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<regulation prefix="Regulation" num=".07" citation="COMAR 32.02.02.07" title_num="32" subtitle_num="02" chapter_num="02" 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>