Maryland Department of Aging Section 11
§ 11.
(a) A provider may not provide continuing care until the issuance of a certificate of registration by the Department. The application shall be filed in a form satisfactory to the Department. The application shall contain at least the following information:
(1) For a project other than a conversion, verification that subscribers' continuing care agreements have been executed for at least 65 percent of the independent living units and at least 10 percent of the total entrance fee for each contracted unit has been collected;
(2) For a conversion project, verification that at least 80% of the accommodations in the project that are not licensed as assisted living or comprehensive care beds are occupied or reserved in accordance with:
(i) Leases;
(ii) Continuing care agreements executed with subscribers who have provided a deposit that:
1. Is equal to at least 10% of the total entrance fee; and
2. Has been deposited by the provider under a proper escrow agreement; or
(iii) Other appropriate contractual arrangements.
(3) Verification that the provider has received a written commitment for permanent long-term financing, and, when requested by the permanent financing lender, the Department may issue a letter stating that all requirements of paragraph (1) of this subsection have been met; and
(4) If construction financing is required, verification that application for construction financing has taken place. When requested by a construction lender, the Department may issue a letter stating that all requirements of paragraphs (1) and (3) of this subsection have been met and on closing of the construction loan the certificate of registration shall be issued.
(b) (1) A certificate of registration shall be issued by the Department when it determines that:
(i) The provider has been issued a preliminary certificate of registration;
(ii) The documents required have been filed;
(iii) The form and substance of all advertising and other promotional materials filed are not deceptive, misleading, or likely to mislead;
(iv) For a project other than a conversion, at least 65 percent of the independent living units have been contracted for with a minimum 10 percent of the entrance fee paid as a deposit for each contracted unit;
(v) For a conversion project, that at least 80% of the accommodations in the project that are not licensed as assisted living or comprehensive care beds are occupied or reserved in accordance with:
1. Leases;
2. Continuing care agreements executed with subscribers who have provided a deposit that:
A. Is equal to at least 10% of the total entrance fee; and
B. Has been deposited by the provider pursuant to a proper escrow agreement; or
3. Other appropriate contractual arrangements.
(vi) If construction financing is required, that closing on the construction financing has taken place; and
(vii) There is a commitment for permanent long-term financing.
(2) The initial certificate of registration may be issued for a period of up to 18 months at the discretion of the Department.
(c) A deposit held in escrow may not be used until a certificate of registration has been issued, construction is completed, the provider has been issued a certificate of occupancy, or the equivalent, by the appropriate local jurisdiction, and the provider has been issued appropriate licenses or certificates by the Department of Health and Mental Hygiene or by the Department.
(d) If a certificate of registration is not issued within 24 months of the issuance of a preliminary certificate of registration or longer time as is allowed by the Department for good cause shown, the provider shall refund all deposits and cease in its attempts to offer continuing care under that application.
(e) Annually, within 120 days after the end of the fiscal year, the provider shall file an application for a renewal certificate in a form satisfactory to the Department which shall contain the following information:
(1) Any additions or changes to the information required by § 10 of this subtitle;
(2) An audited financial statement for the preceding fiscal year prepared in accordance with an audit guide adopted by the Department;
(3) An operating budget for the current fiscal year, and a projected operating budget for the next succeeding fiscal year;
(4) A cash flow projection for the current fiscal year and the next 2 fiscal years;
(5) A projection of the life expectancy and the number of residents who will require nursing home care;
(6) An actuarial study reviewed by a qualified actuary and submitted every 3 years;
(7) The form and substance of any advertising campaign or proposed advertisement and other promotional materials not previously filed with the Department; and
(8) Any further information that the Department requires.
(f) If the application and accompanying information is not received by the Department within the 120-day period, a late fee may be charged. Failure to file the required information within 90 days of the due date shall be a violation of this subtitle.
(g) A renewal of a certificate of registration shall be issued by the Department when it determines that:
(1) The documents required have been filed;
(2) Any revised continuing care agreements meet the requirements of this subtitle;
(3) The provider has complied with § 17A of this subtitle if it has been found to be in financial difficulty;
(4) When appropriate, the facility has been licensed or certified by the Department of Health and Mental Hygiene or the Department; and
(5) The form and substance of all advertising and other promotional materials filed are not deceptive, misleading, or likely to mislead.
(h) A provider shall file a request for approval for each renovation in a form satisfactory to the Department. At least 30 days before filing the request, the provider shall submit to the Department a written statement that sets forth the provider's intent to file a renovation approval request. A request for approval shall include:
(1) A statement of the purpose of and need for the renovation;
(2) A financial plan that demonstrates to the satisfaction of the Department that the renovation will not have an unreasonably adverse effect on the financial ability of the provider to furnish continuing care in accordance with the provider's continuing care agreements and this subtitle at the facility identified in the plan and at each other facility of the provider in the State; and
(3) Any other information that the Department requires.
(i) The Department shall approve any renovation requested in accordance with this section if the Department determines that the proposed renovation will not have an unreasonably adverse effect on the financial ability of the provider to furnish continuing care in accordance with the provider's continuing care agreements and this subtitle. A provider may not begin construction of the renovation until the provider receives written approval from the Department.
(j) A provider shall file a request for approval for each expansion in a form satisfactory to the Department. At least 30 days before filing the request, the provider shall submit to the Department a written statement that sets forth the provider's intent to file an expansion request. The request shall include:
(1) A statement of the purpose of and need for the expansion;
(2) If the expansion involves living units, a plan that demonstrates to the satisfaction of the Department that a market exists for the additional living units;
(3) A financial plan that demonstrates to the satisfaction of the Department that the expansion will not have an unreasonably adverse effect on the financial ability of the provider to furnish continuing care in accordance with the provider's continuing care agreements and this subtitle at the facility identified in the plan and at each other facility of the provider in the State; and
(4) Any other information that the Department requires.
(k) The Department shall approve any expansion requested in accordance with this section and, if appropriate, issue a new certificate of registration if the Department determines that the proposed expansion will not have an unreasonably adverse effect on the financial ability of the provider to furnish continuing care in accordance with the provider's continuing care agreements and this subtitle. A provider may not begin construction of the expansion until the provider receives written approval from the Department.
(l) It shall be the responsibility of the Department to make the information required to be provided pursuant to this subtitle available to all interested persons. The Department shall publicize the availability of this information.
