Md. Code Regs. 32.02.02.22

Current through Register Vol. 51, No. 22, November 1, 2024

Section 32.02.02.22 - Continuing Care At Home Agreement

A. Each continuing care at home agreement shall:

(1) List the total consideration paid, or to be paid, by the subscriber for continuing care at home, including a schedule or inventory that sets forth in one place the value of all entrance fees, subscription fees, property transferred, surcharges, periodic fees, donations, and other fees;

(2) Describe in detail:

(a) All items of service required to be provided to a subscriber by Regulation .02E of this chapter; and

(b) Any additional services to be provided;

(3) For each item described in §A(2) of this regulation, state whether:

(a) There are any limits on the amount of the services to be provided; and

(b) If there are limits, the methodology by which they will be measured or capped;

(4) If adult day care or respite care are not provided, specifically state that they are not;

(5) State:

(a) Whether the provider has a formal arrangement with a facility owned or operated by another person to provide services to a subscriber;

(b) What provisions for care will be made if an assisted living or nursing home bed is not available at a facility with which the provider has a formal arrangement, as described in §A(5)(a) of this regulation, at the time a bed is needed by a subscriber;

(c) What the payment provisions will be for care at a facility with which the provider has a formal arrangement as described in §A(5)(a) of this regulation; and

(d) That the provider shall promptly notify the subscriber and the Department of any change in a formal arrangement described in §A(5)(a);

(6) Designate the categories of subscribers according to the types of entrance fee plans offered;

(7) State that a subscriber may not be relocated except to protect the health or safety of the subscriber or for the general and economic welfare of other subscribers;

(8) While recognizing the constraints of §A(7) of this regulation, describe the procedures the parties to the agreement are to follow in order to temporarily transfer a subscriber;

(9) Describe the procedures the parties to the agreement are to follow in order to return a subscriber to the location where the subscriber resided before a temporary change;

(10) While recognizing the constraints of §A(7) of this regulation, describe the procedures the parties to the agreement are to follow in order to permanently transfer a subscriber;

(11) Describe how the procedures for changes, transfers, and returns, whether temporary or permanent, will operate if the subscriber lives with another subscriber;

(12) State whether there will be a partial refund of an entrance fee, an additional fee, or any increase or decrease in a periodic fee in the event of an increase or decrease in the number of subscribers living together;

(13) Describe the policies of the provider regarding subscribers unable to meet the periodic charges;

(14) State in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, the terms governing the refund of any portion of the entrance fee in the event of:

(a) Discharge by the provider; or

(b) Termination by the subscriber;

(15) State the terms under which an agreement is canceled by the death of a subscriber;

(16) State in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, whether or not periodic fees, if charged, will be subject to periodic increases;

(17) If periodic fees are subject to increase, state in clear and understandable language, and in boldface type of the largest font used in the body of the agreement, the number of days of notice that will be given by the provider before an increase becomes effective;

(18) State that the charges for prepaid care may not be increased, if the agreement provides that care is paid for in advance, in one lump sum;

(19) State whether funeral and burial services are furnished by the provider;

(20) State the address of subscriber's dwelling;

(21) Describe any procedures a subscriber must follow to amend the agreement to change the address of the subscriber's dwelling;

(22) State whether the subscriber may assign the dwelling or agreement to another and, if so, under what conditions;

(23) Describe what, if any, assistance with the maintenance of the subscriber's dwelling will be performed if the subscriber is not residing in the dwelling;

(24) Describe any religious or charitable affiliations of the provider;

(25) Describe the extent to which an affiliate organization will be responsible for the financial and contractual obligations of the provider;

(26) State the subscriber's and provider's respective rights and obligations as to any real and personal property of the subscriber transferred to or placed in the custody of the provider;

(27) State the rights and obligations a subscriber has regarding the use of the provider's facilities, if any, including common areas;

(28) State the rights and obligations a provider has regarding its use of its facilities, if any, and what, if any, rights the provider has to enter a subscriber's dwelling;

(29) State that subscribers have the right to organize and operate a subscriber's association;

(30) State what fee adjustments, if any, will be made by the provider in the event of a subscriber's voluntary absence from the provider's geographic service area or the subscriber's dwelling for an extended period of time;

(31) Specify the circumstances, if any, under which a subscriber will be required to apply for Medicaid, Medicare, public assistance, or any public benefit program;

(32) State whether the provider is, or plans to be, a participant in Medicare or Medicaid;

(33) In a separate paragraph, signed by each subscriber, state: "I have received a copy of the provider's latest certified financial statement at least 2 weeks before signing this agreement, and I have reviewed the certified financial statement provided.";

(34) State that the provider will make available to each subscriber, upon request, any certified financial statement or disclosure statement submitted to the Department;

(35) If an agreement is executed before the provider has received an initial certificate, state:

(a) The conditions that the provider must meet to be issued an initial certificate of registration by the Department; and

(b) That all deposits and entrance fees shall be held in an escrow account in Maryland in a financial institution until:

(i) An initial certificate of registration is issued, and

(ii) The provider has been issued appropriate licenses or certificates by DHMH and MHCC;

(36) State that fees collected by a provider under the terms of a continuing care at home agreement may not be used for purposes other than those set forth in the agreement;

(37) State in boldface type of the largest font used in the body of the agreement: "A preliminary certificate of registration or certificate of registration is not an endorsement or guarantee of this provider by the State of Maryland. The Maryland Department of Aging urges you to consult with an attorney and a suitable financial advisor before signing any documents.";

(38) State in boldface type of the largest font used in the body of the agreement: "The provider has estimated it needs x subscribers before it will be fully financially viable. A provider may begin operating before it is fully financially viable. The provider's financial viability depends on enrolling x subscribers.";

(39) State in boldface type of the largest font used in the body of the agreement: "Continuing care at home is a new concept in delivering services to the elderly. While it promises certain future health services, it is not an insurance product and is not as regulated or secure as an insurance policy. However, it does offer services that typically are not available through an insurance policy.";

(40) State which, if any, benefits are portable if the subscriber moves out of the geographic service area and which are not portable;

(41) Describe the procedures the parties to the agreement are to follow in order for a subscriber to use portable benefits outside the geographic service area;

(42) State the legal remedies available to a subscriber in the event of injury caused by a provider's violation of the Act;

(43) In a separate paragraph, signed by each subscriber, state: "I have received a copy of the provider's latest disclosure statement, and I have reviewed the disclosure statement provided."; and

(44) State that if there are differences between the requirements for continuing care at home certification and the licensure requirements for assisted living and comprehensive care facilities, the applicable requirements most favorable to the subscriber will prevail while the subscriber is residing in an assisted living or comprehensive care facility.

B. Each continuing care at home agreement may contain any other provisions which are:

(1) Agreed upon by the provider and the subscriber to effectuate the purpose of the contract; and

(2) Not in conflict with the Act or this chapter, as determined by the Department.

C. A preliminary certificate of registration may not be issued by the Department if the agreement submitted with the application does not contain all of the provisions of §A of this regulation. The Department shall return to the provider for amendment any agreement which it finds in violation of this chapter. The provider shall submit the agreement to an attorney for legal sufficiency as to content and form before resubmission to the Department.

D. The provider shall request approval from the Department for any modification, addition, or deletion to the terms of a continuing care at home agreement, before the agreement is offered to or used with subscribers. If a proposed change would significantly alter an agreement, the Department may require the submission of an actuarial pricing analysis, performed by a qualified actuary, to support the financial viability of the proposed agreement.

E. Agreements are governed by the version of this regulation that was in effect at the time the agreement was executed by the parties.

Md. Code Regs. 32.02.02.22