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. 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. These regulations provide rules for the administration of grants under the following Authorization Acts: Chapter 910, Laws of Maryland, 1978, as amended; Chapter 680, Laws of Maryland, 1983; Chapter 472, Laws of Maryland, 1984; Chapter 541, Laws of Maryland, 1985, as amended; Chapter 471, Laws of Maryland, 1986; Chapter 366, Laws of Maryland, 1987; and Subsequent similar acts. 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. In this chapter, the following terms have the meanings indicated. Terms Defined. “Acquisition” means purchasing or obtaining ownership of all or part of an existing facility for use as an elderly citizen activities center. “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. “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. “Building” means: All or part of an existing elderly citizen activities center and its surrounding real property; or A facility proposed to be constructed or converted for use as an elderly citizen activities center, and its surrounding real property. “Capital equipment” means essential fixed equipment and furnishings that have an expected useful life of at least 15 years. “Construction” means all work necessary to build an elderly citizen activities center including, but not limited to: Acquisition of real property; Architectural/engineering services; Site development and improvement; Construction; and Equipment for completed buildings. “Conversion” means the work required to transform a building or part of a building for effective use as an elderly citizen activities center. “Department” means the Maryland Department of Aging. “Design” means the work required to prepare architectural/engineering plans and specifications to construct an elderly citizen activities center. “Elderly citizen” means a person 60 years old or older or a spouse of a person 60 years old or older. “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. “Eligible work” means that work for which the use of State funds is authorized under the applicable Authorization Act. “Grant” means a State grant provided under the Elderly Citizen Activities Centers Capital Improvement Grants Program, unless the context clearly implies otherwise. “Local government” means a political subdivision of Maryland. “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. “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. “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. “Project” means: An existing elderly citizen activities center which receives or has received a State grant for eligible work; A proposed elderly citizen activities center which receives or has received a State grant for eligible work; or The development of a comprehensive master plan for elderly citizen activities centers in a political subdivision which receives or has received a State grant. “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. “Secretary” means the Secretary of Aging, or the Secretary's designee. “Senior center” means an elderly citizen activities center. “Site development and improvement” means the work required to develop the exterior of a facility and its surrounding real property. 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. A local government agency may apply for a grant to subgrant to a nonprofit organization. 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. Except as provided in §C of this regulation, to receive a State grant, a senior center shall meet the following mandatory requirements: Population. An urban senior center shall serve a catchment area which has a population of at least 10,000 elderly citizens. A rural senior center shall serve a catchment area which has a population of at least 2,000 elderly citizens. Hours of Operation. The senior center shall operate at least 6 hours a day. Days of Operation. An urban senior center shall operate at least 250 days per year. A rural senior center shall operate at least 150 days per year. 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. 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. Eligible projects shall be classified according to the type of work proposed. Projects classified under the following types of work will receive priority: Projects to renovate or replace senior centers in order to make life safety corrections; Projects to renovate or open senior centers in areas of high concentration of low-income, frail, or minority elderly citizens; Projects to renovate obsolete buildings that have been in use for more than 40 years; Projects to renovate senior centers that have been in use for more than 25 years; and Projects which have not previously received grants under this program. The Office shall consider the total unallocated State funds available at the time applications are submitted in determining priority of projects. The Office shall also consider the following criteria in regards to grants for senior centers: The conformity of the senior center with Statewide objectives for elderly citizen activities centers; The practical and economic feasibilities of the proposed work; The physical environment, location, demographic characteristics, and transportation accessibility of the proposed senior center; and The availability of operating funds for the proposed senior center. A State grant under this program may be used by a local government for the following eligible work: Conversion of a public building or part of a public building for use as a senior center; Acquisition of an existing building or part of an existing building for use as a senior center; Renovation of a senior center; Purchase of capital equipment for a senior center; Planning, design, and construction of a senior center; Architects' and engineers' fees in connection with §A(1)—(5) of this regulation; A subgrant by a local government agency to a nonprofit organization for a purpose stated in §A(1)—(6) of this regulation; and Development of a comprehensive master plan for elderly citizen activities centers in a political subdivision. 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. Use of Part of a Building as a Senior Center. 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. 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. A grant for conversion, acquisition, renovation, equipment, or construction may not exceed $600,000. A grant for the development of a master plan may not exceed $15,000. Except as provided in §E of this regulation: A State grant may not exceed 50 percent of the total cost of eligible work; At least 50 percent of the cost of eligible work shall be provided from local contributions. 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. At the discretion of the Board of Public Works, a grant may exceed 50 percent of the cost of eligible work, if: The grant is for conversion, renovation or planning, design and construction of an elderly citizens activity center; 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; 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 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. 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. In determining the amount of the grant, the Department shall also consider: The senior citizen population density of the area for which the project is proposed; The proximity of the project to existing senior centers; and Localities eligible for funding that have not received funds in the past. 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. The application shall include all of the following information: Program statement, briefly describing the proposed project. Overview of project, including major aspects and justification for the proposed project. Project considerations, detailing needs to be met, services to be provided, and the scope of the project. Physical characteristics, describing the specific physical features of the project. Financial projections, detailing all estimated costs and sources of capital funds for the project. A written opinion of legal counsel certifying the applicant's interest in the project site. 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: 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; A written assessment from the local fire authority that identifies all State and local fire code deficiencies that will require correction. 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”. If, at the time of application, the applicant: Owns property to be used as part of the project, a copy of the deed evidencing the applicant's interest in that property; Rents property to be used as part of the project: Certification that the applicant will continue to rent the property for at least 15 years, 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 A copy of the lease; Does not own or rent property to be used as part of the project: 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 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. 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: 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. 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. 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. 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. Other information required by the application form. 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. The application shall include all of the following information: 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: An analysis of demographic characteristics and trends in the jurisdiction which demonstrate a need for future senior centers; and An analysis of the geographic location of the area and how the location affects the area's need for senior centers. The total cost of the proposed project. Alternative and supplementary sources of funding for the proposed project, including the source of funds that the applicant will provide. Other information required by the application. The applicant shall insure that upon the completion of the project, the master plan shall include the following: A summary of findings and conclusions; A description of the agency that developed the master plan and its involvement with implementing the plan; Background data on each senior center in the project area, including: An overview of each senior center, User data for each senior center, and Programs, services, or operations provided at each senior center; Evaluation of each senior center, including: Coordination with other aging services and programs, and Adequacy of service provision; Master plan proposal for senior centers; and Recommendations based on goals and objectives established by the local government. 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: Cash; The value of real property and improvements made available by the applicant for use as part of the project; and 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. 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. 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. The applicant shall comply with the application procedures required by the Department at the time of application. Applications shall be filed with the Secretary. 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. 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: A statement that: The project has been reviewed by the Maryland State Clearinghouse for Intergovernmental Assistance and the Department of General Services, 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, The project has been approved by the Secretary; and A recommendation that the Board of Public Works make a grant to the applicant, and a recommendation as to the amount of the grant. 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. 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: The grantee shall advertise for competitive bids in appropriate trade publications, including appropriate publications used by the Department of General Services; The grantee may select and recommend as the contractor the bidder whose offer, in the opinion of the applicant, best combines economy and quality; The grantee shall submit the bid tabulation and the name of the recommended contractor to the Department. 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. After a grantee has awarded a contract in accordance with this regulation, the grantee shall submit the following information: 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; 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; 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. Completion of Eligible Work. 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. 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. Extension of Time for Completion; Other Changes. 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. 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. Insurance Requirements. 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. 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. 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. Information and Inspection. 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. The Secretary may inspect a senior center during reasonable business hours. Under the conditions of §B of this regulation, the State may recover State grant funds. The State may recover State grant funds if, within 15 years of the completion of a project: An interest in property with respect to which funds have been paid under this program is assigned, transferred, or conveyed: To any person, agency, or organization which has not been approved by the Board of Public Works as a transferee, or For use other than as a senior center; or Property with respect to which funds have been paid under this program ceases to be operated as a senior center. The amount of State recovery shall be: 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 All costs and reasonable attorney fees incurred by the State in recovery proceedings. Notice Recordation. 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. 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. The grantee shall provide evidence of the recordation to the Department. Human Services Article, §10-510, Annotated Code of Maryland Effective date: 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) Regulations .01, .02B, .04A, .10, and .13 amended effective December 14, 1979 (6:25 Md. R. 1984) Regulations .01, .02B, .03, .04A, .06, .10A, and .13 amended effective May 15, 1981 (8:10 Md. R. 879) Regulations .01, .02B, .08, and .13A amended effective June 16, 1986 (13:12 Md. R. 1374) Regulation .02-1 adopted effective June 17, 1985 (12:12 Md. R. 1166) Regulations .01—.13 amended effective June 17, 1985 (12:12 Md. R. 1166) Regulation .10-1 adopted effective May 15, 1981 (8:10 Md. R. 879); repealed effective June 17, 1985 (12:12 Md. R. 1166) 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) 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) Regulations .01—.14, Senior Citizen Activities Centers Capital Improvement Grants, adopted effective May 2, 1988 (15:9 Md. R. 1113) Chapter recodified from COMAR 14.11.01 to COMAR 32.03.01, October 2000 Regulation .07A amended effective February 12, 2007 (34:3 Md. R. 303) In this chapter, the following terms have the meanings indicated. Terms Defined. “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. “Local ombudsman” means the Director of the local Nursing Home Ombudsman Program. “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. “Related Institution”. “Related institution” means an organized institution, environment, or home that: 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 Admits or retains the individuals for overnight care. “Related institution” does not include: An adult residential environment or home that is certified by the Department of Human Services; or 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. “Secretary” means the Secretary of Aging. “State ombudsman” means the Director of the State Nursing Home Ombudsman Program. 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. The Secretary may delegate the powers specified in §A of this regulation to the director of a local office on aging if: The local office on aging has established a local nursing home ombudsman program within the agency or by grant, or contract; and The local nursing home ombudsman program complies with these regulations. The State ombudsman shall provide, and the local ombudsman shall participate in, the following training for local ombudsman: At least 14 hours of orientation to provide a working knowledge of the long-term care system and the Statewide Ombudsman Program; At least quarterly in-service meetings, each at least 1 day in duration; Technical assistance on a continuing, as-needed basis. The local ombudsman shall provide, and the patient advocates shall participate in, the following training for patient advocates: At least 20 hours of initial training to provide a working knowledge of the long-term care system and the Statewide Ombudsman Program; At least quarterly in-service meetings, each at least 3 hours in duration; Technical assistance on a continuing, as-needed basis. Training shall cover at least the following subjects: Physical, mental, and emotional aspects of aging; History, purpose, objectives of local ombudsman program, and relationship to State Ombudsman Program; Volunteer policies, procedures, and skills for handling complaints; Confidentiality; Overview of nursing home system; Patients' Bill of Rights—State and federal; Regulatory system—federal/State/local laws and regulations; Health care system profile and interrelationships between agencies; Family/resident council; Reading and understanding medical records. 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. Investigation responsibilities shall include but not be limited to: Personal contact with the resident who has made the complaint or on whose behalf the complaint was made; Interviews with appropriate officials and staff of the related institution and other appropriate resource people; 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; Documentation of the complaint and investigation; Periodic communication with the complainant and resident to keep them informed of the status of the investigation. 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. 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. 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. The patient advocate may not disclose the identity of any complainant or resident unless: 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 A court orders the disclosure. 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. 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. After an investigation, if the complaint is fully or partially verified, the patient advocate shall seek to resolve the problem. Complaint resolution responsibilities shall include but not be limited to: Development of a plan for corrective action through discussions with the complainant, resident, and appropriate officials and staff of the related institution; Establishment of a timetable for resolution; Follow-up within 30 days to determine if the problem giving rise to the complaint has been resolved. Complaints of conditions adversely affecting residents that cannot be resolved shall be referred by the State or local ombudsman to the appropriate governmental agency. 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. 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. 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. 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: Name, address, and phone number of the complainant; Name of the resident; Relationship of the complainant to the resident; Name of the facility; Nature of the complaint; Steps taken to investigate the complaint; Outcome of the investigation; Resolution and follow-up. If the complainant refuses to identify himself or the resident, it should be so indicated in the record. 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. 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. 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: The patient advocate presents written authorization from the resident on whom the record is kept; In the event that the resident has been adjudicated a disabled person, the patient advocate presents written authorization from the court appointed guardian; or 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. The Department of Aging shall conduct an annual review of each local ombudsman program. The annual review shall be conducted to ensure local program compliance with all applicable federal and State statutes and regulations. The Long Term Care Ombudsman Program shall support the organization and development of family and resident councils in nursing homes. Organizing a Resident or Family Council. The Ombudsman Program shall promote the development of family and resident councils in nursing homes in their local jurisdictions. 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. 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. Local ombudsman involvement in the development of resident or family councils may include: Providing information about resident or family councils to residents, family members, or the nursing home; Referring residents, family members, or the nursing home to appropriate resources for assistance; Speaking to groups on the role of the Ombudsman Program, family councils; or resident councils; and When invited, participating in organizational meetings for family councils and resident councils. Involvement in Existing Resident or Family Councils. The local ombudsman shall inform the head of each resident and family council in the service area of: The role of the Ombudsman Program; The availability of the Program to assist resident and family councils; and The topics or subject matter on which the local ombudsman is able to provide training. The local ombudsman shall make every effort to attend a resident or family council meeting to which the ombudsman has been invited. Human Services Article, §10-213, Annotated Code of Maryland Effective date: May 9, 1983 (10:9 Md. R. 792) Chapter recodified from COMAR 14.11.05 to COMAR 32.03.02, October 2000 Regulation .10 adopted effective February 26, 2007 (34:4 Md. R. 404) 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. In this chapter, the following terms have the meanings indicated. Terms Defined. “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. “Assets” means real and personal property. “Assisted living program” has the meaning stated in COMAR 10.07.14.02B(11). “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. “Burial spaces” means conventional gravesites, crypts, mausoleums, urns, and other repositories which are customarily and traditionally used for the remains of deceased persons. “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. “Department” means the Maryland Department of Aging. “Earned subsidy” means the amount of subsidy that a subsidized resident qualified for during a reporting period. “Elderly” means an individual who is 62 years old or older. “Enrolled provider” means a licensee who has entered into a service agreement with a local office. “Facility” means the physical plant in which a licensee provides assisted living services. “Functional assessment” means an evaluation of an applicant's physical, mental, and functional status conducted by a geriatric evaluation service or its equivalent. “Immediate family” means an individual's: Spouse or minor and adult children, including adopted children and stepchildren; or Brothers, sisters, parents, adoptive parents, aunts, uncles, and their spouses. “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. “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. “License” means a license issued by the Maryland Department of Health to operate an assisted living program in Maryland. “Licensee” means an entity that has been issued a license to operate an assisted living program. “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. “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. “Net annual income” means net monthly income multiplied by 12. “Net monthly income” means total monthly income from all sources, minus: Monthly recurring nonreimbursable medical expenses greater than 3 percent of total monthly income; and The monthly allowance for personal expenses. “Program” means the Senior Assisted Living Subsidy Program. “Representative” means an agent, guardian of the person, guardian of the property, or any other person referred to in COMAR 10.07.14.34. “Resident” means an elderly individual who resides in an assisted living facility for the purpose of obtaining assisted living services. “Resident agreement” has the meaning stated in COMAR 10.07.14.02B(65). “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. “Subsidy” means funds paid or approved to be paid by the local office to a licensee on behalf of a subsidized resident. If an assisted living facility wants to participate in the Program and receive subsidies on behalf of eligible residents, the licensee shall: Obtain an enrollment form from the local office; Complete the enrollment form; and Submit the enrollment form to the local office, along with: A copy of its license or its application for a license, and A sample copy of its resident agreement. In addition to other routine information, the enrollment form shall require the licensee to demonstrate that it has: The bookkeeping services needed to assure the proper handling of any subsidy funds; A manager who is literate, able to communicate in English, and is: A licensed physician; A licensed registered nurse; A licensed practical nurse; or An individual with at least 3 years' experience in direct patient care in a private home, certified home, or health-related establishment; and Had no deficiencies in the previous 12 months that presented an imminent danger to the residents' health and safety. 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: Prepare a service agreement that contains the agreed upon monthly fee; and Send the service agreement to the licensee to execute. 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. When the service agreement is executed by the local office, the licensee is an enrolled provider. 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. An application for a subsidy shall include: Basic personal information; Income, expense, and asset information, including the amount and type of regular medical expenses; and A release signed by the applicant authorizing the local office to verify the medical and financial information in the application. An applicant is eligible to receive a subsidy paid to the licensee on the applicant's behalf when the following conditions are met: 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; The applicant is determined to be functionally eligible for a subsidy, based on a functional assessment; The applicant is determined to be financially eligible for a subsidy, based on a review and verification of the financial information provided; and 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: The licensee, or Any partner or officer of the licensee. To be functionally eligible for a subsidy, an applicant shall be: Physically or mentally impaired; and In need of assistance with the activities of daily living provided by the assisted living program. To be financially eligible for a subsidy, an applicant shall meet the following conditions: The applicant's net monthly income is less than the approved monthly fee for the services provided; 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; Subject to §H of this regulation, the applicant's resources are not greater than $19,000 if single, or $25,000 if married; and 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: Trust for an immediate family member who was medically dependent; or Special needs trust that meets the requirements of COMAR 10.09.24.08-2C. Calculation of Resources. 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: One personal automobile; Customary household goods; Personal effects; Life insurance policies with a total cash surrender value of not more than $5,000, including available accrued dividends and interest; Real property that satisfies the exclusion requirements of §§E—G of this regulation; Burial spaces for a person and the person’s immediate family; 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 Amounts in burial funds that satisfy the requirements of §D(2) of this regulation. Burial Funds. 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. 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. 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. 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. 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: Secretary grants an extension under §G of this regulation; or Residence is occupied by the applicant's or subsidized resident's: Spouse; Unmarried child younger than 21 years old; or An immediate family member who is medically or financially dependent. 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. 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. 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. If subsidy funds are available, the local office, upon receipt of an application for a subsidy, shall: Arrange for a functional assessment of the applicant; and Determine if the applicant is functionally and financially eligible to receive a subsidy. 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. When a subsidy is awarded, the local office shall annually redetermine each subsidized resident's eligibility to receive a subsidy. 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: Decision; Reason for denial; Specific regulation supporting the denial; Applicant's right to appeal the decision; and Method for obtaining a hearing. Appeal of Decision. An individual whose application is denied may appeal the determination of ineligibility to the Department in accordance with COMAR 32.01.01. 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. 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. Maximum Monthly Subsidy Amount. The monthly subsidy amount paid by the local office to a licensee on behalf of a subsidized resident is equal to the lesser of: The difference between the subsidized resident's net monthly income and the facility's approved monthly fee; or 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. 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. The Department shall publish annually the maximum subsidy amount limit. 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. 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. A resident is considered to be staying at a facility even if absent for up to 14 days if, during the period of absence: The subsidized resident was hospitalized on an in-patient basis; and The subsidized resident's bed was held open for the resident by the enrolled provider. 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. The Department shall designate, in writing, a local office to: Administer the Program’s subsidies; Execute subsidy agreements with licensees; and Make monthly subsidy payments to licensees on behalf of subsidized residents. 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. An enrolled provider may not charge a: 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 Non-subsidized resident less than the approved monthly fee charged to a subsidized resident, unless the non-subsidized resident has a subsidy application pending. 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. A local office shall execute a subsidy administration agreement with the Department to administer Program subsidies. A subsidy administration agreement shall include the: Time period of the agreement; Monitoring and reporting requirements for facilities in the local office's jurisdiction; Responsibilities of the local office for administering subsidies, including: Executing service agreements with licensees who receive subsidies on behalf of subsidized residents, Determining an applicant's eligibility to receive subsidies, Identifying applicants or residents who may be eligible for subsidies, Determining and annually recalculating the amount of subsidy that an enrolled provider may receive for a subsidized resident, Issuing monthly payments to enrolled providers on behalf of subsidized residents, and Filing required reports with the Department concerning subsidies paid; Total amount of subsidy funds allocated by the Department to the area served by the local office; and Portion of the total amount that the local office may use for its administrative costs. 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. A service agreement between a local office and an enrolled provider shall: Specify the number of beds for which the enrolled provider is licensed or for which the enrolled provider has applied for a license; Specify the level of care for which the enrolled provider is licensed or for which the enrolled provider has applied for a license; Specify the approved monthly fee, which is the maximum amount the enrolled provider can charge a subsidized resident; 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; Specify that the enrolled provider is obligated to maintain its license and operate in compliance with COMAR 10.07.14; Specify the minimum services the enrolled provider shall provide to all subsidized residents; Require the local office to approve any contracts the enrolled provider uses for subsidized residents; 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; 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; 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: Authorized to release the information or records by the subsidized resident or the subsidized resident's representative, or Compelled by a subpoena to release the information or records; Specify the maximum monthly subsidy that will be available for payment; Specify how and when payment requests shall be made to the local office; Specify the term of the agreement; Contain the enrolled provider's Federal Employer Identification number or Social Security number; Specify that the subsidized residents are third-party beneficiaries of the service agreement; Require that any amendments to the service agreement be in writing and executed by all parties to the agreement or their authorized representatives; and 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. A local office shall send a copy of the service agreement format to the Department. 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: Conditions in the facility present an imminent danger to the life, safety, health, or welfare of the residents; A licensee fails to meet the licensure requirements of COMAR 10.07.14; An ongoing pattern exists of violations of COMAR 10.07.14 involving the licensee or facility; 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; A licensee fails to correct cited violations of this chapter within the time specified in writing by the Department or local office; 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; A licensee surrenders its license; A licensee fails to comply with the requirements for renewal of the license; A licensee fails to abide by the terms of its service agreement or its resident agreements; or A licensee or one of its principals: 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 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. 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. A notice of denial of enrollment, refusal to subsidize additional residents, or rescission of the service agreement shall: State concisely and simply: The facts that are asserted; or The issues that are involved, if the facts cannot be stated in detail when the notice is given; State the pertinent statutory and regulatory sections under which the local office is taking its action; State the sanction proposed, if any, as a result of the local office's action; State that the licensee has an opportunity to request a hearing, including: What, if anything, the licensee has to do to receive a hearing; and All relevant time requirements; 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 Be sent to the enrolled provider and the Department. 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. The Department shall send notice of a rescission of a licensee's enrollment in the subsidy program to the Maryland Department of Health. 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. Human Services Article, §10-211, Annotated Code of Maryland Effective date: January 14, 1988 (15:1 Md. R. 20) Regulation .24C amended effective June 6, 1994 (21:11 Md. R. 953) Regulation .26 amended effective June 6, 1994 (21:11 Md. R. 953) 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) Chapter recodified from COMAR 14.11.07 to COMAR 32.03.03, October 2000 Regulation .01 amended effective July 27, 2020 (47:15 Md. R. 713) 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) Regulation .02B amended effective February 13, 2006 (33:3 Md. R. 244); July 27, 2020 (47:15 Md. R. 713) Regulation .03 amended effective July 27, 2020 (47:15 Md. R. 713) 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) Regulation .05 amended effective July 27, 2020 (47:15 Md. R. 713) 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) Regulation .07A amended effective July 27, 2020 (47:15 Md. R. 713) Regulation .08 amended effective July 27, 2020 (47:15 Md. R. 713) Regulation .11A amended effective February 13, 2006 (33:3 Md. R. 244) In this chapter, the following terms have the meanings indicated. Terms Defined. Allowable Medical Expenses. “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. “Allowable medical expenses” does not include expenses: Paid by a source other than the participant, such as insurance, Medicare, grants, or charitable organizations; or For medical day care or attendant care, unless prescribed by a physician. “Allowable medical expenses” may include recurring, nonreimbursable expenses for: Services of physicians and other health care professionals; Hospital expenses; Medical insurance premiums; Prescription and nonprescription medicines; Dental expenses; Eyeglasses; and Payments on accumulated medical bills. Assets. “Assets” means all real and personal property, including: Checking and savings account balances; Any automobiles in excess of one per family; Certificates of deposit; Stocks; Bonds; and Revocable trusts. “Assets” does not include: Customary household goods; Personal effects; One automobile per family; Irrevocable funeral trusts; Personal burial space; or Life insurance with a cash surrender value of not more than $5,000. “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. “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: 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 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. “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: The Standard Congregate Housing Services Plan; and The Individualized Congregate Housing Services Plan. “Contact person” means an individual designated by a participant to receive information about the participant's needs or health. “Department” means the Maryland Department of Aging. “Elderly” means an individual who is 62 years old or older. “Emergency” means conditions that: Present a substantial risk of death or serious physical harm; and Require immediate action. “Essential activities of daily living” means the normal daily activities associated with independent living including feeding, bathing, grooming, dressing, and transferring. “Facility” means a specific senior housing building in which: A provider furnishes congregate housing services; or An applicant for a certificate intends to furnish congregate housing services. “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. “Feeding” means providing meals. “Fiscal year” means the 12-month period that constitutes the State fiscal year, beginning July 1 and ending on June 30. “Income” means the gross amount of all earned and unearned income from all sources, including: Employment; Annuities; Social Security benefits; Workers' Compensation; Pensions; Disability payments; Alimony; Interest; Dividends; and Net income from a business or profession. “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. “Instrumental activities of daily living” means: Using the telephone; Interpreting and responding to mail; Shopping for personal needs; Remembering to take medication; Arranging for prescription refills; Making transportation arrangements; and Performing chores. “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. “Net monthly income” means net annual income divided by 12. “Participant” means an individual who: Lives in an apartment in a facility; and Receives congregate housing services from a provider. “Personal assistance services” means services that assist a participant with feeding, bathing, grooming, or dressing. “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. “Program” means the Congregate Housing Services Program. “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. “Provider” means an individual or other legal entity certified by the Department to provide congregate housing services at a facility. “Secretary” means the Secretary of the Department. “Senior housing” means a multiple-family apartment building that: Provides housing under a landlord-tenant arrangement; and Is specifically designed to meet the physical or social needs of elderly individuals. “Service management” means the administrative services needed to insure an individual's access to congregate housing services including: Assessing participant needs; Determining eligibility; Documenting services received; Billing for services; Communicating with families and the contact person; Generally supervising participants; Discharge planning; and Supervising services provided by staff. “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. “Service plan” means a written plan developed by a provider in conjunction with an Individualized Congregate Housing Services Plan participant that identifies: The particular congregate housing services, and any optional services under Regulation .14F of this chapter, that the provider will provide to the participant; When the services will be provided; and Who will provide the services. “Standard Congregate Housing Services Plan” means a single plan that includes the complete set of congregate housing services including: Congregate meals; Housekeeping; Laundry; Personal assistance services; and Service management. “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. “Subsidy services agreement” means a grant agreement between a provider and the Department that specifies the obligations of both parties. 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. 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. Separate Certificate Required. A separate certificate is required for each facility. Term of Certificate. A certificate is valid for the period specified on the certificate. Owner of Certificate. If a certificate is issued, it shall be: For a specific facility; and In the name of the individual or legal entity that made the application. Posting of Certificate. A provider shall post its certificate conspicuously in a public area of the facility at all times. Certificate Contents. A certificate shall state: The name and address of the provider; The name and address of the facility; and The expiration date of the certificate. 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. An applicant for a certificate shall submit to the Department: Documentation that verifies that: The facility in which the applicant proposes to provide congregate housing services is owned, leased, or otherwise under the control of the applicant; or 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 A statement under oath from the owner or manager of the facility stating that: The facility is in compliance with applicable local laws and regulations that govern housing, life safety, zoning, and environmental health; and 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. 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. 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. Evidence submitted to meet the requirements of §C of this regulation shall include: A statement of the mission, goals, and objectives of the applicant; Information about the applicant's experience providing services to the elderly; A description of: All the services to be provided; and A proposed fee schedule; An operating budget that supports the proposed fee schedule and identifies: The anticipated sources of revenue; and Service utilization assumptions; A proposed weekly staffing pattern; Proposed salary schedules; A sample 4-week menu cycle that has been reviewed and approved in writing by a registered dietician; A statement of the applicant's goals and objectives for providing services at the facility; and Any other relevant information requested by the Department. The Department may not issue a certificate until: A completed application for certification has been submitted to the Department; The Department has verified that the requirements in Regulation .03 of this chapter have been met; and The Department has inspected and approved the facility. The Department may waive any requirement in this chapter if a waiver request from a provider: Is submitted to the Department in writing and contains specific facts upon which the waiver is requested; Demonstrates that: Compliance with the regulation for which a waiver is requested will impose a hardship; or The waiver, if granted, will improve the operation of the Program; 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 Demonstrates that the issuance of a waiver will not adversely affect the health and safety of a participant. 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. 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. An application for renewal shall be filed with the Department by a date specified annually by the Department. The Department shall renew a certificate if: The provider is in compliance with this chapter; and The Department has verified that the requirements of Regulation .03 of this chapter have been met. 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: The Department agrees to the change; and The proposed new provider obtains a certificate for the facility. 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. A provider shall remain responsible for the operation of the Program at the facility until the Department approves the proposed change by: Rescinding the provider's certificate; and Issuing a new certificate to a new provider. 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: A proposed date of the change; A name, address, and telephone number of the proposed new provider; and A name and telephone number of an individual in the Department or local agency on aging that a participant may call with questions. 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. To qualify to work in a supervisory position for a provider, an individual: Shall be 21 years old or older; Shall be literate and able to communicate effectively with participants; Shall have sufficient skills, education, training, and experience to perform the required services; Shall have sufficient physical, emotional, and mental capacity to perform the duties required; Shall be of good moral character; 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); 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; May not be cited on the Maryland Geriatric Nursing Assistants Registry under COMAR 10.07.02.42 with a determination of: Abuse; Misappropriation of resident property; or Neglect; and 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. A provider shall have a staff-to-participant ratio which is adequate to provide the services required in Regulation .14 of this chapter. 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. If a provider provides services to individuals with Alzheimer's disease or related disorders: The provider shall provide annual education to staff on the care of individuals with dementia; and 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: 180 days from the beginning of staff member's employment; or December 31, 2005. Employees of a provider whose jobs require them to enter a participant's apartment or have physical contact with a participant: Shall be 18 years old or older; Shall be of good moral character; Shall be literate if job responsibilities require reading or writing; Shall be able to communicate effectively with the participant; Shall have sufficient skills, education, training, and experience to perform the required services; Shall have sufficient physical, emotional, and mental capacity to perform the duties required; 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); 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; May not be cited on the Maryland Geriatric Nursing Assistant Registry under COMAR 10.07.02.42 with a determination of: Abuse; Misappropriation of resident property; or Neglect; and May not have violated any State or local law regulating residential care facilities that resulted in revocation or nonrenewal of a license or certificate. In addition to any other rights, a participant shall have the right to: Be treated with consideration, respect, and full recognition of human dignity and individuality; Receive care and services that are adequate and appropriate; Privacy; Be free from emotional and physical abuse; Practice the religion of the participant's choice or to abstain from religious practice; Be free from discrimination, as provided by State and federal law; and Refuse or consent to medical treatment. A provider shall: Conspicuously post at all times the list of participant rights identified in §A of this regulation: In the facility; and In the provider's office; and Give a copy of the list of participant rights to each participant at the time of admission. 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: The services to be provided; The fees to be charged by the provider; If applicable, the amount of subsidy to be paid on behalf of the participant; and That the provider give at least 30 days notice of any proposed change in a fee charged by the provider for a particular service. 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. A change in the amount of a participant's required contribution following a reassessment of the participant's financial eligibility: May be imposed immediately; and Is not subject to the 30 day notice requirement of §A(4) of this regulation. A provider-participant service agreement shall allow termination by a provider only for the following reasons: 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; Chronic disruptive behavior that is offensive and threatens participants' peaceful enjoyment of their apartments; Nonpayment of fees by the participant; Termination of the Program at the facility through no fault of the provider; or The participant's health has improved sufficiently so that the participant no longer needs congregate housing services. A provider shall give at least 30 days' written notice of termination to a participant. The notice shall include: A statement of intent to terminate; The reason for termination; The proposed termination date, which may not be less than 30 days from the date of the notification; Assurance that services will be provided up to the proposed termination date; and A list of resources in the community that may be able to assist the participant to relocate. The existence of an emergency does not necessarily mean that any of the standards in §A of this regulation have been met. 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: Take immediate steps to obtain necessary care for the participant by calling 9-1-1; Notify the participant's contact person within 1 hour of learning of the emergency; 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 Record the appropriate information in an incident report. A provider shall maintain on-site an accurate and current file for each participant. A participant's file shall contain the following: A completed copy of the following forms prescribed by the Department: Participant assessment form; Application form; Provider-participant service agreement and any addenda; and Subsidy application, if any; Personal data of participant including: Name; Date of birth; Admission date and, if applicable, termination date; The type of housing the participant lived in before admission into the Program; Name, address, and telephone number of the participant's physician; Name, address, and telephone number of the participant's contact person; If obtained by the provider, relevant medical history of the participant, including physicians' health reports and information on recent hospitalizations; and 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; For participants in an Individualized Congregate Housing Services Plan, a service plan; Incident reports related to the participant; Documentation verifying on a weekly basis the housekeeping, laundry, and personal assistance services received by the participant during the prior month; Reasons for any termination or transfer and, if applicable, the location to which the participant was transferred; Any assessments or recommendations concerning the participant which were made by the local health department and received by the provider; and If the participant receives a subsidy, a completed copy of the subsidy calculation form and written documentation of the participant's: Net annual income; Assets; and Allowable medical expenses. Incident Reports. 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. All incident reports shall include the following information: The time, date, and place of the incident; The identity of individuals present at the incident; A complete description of the incident; The response of the staff; and Any appropriate follow-up action taken, including notifying the participant's contact person and licensing or law enforcement authorities. 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: The participant consents in writing to the disclosure; or State or federal law or a court order otherwise requires or permits the disclosure. 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. 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. A provider shall elect to participate in either the Standard Congregate Housing Services Plan or the Individualized Congregate Housing Services Plan. Meals. A Standard Congregate Housing Services Plan provider shall provide at least two nutritionally balanced meals daily. An Individualized Congregate Housing Services Plan provider shall offer a service package that includes at least one nutritionally balanced meal daily. 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. At least one meal a day shall be offered in a congregate setting. 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. A provider or its food service contractor shall prepare in advance a weekly menu of the meals to be serviced. 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. 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. 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. 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: The owner or management of the facility, if the provider is not the owner or manager; or 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. 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. Housekeeping and Laundry. A provider shall provide the supplies and equipment necessary for housekeeping required by this regulation. A provider may require that its participants provide laundry supplies and pay for the cost of operating laundry equipment to clean the participants' laundry. 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. 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. A Standard Congregate Housing Services Plan provider shall provide laundry services to participants at least weekly. 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. 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. Personal Assistance Services. 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. 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. Service Management. A Standard Congregate Housing Services Plan provider shall provide service management as part of the services provided to participants. An Individualized Congregate Housing Services Program provider shall offer at least one service package that includes service management. Optional Services. A provider may provide: Assistance with instrumental activities of daily living; Assistance with arrangements for regular health care appointments; A service to escort a participant to a health care appointment; Meal delivery to a participant's apartment, for a nominal fee, if: A participant elects not to participate in the congregate meal program; and The provider has sufficient staff to provide this service; Opportunities for individual or group activities in accordance with participants' interests, abilities, and needs; Assistance with completing and submitting benefit applications; Assistance with securing additional services needed; Subject to the prior approval of the Department and in accordance with §G of this regulation, medication reminders or administration; and 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. Medications. 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. A provider approved by the Department to offer as an optional service medication reminders may: Remind a participant to take medication; or Provide physical assistance with opening and removing medications from a container. A provider approved by the Department to offer as an optional service the administration of medications shall: Assure that staff who administer medications do so under the supervision of a registered nurse pursuant to COMAR 10.27.11; 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; Assure that every 2 years all staff responsible for medication administration complete a clinical update refresher course; and 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. The Department may award subsidies to a provider if: The Department has certified the facility; Sufficient State funds for congregate housing service subsidies are available in the Department's budget; The cost of services to be provided and the amount of subsidies required per participant are consistent with costs in comparable facilities; and The provider and the Department have entered into a purchase of services agreement for the applicable fiscal year. 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. A subsidy award may be renewed annually if: Sufficient State funds for subsidies are available in the Department's budget; The provider's budget for the next fiscal year has been approved by the Department; The Department and the provider have executed a subsidy services agreement for the next fiscal year; and The provider and facility are in compliance with this chapter. 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. A provider that is approved by the Department to receive State subsidies shall enter into a written subsidy services agreement with the Department. The Department shall give a copy of the executed agreement to the provider. If funds are available the Department shall advance subsidy payments to a provider in good standing on a quarterly basis. For the term of a subsidy services agreement, the Department shall: During the first quarter, advance to the provider a subsidy payment equal to 1/4 of the total subsidy award; and During each subsequent quarter, advance an amount equal to the total amount of subsidies earned during the previous quarter. At the end of each quarter, the provider shall submit the following to the Department on forms provided by the Department: A report of subsidies earned; and A request for funds for the next quarter. 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. 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: The amount of subsidies advanced to the provider by the Department during the fiscal year; and The amount of subsidies earned by the provider during the fiscal year. 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. 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. 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. 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. 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. 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. 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. To be eligible to be a participant and receive congregate housing services, an individual shall: Be 62 years old or older; Be physically or mentally impaired; Need assistance with one or more of the essential activities of daily living; Need one or more of the congregate housing services available in the facility; and Be able to function in the facility if provided with those services. 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. 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. Upon receipt of an application to receive services, the provider shall determine if the applicant meets the requirements of Regulation .20 of this chapter. 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. 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: Accept the applicant as a participant if the applicant has a signed lease for an apartment in the facility; or Place the applicant's name on a waiting list if the applicant does not have a signed lease for an apartment in the facility. 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. 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. A denial of eligibility notice issued under §F of this regulation shall include: The determination; The reason for denial; The specific regulation supporting the denial; and Information about other resources in the community that may be able to assist the applicant. 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. 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: The individual has been determined to be eligible to be a participant and receives services in the facility; 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; 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; None of the exclusions under §G of this regulation applies; and The individual's assets do not exceed $27,375. 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: Both members of the couple have been determined to be eligible to be participants and receive services in the facility; 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; 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; None of the exclusions under §G of this regulation applies; and The couple's combined assets do not exceed $35,587. 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: The individual has been determined to be eligible to be a participant and receive services in the facility; 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; None of the exclusions under §G of this regulation applies; and The individual's assets do not exceed $27,375. 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. An individual applying for a subsidy shall submit, along with the subsidy application, written documentation of all income and assets. 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. An individual is not eligible to receive a subsidy if the individual is enrolled in: A Medicaid waiver program under 26 U.S.C. §1915(c) in Title XIX of the federal Social Security Act; The Program of All-Inclusive Care for the Elderly, commonly known as PACE; or A Medicaid capitated program that includes long-term care services. A provider shall enroll an individual or couple as subsidized participants if: 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 State funds are available to pay the subsidy. If an individual or couple is enrolled to receive a subsidy, the provider shall: Determine the amount of the individual's or couple's subsidy on a form provided by the Department; and Annually, or more frequently if the individual or couple has a significant change in their finances, redetermine: The continued eligibility to receive a subsidy; and The amount of the subsidy. 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. A notice of ineligibility for a subsidy shall include: The decision; The reason for denial of eligibility; The participant's right to request a review of the decision; and What must be done to obtain a review, including the relevant time frames. 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. 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: The decision; The reason for denial of eligibility; The participant's right to appeal the determination; and What must be done to file an appeal, including the relevant time frames. 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. 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. Approved allowances are: 10 percent of the individual's or couple's net monthly income; 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; 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; The monthly rent paid by the individual or couple for an apartment in the facility; 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; The individual's or couple's allowable medical expenses; and 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. 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. 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. The Department may designate another entity to perform monitoring. 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. 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. A notice provided to satisfy §A of this regulation shall include: The provider's reasons for ending its participation in the Program; Plans for alternate services for participants; and An assurance that the provider shall provide congregate housing services up to the termination date in the current subsidy services agreement. 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. A notice of violation shall include: A description of each condition, action, or inaction that constitutes a violation; A citation to each regulation violated; The date by which an ongoing violation shall be corrected; and The sanctions that may be imposed against the provider for failure to correct the violations. 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. 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. 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. The Department shall notify a provider in writing of a decision to suspend the provider's certificate. A notice of certification suspension shall include: The reasons for suspension; A citation to the regulation on which the suspension is based; The period of suspension; 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; The provider's right to appeal the suspension in accordance with Regulation .33 of this chapter; and What a provider shall do to file an appeal, including all relevant time requirements. 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. 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. 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. 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: Conditions that present an imminent danger to the life, safety, health, or welfare of the participants; Failure to meet the initial certification or renewal requirements of this chapter; Failure to correct cited violations within the time specified by the Department; Fraud or misrepresentation in obtaining or attempting to obtain or retain a certificate; Submission of false information to the Department; Request by the provider that the certificate be revoked; and Failure to abide by the terms of the purchase of services agreement. The Department shall notify a provider in writing of a decision to deny, revoke, or deny the renewal of a certificate. A notice provided under §B of this regulation shall include the following information: The reason for the denial, revocation, or refusal to renew the certificate; A citation to the regulations on which the decision is based; The provider's right to appeal the decision in accordance with Regulation .33 of this chapter; What a provider shall do to file an appeal, including all relevant time requirements; and Notification that the provider may not enroll an individual or couple in the Program after the provider receives the notice. 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. 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. Violations Warranting Penalties. The Secretary, or the Secretary’s designee, may impose a civil money penalty against a provider of congregate housing services for: 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; A violation of a participant's rights specified in Regulation .10 of this chapter; or Noncompliance with State or local fire safety regulations. Notice of Violation. If the Department issues a notice of a violation under §A of this regulation, that notice shall provide: The time by which the provider shall submit an acceptable plan of correction to the Department; The time by which the provider shall substantially correct the identified violation, which time may not be less than 30 days; and 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. Action if Violation Not Timely Corrected. 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. If the violation or violations have not been corrected, the Secretary, or the Secretary's designee, may: Extend the time frame during which the violation shall be corrected; or Impose a civil money penalty under §D of this regulation. Amount and Limitation of Civil Money Penalty. 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. In setting the amount of a civil money penalty under §D(1) of this regulation, the following factors shall be considered: The number, nature, and seriousness of the violations; The degree of risk to the health, life, or physical safety of the participants caused by the violations; The efforts made by the provider to correct the violations; Whether the amount of the proposed civil money penalty will jeopardize the financial ability of the provider to continue operating; and Other factors as justice may require. 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: The basis on which the order is made; Each regulation or statute violated; Each penalty imposed and the total amount of the civil money penalty imposed; The manner in which the amount of the civil money penalty was calculated; A statement of the provider's right to request a reduction; and A statement on how to file an administrative appeal, including all relevant time requirements. 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. Payment of Penalty; Civil Action; Deposit in General Fund. A provider shall pay all penalties to the Department within 10 days after the provider receives a final order imposing a civil money penalty. 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. If a provider does not comply with §G of this regulation, the Department may file a civil action to recover the penalty. The Department shall deposit all penalties collected under §G of this regulation into the General Fund. 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. Requests for Penalty Reduction. A provider of congregate housing services may request a reduction of a civil money penalty imposed. The request shall: Be in writing; State the reasons for the request; and Be made within 10 days of the provider's receipt of the notice of the imposition of the civil money penalty. A request for reduction of a civil money penalty does not interrupt the accrual of the penalties under §D of this regulation. 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. The Secretary, or the Secretary's designee, shall consider, for the purpose of reducing the civil money penalty, such factors as: The provider's history of violations; The provider's current and past diligence in correcting violations; The number and severity of the violations; and Other factors which the Secretary, or Secretary's designee, considers appropriate in the particular circumstances. 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. 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. 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. 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. 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. Human Services Article, §§10-209 and 10-210, Annotated Code of Maryland Effective date: July 1, 2005 (32:10 Md. R. 926) Regulation .01B amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .07 amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .14B amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .16C amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .17 amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .18 amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .19 amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .22 amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .23A—C amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .26A amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .28 amended effective June 4, 2018 (45:11 Md. R. 580) Regulation .32A amended effective June 4, 2018 (45:11 Md. R. 580) 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. In this chapter, the following terms have the meanings indicated. Terms Defined. “Department” means the Maryland Department of Aging. “Program” means the Senior Call-Check Service and Notification Program. “Secretary” means the Secretary of Aging. An individual is eligible to participate in the Program if the following conditions are met: 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 The individual is capable of answering and appropriately responding to a daily phone call. In order to enroll in the Program, an individual shall submit a complete application on a form made available by the Department. 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. If an applicant is determined to be eligible for the Program, the applicant will be enrolled as a participant in the Program. Applicants whose applications are not complete or legible will be classified as not eligible. 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: Decision; Reason for ineligibility; Specific regulation supporting the action; Applicant’s right to appeal the decision; and Method for obtaining a hearing. 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. 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. 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. 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: Decision; Reason for the suspension or revocation; Specific regulation supporting the action; Effective date of the suspension or revocation; Applicant’s right to appeal the decision; and Method for obtaining a hearing. An individual whose enrollment is revoked or suspended may appeal the determination to the Department in accordance with COMAR 32.01.01. 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. State Finance and Procurement Article, §3A-702, Annotated Code of Maryland Effective date: September 7, 2020 (47:18 Md. R. 824)