WES MOORE, Governor Ch. 257
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Chapter 257
(Senate Bill 76)
AN ACT concerning
Continuing Care Retirement Communities – Governing Bodies Transparency,
Grievances, and Entrance Fees Unit Reoccupancy
FOR the purpose of altering the membership of governing bodies of continuing care
retirement communities by increasing the number of subscribers under certain
circumstances requiring a provider to post the provider’s most recent disclosure
statement on the provider’s website; altering the number of times select committees
of certain providers are required to meet with hold a meeting open to all of the
provider’s subscribers each year; requiring an authorized officer of a provider to
provide a summary of certain grievance information at certain meetings; authorizing
a subscriber member of a governing body to report on certain nonconfidential
information; requiring the Department of Aging to collect certain information about
certain internal grievances; altering the processes for the termination of a continuing
care agreement under certain circumstances; altering the process for refunding
certain entrance fees under certain circumstances; requiring a provider to submit
certain reports to a subscriber or a subscriber’s beneficiary if the subscriber’s unit
has not been reoccupied within certain periods of time; and generally relating to
continuing care retirement communities.
BY repealing and reenacting, without amendments,
Article – Human Services
Section 10–101(a), (e), and (h)
Annotated Code of Maryland
(2019 Replacement Volume and 2023 Supplement)
BY adding to
Article – Human Services
Section 10–401(v)
Annotated Code of Maryland
(2019 Replacement Volume and 2023 Supplement)
BY repealing and reenacting, with amendments,
Article – Human Services
Section 10–401(v) and (w), 10–408(b)(3), 10–424, 10–426, 10–427, 10–428, and
10–449
Annotated Code of Maryland
(2019 Replacement Volume and 2023 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEM BLY OF MARYLAND,
That the Laws of Maryland read as follows:
Ch. 257 2024 LAWS OF MARYLAND
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Article – Human Services
10–101.
(a) In this title the following words have the meanings indicated.
(e) “Department” means the Department of Aging.
(h) “Secretary” means the Secretary of Aging.
10–401.
(V) “RESIDENT ASSOCIATION ” INCLUDES A RESIDENT ASSOCIATION OR AN
EQUIVALENT BODY .
[(v)] (W) “Subscriber” means an individual for whom a continuing care
agreement is purchased.
[(w)] (X) (1) “Surcharge” means a separate and additional charge that:
(i) is imposed simultaneously with the entrance fee; and
(ii) may be required of some, but not all, subscribers because of a
condition or circumstance that applies only to those subscribers.
(2) “Surcharge” does not include a second person entrance fee.
10–408.
(b) (3) A capital improvement or replacement that does not meet the standard
of [§ 10–401(w)] § 10–401(X) of this subtitle is not subject to review by the Department
under §§ 10–409 through 10–415 of this subtitle.
10–424.
(a) (1) A provider shall give without cost a disclosure statement for each
facility for which the provider holds a preliminary, initial, or renewal certificate of
registration:
(i) to a prospective subscriber before the earlier of payment of any
part of the entrance fee or execution of a continuing care agreement; and
(ii) annually to any subscriber who requests a disclosure statement.
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(2) A provider shall submit its initial disclosure statement to the
Department for review at least 45 days before giving the statement to any prospective
subscriber.
(b) (1) A provider shall revise the disclosure statement annually and file it
with the Department within 120 days after the end of the provider’s fiscal year.
(2) The Department shall review the disclosure statement solely to ensure
compliance with § 10–425 of this subtitle.
(c) (1) An amended disclosure statement is subject to each requirement of this
subtitle.
(2) A provider shall file an amended disclosure statement with the
Department when it is delivered to a subscriber or prospective subscriber.
(D) A PROVIDER SHALL POST THE MOST RECENT DISC LOSURE STATEMENT
ON THE PROVIDER ’S WEBSITE.
10–426.
(a) At least [once a year] QUARTERLY , each provider shall hold a meeting open
to all of the provider’s subscribers.
(b) At the [meeting] MEETINGS, an authorized officer of the provider shall:
(1) summarize the provider’s operations, significant changes from the
previous year, and goals and objectives for the next year; and
(2) answer subscribers’ questions.
(C) AT THE LAST QUARTERLY MEETING OF THE YEAR , AN AUTHORIZED
OFFICER OF THE PROVI DER SHALL PROVIDE AN AGGREGATED , DEIDENTIFIED
SUMMARY OF INTERNAL GRIEVANCES SUBMITTED UNDER § 10–428 OF THIS
SUBTITLE.
10–427.
(a) (1) If a provider has a governing body, at least [one] TWO of the provider’s
subscribers shall be [a] full and regular [member] MEMBERS of the governing body.
(2) If the provider owns or operates [more than three] MULTIPLE facilities
in the State, the governing body shall include at least one of the provider’s subscribers [for
every three facilities] FROM EACH FACILITY in the State.
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(3) [Subject to paragraph (4) of this subsection, a] A member of the
governing body who is selected to meet the requirements of this subsection shall be a
subscriber at a facility in the State and be [selected according to the same general written
standards and criteria used to select other members of the governing body] ELECTED BY
THE RESIDENT ASSOCIA TION OF THE FACILITY .
(4) [The governing body shall confer with the resident association at each
of the provider’s facilities before the subscriber officially joins the governing body].
(5) (I) A SUBSCRIBER MEMBER OF A GOVERNING BODY MAY
REPORT ON NONCONFIDE NTIAL DELIBERATIO NS, ACTIONS, AND POLICIES OF THE
GOVERNING BODY TO TH E RESIDENT ASSOCIATI ON.
(II) THE GOVERNING BODY IN ITS SOLE BUT REASONA BLE
DISCRETION SHALL DET ERMINE WHETHER A MAT TER IS CONFIDENTIAL .
(5) THE GOVERNING BODY OF EACH OF THE PROVIDER ’S FACILITIES
SHALL DIRECT AN OFFI CER OF THE PROVIDER TO MEET AT LEAST QUA RTERLY TO
REVIEW AND DISCUSS T HE CURRENT FINANCIAL STATEMENTS OF THE PR OVIDER
WITH THE RESIDENT AS SOCIATION OR A COMMI TTEE DESIGNATED BY T HE RESIDENT
ASSOCIATION.
(6) The Secretary may waive the requirements of this subsection for a
provider in the process of decertifying as a provider, if the Secretary determines that there
are no subscribers willing and able to serve on the governing body.
(b) (1) If a provider does not have a governing body, the provider shall appoint
a select committee of its officers or partners to meet at least [twice a year] QUARTERLY
with the resident association at each of its facilities to address concerns of the subscribers
and to ensure that the opinions of subscribers are relayed to all officers or partners of the
provider.
(2) If a facility does not have a resident association, the committee shall
meet with a reasonable number of representatives, not required to exceed fifteen, that the
subscribers elect.
(c) As determined by the provider’s governing body, the provider shall make
available to subscribers either the nonconfidential portions of the minutes of each meeting
of the governing body or a summary of the nonconfidential portions of the minutes, within
1 month of approval of the minutes.
10–428.
(a) A provider shall establish an internal grievance procedure to address a
subscriber’s grievance. WES MOORE, Governor Ch. 257
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(b) The internal grievance procedure shall at least:
(1) allow a subscriber or group of subscribers collectively to submit a
written grievance to the provider;
(2) require the provider to send a written acknowledgment to the
subscriber or group of subscribers within 5 days after receipt of the written grievance;
(3) require the provider to assign personnel to investigate the grievance;
(4) give a subscriber or group of subscribers who file a written grievance
the right to meet with management of the provider within 30 days after receipt of the
written grievance to present the grievance; and
(5) require the provider to respond in writing within 45 days after receipt
of the written grievance regarding the investigation and resolution of the grievance.
(c) (1) Within 30 days after the conclusion of an internal grievance procedure
established under this section, a subscriber, group of subscribers, or provider may seek
mediation through one of the Community Mediation Centers in the State or another
mediation provider.
(2) If a provider, subscriber, or group of subscribers seeks mediation under
paragraph (1) of this subsection, the mediation shall be nonbinding.
(D) (1) AT LEAST TWICE EACH Y EAR ON AN ANNUAL BASIS , THE
DEPARTMENT SHALL COLL ECT FROM EACH PROVID ER INFORMATION ABOUT
INTERNAL GRIEVANCES FILED FOR EACH OF TH E PROVIDER ’S FACILITIES,
INCLUDING:
(I) THE NUMBER OF INTERN AL GRIEVANCES FILED ;
(II) THE SUBJECT MATTER OF EA CH GRIEVANCE FILED
AGGREGATED , DEIDENTIFIED SUMMARY OF INTERNAL GRIEVANC ES;
(III) WHETHER A GRIEVANCE WENT TO MEDIATION AN D THE
OUTCOME OF THE MEDIA TION; AND
(IV) THE FINAL DISPOSITIO N OF EACH FILED GRIE VANCE.
(2) ON OR BEFORE DECEMBER 1 EACH YEAR, THE DEPARTMENT
SHALL REPORT TO THE SENATE FINANCE COMMITTEE AND THE HOUSE HEALTH
AND GOVERNMENT OPERATIONS COMMITTEE, IN ACCORDANCE WITH § 2–1257 OF Ch. 257 2024 LAWS OF MARYLAND
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THE STATE GOVERNMENT ARTICLE, ON THE DATA RECEIVED FROM EACH
PROVIDER UNDER PARAG RAPH (1) OF THIS SUBSECTION .
10–449.
(a) A continuing care agreement shall allow a subscriber to terminate the
agreement by giving a written termination notice to the provider.
[(b) If a continuing care agreement is terminated by the subscriber’s election or
death within the first 90 days of occupancy, the provider shall pay any contractual entrance
fee refund within 30 days after the earlier to occur of:
(1) the recontracting of the subscriber’s unit by:
(i) another subscriber for whom an entrance fee has been paid; or
(ii) another party who is not a subscriber; or
(2) the later to occur of:
(i) the 90th day after the date the written termination notice is
given or the date of death; or
(ii) the day the independent living units at the facility have operated
at 95% of capacity for the previous 6 months.
(c) If a continuing care agreement is terminated by the subscriber’s election or
death after the first 90 days of occupancy, the provider shall pay any contractual entrance
fee refund within 60 days after the subscriber’s death or the effective date of termination,
if on the date of death or at any time between the date the written termination notice is
given and the effective date of termination:
(1) the subscriber resides in a unit at a higher level of care than the level
of care in which the subscriber resided on initially entering the facility; and
(2) the last unit in which the subscriber resided at the initial level of care
on entering the facility has been occupied by or reserved for another subscriber who has
paid an entrance fee.]
(B) (1) IF A CONTINUING CARE AGREEMENT IS TERMINA TED:
(I) BY WRITTEN NOTICE GI VEN BY A SUBSCRIBER , THE
TERMINATION DATE OF THE CONTINUI NG CARE AGREEMENT SH ALL BE ON THE DATE
ON WHICH THE SUBSCRI BER VACATED THE UNIT AND REMOVED ALL PERS ONAL
PROPERTY OF THE SUBS CRIBER FROM THE UNIT ; OR WES MOORE, Governor Ch. 257
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(II) ON THE SUBSCRIBER ’S DEATH, THE TERMINATION OF T HE
CONTINUING CARE AGRE EMENT SHALL BE EFFECTIVE ON THE DATE OF THE
SUBSCRIBER’S DEATH.
(2) WHEN A CONTINUING CAR E AGREEMENT IS TERMI NATED BY THE
SUBSCRIBER’S ELECTION OR DEATH , THE PROVIDER SHALL P AY ANY CONTRACTUAL
ENTRANCE FEE REFUND .
(C) (1) IF A CONTINUING CARE AGREEMENT PROVIDES FOR A
REFUNDABLE ENTRANCE FEE CONDITIONED ON T HE REOCCUPANCY OR
RECONTRACTING OF THE SUBSCRIBER’S UNIT, THE PROVIDER SHALL A SSIGN THE
UNIT A SEQUENTIAL RE FUND NUMBER TO DETER MINE THE ORDER OF RE FUNDABLE
ENTRANCE FEES TO BE PAID.
(2) WHEN A SEQU ENTIAL REFUND NUMBER IS ASSIGNED UNDER
PARAGRAPH (1) OF THIS SUBSECTION , THE PROVIDER SHALL R ECORD:
(I) THE DATE WHEN THE NU MBER WAS ASSIGNED ; AND
(II) THE NUMBER OF VACATE D AND AVAILABLE UNIT S AT THE
FACILITY ON THE DATE THE NUMBER WAS ASSIG NED.
(D) (1) EXCEPT AS PROVIDED IN SUBSECTION (E) OF THIS SECTION ,
BEGINNING 60 DAYS AFTER THE EFFEC TIVE DATE OF TERMINA TION OF A
CONTINUING CARE AGRE EMENT, THE SUBSCRIBER OR TH E SUBSCRIBER ’S ESTATE
SHALL HAVE THE RIGHT TO RECEIVE A REFUND IN THE AMOUNT EQUAL TO ANY
ENTRANCE FEE PROVIDE D IN THE CONTINUING CARE AGREEMENT LESS THE
AMOUNT OF ANY :
(I) UNPAID FEES OR CHARG ES INCURRED BY THE S UBSCRIBER,
INCLUDING MONTHLY SE RVICES FEES; AND
(II) CHARITABLE ASSISTANC E PROVIDED BY THE PR OVIDER TO
THE SUBSCRIBER .
(2) AFTER A CONTINUING CA RE AGREEMENT TERMINA TES, THE
BALANCE ESTABLISHED UNDER PARAGRAPH (1) OF THIS SUBSECTION S HALL BE
PAYABLE TO THE SUBSC RIBER OR SUBSCRIBER ’S ESTATE IN THE ORDE R OF THE
SEQUENTIAL REFUND NU MBER ASSIGNED UNDER SUBSECTION (C) OF THIS SECTION.
(E) NOTWITHSTANDING OTHER PROVISIONS OF LAW , A PROVIDER SHALL
PAY THE BALANCE OF A NY CONTRACTUAL ENTRA NCE FEE REFUND WITHI N 60 DAYS
OF THE TERMINATION D ATE IF ON THE TERMIN ATION DATE A SUBSCRI BER RESIDED Ch. 257 2024 LAWS OF MARYLAND
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IN A UNIT AT A HIGHE R LEVEL OF CARE THA N THE LEVEL OF CARE IN WHICH THE
SUBSCRIBER RESIDED W HEN THE SUBSCRIBER I NITIALLY RESIDED AT THE
FACILITY.
[(d)] (F) This section does not prohibit a provider from requiring that a
subscriber’s unit be vacated before any contractual entrance fee refund is paid as a result
of the subscriber’s election to terminate a continuing care agreement.
(G) (E) EVERY 6 MONTHS, A PROVIDER SHALL SUB MIT TO THE
DEPARTMENT A REPORT THAT INCLUDES , FOR THE PRIOR 6 MONTHS:
(1) THE NUMBER OF SATISF IED ENTRANCE FEE REFUNDS;
(2) THE DOLLAR AMOUNT OF EACH SATISFIED ENTRA NCE FEE
REFUND;
(3) THE OUTSTANDING SEQU ENTIAL LIST OF ENTRA NCE FEE
REFUNDS, INCLUDING DOLLAR AMO UNTS DUE;
(4) THE CURRENT PERCENTA GE OF UNITS AT A FAC ILITY THAT ARE
OCCUPIED; AND
(5) THE AVERAGE LENGTH OF TIME THE PROVIDER TAKES T O
CONTRACT OR RECONTRA CT UNITS
(1) IF AN ENTRANCE FEE RE FUND IS CONDITIONED ON THE
REOCCUPYING OF A SUB SCRIBER’S UNIT AND THE UNIT HAS NOT BEEN REOCCUP IED
WITHIN 9 MONTHS OF THE SUBSCR IBER’S DEATH OR THE DATE OF THE CONTRACT
TERMINATION , A PROVIDER SHALL SUB MIT A WRITTEN REPORT TO THE SUBSCRIBER
OR THE SUBSCRIBER ’S BENEFICIARY STATIN G:
(I) THAT THE UNIT HAS NO T BEEN REOCCUPIED ; AND
(II) THE EFFORTS THE PROV IDER HAS MADE TO REO CCUPY THE
UNIT.
(2) AFTER THE PROVIDER SUBMITT ED THE REPORT REQUIR ED
UNDER PARAGRAPH (1) OF THIS SUBSECTION , THE PROVIDER SHALL S UBMIT AN
UPDATED WRITTEN REPO RT TO THE SUBSCRIBER OR THE SUBSCRIBER ’S
BENEFICIARY EVERY 6 MONTHS UNTIL THE SUB SCRIBER’S UNIT HAS BEEN
REOCCUPIED .
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SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall be construed to
apply only prospectively and may not be applied or interpreted to have any effect on or
application to any cause of action arising before the effective date of this Act.
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2024.
Approved by the Governor, April 25, 2024.