Section 10-444 - Continuing care agreements - Contents(a) Except as provided in subsection (b)(25) of this section, a requirement of this section does not apply to any continuing care agreement entered into before the effective date of the requirement.(b) In a form acceptable to the Department, each continuing care agreement shall: (1) show the total consideration paid by the subscriber for continuing care, including the value of all property transferred, donations, entrance fees, subscriptions, monthly fees, and any other fees paid or payable by or on behalf of a subscriber;(2) specify all services that are to be provided by the provider to each subscriber, such as food, shelter, medical care, nursing care, or other health related services, including in detail all items that each subscriber will receive, and whether the items will be provided for life or for a designated time period;(3) designate the classes of subscribers according to types of payment plans;(4) subject to subsection (c) of this section, describe the procedures to be followed by the provider when the provider temporarily or permanently changes the subscriber's accommodations within the facility or transfers the subscriber to another health facility;(5) describe the policies that will be implemented if the subscriber becomes unable to pay the monthly fees;(6) state the policy of the provider concerning changes in accommodations and the procedure to implement that policy if the number of persons occupying an individual unit changes;(7) provide in clear and understandable language, in boldface type, and in the largest type used in the body of the agreement:(i) the terms governing the refund of any portion of the entrance fee if the provider discharges the subscriber or the subscriber cancels the agreement; and(ii) whether monthly fees, if charged, will be subject to periodic increases;(8) state the terms under which an agreement is canceled by the death of the subscriber;(9) provide that charges for care paid in advance in a lump sum may not be increased or changed for the duration of the agreed-upon care;(10) state that the provider represents that the subscriber has received, at least two weeks before signing the agreement:(i) the current version of the written rules of the provider;(ii) the continuing care agreement form, with the attachments, exhibits, and addenda; and(iii) the current disclosure statement, with the attachments, exhibits, and addenda;(11) describe the living quarters;(12) if applicable, state the conditions under which a subscriber may assign a unit for the use of another individual;(13) state the provider's religious or charitable affiliations and the extent, if any, to which the affiliate organization is responsible for the provider's financial and contractual obligations;(14) state the subscriber's and provider's respective rights and obligations concerning:(i) use of the facility; and(ii) any real and personal property of the subscriber placed in the provider's custody;(15) state that subscribers have the right to organize and operate a subscriber association at the facility and to meet privately to conduct business;(16) state that there is an internal grievance procedure to address a subscriber's grievance;(17) state the fee adjustments, if any, that will be made if the subscriber is voluntarily absent from the facility for an extended period of time;(18) specify the circumstances, if any, under which the subscriber will be required to apply for Medicaid, Medicare, public assistance, or any public benefit program and whether the facility participates in Medicare or medical assistance;(19) state that the subscriber received a copy of the latest certified financial statement at least two weeks before signing the agreement and that the subscriber has reviewed the statement;(20) state that the subscriber acknowledges reviewing all of the terms of the entrance fee refund clauses and provisions contained in the continuing care agreement;(21) provide that, on request, the provider will make available to the subscriber any certified financial statement submitted to the Department;(22) if applicable, describe the conditions under which the provider may be issued an initial certificate of registration and the conditions under which the provider may use escrowed deposits, and state the amount of the subscriber's deposit;(23) state that fees collected by a provider under the terms of a continuing care agreement may only be used for purposes set forth in the agreement;(24) include one of the following model statements or a substantially similar statement: (i) "The provider agrees that, for as long as the subscriber's continuing care agreement remains in effect, the provider shall only use fees paid by the subscribers of the community for purposes directly related to the construction, operation, maintenance, or improvement of the community.";(ii) "The provider does not currently use fees paid by subscribers of the community for purposes other than those directly related to the construction, operation, maintenance, or improvement of the community, but the provider reserves the future right to use fees paid by subscribers of the community for purposes unrelated to the construction, operation, maintenance, or improvement of the community."; or(iii) "The provider may use fees paid by subscribers of the community for purposes unrelated to the construction, operation, maintenance, or improvement of the community, including for the furtherance of the provider's corporate mission, to distribute profits, or to benefit an affiliated community.";(25) allow a subscriber to designate a beneficiary to receive any refundable portion of the entrance fee that is owed due to the death of the subscriber on or after the date of occupancy, if the designation is:(ii) witnessed by at least two competent witnesses;(iii) not contingent; and(iv) specified in percentages and accounts for 100% of the refund due;(26) state the funeral and burial services, if any, that the provider will provide;(27) contain a table of contents;(28) if the provider offers a continuing care agreement that promises a contractual entrance fee refund after occupancy, state whether the portion of the entrance fee to be refunded is held in trust or escrow for the subscriber after occupancy, and if so held, state where and how the funds are held;(29) if the payment of a contractual entrance fee refund after occupancy is conditioned on the reoccupancy or recontracting of the subscriber's unit, state that the provider agrees to make reasonable efforts to satisfy the condition; and(30) contain the following statement in boldface type and in the largest type used in the agreement: "A preliminary certificate of registration or certificate of registration is not an endorsement or guarantee of this facility 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.".(c) A subscriber's accommodations may be changed only to protect the health or safety of the subscriber or the general and economic welfare of other residents.(d) A continuing care agreement may contain, in a form acceptable to the Department, any other appropriate provision to effectuate the purpose of the agreement.(e)(1) This subsection applies if:(i) a provider's continuing care agreement includes a provision to provide assisted living program services; and(ii) the provider does not execute a separate assisted living agreement.(2) In addition to any other requirement of this section, the continuing care agreement shall include the following provisions concerning the assisted living program: (i) a statement of the level of care that the assisted living program is licensed to offer;(ii) a description of the procedures to be followed by the provider for notifying the subscriber of the level of care the subscriber needs if the subscriber transfers to an assisted living program;(iii) a statement indicating the options available to a subscriber if the subscriber's level of care, after admission to an assisted living program, exceeds the level of care for which the provider is licensed;(iv) based on a sample list of assisted living program services that the Maryland Department of Health maintains, a statement of which services are provided by the assisted living program and which services are not;(v) a statement of the obligations of the provider and the subscriber or the subscriber's agent for handling the subscriber's finances;(vi) a statement of the obligations of the provider and the subscriber or the subscriber's agent for disposition of the subscriber's property on the subscriber's discharge or death; and(vii) the applicable rate structure and payment provisions covering:1. all rates to be charged to the subscriber, including:B. fee-for-service rates; andC. any other nonservice-related charges;2. criteria to be used for imposing additional charges to provide additional services, if the subscriber's service and care needs change;3. payment arrangements and fees, if known, for third-party services not covered by the continuing care agreement, but arranged for by the subscriber, the subscriber's agent, or the assisted living program;4. identification of the persons responsible to pay all fees and charges and a clear indication of whether the person's responsibility is or is not limited to the extent of the subscriber's funds;5. a provision for notice at least 45 days before any rate increase, except for an increase necessitated by a change in the subscriber's medical condition; and6. fair and reasonable billing and payment policies.