EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb0068*
HOUSE BILL 68
O2, J3 4lr1289
(PRE–FILED) CF SB 76
By: Delegate Stein Delegates Stein, Hill, Feldmark, Alston, Bagnall, Bhandari,
Chisholm, Cullison, Guzzone, Hutchinson, S. Johnson, Kaiser, Kerr, Kipke,
R. Lewis, Lopez, Martinez, M. Morgan, Pena–Melnyk, Reilly, Rosenberg,
Szeliga, Taveras, White Holland, and Woods
Requested: October 30, 2023
Introduced and read first time: January 10, 2024
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 7, 2024
CHAPTER ______
AN ACT concerning 1
Continuing Care Retirement Communities – Governing Bodies Transparency, 2
Grievances, and Entrance Fees Unit Reoccupancy 3
FOR the purpose of altering the membership of governing bodies of continuing care 4
retirement communities by increasing the number of subscribers under certain 5
circumstances requiring a provider to post the provider’s most recent disclosure 6
statement on the provider’s website; altering the number of times select committees 7
of certain providers are required to meet with hold a meeting open to all of the 8
provider’s subscribers each year; requiring an authorized officer of a provider to 9
provide a summary of certain grievance information at certain meetings; authorizing 10
a subscriber member of a governing body to report on certain nonconfidential 11
information; requiring the Department of Aging to collect certain information about 12
certain internal grievances; altering the processes for the termination of a continuing 13
care agreement under certain circumstances; altering the process for refunding 14
certain entrance fees under certain circumstances; requiring a provider to submit 15
certain reports to a subscriber or a subscriber’s beneficiary if the subscriber’s unit 16
has not been reoccupied within certain periods of time; and generally relating to 17
continuing care retirement communities. 18
BY repealing and reenacting, without amendments, 19
Article – Human Services 20 2 HOUSE BILL 68
Section 10–101(a), (e), and (h) 1
Annotated Code of Maryland 2
(2019 Replacement Volume and 2023 Supplement) 3
BY adding to 4
Article – Human Services 5
Section 10–401(v) 6
Annotated Code of Maryland 7
(2019 Replacement Volume and 2023 Supplement) 8
BY repealing and reenacting, with amendments, 9
Article – Human Services 10
Section 10–401(v) and (w), 10–408(b)(3), 10–424, 10–426, 10–427, 10–428, and 11
10–449 12
Annotated Code of Maryland 13
(2019 Replacement Volume and 2023 Supplement) 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Human Services 17
10–101. 18
(a) In this title the following words have the meanings indicated. 19
(e) “Department” means the Department of Aging. 20
(h) “Secretary” means the Secretary of Aging. 21
10–401. 22
(V) “RESIDENT ASSOCIATION ” INCLUDES A RESIDENT ASSOCIATION OR AN 23
EQUIVALENT BODY . 24
[(v)] (W) “Subscriber” means an individual for whom a continuing care 25
agreement is purchased. 26
[(w)] (X) (1) “Surcharge” means a separate and additional charge that: 27
(i) is imposed simultaneously with the entrance fee; and 28
(ii) may be required of some, but not all, subscribers because of a 29
condition or circumstance that applies only to those subscribers. 30
(2) “Surcharge” does not include a second person entrance fee. 31
HOUSE BILL 68 3
10–408. 1
(b) (3) A capital improvement or replacement that does not meet the standard 2
of [§ 10–401(w)] § 10–401(X) of this subtitle is not subject to review by the Department 3
under §§ 10–409 through 10–415 of this subtitle. 4
10–424. 5
(a) (1) A provider shall give without cost a disclosure statement for each 6
facility for which the provider holds a preliminary, initial, or renewal certificate of 7
registration: 8
(i) to a prospective subscriber before the earlier of payment of any 9
part of the entrance fee or execution of a continuing care agreement; and 10
(ii) annually to any subscriber who requests a disclosure statement. 11
(2) A provider shall submit its initial disclosure statement to the 12
Department for review at least 45 days before giving the statement to any prospective 13
subscriber. 14
(b) (1) A provider shall revise the disclosure statement annually and file it 15
with the Department within 120 days after the end of the provider’s fiscal year. 16
(2) The Department shall review the disclosure statement solely to ensure 17
compliance with § 10–425 of this subtitle. 18
(c) (1) An amended disclosure statement is subject to each requirement of this 19
subtitle. 20
(2) A provider shall file an amended disclosure statement with the 21
Department when it is delivered to a subscriber or prospective subscriber. 22
(D) A PROVIDER SHALL POST THE MOST RECENT DISC LOSURE STATEMENT 23
ON THE PROVIDER’S WEBSITE. 24
10–426. 25
(a) At least [once a year] QUARTERLY , each provider shall hold a meeting open 26
to all of the provider’s subscribers. 27
(b) At the [meeting] MEETINGS, an authorized officer of the provider shall: 28
(1) summarize the provider’s operations, significant changes from the 29
previous year, and goals and objectives for the next year; and 30
(2) answer subscribers’ questions. 31 4 HOUSE BILL 68
(C) AT THE LAST QUARTERLY MEETING OF THE YEAR , AN AUTHORIZED 1
OFFICER OF THE PROVI DER SHALL PROVIDE AN AGGREGATED , DEIDENTIFIED 2
SUMMARY OF INTERNAL GRIEVANCES SUBMITTED UNDER § 10–428 OF THIS 3
SUBTITLE. 4
10–427. 5
(a) (1) If a provider has a governing body, at least [one] TWO of the provider’s 6
subscribers shall be [a] full and regular [member] MEMBERS of the governing body. 7
(2) If the provider owns or operates [more than three] MULTIPLE facilities 8
in the State, the governing body shall include at least one of the provider’s subscribers [for 9
every three facilities] FROM EACH FACILITY in the State. 10
(3) [Subject to paragraph (4) of this subsection, a] A member of the 11
governing body who is selected to meet the requirements of this subsection shall be a 12
subscriber at a facility in the State and be [selected according to the same general written 13
standards and criteria used to select other members of the governing body] ELECTED BY 14
THE RESIDENT ASSOCIA TION OF THE FACILITY . 15
(4) [The governing body shall confer with the resident association at each 16
of the provider’s facilities before the subscriber officially joins the governing body]. 17
(5) (I) A SUBSCRIBER MEMBER OF A GOVERNING BODY MAY 18
REPORT ON NONCONFIDE NTIAL DELIBERATIONS , ACTIONS, AND POLICIES OF THE 19
GOVERNING BODY TO TH E RESIDENT ASSOCIATI ON. 20
(II) THE GOVERNING BODY SH ALL DETERMINE WHETHE R A 21
MATTER IS CONFIDENTIAL . 22
(5) THE GOVERNING BODY OF EACH OF THE PROVIDER ’S FACILITIES 23
SHALL DIRECT AN OFFI CER OF THE PROVIDER TO MEET AT LEAST QUA RTERLY TO 24
REVIEW AND DISCUSS T HE CURRENT FINANCIAL STATEMENTS OF THE PR OVIDER 25
WITH THE RESIDENT AS SOCIATION OR A COMMITTEE DESIGNATED BY THE RESIDENT 26
ASSOCIATION. 27
(6) The Secretary may waive the requirements of this subsection for a 28
provider in the process of decertifying as a provider, if the Secretary determines that there 29
are no subscribers willing and able to serve on the governing body. 30
(b) (1) If a provider does not have a governing body, the provider shall appoint 31
a select committee of its officers or partners to meet at least [twice a year] QUARTERLY 32
with the resident association at each of its facilities to address concerns of the subscribers 33 HOUSE BILL 68 5
and to ensure that the opinions of subscribers are relayed to all officers or partners of the 1
provider. 2
(2) If a facility does not have a resident association, the committee shall 3
meet with a reasonable number of representatives, not required to exceed fifteen, that the 4
subscribers elect. 5
(c) As determined by the provider’s governing body, the provider shall make 6
available to subscribers either the nonconfidential portions of the minutes of each meeting 7
of the governing body or a summary of the nonconfidential portions of the minutes, within 8
1 month of approval of the minutes. 9
10–428. 10
(a) A provider shall establish an internal grievance procedure to address a 11
subscriber’s grievance. 12
(b) The internal grievance procedure shall at least: 13
(1) allow a subscriber or group of subscribers collectively to submit a 14
written grievance to the provider; 15
(2) require the provider to send a written acknowledgment to the 16
subscriber or group of subscribers within 5 days after receipt of the written grievance; 17
(3) require the provider to assign personnel to investigate the grievance; 18
(4) give a subscriber or group of subscribers who file a written grievance 19
the right to meet with management of the provider within 30 days after receipt of the 20
written grievance to present the grievance; and 21
(5) require the provider to respond in writing within 45 days after receipt 22
of the written grievance regarding the investigation and resolution of the grievance. 23
(c) (1) Within 30 days after the conclusion of an internal grievance procedure 24
established under this section, a subscriber, group of subscribers, or provider may seek 25
mediation through one of the Community Mediation Centers in the State or another 26
mediation provider. 27
(2) If a provider, subscriber, or group of subscribers seeks mediation under 28
paragraph (1) of this subsection, the mediation shall be nonbinding. 29
(D) (1) AT LEAST TWICE EACH Y EAR ON AN ANNUAL BASIS , THE 30
DEPARTMENT SHALL COLL ECT FROM EACH PROVID ER INFORMAT ION ABOUT 31
INTERNAL GRIEVANCES FILED FOR EACH OF TH E PROVIDER ’S FACILITIES, 32
INCLUDING: 33
6 HOUSE BILL 68
(I) THE NUMBER OF INTERN AL GRIEVANCES FILED ; 1
(II) THE SUBJECT MATTER OF EA CH GRIEVANCE FILED 2
AGGREGATED , DEIDENTIFIED SUMMARY OF INTERNAL GRIEVANC ES; 3
(III) WHETHER A GRIEVANCE WENT TO MEDIATION AN D THE 4
OUTCOME OF THE MEDIA TION; AND 5
(IV) THE FINAL DISPOSITIO N OF EACH FILED GRIE VANCE. 6
(2) ON OR BEFORE DECEMBER 1 EACH YEAR, THE DEPARTMENT 7
SHALL REPORT TO THE SENATE FINANCE COMMITTEE AND THE HOUSE HEALTH 8
AND GOVERNMENT OPERATIONS COMMITTEE, IN ACCORDANCE WITH § 2–1257 OF 9
THE STATE GOVERNMENT ARTICLE, ON THE DATA RECEIVED FROM EACH 10
PROVIDER UNDER PARAG RAPH (1) OF THIS SUBSECTION . 11
10–449. 12
(a) A continuing care agreement shall allow a subscriber to terminate the 13
agreement by giving a written termination notice to the provider. 14
[(b) If a continuing care agreement is terminated by the subscriber’s election or 15
death within the first 90 days of occupancy, the provider shall pay any contractual entrance 16
fee refund within 30 days after the earlier to occur of: 17
(1) the recontracting of the subscriber’s unit by: 18
(i) another subscriber for whom an entrance fee has been paid; or 19
(ii) another party who is not a subscriber; or 20
(2) the later to occur of: 21
(i) the 90th day after the date the written termination notice is 22
given or the date of death; or 23
(ii) the day the independent living units at the facility have operated 24
at 95% of capacity for the previous 6 months. 25
(c) If a continuing care agreement is terminated by the subscriber’s election or 26
death after the first 90 days of occupancy, the provider shall pay any contractual entrance 27
fee refund within 60 days after the subscriber’s death or the effective date of termination, 28
if on the date of death or at any time between the date the written termination notice is 29
given and the effective date of termination: 30
HOUSE BILL 68 7
(1) the subscriber resides in a unit at a higher level of care than the level 1
of care in which the subscriber resided on initially entering the facility; and 2
(2) the last unit in which the subscriber resided at the initial level of care 3
on entering the facility has been occupied by or reserved for another subscriber who has 4
paid an entrance fee.] 5
(B) (1) IF A CONTINUING CARE AGREEMENT IS TERMINATED : 6
(I) BY WRITTEN NOTICE GI VEN BY A SUBSCRIBER , THE 7
TERMINATION DATE OF THE CONTINUING CARE AGREEMENT SHALL BE O N THE DATE 8
ON WHICH THE SUBSCRI BER VACATED THE UNIT AND REMOVED ALL PERS ONAL 9
PROPERTY OF THE SUBS CRIBER FROM THE UNIT ; OR 10
(II) ON THE SUBSCRIBER ’S DEATH, THE TERMINATION OF T HE 11
CONTINUING CARE AGRE EMENT SHALL BE EFFEC TIVE ON THE DATE OF THE 12
SUBSCRIBER’S DEATH. 13
(2) WHEN A CONTINUING CAR E AGREEMENT IS TERMI NATED BY THE 14
SUBSCRIBER’S ELECTION OR DEATH , THE PROVIDER SHALL P AY ANY CONTRACTUAL 15
ENTRANCE FEE REFUND . 16
(C) (1) IF A CONTINUING CARE AGREEMENT PROVIDES F OR A 17
REFUNDABLE ENTRANCE FEE CONDITIONED ON T HE REOCCUPANCY OR 18
RECONTRACTING OF THE SUBSCRIBER’S UNIT, THE PROVIDER SHALL A SSIGN THE 19
UNIT A SEQUENTIAL RE FUND NUMBER TO DETERMINE THE ORDER OF REFUNDABLE 20
ENTRANCE FEES TO BE PAID. 21
(2) WHEN A SEQUENTIAL REF UND NUMBER IS ASSIGN ED UNDER 22
PARAGRAPH (1) OF THIS SUBSECTION , THE PROVIDER SHALL R ECORD: 23
(I) THE DATE WHEN THE NU MBER WAS ASSIGNED ; AND 24
(II) THE NUMBER OF VACATED AND AVAILABL E UNITS AT THE 25
FACILITY ON THE DATE THE NUMBER WAS ASSIG NED. 26
(D) (1) EXCEPT AS PROVIDED IN SUBSECTION (E) OF THIS SECTION , 27
BEGINNING 60 DAYS AFTER THE EFFEC TIVE DATE OF TERMINA TION OF A 28
CONTINUING CARE AGRE EMENT, THE SUBSCRIBER OR TH E SUBSCRIBER’S ESTATE 29
SHALL HAVE THE RIGHT TO RECEIVE A REFUND IN THE AMOUNT EQUAL TO ANY 30
ENTRANCE FEE PROVIDE D IN THE CONTINUING CARE AGREEMENT LESS THE 31
AMOUNT OF ANY : 32
8 HOUSE BILL 68
(I) UNPAID FEES OR CHARG ES INCURRED BY THE S UBSCRIBER, 1
INCLUDING MONTHLY SE RVICES FEES; AND 2
(II) CHARITABLE ASSISTANC E PROVIDED BY THE PR OVIDER TO 3
THE SUBSCRIBER . 4
(2) AFTER A CONTINUING CA RE AGREEMENT TERMINA TES, THE 5
BALANCE ESTABLISHED UNDER PARAGRAPH (1) OF THIS SUBSECTION S HALL BE 6
PAYABLE TO THE SUBSC RIBER OR SUBSCRIBER ’S ESTATE IN THE ORDER OF T HE 7
SEQUENTIAL REFUND NU MBER ASSIGNED UNDER SUBSECTION (C) OF THIS SECTION. 8
(E) NOTWITHSTANDING OTHER PROVISIONS OF LAW , A PROVIDER SHALL 9
PAY THE BALANCE OF A NY CONTRACTUAL ENTRA NCE FEE REFUND WITHI N 60 DAYS 10
OF THE TERMINATION D ATE IF ON THE TERMINATION D ATE A SUBSCRIBER RES IDED 11
IN A UNIT AT A HIGHE R LEVEL OF CARE THAN THE LEVEL OF CARE IN WHICH THE 12
SUBSCRIBER RESIDED W HEN THE SUBSCRIBER I NITIALLY RESIDED AT THE 13
FACILITY. 14
[(d)] (F) This section does not prohibit a provider from requiring that a 15
subscriber’s unit be vacated before any contractual entrance fee refund is paid as a result 16
of the subscriber’s election to terminate a continuing care agreement. 17
(G) (E) EVERY 6 MONTHS, A PROVIDER SHALL SUB MIT TO THE 18
DEPARTMENT A REPORT THAT INCLUDES, FOR THE PRIOR 6 MONTHS: 19
(1) THE NUMBER OF SATISF IED ENTRANCE FEE REF UNDS; 20
(2) THE DOLLAR AMOUNT OF EACH SATISFIED ENTRA NCE FEE 21
REFUND; 22
(3) THE OUTSTANDING SEQU ENTIAL LIST OF ENTRA NCE FEE 23
REFUNDS, INCLUDING DOLLAR AMO UNTS DUE; 24
(4) THE CURRENT PERCENTAGE O F UNITS AT A FACILIT Y THAT ARE 25
OCCUPIED; AND 26
(5) THE AVERAGE LENGTH O F TIME THE PROVIDER TAKES TO 27
CONTRACT OR RECONTRA CT UNITS 28
(1) IF AN ENTRANCE FEE RE FUND IS CONDITIONED ON THE 29
REOCCUPYING OF A SUB SCRIBER’S UNIT AND THE UNIT HAS NOT BEEN REOCCUP IED 30
WITHIN 9 MONTHS OF THE SUBSCR IBER’S DEATH OR THE DATE OF THE CONTRACT 31
TERMINATION , A PROVIDER SHALL SUB MIT A WRITTEN REPORT TO THE SUBSCRIBER 32
OR THE SUBSCRIBER ’S BENEFICIARY STATIN G: 33 HOUSE BILL 68 9
(I) THAT THE UNIT HAS NO T BEEN REOCCUPIED ; AND 1
(II) THE EFFORTS THE PROV IDER HAS MADE TO REO CCUPY THE 2
UNIT. 3
(2) AFTER THE PROVIDER SU BMITTED THE REPORT R EQUIRED 4
UNDER PARAGRAPH (1) OF THIS SUBSECTION , THE PROVIDER SHALL S UBMIT AN 5
UPDATED WRITTEN REPO RT TO THE SUBSCRIBER OR THE SUBSCRIBER ’S 6
BENEFICIARY EVERY 6 MONTHS UNTIL THE SUB SCRIBER’S UNIT HAS BEEN 7
REOCCUPIED . 8
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall be construed to 9
apply only prospectively and may not be applied or interpreted to have any effect on or 10
application to any cause of action arising before the effective date of this Act. 11
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 12
October 1, 2024. 13
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.