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.
Italics indicate opposite chamber/conference committee amendments.
*hb0068*
HOUSE BILL 68
O2, J3 (4lr1289)
ENROLLED BILL
— Health and Government Operations/Finance —
Introduced 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
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at ________________________ o’c lock, ________M.
______________________________________________
Speaker.
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 2 HOUSE BILL 68
certain internal grievances; altering the processes for the termination of a continuing 1
care agreement under certain circumstances; altering the process for refunding 2
certain entrance fees under certain circumstances; requiring a provider to submit 3
certain reports to a subscriber or a subscriber’s beneficiary if the subscriber’s unit 4
has not been reoccupied within certain periods of time; and generally relating to 5
continuing care retirement communities. 6
BY repealing and reenacting, without amendments, 7
Article – Human Services 8
Section 10–101(a), (e), and (h) 9
Annotated Code of Maryland 10
(2019 Replacement Volume and 2023 Supplement) 11
BY adding to 12
Article – Human Services 13
Section 10–401(v) 14
Annotated Code of Maryland 15
(2019 Replacement Volume and 2023 Supplement) 16
BY repealing and reenacting, with amendments, 17
Article – Human Services 18
Section 10–401(v) and (w), 10–408(b)(3), 10–424, 10–426, 10–427, 10–428, and 19
10–449 20
Annotated Code of Maryland 21
(2019 Replacement Volume and 2023 Supplement) 22
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 23
That the Laws of Maryland read as follows: 24
Article – Human Services 25
10–101. 26
(a) In this title the following words have the meanings indicated. 27
(e) “Department” means the Department of Aging. 28
(h) “Secretary” means the Secretary of Aging. 29
10–401. 30
(V) “RESIDENT ASSOCIATION ” INCLUDES A RESIDENT ASSOCIATION OR AN 31
EQUIVALENT BODY . 32
[(v)] (W) “Subscriber” means an individual for whom a continuing care 33
agreement is purchased. 34 HOUSE BILL 68 3
[(w)] (X) (1) “Surcharge” means a separate and additional charge that: 1
(i) is imposed simultaneously with the entrance fee; and 2
(ii) may be required of some, but not all, subscribers because of a 3
condition or circumstance that applies only to those subscribers. 4
(2) “Surcharge” does not include a second person entrance fee. 5
10–408. 6
(b) (3) A capital improvement or replacement that does not meet the standard 7
of [§ 10–401(w)] § 10–401(X) of this subtitle is not subject to review by the Department 8
under §§ 10–409 through 10–415 of this subtitle. 9
10–424. 10
(a) (1) A provider shall give without cost a disclosure statement for each 11
facility for which the provider holds a preliminary, initial, or renewal certificate of 12
registration: 13
(i) to a prospective subscriber before the earlier of payment of any 14
part of the entrance fee or execution of a continuing care agreement; and 15
(ii) annually to any subscriber who requests a disclosure statement. 16
(2) A provider shall submit its initial disclosure statement to the 17
Department for review at least 45 days before giving the statement to any prospective 18
subscriber. 19
(b) (1) A provider shall revise the disclosure statement annually and file it 20
with the Department within 120 days after the end of the provider’s fiscal year. 21
(2) The Department shall review the disclosure statement solely to ensure 22
compliance with § 10–425 of this subtitle. 23
(c) (1) An amended disclosure statement is subject to each requirement of this 24
subtitle. 25
(2) A provider shall file an amended disclosure statement with the 26
Department when it is delivered to a subscriber or prospective subscriber. 27
(D) A PROVIDER SHALL POST THE MOST RECENT DISC LOSURE STATEMENT 28
ON THE PROVIDER ’S WEBSITE. 29
4 HOUSE BILL 68
10–426. 1
(a) At least [once a year] QUARTERLY , each provider shall hold a meeting open 2
to all of the provider’s subscribers. 3
(b) At the [meeting] MEETINGS, an authorized officer of the provider shall: 4
(1) summarize the provider’s operations, significant changes from the 5
previous year, and goals and objectives for the next year; and 6
(2) answer subscribers’ questions. 7
(C) AT THE LAST QUARTERLY MEETING OF THE YEAR , AN AUTHORIZED 8
OFFICER OF THE PROVI DER SHALL PROVIDE AN AGGREGATED , DEIDENTIFIED 9
SUMMARY OF INTERNAL GRIEVANCES SUBMITTED UNDER § 10–428 OF THIS 10
SUBTITLE. 11
10–427. 12
(a) (1) If a provider has a governing body, at least [one] TWO of the provider’s 13
subscribers shall be [a] full and regular [member] MEMBERS of the governing body. 14
(2) If the provider owns or operates [more than three] MULTIPLE facilities 15
in the State, the governing body shall include at least one of the provider’s subscribers [for 16
every three facilities] FROM EACH FACILITY in the State. 17
(3) [Subject to paragraph (4) of this subsection, a] A member of the 18
governing body who is selected to meet the requirements of this subsection shall be a 19
subscriber at a facility in the State and be [selected according to the same general written 20
standards and criteria used to select other members of the governing body] ELECTED BY 21
THE RESIDENT ASSOCIA TION OF THE FACILITY . 22
(4) [The governing body shall confer with the resident association at each 23
of the provider’s facilities before the subscriber officially joins the governing body]. 24
(5) (I) A SUBSCRIBER MEMBER OF A GOVERNING BODY MAY 25
REPORT ON NONCONFIDE NTIAL DELIBERATIONS , ACTIONS, AND POLICIES OF THE 26
GOVERNING BODY TO TH E RESIDENT ASSOCIATI ON. 27
(II) THE GOVERNING BODY IN ITS SOLE BUT REAS ONABLE 28
DISCRETION SHALL DETERMINE WHET HER A MATTER IS CONF IDENTIAL. 29
(5) THE GOVERNING BODY OF EACH OF THE PROVIDER ’S FACILITIES 30
SHALL DIRECT AN OFFI CER OF THE PROVIDER TO MEET AT LEAST QUA RTERLY TO 31
REVIEW AND DISCUSS T HE CURRENT FINANCIAL STATEMENTS OF THE PR OVIDER 32 HOUSE BILL 68 5
WITH THE RESIDENT AS SOCIATION OR A COMMI TTEE DESIGNATED BY T HE RESIDENT 1
ASSOCIATION. 2
(6) The Secretary may waive the requirements of this subsection for a 3
provider in the process of decertifying as a provider, if the Secretary determines that there 4
are no subscribers willing and able to serve on the governing body. 5
(b) (1) If a provider does not have a governing body, the provider shall appoint 6
a select committee of its officers or partners to meet at least [twice a year] QUARTERLY 7
with the resident association at each of its facilities to address concerns of the subscribers 8
and to ensure that the opinions of subscribers are relayed to all officers or partners of the 9
provider. 10
(2) If a facility does not have a resident association, the committee shall 11
meet with a reasonable number of representatives, not required to exceed fifteen, that the 12
subscribers elect. 13
(c) As determined by the provider’s governing body, the provider shall make 14
available to subscribers either the nonconfidential portions of the minutes of each meeting 15
of the governing body or a summary of the nonconfidential portions of the minutes, within 16
1 month of approval of the minutes. 17
10–428. 18
(a) A provider shall establish an internal grievance procedure to address a 19
subscriber’s grievance. 20
(b) The internal grievance procedure shall at least: 21
(1) allow a subscriber or group of subscribers collectively to submit a 22
written grievance to the provider; 23
(2) require the provider to send a written acknowledgment to the 24
subscriber or group of subscribers within 5 days after receipt of the written grievance; 25
(3) require the provider to assign personnel to investigate the grievance; 26
(4) give a subscriber or group of subscribers who file a written grievance 27
the right to meet with management of the provider within 30 days after receipt of the 28
written grievance to present the grievance; and 29
(5) require the provider to respond in writing within 45 days after receipt 30
of the written grievance regarding the investigation and resolution of the grievance. 31
(c) (1) Within 30 days after the conclusion of an internal grievance procedure 32
established under this section, a subscriber, group of subscribers, or provider may seek 33 6 HOUSE BILL 68
mediation through one of the Community Mediation Centers in the State or another 1
mediation provider. 2
(2) If a provider, subscriber, or group of subscribers seeks mediation under 3
paragraph (1) of this subsection, the mediation shall be nonbinding. 4
(D) (1) AT LEAST TWICE EACH Y EAR ON AN ANNU AL BASIS, THE 5
DEPARTMENT SHALL COLL ECT FROM EACH PROVID ER INFORMATION ABOUT 6
INTERNAL GRIEVANCES FILED FOR EACH OF TH E PROVIDER ’S FACILITIES, 7
INCLUDING: 8
(I) THE NUMBER OF INTERN AL GRIEVANCES FILED ; 9
(II) THE SUBJECT MATTER OF EA CH GRIEVANCE FILED 10
AGGREGATED , DEIDENTIFIED SUMMARY OF INTERNAL GRIEVANC ES; 11
(III) WHETHER A GRIEVANCE WENT TO MEDIATION AN D THE 12
OUTCOME OF THE MEDIA TION; AND 13
(IV) THE FINAL DISPOSITIO N OF EACH FILED GRIE VANCE. 14
(2) ON OR BEFORE DECEMBER 1 EACH YEAR, THE DEPARTMENT 15
SHALL REPORT TO THE SENATE FINANCE COMMITTEE AND THE HOUSE HEALTH 16
AND GOVERNMENT OPERATIONS COMMITTEE, IN ACCORDANCE WITH § 2–1257 OF 17
THE STATE GOVERNMENT ARTICLE, ON THE DATA RECEIVED FROM EACH 18
PROVIDER UNDER PARAG RAPH (1) OF THIS SUBSECTION . 19
10–449. 20
(a) A continuing care agreement shall allow a subscriber to terminate the 21
agreement by giving a written termination notice to the provider. 22
[(b) If a continuing care agreement is terminated by the subscriber’s election or 23
death within the first 90 days of occupancy, the provider shall pay any contractual entrance 24
fee refund within 30 days after the earlier to occur of: 25
(1) the recontracting of the subscriber’s unit by: 26
(i) another subscriber for whom an entrance fee has been paid; or 27
(ii) another party who is not a subscriber; or 28
(2) the later to occur of: 29
HOUSE BILL 68 7
(i) the 90th day after the date the written termination notice is 1
given or the date of death; or 2
(ii) the day the independent living units at the facility have operated 3
at 95% of capacity for the previous 6 months. 4
(c) If a continuing care agreement is terminated by the subscriber’s election or 5
death after the first 90 days of occupancy, the provider shall pay any contractual entrance 6
fee refund within 60 days after the subscriber’s death or the effective date of termination, 7
if on the date of death or at any time between the date the written termination notice is 8
given and the effective date of termination: 9
(1) the subscriber resides in a unit at a higher level of care than the level 10
of care in which the subscriber resided on initially entering the facility; and 11
(2) the last unit in which the subscriber resided at the initial level of care 12
on entering the facility has been occupied by or reserved for another subscriber who has 13
paid an entrance fee.] 14
(B) (1) IF A CONTINUING CARE AGREEMENT IS TERMINA TED: 15
(I) BY WRITTEN NOTICE GI VEN BY A SUBSCRIBER , THE 16
TERMINATION DATE OF THE CONTINUING CARE AGREEMENT SHALL BE O N THE DATE 17
ON WHICH THE SUBSCRI BER VACATED THE UNIT AND REMOVED ALL PERSONAL 18
PROPERTY OF THE SUBS CRIBER FROM THE UNIT ; OR 19
(II) ON THE SUBSCRIBER ’S DEATH, THE TERMINATION OF T HE 20
CONTINUING CARE AGRE EMENT SHALL BE EFFEC TIVE ON THE DATE OF THE 21
SUBSCRIBER’S DEATH. 22
(2) WHEN A CONTINUING CAR E AGREEMENT IS TERMINATED BY THE 23
SUBSCRIBER’S ELECTION OR DEATH , THE PROVIDER SHALL P AY ANY CONTRACTUAL 24
ENTRANCE FEE REFUND . 25
(C) (1) IF A CONTINUING CARE AGREEMENT PROVIDES F OR A 26
REFUNDABLE ENTRANCE FEE CONDITIONED ON T HE REOCCUPANCY OR 27
RECONTRACTING OF THE SUBSCRIBER’S UNIT, THE PROVIDER SHALL A SSIGN THE 28
UNIT A SEQUENTIAL RE FUND NUMBER TO DETER MINE THE ORDER OF RE FUNDABLE 29
ENTRANCE FEES TO BE PAID. 30
(2) WHEN A SEQUENTIAL REF UND NUMBER IS ASSIGN ED UNDER 31
PARAGRAPH (1) OF THIS SUBSECTION , THE PROVIDER SHALL R ECORD: 32
(I) THE DATE WHEN THE NU MBER WAS ASSIGNED ; AND 33
8 HOUSE BILL 68
(II) THE NUMBER OF VACATE D AND AVAILABLE UNIT S AT THE 1
FACILITY ON THE DATE THE NUMBER WAS ASSIG NED. 2
(D) (1) EXCEPT AS PROVIDED IN SUBSECTION (E) OF THIS SECTION , 3
BEGINNING 60 DAYS AFTER THE EFFEC TIVE DATE OF TERMINATION OF A 4
CONTINUING CARE AGRE EMENT, THE SUBSCRIBER OR TH E SUBSCRIBER ’S ESTATE 5
SHALL HAVE THE RIGHT TO RECEIVE A REFUND IN THE AMOUNT EQUAL TO ANY 6
ENTRANCE FEE PROVIDE D IN THE CONTINUING CARE AGREEMENT LESS THE 7
AMOUNT OF ANY : 8
(I) UNPAID FEES OR CHARGES INCU RRED BY THE SUBSCRIB ER, 9
INCLUDING MONTHLY SE RVICES FEES; AND 10
(II) CHARITABLE ASSISTANC E PROVIDED BY THE PR OVIDER TO 11
THE SUBSCRIBER . 12
(2) AFTER A CONTINUING CA RE AGREEMENT TERMINA TES, THE 13
BALANCE ESTABLISHED UNDER PARAGRAPH (1) OF THIS SUBSECTION SHAL L BE 14
PAYABLE TO THE SUBSC RIBER OR SUBSCRIBER ’S ESTATE IN THE ORDE R OF THE 15
SEQUENTIAL REFUND NU MBER ASSIGNED UNDER SUBSECTION (C) OF THIS SECTION. 16
(E) NOTWITHSTANDING OTHER PROVISIONS OF LAW , A PROVIDER SHALL 17
PAY THE BALANCE OF A NY CONTRACTUAL ENTRANCE FE E REFUND WITHIN 60 DAYS 18
OF THE TERMINATION D ATE IF ON THE TERMIN ATION DATE A SUBSCRI BER RESIDED 19
IN A UNIT AT A HIGHE R LEVEL OF CARE THAN THE LEVEL OF CARE IN WHICH THE 20
SUBSCRIBER RESIDED W HEN THE SUBSCRIBER I NITIALLY RESIDED AT THE 21
FACILITY. 22
[(d)] (F) This section does not prohibit a provider from requiring that a 23
subscriber’s unit be vacated before any contractual entrance fee refund is paid as a result 24
of the subscriber’s election to terminate a continuing care agreement. 25
(G) (E) EVERY 6 MONTHS, A PROVIDER SHALL SUB MIT TO THE 26
DEPARTMENT A REPORT THAT INCLUDES , FOR THE PRIOR 6 MONTHS: 27
(1) THE NUMBER OF SATISF IED ENTRANCE FEE REF UNDS; 28
(2) THE DOLLAR AMOUNT OF EACH SATISFIED ENTRA NCE FEE 29
REFUND; 30
(3) THE OUTSTANDING SEQU ENTIAL LIST OF ENTRANCE FEE 31
REFUNDS, INCLUDING DOLLAR AMO UNTS DUE; 32
HOUSE BILL 68 9
(4) THE CURRENT PERCENTA GE OF UNITS AT A FAC ILITY THAT ARE 1
OCCUPIED; AND 2
(5) THE AVERAGE LENGTH O F TIME THE PROVIDER TAKES TO 3
CONTRACT OR RECONTRA CT UNITS 4
(1) IF AN ENTRANCE FEE RE FUND IS CONDITIONED ON TH E 5
REOCCUPYING OF A SUB SCRIBER’S UNIT AND THE UNIT HAS NOT BEEN REOCCUP IED 6
WITHIN 9 MONTHS OF THE SUBSCR IBER’S DEATH OR THE DATE OF THE CONTRACT 7
TERMINATION , A PROVIDER SHALL SUB MIT A WRITTEN REPORT TO THE SUBSCRIBER 8
OR THE SUBSCRIBER ’S BENEFICIARY STATING : 9
(I) THAT THE UNIT HAS NO T BEEN REOCCUPIED ; AND 10
(II) THE EFFORTS THE PROV IDER HAS MADE TO REO CCUPY THE 11
UNIT. 12
(2) AFTER THE PROVIDER SU BMITTED THE REPORT R EQUIRED 13
UNDER PARAGRAPH (1) OF THIS SUBSECTION , THE PROVIDER SHALL S UBMIT AN 14
UPDATED WRITTEN REPO RT TO THE SUBSCRIBER OR THE SUBSCRIBER ’S 15
BENEFICIARY EVERY 6 MONTHS UNTIL THE SUB SCRIBER’S UNIT HAS BEEN 16
REOCCUPIED . 17
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall be construed to 18
apply only prospectively and may not be applied or interpreted to have any effect on or 19
application to any cause of action arising before the effective date of this Act. 20
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 21
October 1, 2024. 22
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.