Chapter 03. Senior Assisted Living Subsidy Program

“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:

“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:

“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.

Obtain an enrollment form from the local office;

Complete the enrollment form; and

Submit the enrollment form to the local office, along with:

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:

Had no deficiencies in the previous 12 months that presented an imminent danger to the residents' health and safety.

Prepare a service agreement that contains the agreed upon monthly fee; and

Send the service agreement to the licensee to execute.

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.

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:

Physically or mentally impaired; and

In need of assistance with the activities of daily living provided by the assisted living program.

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:

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:

Burial Funds.

Secretary grants an extension under §G of this regulation; or

Residence is occupied by the applicant's or subsidized resident's:

Arrange for a functional assessment of the applicant; and

Determine if the applicant is functionally and financially eligible to receive a subsidy.

Decision;

Reason for denial;

Specific regulation supporting the denial;

Applicant's right to appeal the decision; and

Method for obtaining a hearing.

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.

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 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.

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.

Administer the Program’s subsidies;

Execute subsidy agreements with licensees; and

Make monthly subsidy payments to licensees on behalf of subsidized residents.

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.

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:

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.

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:

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.

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:

State concisely and simply:

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:

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.