MaCCRA Brief History – Legislation of Note

1996 Session of the Maryland General Assembly:

MaCCRA in collaboration with MANPHA (CCRC Management Membership Association prior to becoming LifeSpan), the Department of Aging, and consumers developed amendments to Article 70B. This legislation, Senate Bill 543 (Senator Hoffman, et al) “Continuing Care Contracts” [Passed into Law] is an important achievement as it established requirements concerning the following: the operating reserve, governance, disclosure statement, transfer of assets, change of ownership, bankruptcy, renovations and expansions.

1998 Session of the Maryland General Assembly:

MaCCRA supported House Bill 269/Senate Bill 176 – “State Government – Department of Aging” [passed into law]. Removed the Office on Aging from the Executive Department and created the Department of Aging as a principal department of the State government.

2001 Session of the Maryland General Assembly:

MaCCRA supported House Bill 472 (Del. Hammen) “Continuing Care Agreements – Designation of a Beneficiary – Entrance Fee” [Passed Into Law] which requires a continuing care agreement to be in a form acceptable to the Department of Aging (DOA), and include a provision allowing a subscriber (resident) to designate a beneficiary for receipt of any refundable portion of the facility’s entrance fee upon the subscriber’s death. The designation must be: (1) made in writing; (2) witnessed by two or more competent witnesses; (3) noncontingent; and (4) specified in percentages to account for 100% of the refund due.

2002 Session of the Maryland General Assembly:

MaCCRA supported Senate Bill 355 (Chairman, Finance Committee) “Department of Aging – Continuing Care Retirement Communities – Regulation” [Passed into Law] adopts recommendations made by the Department of Aging’s Continuing Care Advisory Committee. It broadens the health-related services CCRCs must provide and what it means to make medical and nursing services or other health related services available to subscribers. Health related services must include priority admission to a nursing home or assisted living program, or assistance in daily living activities that do not include meals. Making available either medical and nursing services or other health related services means the provider or affiliate has the services readily accessible for subscribers whether or not the services are specifically offered in the written agreement for shelter.

The bill also enables people to receive refunds from CCRCs more quickly if they move out within the first 90 days. It also requires providers to refund an individual’s entrance fee within 60 days of an agreement being terminated or the individual’s death under certain circumstances. An entrance fee is defined as a sum of money or other consideration, other than a surcharge, paid that assures continuing care for more than one year or for life and is at least three times the weighted average of the monthly cost of periodic fees charged for independent and assisted living units.

The bill requires CCRCs to include at least one resident on its governing board. If the provider owns or operates more than three CCRCs in the State, there must be at least one resident on the governing board for every three facilities.

The Department of Aging (MDoA) may petition for the appointment of a receiver for a CCRC if the department has determined that there is a significant risk of the provider’s financial failure. In addition, CCRCs will have a more flexible time frame to fund their operating reserves. CCRCs will have up to ten fiscal years after the later of October 1, 1996 or the date of the CCRC’s initial certificate of registration to set aside operating reserves for each facility that equal 15% of the net operating expenses for the most recent fiscal year a certified financial statement is available.

MDoA may impose a civil penalty of up to $5,000 per violation for any action or inaction that violates the bill’s provisions or related regulations. Before imposing the penalty, MdoA must give a violation notice to the provider. CCRCs will have the right to appeal the penalty under the Administrative Procedure Act. All money collected from penalties must be deposited into the general fund.

2003 Session of the Maryland General Assembly:

*MaCCRA supported the introduction of House Bill 79 (Delegate V. Clagett) /Senate Bill 127 (Senator Astle) “Task Force to Study Continuing Care Retirement Communities “ [Did Not Pass]. The intent of the legislation was to address key areas of concern still left unresolved from the 2002 Session and Senate Bill 355. This bill would have created a seven-member Task Force to Study Continuing Care Retirement Communities. The task force would have investigated and made recommendations concerning licensing requirements for executive directors, residents’ representation on the communities’ governing body subcommittees, residents’ shareholder rights in the corporations operating the communities, and making the resident association executive board as a standing committee of the communities’ governing body. The task force also would have investigated communities’ admissions criteria, any notice residents receive about the substantial financial impact of programs, mediation proceedings between communities’ governing bodies and residents, and the expansion of the Department of Aging Long Term Care Ombudsman program to include continuing care retirement community issues. Even though the bills did not pass, MaCCRA testimony raised awareness among the legislators off some of the concerns of CCRC residents.

2004 Session of the Maryland General Assembly:

*MaCCRA supported introduction of House Bill 1001 (Delegate Goldwater, et al)/ Senate Bill 785 (Senator Klausmeier) “Continuing Care Facilities – Internal Grievance Procedure” [Passed into law]. This bill requires a continuing care facility to establish an internal grievance procedure for addressing complaints. A facility must include in its disclosure statement to the Maryland Department of Aging (MDoA) a description of its internal grievance procedure. Each agreement executed between a subscriber and a provider must state that there is an internal grievance procedure to investigate subscribers’ grievances. The law went into effect October 1, 2004.

2006Session of the Maryland General Assembly:

*MaCCRA supported introduction of Senate Bill 103 (Chairman, Finance Committee – By Request Department of Aging) – “Continuing Care Contracts” [Passed into Law] This departmental bill makes various changes to the statute authorizing Department of Aging to regulate continuing care contracts. It also expanded the grievance procedure to include the following 2 requirements:

(1) a provider must respond in writing within five days after receiving a subscriber’s written grievance, and

(2) the subscriber who files a written grievance has the right to a meeting with management within 45 days after the provider receives the written grievance

2008 Session of the Maryland General Assembly:

*MaCCRA supported introduction of House Bill 1351 – “Continuing Care Retirement Communities – Subscriber Grievances” [Passed into Law] The original provisions of the bill included a series of step by step guidelines guaranteeing both management and resident attention to a grievance, an external channel of appeal allowing CCRC residents to take their grievance outside of the facility to the Attorney General’s office if necessary, and a requirement that CCRC providers submit, on a quarterly basis, the number and nature of grievances and any provider action taken as a result of them to the Department of Aging and the Health Education and Advocacy Unit of the Attorney General’s Office.

The bill was amended in the Health and Government Operations Committee, and as passed the General Assembly it required: continuing care retirement communities, by December 1, 2008, to submit to the Department of Aging and the Health Education and Advocacy Unit in the Office of the Attorney General: (1) the number of written grievances submitted during calendar 2007, (2) a brief summary of each grievance filed using non individually identifiable information, and (3) any action taken by the provider regarding the resolution of each grievance.

2009 Session of the Maryland General Assembly:

*MaCCRA supported introduction of House Bill 843 (Del. Mary Ann Love, et al) “Continuing Care Retirement Communities – Internal Grievance Procedure and Mediation” [Passed into Law]. This bill expands the components that must be included in a continuing care retirement community’s (CCRC) internal grievance procedure. CCRC internal grievance procedures must at least allow a subscriber or group of subscribers collectively to submit a written complaint; require the provider to assign personnel to investigate the grievance; and give a subscriber the right to meet with management within 30, rather than 45, days after submission of a written grievance. The bill also authorizes subscribers and providers to seek mediation within 30 days after the conclusion of an internal grievance procedure. The mediation must be nonbinding, and the provider and subscriber may not be represented by counsel.

2010-12 Sessions of the Maryland General Assembly:

In 2010 The Secretary of Aging reconvened the Continuing Care Advisory Committee (CCAC) to conduct a thorough review of current regulations and statutes concerning continuing care retirement communities, and to make recommendations regarding changes that need to be made to the regulations and/or statutes. The CCAC is made up of representatives from the Department of Aging, the legislature, the CCRC management companies, elder law, and consumers. MaCCRA had two representatives in addition to 2 other residents on the CCAC. In 2011 the Continuing Care Advisory Committee (CCAC) completed its more than one year long review of legislation and regulations affecting continuing care retirement communities (CCRCs) in Maryland. CCAC recommendations make progress in protecting the following fundamental rights of CCRC residents: Recognition of residents as principal stakeholders; Access to information; Response to grievances; Transparency of business operations; Reduction of risks to residents; and Department of Aging oversight and authority to act.

During the 2011 Session, Legislation was introduced in two bills to implement the CCAC recommendations: House Bill 1286 “Maryland Department of Aging – Continuing Care in a Retirement Community” [Did Not Pass] contained recommendations, approved unanimously by the CCAC members, which would have: Increased the statutory operating reserve from 55 to 90 days of expenses and limit the circumstances under which it could be pledged; Required disclosure of the community’s operating budget; Broadened grounds for Department of Aging disapproval of contract terms; and Required that responses to grievances be in writing.

House Bill 1285 “Maryland Department of Aging – Continuing Care in a Retirement Community” [Did Not Pass] contained recommendations, approved in most cases by large majority votes in the CCAC but with some “No” votes, which would have: Permited inter-State obligated groups that have joint and several liability among members; Lowered threshold for Department approval of asset transfers in any 12- month period from 10% to 5% of total assets; Required actuarial studies for all CCRCs, but only every five years for CCRCs offering fee-for-services contracts; Increased from one to two residents on governing boards; Permitted residents to nominate, and to ratify selection of, resident board members; Permitted Department to revisit existing contracts; Permitted resident to seek help, except from an unrelated attorney, in presenting a grievance; Required disclosure of: Summary of non-confidential board actions; Existence of a MaCCRA chapter; Delayed entrance fee refunds; Whether a CCRC is stand-alone or financially tied to one or more other entities; and Financial statements of entities receiving fund transfers and of parent corporation.

Neither bill passed in 2011. MaCCRA in collaboration with the other CCAC stakeholders supported the legislation that was introduced in the 2012 Session addressing issues and recommendations developed by the Continuing Care Advisory Committee (CCAC). Senate Bill 485 (Senator Kelley, et al) and House Bill 556 (Delegate Hubbard) “Continuing Care Retirement Communities – Regulation” [Passed into Law]. The bills establish additional requirements with regard to continuing care agreements, disclosure statements, and grievance procedures; require providers to make specified information available to subscribers; modify requirements for the sale or transfer of a facility; restrict the pledging or encumbering of operating reserve assets; and increase the operating reserve that a provider must set aside for each facility.

2014 Session of the Maryland General Assembly:

*MaCCRA supported introduction of Senate Bill 276 (Senator Kelley, et al)/ House Bill 271 (Delegate Bromwell, et al) “Continuing Care Retirement Communities – Continuing Care Agreements – Actuarial Studies” [Did Not Pass] This bill distinguishes among three types of continuing care agreements: “extensive agreement,” “fee-for-service agreement,” and “modified agreement.” The bill would have altered the contents of a renewal application for a continuing care retirement community (CCRC) by modifying the existing requirement that a qualified actuary review actuarial studies for certain types of providers. Studies must be reviewed and submitted every three to five years, depending on the type of continuing care agreement. Specifically, unless otherwise exempted, a provider with extensive or modified agreements must continue to submit an actuarial study that is reviewed by a qualified actuary every three years, whereas a provider with only fee-for-service agreements must now provide an actuarial study that is reviewed by a qualified actuary every five years.

There was excellent MaCCRA representation and testimonials. Plan to return 2015 requesting same legislation as there will be a new HGO committee and subcommittee because of retirement and elections.

2015 Session of the Maryland General Assembly:

*MaCCRA supported introduction of legislation Senate Bill 91 (Senator Kelley, et al)/ House Bill 282 (Delegate Bromwell, et al) “Continuing Care Retirement Communities – Continuing Care Agreements – Actuarial Studies” [Did Not Pass]. The bill was a reintroduction of the 2014 Session and continued to meet fierce opposition from the providers and CCRC management lobbying entities.

2016 Session of the Maryland General Assembly:

*MaCCRA supported introduction of legislation, House Bill 588 (Del. Bromwell, et al) “Continuing Care Retirement Communities – Continuing Care Agreements – Actuarial Studies” [Did Not Pass].

2018 Session of the Maryland General Assembly:

Although MaCCRA did not support the introduction of specific legislation this session, of the bills concerning CCRCs that did appear before the legislature this year, MaCCRA took a position on House Bill 344 (Delegate A. Jones, et al)/Senate Bill 425 (Senator Bates, et al)– “Continuing Care Agreements – Termination – Notice and Contractual Entrance Fee Refunds” [Did Not Pass] This legislation would have required (1) a continuing care provider pay any contractual entrance fee refund within 30 days after the subscriber’s death or the effective date of termination of a continuing care agreement, and (2) a continuing care agreement must allow a subscriber to terminate the agreement by giving a written termination notice to the provider at least 30 days before the effective date of termination.

MaCCRA offered an amendment which would have (1) Eliminated the requirement that the continuing care provider refund the contractual entrance fee within 30 days after the subscriber’s death or the effective date of termination of a continuing care agreement, and (2) give the continuing care provider a one-year timeframe to refund the entrance fee if the contract was conditioned on the reoccupancy or recontracting of a subscriber’s unit. If the provider fails to recontract the unit or refund the funds if the unit is recontracted the provider must send the reason for the delay in writing to the Department of Aging.

2024 Session of the Maryland General Assembly:

*MaCCRA supported introduction of House Bill 0068 (Delegate Stein, et al)/(Senate Bill 0076 (Sen. Lam) – “Continuing Care Retirement Communities – Transparency, Grievances, and Unit Reoccupancy” [Passed into Law]. “Requires providers to (1) post the most recent disclosure statement on their website; (2) hold a meeting open to all of the provider’s subscribers at least quarterly; (3) provide an aggregated, deidentified summary of internal grievances at the last quarterly meeting of the year; and (4) provide specified information to a subscriber or the subscriber’s beneficiary regarding entrance fee refunds if the refund is conditioned on the reoccupancy of the subscriber’s unit. These bills also expressly enable the resident member of the Board of Directors to report to the Resident Association on the Board’s nonconfidential deliberations, actions and policies; and the Board’s determination of what is or is not confidential must be reasonable. The Maryland Department of Aging (MDOA) must collect specified information from providers regarding internal grievances and report on the data received by December 1 each year to specified committees of the General Assembly.”

2025 Session of the Maryland General Assembly:

*MaCCRA supported introduction of House Bill 938 (Delegate Stein, et al) “Continuing Care Providers – Governing Bodies – Membership” [Passed into Law] which further clarifies legislation that passed in 2024. The bill requires the governing body of a continuing care provider that has only one subscriber to authorize the appointment of an alternate subscriber to serve as a regular member of the governing body if the regular subscriber is unable to fulfill the subscriber’s duties. The alternate subscriber may: (1) attend all meetings of the governing body, and (2) vote only if the regular subscriber is unable to fulfill the subscriber’s duties as a regular member of the governing body.