§ 4608 — Contracts

§ 4608. Contracts. A continuing care retirement contract or continuing\ncare at home contract shall contain all of the following information in\nno less than twelve point type and in plain language, in addition to any\nother terms or matter as may be required by regulations adopted by the\ncouncil and issued by the superintendent:\n 1. The amount of all money transferred, including, but not limited to,\ndonations, subscriptions, deposits, fees, and any other amounts paid or\npayable by, or on behalf of, the resident or residents or continuing\ncare at home contract holder or holders;\n 2. A description of all services which are to be furnished by the\noperator, a description of any fees in addition to the entrance fee and\nperiodic charges provided for in the contract, and the conditions under\nwhich the fees may be adjusted, provided that an operator shall not\ncharge any non-refundable application fee to a prospective resident who\nhas paid a non-refundable priority reservation agreement application\nfee;\n 3. The procedures of the community relating to a resident's or\ncontract holder's failure to pay the required monthly fees;\n 4. A statement of the figures and terms concerning the entry of a\nspouse to the community and the consequences if the spouse does not meet\nthe requirements for entry;\n 5. A statement of the terms and conditions under which a contract may\nbe cancelled by the operator or by a resident or contract holder and the\nconditions under which all or any portion of the entrance fee will be\nrefunded by the operator, including the mandatory refund provisions set\nforth in sections forty-six hundred nine and forty-six hundred ten of\nthis article;\n 6. a. The procedures and conditions under which a resident may be\ntransferred from his or her living unit or home including a statement\nthat, at the time of transfer, the resident will be given the reasons\nfor the transfer; the process by which a transfer decision is made; the\npersons with the authority to make the decision to transfer; a\ndescription of any change in charges to be paid by the resident for\nservices not covered by the contract fees as a result of the transfer;\nand a statement regarding the disposition of and the right to return to\nthe living unit in cases of temporary and permanent transfers.\n b. For continuing care retirement contracts, the circumstances under\nwhich a living unit may be considered vacant and eligible for transfer\nor resale to a new resident, either due to the permanent transfer of a\nresident to the community's nursing or other specialized facility or due\nto the permanent transfer of a resident to a hospital or other facility\noutside of the community; provided, however, that nothing therein shall\nrelieve a community from its obligations to provide or to insure\nprovision of all contractually required care pursuant to the terms of a\ncontinuing care retirement contract. Should a resident's chronic\ncondition require placement in a more specialized chronic care facility\nthat provides services beyond those provided through the community's\nnursing facility, the liability of the community pursuant to the terms\nof a continuing care retirement contract shall be equal to the current\nper diem rate of the nursing facility minus the pro rata apportionment\nof the resident's monthly fee for the period of care required by the\ncontract. Nothing herein shall obligate a continuing care retirement\ncommunity which does not have a life care contract with a resident to\nprovide or pay for a level of nursing facility services nor for any\nduration beyond what is specifically described in its continuing care\nretirement contract with that resident. This section shall not affect\nthe operator's obligation under subdivision two of section forty-six\nhundred twenty-four of this article;\n 7. For continuing care retirement contracts, a statement that, if the\nresident dies prior to occupancy date or, through illness, injury, or\nincapacity is precluded from becoming a resident under the terms of the\ncontract, the contract is automatically rescinded and the resident or\nhis or her legal representative shall receive a full refund of all\nmoneys paid to the facility, except for those costs specifically\nincurred by the facility at the request of the resident and set forth in\nwriting in a separate addendum, signed by the parties to the contract;\n 8. For continuing care at home contracts, a statement that, if the\nresident dies prior to the effective start date of services or, through\nillness, injury, or incapacity is precluded from meeting the eligibility\nterms of the contract, the contract is automatically rescinded and the\nresident or his or her legal representative shall receive a full refund\nof all moneys paid to the facility, except for those costs specifically\nincurred by the facility at the request of the resident and set forth in\nwriting in a separate addendum, signed by the parties to the contract;\n 9. For continuing care retirement contracts, a statement of the\nconditions under which all or any portion of the entrance fee will be\nreleased to the operator before the living unit becomes available for\noccupancy, and a statement of the conditions under which all or any\nportion of that fee will be refunded in the event of the death of the\nresident and/or spouse following occupancy of a living unit, including\nthe mandatory refund provisions set forth in section forty-six hundred\nnine of this article;\n 10. A statement of the advance notice to be provided the resident or\ncontract holder, of not less than sixty days, of any change in fees or\ncharges or scope of care or services;\n 11. A statement that no act, agreement, or statement of any resident\nor contract holder, or of an individual purchasing care for a resident\nor contract holder under any agreement to furnish care to the resident\nor contract holder, shall constitute a valid waiver of any provision of\nthis article or of any regulation enacted pursuant thereto intended for\nthe benefit or protection of the resident or contract holder or the\nindividual purchasing care for the resident or contract holder;\n 12. For continuing care retirement contracts, a description of the\nreinstatement policies if a resident leaves the facility or the contract\nis cancelled; and for continuing care at home contracts, a description\nof policies if the home resident relocates their private residence or\nthe contract is cancelled.\n 13. A statement that internal procedures to resolve disputes and\ngrievances have been established, and residents and contract holders\nnotified of them;\n 14. A statement of the grace period, if any, for the payment of\nperiodic fees without a penalty, and the extent of any penalty for the\nlate payment thereof;\n 15. A statement that: a. the resident or contract holder, as\napplicable shall, if eligible, enroll in medicare parts a and b or the\nequivalent and shall continue to maintain that coverage, together with\nmedicare supplement coverage at least equivalent in benefits to those\nestablished by the superintendent as minimum benefits for medicare\nsupplement policies;\n b. if the resident or contract holder fails to maintain medicare\ncoverage and a medicare supplement coverage, or is ineligible for such\ncoverage and fails to purchase the equivalent of such coverage, the\ncommunity shall purchase the coverage or equivalent coverage on behalf\nand at the expense of the resident or contract holder and shall have the\nauthority to require an appropriate adjustment in payments by the\nresident or contract holder to the community;\n c. if the community cannot purchase medicare coverage and medicare\nsupplement coverage or the equivalent, the community shall have the\nauthority to require an adjustment in monthly fees, subject to the\napproval of the superintendent, to fund the additional risk to the\nfacility; and\n d. if the resident or contract holder fails to purchase or maintain\nmedicare coverage and medicare supplement coverage or the equivalent,\nand the community has not purchased such coverage, the community will be\nresponsible for any expenses which would have been covered by medicare\nand medicare supplement coverage. The community may add the amount of\nsuch expenses to the resident's or contract holder's monthly fees.\n * 16. A statement that any amendment to the contract and any change in\nfees or charges, other than those within the guidelines of an approved\nrating system, must be approved by the superintendent of financial\nservices;\n * NB Effective until June 1, 2026\n * 16. A statement that any amendment to the contract and any change in\nfees or charges, other than those within the guidelines of an approved\nrating system, must be approved by the commissioner;\n * NB Effective June 1, 2026\n 17. A statement that property shall not be substituted as payment for\neither the entrance fee or monthly fee;\n 18. A statement describing the method by which the community will\ndetermine priority for access to available adult care facility or\nnursing facility beds between a continuing care retirement contract\nholder and a continuing care at home contract holder;\n 19. For continuing care retirement contracts, a statement whether the\ncontinuing care retirement contract includes any ownership, beneficial\nor trust interest in the assets of the operator, the assets of the\nfacility, or both. Assets shall include, but are not limited to,\nproperty, trusts, reserves, interest and other assets; and\n 20. Continuing care at home contracts shall include the following:\n a. a statement describing the circumstances under which a contract\nholder may move into a campus independent living unit, adult care\nfacility or nursing home;\n b. a statement as to whether and under what circumstances\ntransportation will be provided to continuing care at home contract\nholders;\n c. a statement describing the mechanism for monitoring continuing care\nat home contract holders;\n d. a statement describing the method by which the community will\ndetermine priority for access to available ILUs between a continuing\ncare at home contract holder who wishes to convert the contract to a\ncontinuing care retirement contract and a continuing care retirement\ncontract holder;\n e. a statement describing any applicable geographical limits of the\ncontinuing care at home services, and the policy that will be followed\nin the event that a continuing care at home contract holder relocates to\na different residence outside the geographical limits covered by the\ncontinuing care at home contract; and\n f. a statement describing any applicable policy that would entitle a\ncontinuing care at home contract holder to select adult care facility or\nskilled nursing facility placement in a facility that is not part of the\ncontinuing care retirement community.\n