EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb1177*
HOUSE BILL 1177
O2, J3 4lr1836
By: Delegates Hill, Kaufman, Simmons, and Stein
Introduced and read first time: February 7, 2024
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Continuing Care Retirement Communit ies – Subscriber Rights and Provider 2
Duties 3
FOR the purpose of altering the membership of governing bodies of continuing care 4
retirement communities by increasing the number of subscribers; prohibiting a 5
provider of a continuing care retirement community from infringing on certain rights 6
of certain subscribers; providing that certain individuals, before signing a continuing 7
care agreement, are entitled to a certain visit and to receive certain information; 8
authorizing subscribers in a continuing care retirement community to take certain 9
actions and to participate in certain activities; authorizing the establishment of a 10
certain resident association under certain circumstances; requiring certain providers 11
to undertake certain actions and to provide certain information; requiring the 12
Secretary of Aging to establish a Continuing Care in a Retirement Community 13
Ombudsman in each county; and generally relating to continuing care retirement 14
communities. 15
BY repealing and reenacting, without amendments, 16
Article – Human Services 17
Section 10–101(a) and (h) 18
Annotated Code of Maryland 19
(2019 Replacement Volume and 2023 Supplement) 20
BY repealing and reenacting, with amendments, 21
Article – Human Services 22
Section 10–427 23
Annotated Code of Maryland 24
(2019 Replacement Volume and 2023 Supplement) 25
BY adding to 26
Article – Human Services 27
Section 10–451 and 10–452 28 2 HOUSE BILL 1177
Annotated Code of Maryland 1
(2019 Replacement Volume and 2023 Supplement) 2
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 3
That the Laws of Maryland read as follows: 4
Article – Human Services 5
10–101. 6
(a) In this title the following words have the meanings indicated. 7
(h) “Secretary” means the Secretary of Aging. 8
10–427. 9
(a) (1) If a provider has a governing body, at least [one] THREE of the 10
provider’s subscribers shall be [a] full and regular [member] MEMBERS of the governing 11
body. 12
(2) If the provider owns or operates more than three facilities in the State, 13
the governing body shall include at least one of the provider’s subscribers for every three 14
facilities in the State. 15
(3) [Subject to paragraph (4) of this subsection, a] A member of the 16
governing body who is selected to meet the requirements of this subsection shall be a 17
subscriber at a facility in the State and be [selected according to the same general written 18
standards and criteria used to select other members of the governing body] ELECTED BY 19
THE RESIDENT ASSOCIA TION OF THE FACILITY IN ACCORDANCE WITH T HE BYLAWS 20
OF THE RESIDENT ASSO CIATION. 21
(4) [The governing body shall confer with the resident association at each 22
of the provider’s facilities before the subscriber officially joins the governing body] A 23
SUBSCRIBER MEMBER OF A GOVERNING BODY MAY REPORT ON NONCONFIDE NTIAL 24
DELIBERATIONS , ACTIONS, AND POLICIES OF THE GOVERNIN G BODY TO THE 25
RESIDENT ASSOCIATION . 26
(5) The Secretary may waive the requirements of this subsection for a 27
provider in the process of decertifying as a provider, if the Secretary determines that there 28
are no subscribers willing and able to serve on the governing body. 29
(b) (1) If a provider does not have a governing body, the provider shall appoint 30
a select committee of its officers or partners to meet at least twice a year with the resident 31
association at each of its facilities to address concerns of the subscribers and to ensure that 32
the opinions of subscribers are relayed to all officers or partners of the provider. 33
HOUSE BILL 1177 3
(2) If a facility does not have a resident association, the committee shall 1
meet with a reasonable number of representatives, not required to exceed fifteen, that the 2
subscribers elect. 3
(c) (1) A PROVIDER MAY DESIGNA TE A PORTION OF A GO VERNING BODY 4
MEETING TO BE CONFID ENTIAL IF THE GOVERN ING BODY DISCUSSES I NDIVIDUAL 5
PERSONNEL OR INDIVID UAL SUBSCRIBER ’S HEALTH ISSUES. 6
(2) A PROVIDER MAY NOT PREVENT THE ACCESS OF A SUBSCRIB ER 7
OR A DESIGNATED REPR ESENTATIVE OF A SUBS CRIBER TO A NONCONFI DENTIAL 8
PORTION OF A MEETING OF THE GOVERNING BOD Y UNLESS THE PORTION OF THE 9
MEETING IS CLOSED IN COMPLIANCE WITH THIS SUBSECTION OR A FEDE RAL, STATE, 10
OR LOCAL LAW. 11
(3) [As determined by the provider’s governing body, the] A provider shall 12
make available to subscribers either the nonconfidential portions of the minutes of each 13
meeting of the governing body or a summary of the nonconfidential portions of the minutes, 14
within 1 month of approval of the minutes. 15
10–451. 16
(A) A PROVIDER MAY NOT INF RINGE ON THE CIVIL LIBERTIES OF A 17
SUBSCRIBER THAT ARE PROTECTED BY THE UNITED STATES CONSTITUTION AND 18
THE MARYLAND CONSTITUTION. 19
(B) BEFORE AN INDIVIDUAL SIGNS A CONTINUING C ARE AGREEMENT : 20
(1) AN INDIVIDUAL MAY VISIT A FACILITY , INCLUDING THE 21
AMENITIES ASSOCIATED WITH INDEPENDENT LIV ING; AND 22
(2) A PROVIDER SHALL PROVI DE AN INDIVIDUAL A LIST WRITTEN IN 23
PLAIN LANGUAGE STATING THE SERVICES GUARANTEED BY A CONTINUING CARE 24
AGREEMENT AND SERVICES THAT AR E INCLUDED, BUT NOT GUARANTEED , BY A 25
CONTINUING CARE AGRE EMENT. 26
(C) A SUBSCRIBER MAY : 27
(1) (I) SELECT AN INDEPENDEN T LIVING APARTMENT O F THE 28
SUBSCRIBER’S CHOICE BASED ON THE AVAILABLY OF LIV ING APARTMENTS AND T HE 29
SUBSCRIBER’S FINANCIAL QUALIFIC ATIONS; AND 30
(II) CHOOSE HOW TO FURNIS H AN INDEPENDENT LIV ING 31
APARTMENT , CONSISTENT WITH THE TERMS OF THE CONTINU ING CARE AGREEMENT 32
AND APPLICABLE FIRE AND SAFETY REGULATIO NS; 33 4 HOUSE BILL 1177
(2) INDIVIDUALLY OR THRO UGH A DESIGNATED REP RESENTATIVE, 1
REFUSE MEDICATION OR TREATMENT OFFERED BY THE PROVIDER ; 2
(3) PARTICIPATE FULLY IN DISCUSSIONS WITH THE PROVIDER 3
REGARDING THE NEED TO TRANSFER THE SUBS CRIBER TO AN ASSISTE D LIVING 4
PROGRAM OR SKILLED NURSING F ACILITY; 5
(4) WITH OR WITHOUT PART ICIPATION OF A PROVI DER, OR THE 6
GOVERNING BODY OF TH E CONTINUING CARE FA CILITY, FREELY ASSEMBLE TO 7
SHARE INFORMATION WI TH OTHER SUBSCRIBERS OR LEARN ABOUT ISSUES F ACING 8
THE SUBSCRIBER COMMU NITY; 9
(5) OPERATE INFORMAL ACT IVITIES THAT DO NOT NEGATIVELY 10
IMPACT OTHER SUBSCRI BERS OR REQUIRE RESI DENT ASSOCIATION FUN DS; 11
(6) ADVOCATE FOR A SUBSCRIBER ’S OWN WELL–BEING, RIGHTS, OR 12
PREFERENCES REGARDING ISSUES FACING A CONT INUING CARE RETIREME NT 13
COMMUNITY ; AND 14
(7) PARTICIPATE IN A RES IDENT ASSOCIATION . 15
(D) (1) UNLESS A RESIDENT ASS OCIATION IS IN OPERA TION IN A 16
CONTINUING CARE RETI REMENT COMMUNITY , A SUBSCRIBER MAY ESTABLISH AND 17
OPERATE A RESIDENT ASSOCIATION FOR SUBSCRIBERS RESIDING IN A FACILITY. 18
(2) A RESIDENT ASSOCIATION SHALL REPRESENT THE INTERESTS OF 19
SUBSCRIBERS IN A FACILITY, INCLUDING DURING MEETINGS WITH THE GO VERNING 20
BODY OF A FACILITY O R PROVIDER. 21
(3) (I) A RESIDENT ASSOCIATION MAY COLLECT FEES OR OTHER 22
CONTRIBUTIONS TO MAI NTAIN A RESIDENT ASSOCIATION FUN D. 23
(II) A RESIDENT ASSOCIATION MAY USE A RESIDENT 24
ASSOCIATION FUND TO SUPPORT ACTIVITIES F OR SUBSCRIBERS OR AD VOCATE FOR 25
THE WELL–BEING, RIGHTS, AND PREFERENCES OF S UBSCRIBERS IN A FACI LITY. 26
(E) A PROVIDER SHALL : 27
(1) DELIVER COMPLETE AND PROMPT FULFILLMENT OF THE 28
SERVICES AND TERMS S ET IN A CONTINUING C ARE AGREEMENT AND AN Y OTHER 29
CONTRACT MADE WITH A SUBSCRIBER; 30
HOUSE BILL 1177 5
(2) PROVIDE THE BENEFITS OF LIVING IN CONTINU ING CARE IN A 1
RETIREMENT COMMUNITY AND ENFORCE RULES FO R LIVING IN CONTINUING CARE 2
IN A RETIREMENT COMMUNITY WITHOUT PREJUDICE , REGARDLESS OF THE 3
SUBSCRIBER’S AGE, GENDER, SEXUAL ORIENTATION , RELIGION, RACE, ECONOMIC 4
STATUS, PROFESSIONAL BACKGRO UND, POLITICAL AFFILIATIO N, ADVOCACY OF 5
ISSUES IN THE RETIRE MENT COMMUNITY , OR INVOLVEMENT IN A RESIDENT 6
ASSOCIATION; 7
(3) CONDUCT A N ANNUAL SURVEY TO EVALUATE S UBSCRIBERS’ 8
SATISFACTION WITH TH E FULFILLMENT OF THE SERVICES AND TERMS S ET IN A 9
CONTINUING CARE AGREEMENT AND OTHER CONTRACTS MADE WITH SUBSCRIBERS ; 10
(4) PROVIDE A CO PY OF A CONTINUING C ARE AGREEMENT OR 11
CONTRACT SIGNED BY A SUBSCRIBER TO THE SU BSCRIBER ON REQUEST BY THE 12
SUBSCRIBER OR THE SUBSCRIBER’S DESIGNATED REPRESENTATIVE ; 13
(5) EVERY 6 MONTHS, REPORT TO A SUBSCRIBER THE SIGNI FICANT 14
ISSUES AFFECTING THE CONTIN UING CARE RETIREMENT COMMUNITY THAT AFFEC T 15
SUBSCRIBERS ’ WELL–BEING OR FINANCIAL I NVESTMENT IN A CONTINUING CARE 16
AGREEMENT , INCLUDING ISSUES THA T HAVE BEEN ADDRESS ED BY SUBSCRIBERS OR 17
A RESIDENT ASSOCIATI ON SINCE THE IMMEDIA TELY PRECEDIN G REPORT WAS 18
PROVIDED; 19
(6) (I) ANNUALLY DISCLOSE TO A SUBSCR IBER THE FINANCES OF 20
AN ENTITY THAT OWNS OR HAS A S TAKE IN A CONTINUING CARE RETIREMENT 21
COMMUNITY OR FACIL ITY THAT A SUBSCRIBER IS PART OF; AND 22
(II) IF AN ENTITY OWNS OR HAS AN INTEREST IN MULTIPLE 23
CONTINUING CARE RETI REMENT COMMUNITIES O R FACILITIES, ANNUALLY 24
DISCLOSE TO A SUBSCR IBER THE FINANCES OF THE ENTITY TO A SUBSCRIBER IN 25
EACH CONTINUING CARE RETIREMENT COMMUNITY OR FACILITY THE ENTI TY OWNS 26
OR HAS AN INTEREST IN; 27
(7) ON REQUEST, PROVIDE A REPORT WRI TTEN BY A CERTIFIED 28
ACTUARY AFFIRMING TH AT A PROVIDER HAS SU FFICIENT FUNDS TO PR OVIDE FOR 29
THE FUTURE OF THE CO NTINUING CARE RETIRE MENT COMMUNITY ; 30
(8) INFORM A SUBSCRIBER OF A PLAN TO SELL OR TRANSFER 31
OWNERSHIP OF A CONTINUIN G CARE RETIREMENT CO MMUNITY OR FACILITY : 32
(I) IN ACCORDANCE WITH § 10–433 OF THIS SUBTITLE; OR 33
6 HOUSE BILL 1177
(II) AS SOON AS POSSIBLE , IF THE SALE OR TRANSFER WILL 1
OCCUR UNDER EMERGENC Y CIRCUMSTANCES ; 2
(9) (I) AT LEAST 90 DAYS BEFORE CHANGING A FEE CHARGED TO A 3
SUBSCRIBER, NOTIFY THE SUBSCRIBER OF THE PL AN TO CHANGE THE FEE ; 4
(II) PROVIDE AN OPPORTUNI TY FOR A SUBSCRIBER TO PROVIDE 5
FEEDBACK ON THE PLANNED FEE CHANGE; AND 6
(III) RESPOND IN WRITING T O FEEDBACK FROM A SU BSCRIBER 7
REGARDING A PL ANNED FEE CHANGE; AND 8
(10) (I) BEFORE IMPLEMENTING A CHANGE TO THE DELI VERY OF 9
HEALTH CARE SERVICES , FOOD SERVICES , AND FACILITIES MAINT ENANCE, 10
INCLUDING STAFFING L EVELS OR STAFF CREDE NTIALING, NOTIFY A SUBSCRIBER OF 11
THE PLANNED CHANGE ; 12
(II) PROVIDE AN OPPORTUNITY FOR A SUBSCRIBER TO PROVID E 13
FEEDBACK ON THE PLAN NED CHANGE TO THE DE LIVERY OF SERVICES ; AND 14
(III) RESPOND IN WRITING T O FEEDBACK FROM A SU BSCRIBER 15
REGARDING A PLANNED CHANGE IN THE DELIVE RY OF SERVICES. 16
(F) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , IF A 17
SUBSCRIBER IS IN AN ASSISTED LIVING PROG RAM OR A SKILLED NUR SING FACILITY, 18
A PROVIDER REGULARLY SHALL INFORM THE SUBSCRIBER’S FAMILY MEMBERS , AS 19
DESIGNATED BY THE SUBSCRIBER , ABOUT THE SUBSCRIBER ’S CONDITION AND CARE 20
PLAN. 21
(2) (I) A PROVIDER MAY SET A M AXIMUM NUMBER OF FAM ILY 22
MEMBERS THAT A SUBSCRIBER MAY DESIGNATE UNDER PARAGRAPH (1) OF THIS 23
SUBSECTION. 24
(II) THE MAXIMUM NUMBER OF FAMILY MEMBERS SET B Y A 25
PROVIDER UNDER THIS PARAGRAPH SHALL BE NO T LESS THAN TWO FAMILY 26
MEMBER S AND AN ALTERNATE F AMILY MEMBER TO BE I NFORMED IF ONE OF TH E 27
OTHER TWO FAMILY MEM BERS IS UNAVAILABLE . 28
10–452. 29
(A) IN THIS SECTION , “OMBUDSMAN ” MEANS A CONTINUING CARE IN A 30
RETIREMENT COMMUNITY OMBUDSMAN . 31
HOUSE BILL 1177 7
(B) IF APPLICABLE, THE SECRETARY SHALL APPOI NT A CONTINUING CARE 1
IN A RETIREMENT COMMUNITY OMBUDSMAN FOR EACH CO UNTY. 2
(C) THE OMBUDSMAN SHALL MONITOR THE RIGHTS A ND PROTECTIONS 3
PROVIDED IN THIS PART FOR A SUBSCRIBER OR A POTENTIAL SUBSCRIBER . 4
(D) SUBSCRIBERS AND FAMILY MEMBERS O F SUBSCRIBERS MAY REPORT 5
COMPLAINTS , COMPLIMENTS , AND COMMENTS TO THE OMBUDSMAN FOR THE 6
COUNTY WHERE THE SUB SCRIBER’S RETIREMENT COMMUNI TY FACILITY IS 7
LOCATED. 8
(E) A COMPLAINT, COMPLIMENT , OR COMMENT MADE TO THE OMBUDSMAN 9
IS A PUBLIC RECORD S UBJECT TO TITLE 4 OF THE GENERAL PROVISIONS ARTICLE. 10
(F) THE SECRETARY SHALL ADOPT REGULATIONS TO IMPLEMENT THIS 11
SECTION. 12
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 13
October 1, 2024. 14