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<regulation prefix="Regulation" num=".13" citation="COMAR 32.02.01.13" title_num="32" subtitle_num="02" chapter_num="01" 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>