Maryland Department of Aging Section 13

      (a)      In addition to such other provisions as may be considered proper to effectuate the purpose of any continuing care agreement, each agreement executed between a subscriber and a provider shall, in a form acceptable to the Department:

            (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 such as food, shelter, medical care, nursing care, or other health related services, which are to be provided by the provider to each subscriber, including in detail all items which each subscriber will receive, whether the items will be provided for a designated time period or for life;

            (3)      Designate the classes of subscribers according to types of payment plans;

            (4)      Describe the procedures to be followed by the provider when the provider temporarily or permanently changes the subscriber's accommodation within the facility or transfers the subscriber to another health facility, but a subscriber's accommodations shall be changed only for the protection of the health or safety of the subscriber or the general and economic welfare of the residents;

            (5)      Describe the policies that will be implemented in the event the subscriber becomes unable to meet the monthly fees;

            (6)      State the policy of the provider with regard to changes in accommodations and the procedure to be followed to implement that policy in the event of an increase or decrease in the number of persons occupying an individual unit;

            (7)      Provide in clear and understandable language, boldface type, and in the largest type used in the body of the agreement, the terms governing the refund of any portion of the entrance fee in the event of discharge by the provider or cancellation by the subscriber;

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

            (9)      Provide in clear and understandable language, boldface type, and in the largest type used in the agreement, whether or not monthly fees, if charged, will be subject to periodic increases;

            (10)      Provide that charges for care paid in advance in 1 lump sum only shall not be increased or changed during the duration of the agreed upon care;

            (11)      State which funeral and burial services, if any, will be provided by the provider;

            (12)      Give a description of the living quarters;

            (13)      State the conditions, if any, under which a unit may be assigned to the use of another by the subscriber;

            (14)      State the religious or charitable affiliations of the provider and the extent, if any, to which the affiliate organization will be responsible for the financial and contractual obligations of the provider;

            (15)      State the subscriber's and provider's respective rights and obligations as to use of the facility and as to real and personal property of the subscriber placed in the custody of the provider;

            (16)      State that the subscribers shall have the right to organize and operate a subscriber association at the facility and to meet privately to conduct business;

            (17)      State that there is an internal grievance procedure to investigate the grievances of subscribers;

            (18)      State what, if any, fee adjustments will be made in the event the subscriber is voluntarily absent from the facility for an extended period of time;

            (19)      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 or not the facility is a participant in Medicare or medical assistance;

            (20)      State that the subscriber has received and reviewed the latest certified financial statement and that a copy of the certified financial statement was received at least 2 weeks before signing the agreement;

            (21)      Provide that the facility will make available to the subscriber, upon request, any certified financial statement transmitted to the Department;

            (22)      Where applicable, describe the conditions under which the provider may be issued a certificate of registration, describe the conditions under which the provider may use escrowed deposits, and state the amount of the subscriber's deposit that may be used upon issuance of a certificate of registration;

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

            (24)      Allow a subscriber to designate a beneficiary for receipt of any refundable portion of the entrance fee, if:

                  (i)      The designation is in writing;

                  (ii)      The designation is witnessed by two or more competent witnesses;

                  (iii)      The designation is noncontingent; and

                  (iv)      The designation is specified in percentages and accounts for 100 percent of the refund due; and

            (25)      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."

      (b)      Except as provided in subsection (a)(24) of this section, a requirement of this section shall not apply to any continuing care agreements entered into before the effective date of the requirement.

      (c)      The provider shall maintain the continuing care agreement on site and make it available for inspection by the Department of Health and Mental Hygiene under Title 19, Subtitle 18, of the Health - General Article.

      (d)      In addition to any other requirements of this section, if a provider's continuing care agreement includes a provision to provide assisted living program services and the provider does not execute a separate assisted living agreement, each continuing care agreement executed between a subscriber and a provider shall include with regard to the assisted living program:

            (1)      A statement of the level of care for which the assisted living program is licensed;

            (2)      As part of the procedures to be followed under subsection (a)(4) of this section, if the subscriber is transferred to an assisted living program, the procedures to be followed by the provider for notifying the subscriber of the level of care needed by the subscriber;

            (3)      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;

            (4)      Based on a sample list of assisted living program services maintained by the Department of Health and Mental Hygiene, a statement of those services provided by the assisted living program and those services not provided by the assisted living program;

            (5)      A statement of the obligations of the provider and the subscriber or the subscriber's agent as to handling the finances of the subscriber;

            (6)      A statement of the obligations of the provider and the subscriber or the subscriber's agent as to disposition of the subscriber's property upon discharge or death of the subscriber; and

            (7)      The applicable rate structure and payment provisions covering:

                  (i)      All rates to be charged to the subscriber, including:

                        1.      Service packages;

                        2.      Fee-for-service rates; and

                        3.      Any other nonservice-related charges;

                  (ii)      Criteria to be used for imposing additional charges for the provision of additional services, if the subscriber's service and care needs change;

                  (iii)      Payment arrangements and fees, if known, for third-party services not covered by the continuing care agreement, but arranged for by either the subscriber, the subscriber's agent, or the assisted living program;

                  (iv)      Identification of the persons responsible for payment of 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;

                  (v)      A provision for at least 45 days' notice of any rate increase, except if necessitated by a change in the subscriber's medical condition; and

                  (vi)      Fair and reasonable billing and payment policies.

      (e)      (1)      If a provider's feasibility study has been approved under § 10 of this subheading, the Department shall decide whether to approve a continuing care agreement within 180 days of receipt of a complete agreement.

            (2)      If the Department takes no action within 180 days, the agreement is deemed approved.