse is 55 years old or older and meets the requirements of §A(2)—(5) of this regulation.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".21" heading="Determination of Eligibility to Receive Services."> <paragraph num="A."> <text>An individual who wants to apply to be a participant in the Program shall file an application with the provider from which the individual wants to receive services. The Department shall provide an application form that individuals applying for the Program shall use.</text> </paragraph> <paragraph num="B."> <text>Upon receipt of an application to receive services, the provider shall determine if the applicant meets the requirements of Regulation .20 of this chapter.</text> </paragraph> <paragraph num="C."> <text>To determine whether an applicant meets the requirements of §A(4) and (5) of Regulation .20 of this chapter, a provider shall assess the applicant's functional abilities using an assessment form approved by the Department or arrange for an assessment through the Maryland Department of Health's Adult Evaluation and Review Services program. Unless more frequent evaluation is warranted, a reassessment to determine whether the applicant still meets the requirements of §A(4) and (5) of Regulation .20 of this chapter shall be conducted every 2 years using either the Adult Evaluation and Review Services program or an assessment form approved by the Department.</text> </paragraph> <paragraph num="D."> <text>If a provider determines an applicant is eligible to receive services and if sufficient financial resources are available through participant's payments, State subsidies, or other sources to cover the cost of providing the congregate housing services needed by the applicant, the provider shall:</text> <paragraph num="(1)"> <text>Accept the applicant as a participant if the applicant has a signed lease for an apartment in the facility; or</text> </paragraph> <paragraph num="(2)"> <text>Place the applicant's name on a waiting list if the applicant does not have a signed lease for an apartment in the facility.</text> </paragraph> </paragraph> <paragraph num="E."> <text>If a provider determines an applicant is eligible to receive services, but there are not sufficient financial resources available to cover the cost of providing the services needed, the provider shall place the applicant's name on a waiting list for subsidies.</text> </paragraph> <paragraph num="F."> <text>If a provider determines that an applicant is ineligible for services, the provider shall notify the applicant in writing of the determination within 10 days after making the determination. The provider shall send a copy of the written determination immediately to the Department by mail and by fax machine.</text> </paragraph> <paragraph num="G."> <text>A denial of eligibility notice issued under §F of this regulation shall include:</text> <paragraph num="(1)"> <text>The determination;</text> </paragraph> <paragraph num="(2)"> <text>The reason for denial;</text> </paragraph> <paragraph num="(3)"> <text>The specific regulation supporting the denial; and</text> </paragraph> <paragraph num="(4)"> <text>Information about other resources in the community that may be able to assist the applicant.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".22" heading="Participant Application for Subsidy."> <text>If an individual resides in a facility that has a subsidy services agreement with the Department, the individual may file an application for a subsidy with the provider at the facility on a form provided by the Department. An application for a subsidy may be filed at the same time as an application for eligibility is filed or may be filed after an application for eligibility is filed.</text> </regulation> <regulation prefix="Regulation" num=".23" heading="Participant Eligibility for Subsidy."> <paragraph num="A."> <text>An individual in a facility whose provider has a subsidy services agreement for a Standard Congregate Housing Services Plan is eligible to receive a subsidy if:</text> <paragraph num="(1)"> <text>The individual has been determined to be eligible to be a participant and receives services in the facility;</text> </paragraph> <paragraph num="(2)"> <text>The individual’s net monthly income is insufficient to pay the full monthly fee approved by the Department in the subsidy services agreement with the provider;</text> </paragraph> <paragraph num="(3)"> <text>The individual's net annual income is less than 60 percent of the State median income as most recently published by the Maryland Department of Human Services;</text> </paragraph> <paragraph num="(4)"> <text>None of the exclusions under §G of this regulation applies; and</text> </paragraph> <paragraph num="(5)"> <text>The individual's assets do not exceed $27,375.</text> </paragraph> </paragraph> <paragraph num="B."> <text>A couple in a facility whose provider has a subsidy services agreement for a Standard Congregate Housing Services Plan shall be eligible to receive a subsidy if:</text> <paragraph num="(1)"> <text>Both members of the couple have been determined to be eligible to be participants and receive services in the facility;</text> </paragraph> <paragraph num="(2)"> <text>The couple’s net monthly income is insufficient to pay the full monthly fee for a couple approved by the Department in the subsidy services agreement with the provider;</text> </paragraph> <paragraph num="(3)"> <text>The combined net annual income of the members of the couple is less than 60 percent of the State median income for a couple as most recently published by the Maryland Department of Human Services;</text> </paragraph> <paragraph num="(4)"> <text>None of the exclusions under §G of this regulation applies; and</text> </paragraph> <paragraph num="(5)"> <text>The couple's combined assets do not exceed $35,587.</text> </paragraph> </paragraph> <paragraph num="C."> <text>An individual in a facility whose provider has a subsidy services agreement for an Individualized Congregate Housing Services Plan shall be eligible for a subsidy if:</text> <paragraph num="(1)"> <text>The individual has been determined to be eligible to be a participant and receive services in the facility;</text> </paragraph> <paragraph num="(2)"> <text>The individual's net annual income is less than 60 percent of the State median income as most recently published by the Maryland Department of Human Services;</text> </paragraph> <paragraph num="(3)"> <text>None of the exclusions under §G of this regulation applies; and</text> </paragraph> <paragraph num="(4)"> <text>The individual's assets do not exceed $27,375.</text> </paragraph> </paragraph> <paragraph num="D."> <text>Real property that was the primary residence of a participant immediately before admission to the Program may not be counted towards the asset limit for 1 year after the date of admission to the Program. If after 1 year from admission the participant retains any ownership interest in the real property that was the primary residence of the participant immediately before admission, the value of the participant's ownership interest shall be counted against the asset limit.</text> </paragraph> <paragraph num="E."> <text>An individual applying for a subsidy shall submit, along with the subsidy application, written documentation of all income and assets.</text> </paragraph> <paragraph num="F."> <text>If an individual is placed on a waiting list under Regulation .21D(2) of this chapter, the provider may process an advisory subsidy application and subsidy calculation form in order to estimate for the individual the probable amount of subsidy, if any, the individual could receive if enrolled in the program.</text> </paragraph> <paragraph num="G."> <text>An individual is not eligible to receive a subsidy if the individual is enrolled in:</text> <paragraph num="(1)"> <text>A Medicaid waiver program under 26 U.S.C. §1915(c) in Title XIX of the federal Social Security Act;</text> </paragraph> <paragraph num="(2)"> <text>The Program of All-Inclusive Care for the Elderly, commonly known as PACE; or</text> </paragraph> <paragraph num="(3)"> <text>A Medicaid capitated program that includes long-term care services.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".24" heading="Enrollment of Participant for Subsidy."> <paragraph num="A."> <text>A provider shall enroll an individual or couple as subsidized participants if:</text> <paragraph num="(1)"> <text>The individual or couple has been determined to be eligible to receive services according to the requirements of Regulation .21 of this chapter and to receive a subsidy according to the requirements of Regulation .23 of this chapter; and</text> </paragraph> <paragraph num="(2)"> <text>State funds are available to pay the subsidy.</text> </paragraph> </paragraph> <paragraph num="B."> <text>If an individual or couple is enrolled to receive a subsidy, the provider shall:</text> <paragraph num="(1)"> <text>Determine the amount of the individual's or couple's subsidy on a form provided by the Department; and</text> </paragraph> <paragraph num="(2)"> <text>Annually, or more frequently if the individual or couple has a significant change in their finances, redetermine:</text> <paragraph num="(a)"> <text>The continued eligibility to receive a subsidy; and</text> </paragraph> <paragraph num="(b)"> <text>The amount of the subsidy.</text> </paragraph> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".25" heading="Notification of Ineligibility to Receive a Subsidy."> <paragraph num="A."> <text>If an individual or couple is determined to be ineligible to receive a subsidy or no longer eligible to receive a subsidy, a provider shall notify the individual or couple in writing of the ineligibility determination within 10 days.</text> </paragraph> <paragraph num="B."> <text>A notice of ineligibility for a subsidy shall include:</text> <paragraph num="(1)"> <text>The decision;</text> </paragraph> <paragraph num="(2)"> <text>The reason for denial of eligibility;</text> </paragraph> <paragraph num="(3)"> <text>The participant's right to request a review of the decision; and</text> </paragraph> <paragraph num="(4)"> <text>What must be done to obtain a review, including the relevant time frames.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Request for Review. An individual or couple may obtain a review of a determination of ineligibility for a subsidy by requesting in writing a review of the provider's determination. A written request for a review shall be mailed within 30 days of receipt of the notice of ineligibility to the Congregate Housing Services Program Manager, Maryland Department of Aging, 301 West Preston Street, Baltimore, MD 21201. Upon receipt of a request for review, the Congregate Housing Services Program Manager shall examine and investigate the basis for the denial, gather additional information considered necessary by the Congregate Housing Services Program Manager, and issue a new determination.</text> </paragraph> <paragraph num="D."> <text>Determination. If the new determination from the Congregate Housing Services Program Manager finds an individual or couple ineligible, the Department shall issue a notice of ineligibility, which shall include:</text> <paragraph num="(1)"> <text>The decision;</text> </paragraph> <paragraph num="(2)"> <text>The reason for denial of eligibility;</text> </paragraph> <paragraph num="(3)"> <text>The participant's right to appeal the determination; and</text> </paragraph> <paragraph num="(4)"> <text>What must be done to file an appeal, including the relevant time frames.</text> </paragraph> </paragraph> <paragraph num="E."> <text>An individual or couple may appeal a determination of ineligibility issued by the Department in accordance with Regulation .33 of this chapter and COMAR 32.01.01.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".26" heading="Determination of Participant Subsidy Amount."> <paragraph num="A."> <text>In the Standard Congregate Housing Services Program, the amount of the subsidy to be paid monthly on behalf of an eligible participant shall equal the difference between the participant’s projected monthly income, less approved allowances set forth in §B of this regulation, and the monthly fee for congregate housing services as approved by the Department in the subsidy services agreement.</text> </paragraph> <paragraph num="B."> <text>Approved allowances are:</text> <paragraph num="(1)"> <text>10 percent of the individual's or couple's net monthly income;</text> </paragraph> <paragraph num="(2)"> <text>The applicable monthly personal allowance for an individual or couple as established on the subsidy calculation form approved by the Department for the Standard Congregate Housing Services Plan;</text> </paragraph> <paragraph num="(3)"> <text>If the provider is regulated by the U.S. Department of Housing and Urban Development, any monthly elderly allowance provided for under the U.S. Department of Housing and Urban Development's applicable regulations;</text> </paragraph> <paragraph num="(4)"> <text>The monthly rent paid by the individual or couple for an apartment in the facility;</text> </paragraph> <paragraph num="(5)"> <text>If the U. S. Department of Housing and Urban Development permits a monthly utility allowance in the calculation of the participant's rent at the facility, the amount of the monthly utility allowance;</text> </paragraph> <paragraph num="(6)"> <text>The individual's or couple's allowable medical expenses; and</text> </paragraph> <paragraph num="(7)"> <text>If the provider provides two meals a day, a food allowance as established on the Standard Congregate Housing Services Program subsidy calculation form approved by the Department.</text> </paragraph> </paragraph> <paragraph num="C."> <text>In the Individualized Congregate Housing Services Program, the amount of the subsidy to be paid monthly on behalf of an eligible participant shall be determined by using the Individualized Congregate Housing Services Program Subsidy Calculation Form issued by the Department to the provider.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".27" heading="Monitoring."> <paragraph num="A."> <text>The Department or its designee may conduct reviews of a provider's administration of the Program and conduct announced or unannounced on-site visits of a facility at any time.</text> </paragraph> <paragraph num="B."> <text>The Department may designate another entity to perform monitoring.</text> </paragraph> <paragraph num="C."> <text>The Department shall have the right to review a provider's records to ensure compliance with this chapter, including participant files and files that contain the results of the background checks required by Regulations .08 and .09 of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".28" heading="Notification of Intent Not to Renew Subsidy Services Agreement."> <paragraph num="A."> <text>If a provider does not intend to seek the award of another subsidy services agreement after the current one expires, the provider shall give the Department written notice of that intention at least 120 days before the expiration of the current agreement.</text> </paragraph> <paragraph num="B."> <text>A notice provided to satisfy §A of this regulation shall include:</text> <paragraph num="(1)"> <text>The provider's reasons for ending its participation in the Program;</text> </paragraph> <paragraph num="(2)"> <text>Plans for alternate services for participants; and</text> </paragraph> <paragraph num="(3)"> <text>An assurance that the provider shall provide congregate housing services up to the termination date in the current subsidy services agreement.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".29" heading="Violations."> <paragraph num="A."> <text>If the Department determines that a provider violated or is violating a regulation of this chapter, the Department shall prepare a written notice of violation.</text> </paragraph> <paragraph num="B."> <text>A notice of violation shall include:</text> <paragraph num="(1)"> <text>A description of each condition, action, or inaction that constitutes a violation;</text> </paragraph> <paragraph num="(2)"> <text>A citation to each regulation violated;</text> </paragraph> <paragraph num="(3)"> <text>The date by which an ongoing violation shall be corrected; and</text> </paragraph> <paragraph num="(4)"> <text>The sanctions that may be imposed against the provider for failure to correct the violations.</text> </paragraph> </paragraph> <paragraph num="C."> <text>If the Department intends to impose a civil money penalty pursuant to Regulation .32A of this chapter, the notice of violation shall also comply with the requirements of Regulation .32B of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".30" heading="Suspension of Certificate."> <paragraph num="A."> <text>The Department may suspend a provider's certificate if the provider has violated a regulation of this chapter, and the violation has not been corrected within the time specified in the notice of violation.</text> </paragraph> <paragraph num="B."> <text>The Department may immediately suspend a provider's certificate if a violation of a regulation of this chapter results in conditions that pose an imminent danger to the health or safety of a participant.</text> </paragraph> <paragraph num="C."> <text>The Department shall notify a provider in writing of a decision to suspend the provider's certificate.</text> </paragraph> <paragraph num="D."> <text>A notice of certification suspension shall include:</text> <paragraph num="(1)"> <text>The reasons for suspension;</text> </paragraph> <paragraph num="(2)"> <text>A citation to the regulation on which the suspension is based;</text> </paragraph> <paragraph num="(3)"> <text>The period of suspension;</text> </paragraph> <paragraph num="(4)"> <text>Notification that the violation may lead to revocation of the certificate if the violation is not corrected within the number of days specified in the notice;</text> </paragraph> <paragraph num="(5)"> <text>The provider's right to appeal the suspension in accordance with Regulation .33 of this chapter; and</text> </paragraph> <paragraph num="(6)"> <text>What a provider shall do to file an appeal, including all relevant time requirements.</text> </paragraph> </paragraph> <paragraph num="E."> <text>The Department shall notify the participants and the owner of the facility, or the management agent for the owner, of a decision to suspend a certificate under this regulation. The contents of the notice shall comply with §D of this regulation.</text> </paragraph> <paragraph num="F."> <text>Upon notification of a suspension and until the suspension has been lifted, a provider may not enter into a provider-participant agreement with an individual who was not a participant at the time of the suspension.</text> </paragraph> <paragraph num="G."> <text>A provider aggrieved by a notice of certification suspension may appeal the Department's action by filing a request for an appeal in accordance with Regulation .33 of this chapter.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".31" heading="Revocation or Denial of a Certificate."> <paragraph num="A."> <text>The Department may revoke, deny, or refuse to renew a certificate for cause. Cause for revocation of a certificate, denial of a certificate, or refusal to renew a certificate includes, but is not limited to, the following:</text> <paragraph num="(1)"> <text>Conditions that present an imminent danger to the life, safety, health, or welfare of the participants;</text> </paragraph> <paragraph num="(2)"> <text>Failure to meet the initial certification or renewal requirements of this chapter;</text> </paragraph> <paragraph num="(3)"> <text>Failure to correct cited violations within the time specified by the Department;</text> </paragraph> <paragraph num="(4)"> <text>Fraud or misrepresentation in obtaining or attempting to obtain or retain a certificate;</text> </paragraph> <paragraph num="(5)"> <text>Submission of false information to the Department;</text> </paragraph> <paragraph num="(6)"> <text>Request by the provider that the certificate be revoked; and</text> </paragraph> <paragraph num="(7)"> <text>Failure to abide by the terms of the purchase of services agreement.</text> </paragraph> </paragraph> <paragraph num="B."> <text>The Department shall notify a provider in writing of a decision to deny, revoke, or deny the renewal of a certificate.</text> </paragraph> <paragraph num="C."> <text>A notice provided under §B of this regulation shall include the following information:</text> <paragraph num="(1)"> <text>The reason for the denial, revocation, or refusal to renew the certificate;</text> </paragraph> <paragraph num="(2)"> <text>A citation to the regulations on which the decision is based;</text> </paragraph> <paragraph num="(3)"> <text>The provider's right to appeal the decision in accordance with Regulation .33 of this chapter;</text> </paragraph> <paragraph num="(4)"> <text>What a provider shall do to file an appeal, including all relevant time requirements; and</text> </paragraph> <paragraph num="(5)"> <text>Notification that the provider may not enroll an individual or couple in the Program after the provider receives the notice.</text> </paragraph> </paragraph> <paragraph num="D."> <text>A provider aggrieved by a notice to deny, revoke, or deny the renewal of a certification may appeal the Department's action by filing a request for an appeal in accordance with Regulation .33 of this chapter.</text> </paragraph> <paragraph num="E."> <text>The Department shall notify the participants and the owner of the facility, or the management agent for the owner, in writing of a decision to revoke or deny the renewal of a certificate. The notice shall comply with §C of this regulation and shall include a list of community resources available to assist the participants.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".32" heading="Civil Money Penalties."> <paragraph num="A."> <text>Violations Warranting Penalties. The Secretary, or the Secretary’s designee, may impose a civil money penalty against a provider of congregate housing services for:</text> <paragraph num="(1)"> <text>A violation of this chapter or the provider’s subsidy services agreement that results in conditions presenting an imminent danger or substantial probability of death or serious physical harm to a participant;</text> </paragraph> <paragraph num="(2)"> <text>A violation of a participant's rights specified in Regulation .10 of this chapter; or</text> </paragraph> <paragraph num="(3)"> <text>Noncompliance with State or local fire safety regulations.</text> </paragraph> </paragraph> <paragraph num="B."> <text>Notice of Violation. If the Department issues a notice of a violation under §A of this regulation, that notice shall provide:</text> <paragraph num="(1)"> <text>The time by which the provider shall submit an acceptable plan of correction to the Department;</text> </paragraph> <paragraph num="(2)"> <text>The time by which the provider shall substantially correct the identified violation, which time may not be less than 30 days; and</text> </paragraph> <paragraph num="(3)"> <text>That failure to submit an acceptable plan of correction as required by §B(1) of this regulation or to correct the identified violation as required by §B(2) of this regulation may result in an order imposing a civil money penalty under §D of this regulation.</text> </paragraph> </paragraph> <paragraph num="C."> <text>Action if Violation Not Timely Corrected.</text> <paragraph num="(1)"> <text>After the expiration of the time set forth in §B(2) of this regulation the Department shall inspect the facility to determine whether the violation or violations have been corrected.</text> </paragraph> <paragraph num="(2)"> <text>If the violation or violations have not been corrected, the Secretary, or the Secretary's designee, may:</text> <paragraph num="(a)"> <text>Extend the time frame during which the violation shall be corrected; or</text> </paragraph> <paragraph num="(b)"> <text>Impose a civil money penalty under §D of this regulation.</text> </paragraph> </paragraph> </paragraph> <paragraph num="D."> <text>Amount and Limitation of Civil Money Penalty.</text> <paragraph num="(1)"> <text>The Secretary, or the Secretary's designee, may impose a civil money penalty in the amount of $20 per violation per participant for each day that a violation remains uncorrected beyond the expiration of the time set forth in §B(2) of this regulation. A civil money penalty imposed under this regulation may not exceed $1,000 per violation or $5,000 in total.</text> </paragraph> <paragraph num="(2)"> <text>In setting the amount of a civil money penalty under §D(1) of this regulation, the following factors shall be considered:</text> <paragraph num="(a)"> <text>The number, nature, and seriousness of the violations;</text> </paragraph> <paragraph num="(b)"> <text>The degree of risk to the health, life, or physical safety of the participants caused by the violations;</text> </paragraph> <paragraph num="(c)"> <text>The efforts made by the provider to correct the violations;</text> </paragraph> <paragraph num="(d)"> <text>Whether the amount of the proposed civil money penalty will jeopardize the financial ability of the provider to continue operating; and</text> </paragraph> <paragraph num="(e)"> <text>Other factors as justice may require.</text> </paragraph> </paragraph> </paragraph> <paragraph num="E."> <text>Notice. If a civil money penalty is imposed under this regulation, the Secretary, or the Secretary's designee, shall provide written notice to a provider of the imposition of the civil money penalty. The notice shall be served on the provider by certified mail and shall include:</text> <paragraph num="(1)"> <text>The basis on which the order is made;</text> </paragraph> <paragraph num="(2)"> <text>Each regulation or statute violated;</text> </paragraph> <paragraph num="(3)"> <text>Each penalty imposed and the total amount of the civil money penalty imposed;</text> </paragraph> <paragraph num="(4)"> <text>The manner in which the amount of the civil money penalty was calculated;</text> </paragraph> <paragraph num="(5)"> <text>A statement of the provider's right to request a reduction; and</text> </paragraph> <paragraph num="(6)"> <text>A statement on how to file an administrative appeal, including all relevant time requirements.</text> </paragraph> </paragraph> <paragraph num="F."> <text>Appeal. If a civil money penalty is imposed under this regulation, the provider shall have the right to appeal from the order in accordance with Regulation .33 of this chapter.</text> </paragraph> <paragraph num="G."> <text>Payment of Penalty; Civil Action; Deposit in General Fund.</text> <paragraph num="(1)"> <text>A provider shall pay all penalties to the Department within 10 days after the provider receives a final order imposing a civil money penalty.</text> </paragraph> <paragraph num="(2)"> <text>An order imposing a civil money penalty is final when the provider has exhausted all opportunities to contest the penalty in accordance with the Administrative Procedure Act, State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.</text> </paragraph> <paragraph num="(3)"> <text>If a provider does not comply with §G of this regulation, the Department may file a civil action to recover the penalty.</text> </paragraph> <paragraph num="(4)"> <text>The Department shall deposit all penalties collected under §G of this regulation into the General Fund.</text> </paragraph> </paragraph> <paragraph num="H."> <text>Enhanced Penalties. The Secretary, or Secretary's designee, may impose a penalty three times the amount set forth in §D of this regulation if a sanction has been imposed on the provider for the same violation within 2 years before issuance of the notice of violation.</text> </paragraph> <paragraph num="I."> <text>Requests for Penalty Reduction.</text> <paragraph num="(1)"> <text>A provider of congregate housing services may request a reduction of a civil money penalty imposed. The request shall:</text> <paragraph num="(a)"> <text>Be in writing;</text> </paragraph> <paragraph num="(b)"> <text>State the reasons for the request; and</text> </paragraph> <paragraph num="(c)"> <text>Be made within 10 days of the provider's receipt of the notice of the imposition of the civil money penalty.</text> </paragraph> </paragraph> <paragraph num="(2)"> <text>A request for reduction of a civil money penalty does not interrupt the accrual of the penalties under §D of this regulation.</text> </paragraph> <paragraph num="(3)"> <text>If a provider properly requests a reduction of a penalty under §I(1) of this regulation, the Department shall confer informally with the provider about whether to reduce the civil money penalty. The Department shall schedule the conference within 14 days of receipt of a request for reduction.</text> </paragraph> <paragraph num="(4)"> <text>The Secretary, or the Secretary's designee, shall consider, for the purpose of reducing the civil money penalty, such factors as:</text> <paragraph num="(a)"> <text>The provider's history of violations;</text> </paragraph> <paragraph num="(b)"> <text>The provider's current and past diligence in correcting violations;</text> </paragraph> <paragraph num="(c)"> <text>The number and severity of the violations; and</text> </paragraph> <paragraph num="(d)"> <text>Other factors which the Secretary, or Secretary's designee, considers appropriate in the particular circumstances.</text> </paragraph> </paragraph> <paragraph num="(5)"> <text>If the Secretary, or Secretary's designee, grants a provider's request for reduction of a civil money penalty, the Secretary, or Secretary's designee, shall impose as a condition on the reduction of the penalty the correction of all violations.</text> </paragraph> <paragraph num="(6)"> <text>The Secretary, or Secretary's designee, shall issue a written determination either granting or denying a request for reduction of a civil money penalty and shall state the reasons for the determination.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".33" heading="Appeals."> <paragraph num="A."> <text>A person aggrieved by a denial of a certificate, a revocation of a certificate, a suspension of a certificate, a refusal to renew a certificate, or by any other action of the Department or the Secretary under this chapter may file a written appeal.</text> </paragraph> <paragraph num="B."> <text>An appeal of any action taken by the Department or the Secretary under this chapter shall be conducted in accordance with COMAR 32.01.01 and the Administrative Procedure Act, State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.</text> </paragraph> <paragraph num="C."> <text>Unless the Secretary states in writing that a provider may enroll new participants while the provider's appeal of a suspension or revocation of its certificate is pending, the provider may not enroll new participants while the appeal is pending.</text> </paragraph> </regulation> <annotations> <annotation type="Authority">Human Services Article, §§10-209 and 10-210, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: July 1, 2005 (32:10 Md. R. 926)</annotation> <annotation type="History" subtype="Administrative History">Regulation .01B amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .07 amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .14B amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .16C amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .17 amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .18 amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .19 amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .22 amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .23A—C amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .26A amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .28 amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> <annotation type="History" subtype="Administrative History">Regulation .32A amended effective June 4, 2018 (45:11 Md. R. 580)</annotation> </annotations> </chapter> <chapter num="05" heading="Senior Call-Check Service and Notification Program"> <regulation prefix="Regulation" num=".01" heading="Purpose."> <text>The purpose of the Program is to offer a free, opt-in, telephonic service to check on eligible elderly Maryland residents at a regularly scheduled time each day. The Program may be provided by the Department through a private vendor, nonprofit organization, or other entity. The Program may also provide automated telephonic “notifications” in the form of public service announcements related to emergency conditions. These notifications will be separate from the daily call process.</text> </regulation> <regulation prefix="Regulation" num=".02" heading="Definitions."> <paragraph num="A."> <text>In this chapter, the following terms have the meanings indicated.</text> </paragraph> <paragraph num="B."> <text>Terms Defined.</text> <paragraph num="(1)"> <text>“Department” means the Maryland Department of Aging.</text> </paragraph> <paragraph num="(2)"> <text>“Program” means the Senior Call-Check Service and Notification Program.</text> </paragraph> <paragraph num="(3)"> <text>“Secretary” means the Secretary of Aging.</text> </paragraph> </paragraph> </regulation> <regulation prefix="Regulation" num=".03" heading="Eligibility."> <text>An individual is eligible to participate in the Program if the following conditions are met:</text> <paragraph num="A."> <text>The individual is a Maryland resident who is 65 years old or older who has a landline phone or a cell phone that does not block automated calls from the Program; and</text> </paragraph> <paragraph num="B."> <text>The individual is capable of answering and appropriately responding to a daily phone call.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".04" heading="Application."> <text>In order to enroll in the Program, an individual shall submit a complete application on a form made available by the Department.</text> </regulation> <regulation prefix="Regulation" num=".05" heading="Assessment of Application."> <paragraph num="A."> <text>Upon receipt of an enrollment application for the Program, the Department or an entity it has retained to administer the Program shall determine whether the applicant is eligible to participate in the Program.</text> </paragraph> <paragraph num="B."> <text>If an applicant is determined to be eligible for the Program, the applicant will be enrolled as a participant in the Program.</text> </paragraph> <paragraph num="C."> <text>Applicants whose applications are not complete or legible will be classified as not eligible.</text> </paragraph> <paragraph num="D."> <text>If the Department or an entity it has retained to administer the Program determines that an applicant is not eligible for the Program, and if the applicant has provided such applicant’s current name and address in a legible format, the Department will provide the applicant with a written notification of ineligibility. The notice shall include the following information:</text> <paragraph num="(1)"> <text>Decision;</text> </paragraph> <paragraph num="(2)"> <text>Reason for ineligibility;</text> </paragraph> <paragraph num="(3)"> <text>Specific regulation supporting the action;</text> </paragraph> <paragraph num="(4)"> <text>Applicant’s right to appeal the decision; and</text> </paragraph> <paragraph num="(5)"> <text>Method for obtaining a hearing.</text> </paragraph> </paragraph> <paragraph num="E."> <text>If an applicant was determined to be ineligible because the applicant’s application was incomplete or illegible, the notification of ineligibility shall also inform the applicant that the applicant may apply again by submitting a new, complete, and legible application. An individual whose application is determined ineligible may appeal the determination of ineligibility to the Department in accordance with COMAR 32.01.01.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".06" heading="Revocation or Suspension of Participation."> <paragraph num="A."> <text>If Department determines that a participant is no longer eligible to participate in the Program, the Department shall provide the participant with a written notification of enrollment revocation at least 10 business days before the effective date of revocation.</text> </paragraph> <paragraph num="B."> <text>The Department may revoke or suspend a participant from the Program if the Department determines that a participant misused or abused the service provided by the Program or repeatedly failed to follow the Program’s protocols or other requirement, including any Program limitations or requirements specified in the application form supplied by the Department.</text> </paragraph> <paragraph num="C."> <text>If the Department determines to revoke or suspend a participant’s enrollment, the Department shall notify the participant in writing of the suspension or revocation. The notice shall include the following information:</text> <paragraph num="(1)"> <text>Decision;</text> </paragraph> <paragraph num="(2)"> <text>Reason for the suspension or revocation;</text> </paragraph> <paragraph num="(3)"> <text>Specific regulation supporting the action;</text> </paragraph> <paragraph num="(4)"> <text>Effective date of the suspension or revocation;</text> </paragraph> <paragraph num="(5)"> <text>Applicant’s right to appeal the decision; and</text> </paragraph> <paragraph num="(6)"> <text>Method for obtaining a hearing.</text> </paragraph> </paragraph> <paragraph num="D."> <text>An individual whose enrollment is revoked or suspended may appeal the determination to the Department in accordance with COMAR 32.01.01.</text> </paragraph> </regulation> <regulation prefix="Regulation" num=".07" heading="Appeals."> <text>An appeal of any action taken by the Department or the Secretary under this chapter shall be conducted in accordance with COMAR 32.01.01 and the Administrative Procedure Act, State Government Article, Title 10, Subtitle 2, Annotated Code of Maryland.</text> </regulation> <annotations> <annotation type="Authority">State Finance and Procurement Article, §3A-702, Annotated Code of Maryland</annotation> <annotation type="History" subtype="Administrative History">Effective date: September 7, 2020 (47:18 Md. R. 824)</annotation> </annotations> </chapter> </subtitle>