AB 713: Continuing care retirement facilities: transfers of residents.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2017-10-09
Existing law requires a continuing care retirement facility, as defined, to possess a certificate of authority issued by the State Department of Social Services before it can enter into a continuing care contract, as defined, with a resident. Existing law requires that a continuing care contract be in writing and contain specified information. Existing law authorizes a continuing care retirement community to transfer a resident under certain circumstances, including when the resident develops a physical or mental condition that endangers the health, safety, or well-being of the resident or another person. Prior to any transfer under those provisions, existing law requires the continuing care retirement community to satisfy certain requirements, including, but not limited to, involving the resident and the residents responsible person in the assessment process that forms the basis for the transfer and providing an explanation of the assessment process. If assessment tools are used in making that determination, existing law authorizes the resident or residents responsible person to request copies of the completed assessment. Existing law authorizes the resident or the residents responsible person to dispute a transfer decision, and existing law requires a timely review of transfer disputes by the Continuing Care Contracts Branch of the department, as prescribed. Existing law requires any transfer decision of the branch of the department to be in writing.
The bill would authorize a continuing care retirement community to transfer a resident if he or she develops a physical or mental condition that is detrimental to the health, safety, or well-being of the resident or another person, without being a danger. With regard to the assessment process, this bill would require a continuing care retirement community to use specified assessment tools during that process, and would require that a provider share copies of the completed assessment with the resident or the residents responsible person. For disputed transfer decisions, the bill would require the provider to provide documentation of the residents medical reports, other documents showing the residents current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable, and to make copies of the report to share with the resident or the residents responsible person. In a transfer dispute, the bill would require the branch of the department to provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, as prescribed. The bill would require the branch of the department, in its decision, to also specify whether the transfer is appropriate and necessary.
Existing law requires a continuing care retirement facility, as defined, to possess a certificate of authority issued by the State Department of Social Services before it can enter into a continuing care contract, as defined, with a resident. Existing law requires that a continuing care contract be in writing and contain specified information. Existing law authorizes a continuing care retirement community to transfer a resident under certain circumstances, including when the resident develops a physical or mental condition that endangers the health, safety, or well-being of the resident or another person. Prior to any transfer under those provisions, existing law requires the continuing care retirement community to satisfy certain requirements, including, but not limited to, involving the resident and the residents responsible person in the assessment process that forms the basis for the transfer and providing an explanation of the assessment process. If assessment tools are used in making that determination, existing law authorizes the resident or residents responsible person to request copies of the completed assessment. Existing law authorizes the resident or the residents responsible person to dispute a transfer decision, and existing law requires a timely review of transfer disputes by the Continuing Care Contracts Branch of the department, as prescribed. Existing law requires any transfer decision of the branch of the department to be in writing.
The bill would authorize a continuing care retirement community to transfer a resident if he or she develops a physical or mental condition that is detrimental to the health, safety, or well-being of the resident or another person, without being a danger. With regard to the assessment process, this bill would require a continuing care retirement community to use specified assessment tools during that process, and would require that a provider share copies of the completed assessment with the resident or the residents responsible person. For disputed transfer decisions, the bill would require the provider to provide documentation of the residents medical reports, other documents showing the residents current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable, and to make copies of the report to share with the resident or the residents responsible person. In a transfer dispute, the bill would require the branch of the department to provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, as prescribed. The bill would require the branch of the department, in its decision, to also specify whether the transfer is appropriate and necessary.
Existing law requires a continuing care retirement facility, as defined, to possess a certificate of authority issued by the State Department of Social Services before it can enter into a continuing care contract, as defined, with a resident. Existing law requires that a continuing care contract be in writing and contain specified information. Existing law authorizes a continuing care retirement community to transfer a resident under certain circumstances. circumstances, including when the resident develops a physical or mental condition that endangers the health, safety, or well-being of the resident or another person. Prior to any transfer under those provisions, existing law requires the continuing care retirement community to satisfy certain requirements, including, but not limited to, involving the resident and the residents responsible person in the assessment process that forms the basis for the transfer and providing an explanation of the assessment process. If assessment tools are used in making that determination, existing law authorizes the resident or residents responsible person to request copies of the completed assessment. Existing law authorizes the resident or the residents responsible person to dispute a transfer decision, and existing law requires a timely review of transfer disputes by the Continuing Care Contracts Branch of the department, as prescribed. Existing law requires any transfer decision of the branch of the department to be in writing.
The bill would authorize a continuing care retirement community to transfer a resident if he or she develops a physical or mental condition that is detrimental to the health, safety, or well-being of the resident or another person, without being a danger. With regard to the assessment process, this bill would require a continuing care retirement community to use specified assessment tools during that process, and would require that a provider share copies of the completed assessment with the resident or the residents responsible person. For disputed transfer decisions, the bill would require the provider to provide documentation of the residents medical reports, other documents showing the residents current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable, and to make copies of the report to share with the resident or the residents responsible person. In a transfer dispute, the bill would require the branch of the department to provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, as prescribed. The bill would require the branch of the department, in its decision, to also specify whether the transfer is appropriate and necessary.
Existing law requires a continuing care retirement facility, as defined, to possess a certificate of authority issued by the State Department of Social Services before it can enter into a continuing care contract, as defined, with a resident. Existing law requires that a continuing care contract be in writing and contain specified information. Existing law authorizes a continuing care retirement community to transfer a resident under certain circumstances. Prior to any transfer under those provisions, existing law requires the continuing care retirement community to satisfy certain requirements, including, but not limited to, involving the resident and the residents responsible person in the assessment process that forms the basis for the transfer and providing an explanation of the assessment process. If assessment tools are used in making that determination, existing law authorizes the resident or residents responsible person to request copies of the completed assessment. Existing law authorizes the resident or the residents responsible person to dispute a transfer decision, and existing law requires a timely review of transfer disputes by the Continuing Care Contracts Branch of the department, as prescribed. Existing law requires any transfer decision of the branch of the department to be in writing.
With regard to the assessment process, this bill would require the a continuing care retirement community to use specified assessment tools during that process, and would require that the a provider share copies of the completed assessment with the resident or the residents responsible person. In any a transfer dispute, the bill would require the branch of the department to consider the appropriateness and necessity of the transfer and provide an explanation of the assessment used by the provider, provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, as prescribed. The bill would require the branch of the department, in its decision, to also specify whether the transfer is appropriate and necessary.
Existing law requires a continuing care retirement facility, as defined, to possess a certificate of authority issued by the State Department of Social Services before it can enter into a continuing care contract, as defined, with a resident. Existing law requires that a continuing care contract be in writing and contain specified information. Existing law authorizes a continuing care retirement community to transfer a resident under certain circumstances. Prior to any transfer under those provisions, existing law requires the continuing care retirement community to satisfy certain requirements, including, but not limited to, involving the resident and the residents responsible person in the assessment process that forms the basis for the transfer and providing an explanation of the assessment process. If assessment tools are used in making that determination, existing law authorizes the resident or residents responsible person to request copies of the completed assessment. Existing law authorizes the resident or the residents responsible person to dispute a transfer decision, and existing law requires a timely review of transfer disputes by the Continuing Care Contracts Branch of the department, as prescribed. Existing law requires any transfer decision of the branch of the department to be in writing.
With regard to the assessment process, this bill would require the continuing care retirement community to use specified assessment tools during that process, and would require that the provider share copies of the completed assessment with the resident or the residents responsible person. In any transfer dispute, the bill would require the branch of the department to consider the appropriateness and necessity of the transfer and provide an explanation of the assessment used by the provider, as prescribed. The bill would require the branch of the department, in its decision, to also specify whether the transfer is appropriate and necessary.
(a)A continuing care contract shall contain all of the following:
(1)The legal name and address of each provider.
(2)The name and address of the continuing care retirement community.
(3)The residents name and the identity of the unit the resident will occupy.
(4)If there is a transferor other than the resident, the transferor shall be a party to the contract and the transferors name and address shall be specified.
(5)If the provider has used the name of any charitable or religious or nonprofit organization in its title before January 1, 1979, and continues to use that name, and that organization is not responsible for the financial and contractual obligations of the provider or the obligations specified in the continuing care contract, the provider shall include in every continuing care contract a conspicuous statement that clearly informs the resident that the organization is not financially responsible.
(6)The date the continuing care contract is signed by the resident and, where applicable, any other transferor.
(7)The duration of the continuing care contract.
(8)A list of the services that will be made available to the resident as required to provide the appropriate level of care. The list of services shall include the services required as a condition for licensure as a residential care facility for the elderly, including all of the following:
(A)Regular observation of the residents health status to ensure that his or her dietary needs, social needs, and needs for special services are satisfied.
(B)Safe and healthful living accommodations, including housekeeping services and utilities.
(C)Maintenance of house rules for the protection of residents.
(D)A planned activities program, which includes social and recreational activities appropriate to the interests and capabilities of the resident.
(E)Three balanced, nutritious meals and snacks made available daily, including special diets prescribed by a physician as a medical necessity.
(F)Assisted living services.
(G)Assistance with taking medications.
(H)Central storing and distribution of medications.
(I)Arrangements to meet health needs, including arranging transportation.
(9)An itemization of the services that are included in the monthly fee and the services that are available at an extra charge. The provider shall attach a current fee schedule to the continuing care contract. The schedule shall state that a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(10)The procedures and conditions under which a resident may be voluntarily and involuntarily transferred from a designated living unit. The transfer procedures, at a minimum, shall include provisions addressing all of the following circumstances under which a transfer may be authorized:
(A)A continuing care retirement community may transfer a resident under the following conditions, taking into account the appropriateness and necessity of the transfer and the goal of promoting resident independence:
(i)The resident is nonambulatory. The definition of nonambulatory, as provided in Section 13131, shall either be stated in full in the continuing care contract or be cited. If Section 13131 is cited, a copy of the statute shall be made available to the resident, either as an attachment to the continuing care contract or by specifying that it will be provided upon request. If a nonambulatory resident occupies a room that has a fire clearance for nonambulatory residents, transfer shall not be necessary.
(ii)The resident develops a physical or mental condition that is detrimental to or endangers the health, safety, or well-being of the resident or another person.
(iii)The residents condition or needs require the residents transfer to an assisted living care unit or skilled nursing facility, because the level of care required by the resident exceeds that which may be appropriately provided in the living unit.
(iv)The residents condition or needs require the residents transfer to a nursing facility, hospital, or other facility, and the provider has no facilities available to provide that level of care.
(B)Before the continuing care retirement community transfers a resident under any of the conditions set forth in subparagraph (A), the community shall satisfy all of the following requirements:
(i)Involve the resident and the residents responsible person, as defined in paragraph (6) of subdivision (r) of Section 87101 of Title 22 of the California Code of Regulations, and upon the residents or responsible persons request, family members, or the residents physician or other appropriate health professional, in the assessment process that forms the basis for the level of care transfer decision by the provider. The provider shall offer an explanation of the assessment process, which shall include, but not be limited to, an evaluation of the physical and cognitive capacities of the resident. An assessment tool or tools, including scoring and evaluating criteria, shall be used in the determination of the appropriateness of the transfer. The provider shall make copies of the completed assessment to share with the resident or the residents responsible person.
(ii)Prior to sending a formal notification of transfer, the provider shall conduct a care conference with the resident and the residents responsible person, and, upon the residents or responsible persons request, family members, and the residents health care professionals, to explain the reasons for transfer.
(iii)Notify the resident and the residents responsible person of the reasons for the transfer in writing.
(iv)Notwithstanding any other provision of this subparagraph, if the resident does not have impairment of cognitive abilities, the resident may request that his or her responsible person not be involved in the transfer process.
(v)The notice of transfer shall be made at least 30 days before the transfer is expected to occur, except when the health or safety of the resident or other residents is in danger, or the transfer is required by the residents urgent medical needs. Under those circumstances, the written notice shall be made as soon as practicable before the transfer.
(vi)The written notice shall contain the reasons for the transfer, the effective date, the designated level of care or location to which the resident will be transferred, a statement of the residents right to a review of the transfer decision at a care conference, as provided for in subparagraph (C), and for disputed transfer decisions, the right to review by the Continuing Care Contracts Branch of the State Department of Social Services, as provided for in subparagraph (D). The notice shall also contain the name, address, and telephone number of the departments Continuing Care Contracts Branch.
(vii)The continuing care retirement community shall provide sufficient preparation and orientation to the resident to ensure a safe and orderly transfer and to minimize trauma.
(viii)For disputed transfer decisions, the provider shall provide documentation of the residents medical reports, other documents showing the residents current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable. The documentation shall include an explanation of how the criteria set out in subparagraph (A) are met. The provider shall make copies of the completed report to share with the resident or the residents responsible person.
(C)The resident has the right to review and dispute the transfer decision at a subsequent care conference that shall include the resident, the residents responsible person, and, upon the residents or responsible persons request, family members, the residents physician or other appropriate health care professional, and members of the providers interdisciplinary team. The local ombudsperson may also be included in the care conference, upon the request of the resident, the residents responsible person, or the provider.
(D)For disputed transfer decisions, the resident or the residents responsible person has the right to a prompt and timely review of the transfer process by the Continuing Care Contracts Branch of the State Department of Social Services. The branch of the department shall provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
(E)The decision of the departments Continuing Care Contracts Branch shall be in writing and shall determine whether the provider failed to comply with the transfer process pursuant to subparagraphs (A) to (C), inclusive, and whether the transfer is appropriate and necessary. Pending the decision of the Continuing Care Contracts Branch, the provider shall specify any additional care the provider believes is necessary in order for the resident to remain in his or her unit. The resident may be required to pay for the extra care, as provided in the contract.
(F)Transfer of a second resident when a shared accommodation arrangement is terminated.
(11)Provisions describing any changes in the residents monthly fee and any changes in the entrance fee refund payable to the resident that will occur if the resident transfers from any unit, including, but not limited to, terminating his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Unless the fee is part of an equity interest contract, a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident.
(12)The providers continuing obligations, if any, in the event a resident is transferred from the continuing care retirement community to another facility.
(13)The providers obligations, if any, to resume care upon the residents return after a transfer from the continuing care retirement community.
(14)The providers obligations to provide services to the resident while the resident is absent from the continuing care retirement community.
(15)The conditions under which the resident must permanently release his or her living unit.
(16)If real or personal properties are transferred in lieu of cash, a statement specifying each items value at the time of transfer, and how the value was ascertained.
(A)An itemized receipt that includes the information described above is acceptable if incorporated as a part of the continuing care contract.
(B)When real property is or will be transferred, the continuing care contract shall include a statement that the deed or other instrument of conveyance shall specify that the real property is conveyed pursuant to a continuing care contract and may be subject to rescission by the transferor within 90 days from the date that the resident first occupies the residential unit.
(C)The failure to comply with this paragraph shall not affect the validity of title to real property transferred pursuant to this chapter.
(17)The amount of the entrance fee.
(18)In the event two parties have jointly paid the entrance fee or other payment that allows them to occupy the unit, the continuing care contract shall describe how any refund of entrance fees is allocated.
(19)The amount of any processing fee.
(20)The amount of any monthly care fee.
(21)For continuing care contracts that require a monthly care fee or other periodic payment, the continuing care contract shall include the following:
(A)A statement that the occupancy and use of the accommodations by the resident is contingent upon the regular payment of the fee.
(B)The regular rate of payment agreed upon (per day, week, or month).
(C)A provision specifying whether payment will be made in advance or after services have been provided.
(D)A provision specifying the provider will adjust monthly care fees for the residents support, maintenance, board, or lodging, when a resident requires medical attention while away from the continuing care retirement community.
(E)A provision specifying whether a credit or allowance will be given to a resident who is absent from the continuing care retirement community or from meals. This provision shall also state, when applicable, that the credit may be permitted at the discretion or by special permission of the provider.
(F)A statement of billing practices, procedures, and timelines. A provider shall allow a minimum of 14 days between the date a bill is sent and the date payment is due. A charge for a late payment may only be assessed if the amount and any condition for the penalty is stated on the bill.
(G)A statement that the provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(22)All continuing care contracts that include monthly care fees shall address changes in monthly care fees by including either of the following provisions:
(A)For prepaid continuing care contracts, which include monthly care fees, one of the following methods:
(i)Fees shall not be subject to change during the lifetime of the agreement.
(ii)Fees shall not be increased by more than a specified number of dollars in any one year and not more than a specified number of dollars during the lifetime of the agreement.
(iii)Fees shall not be increased in excess of a specified percentage over the preceding year and not more than a specified percentage during the lifetime of the agreement.
(B)For monthly fee continuing care contracts, except prepaid contracts, changes in monthly care fees shall be based on projected costs, prior year per capita costs, and economic indicators.
(23)A provision requiring that the provider give written notice to the resident at least 30 days in advance of any change in the residents monthly care fees or in the price or scope of any component of care or other services.
(24)A provision indicating whether the residents rights under the continuing care contract include any proprietary interests in the assets of the provider or in the continuing care retirement community, or both. Any statement in a contract concerning an ownership interest shall appear in a large-sized font or print.
(25)If the continuing care retirement community property is encumbered by a security interest that is senior to any claims the residents may have to enforce continuing care contracts, a provision shall advise the residents that any claims they may have under the continuing care contract are subordinate to the rights of the secured lender. For equity projects, the continuing care contract shall specify the type and extent of the equity interest and whether any entity holds a security interest.
(26)Notice that the living units are part of a continuing care retirement community that is licensed as a residential care facility for the elderly and, as a result, any duly authorized agent of the department may, upon proper identification and upon stating the purpose of his or her visit, enter and inspect the entire premises at any time, without advance notice.
(27)A conspicuous statement, in at least 10-point boldface type in immediate proximity to the space reserved for the signatures of the resident and, if applicable, the transferor, that provides as follows: You, the resident or transferor, may cancel the transaction without cause at any time within 90 days from the date you first occupy your living unit. See the attached notice of cancellation form for an explanation of this right.
(28)Notice that during the cancellation period, the continuing care contract may be canceled upon 30 days written notice by the provider without cause, or that the provider waives this right.
(29)The terms and conditions under which the continuing care contract may be terminated after the cancellation period by either party, including any health or financial conditions.
(30)A statement that, after the cancellation period, a provider may unilaterally terminate the continuing care contract only if the provider has good and sufficient cause.
(A)Any continuing care contract containing a clause that provides for a continuing care contract to be terminated for just cause, good cause, or other similar provision, shall also include a provision that none of the following activities by the resident, or on behalf of the resident, constitutes just cause, good cause, or otherwise activates the termination provision:
(i)Filing or lodging a formal complaint with the department or other appropriate authority.
(ii)Participation in an organization or affiliation of residents, or other similar lawful activity.
(B)The provision required by this paragraph shall also state that the provider shall not discriminate or retaliate in any manner against any resident of a continuing care retirement community for contacting the department, or any other state, county, or city agency, or any elected or appointed government official to file a complaint or for any other reason, or for participation in a residents organization or association.
(C)Nothing in this paragraph diminishes the providers ability to terminate the continuing care contract for good and sufficient cause.
(31)A statement that at least 90 days written notice to the resident is required for a unilateral termination of the continuing care contract by the provider.
(32)A statement concerning the length of notice that a resident is required to give the provider to voluntarily terminate the continuing care contract after the cancellation period.
(33)The policy or terms for refunding or repaying a lump sum of any portion of the entrance fee, in the event of cancellation, termination, or death. Every continuing care contract that provides for a refund or repaying a lump sum of all or a part of the entrance fee shall also do all of the following:
(A)Specify the amount, if any, the resident has paid or will pay for upgrades, special features, or modifications to the residents unit.
(B)State that if the continuing care contract is canceled or terminated by the provider, the provider shall do both of the following:
(i)Amortize the specified amount at the same rate as the residents entrance fee.
(ii)Refund the unamortized balance to the resident at the same time the provider pays the residents entrance fee refund.
(C)State that the resident has a right to terminate his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Provisions for refunds due to cancellation pursuant to this subparagraph shall be set forth in the contract.
(D)State the provider shall make a good-faith effort to reoccupy or resell a unit for which a lump-sum payment is conditioned upon resale of the unit. No later than July 1, 2017, a provider shall provide notice to all current residents with contracts applicable to this subparagraph regarding the statement required by this subparagraph as a clarification of the residents existing contract.
(E)For all contracts with a repayment of all or a portion of the entrance fee conditioned upon the resale of the unit, the provider shall state the average and longest amount of time that it has taken to resell a unit within the last five calendar years.
(34)The following notice at the bottom of the signatory page:
NOTICE | (date) |
This is a continuing care contract as defined by paragraph (8) of subdivision (c), or subdivision (l) of Section 1771 of the California Health and Safety Code. This continuing care contract form has been approved by the State Department of Social Services as required by subdivision (b) of Section 1787 of the California Health and Safety Code. The basis for this approval was a determination that (provider name) has submitted a contract that complies with the minimum statutory requirements applicable to continuing care contracts. The department does not approve or disapprove any of the financial or health care coverage provisions in this contract. Approval by the department is NOT a guaranty of performance or an endorsement of any continuing care contract provisions. Prospective transferors and residents are strongly encouraged to carefully consider the benefits and risks of this continuing care contract and to seek financial and legal advice before signing.
(35)The provider may not attempt to absolve itself in the continuing care contract from liability for its negligence by any statement to that effect, and shall include the following statement in the contract: Nothing in this continuing care contract limits either the providers obligation to provide adequate care and supervision for the resident or any liability on the part of the provider which may result from the providers failure to provide this care and supervision.
(36)Provisions describing how the provider will proceed in the event of a closure, including an explanation of how the provider will comply with Sections 1793.80, 1793.81, 1793.82, and 1793.83.
(b)A life care contract shall also provide that:
(1)All levels of care, including acute care and physicians and surgeons services, will be provided to a resident.
(2)Care will be provided for the duration of the residents life unless the life care contract is canceled or terminated by the provider during the cancellation period or after the cancellation period for good cause.
(3)A comprehensive continuum of care will be provided to the resident, including skilled nursing, in a facility under the ownership and supervision of the provider on, or adjacent to, the continuing care retirement community premises.
(4)Monthly care fees will not be changed based on the residents level of care or service.
(5)A resident who becomes financially unable to pay his or her monthly care fees shall be subsidized provided the residents financial need does not arise from action by the resident to divest the resident of his or her assets.
(c)Continuing care contracts may include provisions that do any of the following:
(1)Subsidize a resident who becomes financially unable to pay for his or her monthly care fees at some future date. If a continuing care contract provides for subsidizing a resident, it may also provide for any of the following:
(A)The resident shall apply for any public assistance or other aid for which he or she is eligible and that the provider may apply for assistance on behalf of the resident.
(B)The providers decision shall be final and conclusive regarding any adjustments to be made or any action to be taken regarding any charitable consideration extended to any of its residents.
(C)The provider is entitled to payment for the actual costs of care out of any property acquired by the resident subsequent to any adjustment extended to the resident under this paragraph, or from any other property of the resident that the resident failed to disclose.
(D)The provider may pay the monthly premium of the residents health insurance coverage under Medicare to ensure that those payments will be made.
(E)The provider may receive an assignment from the resident of the right to apply for and to receive the benefits, for and on behalf of the resident.
(F)The provider is not responsible for the costs of furnishing the resident with any services, supplies, and medication, when reimbursement is reasonably available from any governmental agency, or any private insurance.
(G)Any refund due to the resident at the termination of the continuing care contract may be offset by any prior subsidy to the resident by the provider.
(2)Limit responsibility for costs associated with the treatment or medication of an ailment or illness existing prior to the date of admission. In these cases, the medical or surgical exceptions, as disclosed by the medical entrance examination, shall be listed in the continuing care contract or in a medical report attached to and made a part of the continuing care contract.
(3)Identify legal remedies that may be available to the provider if the resident makes any material misrepresentation or omission pertaining to the residents assets or health.
(4)Restrict transfer or assignments of the residents rights and privileges under a continuing care contract due to the personal nature of the continuing care contract.
(5)Protect the providers ability to waive a residents breach of the terms or provisions of the continuing care contract in specific instances without relinquishing its right to insist upon full compliance by the resident with all terms or provisions in the contract.
(6)Provide that the resident shall reimburse the provider for any uninsured loss or damage to the residents unit, beyond normal wear and tear, resulting from the residents carelessness or negligence.
(7)Provide that the resident agrees to observe the off-limit areas of the continuing care retirement community designated by the provider for safety reasons. The provider may not include any provision in a continuing care contract that absolves the provider from liability for its negligence.
(8)Provide for the subrogation to the provider of the residents rights in the case of injury to a resident caused by the acts or omissions of a third party, or for the assignment of the residents recovery or benefits in this case to the provider, to the extent of the value of the goods and services furnished by the provider to or on behalf of the resident as a result of the injury.
(9)Provide for a lien on any judgment, settlement, or recovery for any additional expense incurred by the provider in caring for the resident as a result of injury.
(10)Require the residents cooperation and assistance in the diligent prosecution of any claim or action against any third party.
(11)Provide for the appointment of a conservator or guardian by a court with jurisdiction in the event a resident becomes unable to handle his or her personal or financial affairs.
(12)Allow a provider, whose property is tax exempt, to charge the resident, on a pro rata basis, property taxes, or in-lieu taxes, that the provider is required to pay.
(13)Make any other provision approved by the department.
(d)A copy of the residents rights as described in Section 1771.7 shall be attached to every continuing care contract.
(e)A copy of the current audited financial statement of the provider shall be attached to every continuing care contract. For a provider whose current audited financial statement does not accurately reflect the financial ability of the provider to fulfill the continuing care contract obligations, the financial statement attached to the continuing care contract shall include all of the following:
(1)A disclosure that the reserve requirement has not yet been determined or met, and that entrance fees will not be held in escrow.
(2)A disclosure that the ability to provide the services promised in the continuing care contract will depend on successful compliance with the approved financial plan.
(3)A copy of the approved financial plan for meeting the reserve requirements.
(4)Any other supplemental statements or attachments necessary to accurately represent the providers financial ability to fulfill its continuing care contract obligations.
(f)A schedule of the average monthly care fees charged to residents for each type of residential living unit for each of the five years preceding execution of the continuing care contract shall be attached to every continuing care contract. The provider shall update this schedule annually at the end of each fiscal year. If the continuing care retirement community has not been in existence for five years, the information shall be provided for each of the years the continuing care retirement community has been in existence.
(g)If any continuing care contract provides for a health insurance policy for the benefit of the resident, the provider shall attach to the continuing care contract a binder complying with Sections 382 and 382.5 of the Insurance Code.
(h)The provider shall attach to every continuing care contract a completed form in duplicate, captioned Notice of Cancellation. The notice shall be easily detachable, and shall contain, in at least 10-point boldface type, the following statement:
NOTICE OF CANCELLATION | (date) |
Your first date of occupancy under this contract | |
is: _____________________________________________ | |
You may cancel this transaction, without any penalty within 90 calendar days from the above date.
If you cancel, any property transferred, any payments made by you under the contract, and any negotiable instrument executed by you will be returned within 14 calendar days after making possession of the living unit available to the provider. Any security interest arising out of the transaction will be canceled.
If you cancel, you are obligated to pay a reasonable processing fee to cover costs and to pay for the reasonable value of the services received by you from the provider up to the date you canceled or made available to the provider the possession of any living unit delivered to you under this contract, whichever is later.
If you cancel, you must return possession of any living unit delivered to you under this contract to the provider in substantially the same condition as when you took possession.
Possession of the living unit must be made available to the provider within 20 calendar days of your notice of cancellation. If you fail to make the possession of any living unit available to the provider, then you remain liable for performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice, or send a telegram
to | |
(Name of provider) | |
|---|---|
at | |
(Address of providers place of business) | |
not later than midnight of_____________(date). | |
I hereby cancel this | |
(Residentsor | |
(a)A continuing care contract shall contain all of the following:
(1)The legal name and address of each provider.
(2)The name and address of the continuing care retirement community.
(3)The residents name and the identity of the unit the resident will occupy.
(4)If there is a transferor other than the resident, the transferor shall be a party to the contract and the transferors name and address shall be specified.
(5)If the provider has used the name of any charitable or religious or nonprofit organization in its title before January 1, 1979, and continues to use that name, and that organization is not responsible for the financial and contractual obligations of the provider or the obligations specified in the continuing care contract, the provider shall include in every continuing care contract a conspicuous statement that clearly informs the resident that the organization is not financially responsible.
(6)The date the continuing care contract is signed by the resident and, where applicable, any other transferor.
(7)The duration of the continuing care contract.
(8)A list of the services that will be made available to the resident as required to provide the appropriate level of care. The list of services shall include the services required as a condition for licensure as a residential care facility for the elderly, including all of the following:
(A)Regular observation of the residents health status to ensure that his or her dietary needs, social needs, and needs for special services are satisfied.
(B)Safe and healthful living accommodations, including housekeeping services and utilities.
(C)Maintenance of house rules for the protection of residents.
(D)A planned activities program, which includes social and recreational activities appropriate to the interests and capabilities of the resident.
(E)Three balanced, nutritious meals and snacks made available daily, including special diets prescribed by a physician as a medical necessity.
(F)Assisted living services.
(G)Assistance with taking medications.
(H)Central storing and distribution of medications.
(I)Arrangements to meet health needs, including arranging transportation.
(9)An itemization of the services that are included in the monthly fee and the services that are available at an extra charge. The provider shall attach a current fee schedule to the continuing care contract. The schedule shall state that a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(10)The procedures and conditions under which a resident may be voluntarily and involuntarily transferred from a designated living unit. The transfer procedures, at a minimum, shall include provisions addressing all of the following circumstances under which a transfer may be authorized:
(A)A continuing care retirement community may transfer a resident under the following conditions, taking into account the appropriateness and necessity of the transfer and the goal of promoting resident independence:
(i)The resident is nonambulatory. The definition of nonambulatory, as provided in Section 13131, shall either be stated in full in the continuing care contract or be cited. If Section 13131 is cited, a copy of the statute shall be made available to the resident, either as an attachment to the continuing care contract or by specifying that it will be provided upon request. If a nonambulatory resident occupies a room that has a fire clearance for nonambulatory residents, transfer shall not be necessary.
(ii)The resident develops a physical or mental condition that is detrimental to or endangers the health, safety, or well-being of the resident or another person.
(iii)The residents condition or needs require the residents transfer to an assisted living care unit or skilled nursing facility, because the level of care required by the resident exceeds that which may be appropriately provided in the living unit.
(iv)The residents condition or needs require the residents transfer to a nursing facility, hospital, or other facility, and the provider has no facilities available to provide that level of care.
(B)Before the continuing care retirement community transfers a resident under any of the conditions set forth in subparagraph (A), the community shall satisfy all of the following requirements:
(i)Involve the resident and the residents responsible person, as defined in paragraph (6) of subdivision (r) of Section 87101 of Title 22 of the California Code of Regulations, and upon the residents or responsible persons request, family members, or the residents physician or other appropriate health professional, in the assessment process that forms the basis for the level of care transfer decision by the provider. The provider shall offer an explanation of the assessment process, which shall include, but not be limited to, an evaluation of the physical and cognitive capacities of the resident. An assessment tool or tools, including scoring and evaluating criteria, shall be used in the determination of the appropriateness of the transfer. The provider shall make copies of the completed assessment to share with the resident or the residents responsible person.
(ii)Prior to sending a formal notification of transfer, the provider shall conduct a care conference with the resident and the residents responsible person, and, upon the residents or responsible persons request, family members, and the residents health care professionals, to explain the reasons for transfer.
(iii)Notify the resident and the residents responsible person of the reasons for the transfer in writing.
(iv)Notwithstanding any other provision of this subparagraph, if the resident does not have impairment of cognitive abilities, the resident may request that his or her responsible person not be involved in the transfer process.
(v)The notice of transfer shall be made at least 30 days before the transfer is expected to occur, except when the health or safety of the resident or other residents is in danger, or the transfer is required by the residents urgent medical needs. Under those circumstances, the written notice shall be made as soon as practicable before the transfer.
(vi)The written notice shall contain the reasons for the transfer, the effective date, the designated level of care or location to which the resident will be transferred, a statement of the residents right to a review of the transfer decision at a care conference, as provided for in subparagraph (C), and for disputed transfer decisions, the right to review by the Continuing Care Contracts Branch of the State Department of Social Services, as provided for in subparagraph (D). The notice shall also contain the name, address, and telephone number of the departments Continuing Care Contracts Branch.
(vii)The continuing care retirement community shall provide sufficient preparation and orientation to the resident to ensure a safe and orderly transfer and to minimize trauma.
(viii)For disputed transfer decisions, the provider shall provide documentation of the residents medical reports, other documents showing the residents current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable. The documentation shall include an explanation of how the criteria set out in subparagraph (A) are met. The provider shall make copies of the completed report to share with the resident or the residents responsible person.
(C)The resident has the right to review and dispute the transfer decision at a subsequent care conference that shall include the resident, the residents responsible person, and, upon the residents or responsible persons request, family members, the residents physician or other appropriate health care professional, and members of the providers interdisciplinary team. The local ombudsperson may also be included in the care conference, upon the request of the resident, the residents responsible person, or the provider.
(D)For disputed transfer decisions, the resident or the residents responsible person has the right to a prompt and timely review of the transfer process by the Continuing Care Contracts Branch of the State Department of Social Services. The branch of the department shall provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
(E)The decision of the departments Continuing Care Contracts Branch shall be in writing and shall determine whether the provider failed to comply with the transfer process pursuant to subparagraphs (A) to (C), inclusive, and whether the transfer is appropriate and necessary. Pending the decision of the Continuing Care Contracts Branch, the provider shall specify any additional care the provider believes is necessary in order for the resident to remain in his or her unit. The resident may be required to pay for the extra care, as provided in the contract.
(F)Transfer of a second resident when a shared accommodation arrangement is terminated.
(11)Provisions describing any changes in the residents monthly fee and any changes in the entrance fee refund payable to the resident that will occur if the resident transfers from any unit, including, but not limited to, terminating his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Unless the fee is part of an equity interest contract, a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident.
(12)The providers continuing obligations, if any, in the event a resident is transferred from the continuing care retirement community to another facility.
(13)The providers obligations, if any, to resume care upon the residents return after a transfer from the continuing care retirement community.
(14)The providers obligations to provide services to the resident while the resident is absent from the continuing care retirement community.
(15)The conditions under which the resident must permanently release his or her living unit.
(16)If real or personal properties are transferred in lieu of cash, a statement specifying each items value at the time of transfer, and how the value was ascertained.
(A)An itemized receipt that includes the information described above is acceptable if incorporated as a part of the continuing care contract.
(B)When real property is or will be transferred, the continuing care contract shall include a statement that the deed or other instrument of conveyance shall specify that the real property is conveyed pursuant to a continuing care contract and may be subject to rescission by the transferor within 90 days from the date that the resident first occupies the residential unit.
(C)The failure to comply with this paragraph shall not affect the validity of title to real property transferred pursuant to this chapter.
(17)The amount of the entrance fee.
(18)In the event two parties have jointly paid the entrance fee or other payment that allows them to occupy the unit, the continuing care contract shall describe how any refund of entrance fees is allocated.
(19)The amount of any processing fee.
(20)The amount of any monthly care fee.
(21)For continuing care contracts that require a monthly care fee or other periodic payment, the continuing care contract shall include the following:
(A)A statement that the occupancy and use of the accommodations by the resident is contingent upon the regular payment of the fee.
(B)The regular rate of payment agreed upon (per day, week, or month).
(C)A provision specifying whether payment will be made in advance or after services have been provided.
(D)A provision specifying the provider will adjust monthly care fees for the residents support, maintenance, board, or lodging, when a resident requires medical attention while away from the continuing care retirement community.
(E)A provision specifying whether a credit or allowance will be given to a resident who is absent from the continuing care retirement community or from meals. This provision shall also state, when applicable, that the credit may be permitted at the discretion or by special permission of the provider.
(F)A statement of billing practices, procedures, and timelines. A provider shall allow a minimum of 14 days between the date a bill is sent and the date payment is due. A charge for a late payment may only be assessed if the amount and any condition for the penalty is stated on the bill.
(G)A statement that the provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(22)All continuing care contracts that include monthly care fees shall address changes in monthly care fees by including either of the following provisions:
(A)For prepaid continuing care contracts, which include monthly care fees, one of the following methods:
(i)Fees shall not be subject to change during the lifetime of the agreement.
(ii)Fees shall not be increased by more than a specified number of dollars in any one year and not more than a specified number of dollars during the lifetime of the agreement.
(iii)Fees shall not be increased in excess of a specified percentage over the preceding year and not more than a specified percentage during the lifetime of the agreement.
(B)For monthly fee continuing care contracts, except prepaid contracts, changes in monthly care fees shall be based on projected costs, prior year per capita costs, and economic indicators.
(23)A provision requiring that the provider give written notice to the resident at least 30 days in advance of any change in the residents monthly care fees or in the price or scope of any component of care or other services.
(24)A provision indicating whether the residents rights under the continuing care contract include any proprietary interests in the assets of the provider or in the continuing care retirement community, or both. Any statement in a contract concerning an ownership interest shall appear in a large-sized font or print.
(25)If the continuing care retirement community property is encumbered by a security interest that is senior to any claims the residents may have to enforce continuing care contracts, a provision shall advise the residents that any claims they may have under the continuing care contract are subordinate to the rights of the secured lender. For equity projects, the continuing care contract shall specify the type and extent of the equity interest and whether any entity holds a security interest.
(26)Notice that the living units are part of a continuing care retirement community that is licensed as a residential care facility for the elderly and, as a result, any duly authorized agent of the department may, upon proper identification and upon stating the purpose of his or her visit, enter and inspect the entire premises at any time, without advance notice.
(27)A conspicuous statement, in at least 10-point boldface type in immediate proximity to the space reserved for the signatures of the resident and, if applicable, the transferor, that provides as follows: You, the resident or transferor, may cancel the transaction without cause at any time within 90 days from the date you first occupy your living unit. See the attached notice of cancellation form for an explanation of this right.
(28)Notice that during the cancellation period, the continuing care contract may be canceled upon 30 days written notice by the provider without cause, or that the provider waives this right.
(29)The terms and conditions under which the continuing care contract may be terminated after the cancellation period by either party, including any health or financial conditions.
(30)A statement that, after the cancellation period, a provider may unilaterally terminate the continuing care contract only if the provider has good and sufficient cause.
(A)Any continuing care contract containing a clause that provides for a continuing care contract to be terminated for just cause, good cause, or other similar provision, shall also include a provision that none of the following activities by the resident, or on behalf of the resident, constitutes just cause, good cause, or otherwise activates the termination provision:
(i)Filing or lodging a formal complaint with the department or other appropriate authority.
(ii)Participation in an organization or affiliation of residents, or other similar lawful activity.
(B)The provision required by this paragraph shall also state that the provider shall not discriminate or retaliate in any manner against any resident of a continuing care retirement community for contacting the department, or any other state, county, or city agency, or any elected or appointed government official to file a complaint or for any other reason, or for participation in a residents organization or association.
(C)Nothing in this paragraph diminishes the providers ability to terminate the continuing care contract for good and sufficient cause.
(31)A statement that at least 90 days written notice to the resident is required for a unilateral termination of the continuing care contract by the provider.
(32)A statement concerning the length of notice that a resident is required to give the provider to voluntarily terminate the continuing care contract after the cancellation period.
(33)The policy or terms for refunding or repaying a lump sum of any portion of the entrance fee, in the event of cancellation, termination, or death. Every continuing care contract that provides for a refund or repaying a lump sum of all or a part of the entrance fee shall also do all of the following:
(A)Specify the amount, if any, the resident has paid or will pay for upgrades, special features, or modifications to the residents unit.
(B)State that if the continuing care contract is canceled or terminated by the provider, the provider shall do both of the following:
(i)Amortize the specified amount at the same rate as the residents entrance fee.
(ii)Refund the unamortized balance to the resident at the same time the provider pays the residents entrance fee refund.
(C)State that the resident has a right to terminate his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Provisions for refunds due to cancellation pursuant to this subparagraph shall be set forth in the contract.
(D)State the provider shall make a good-faith effort to reoccupy or resell a unit for which a lump-sum payment is conditioned upon resale of the unit. No later than July 1, 2017, a provider shall provide notice to all current residents with contracts applicable to this subparagraph regarding the statement required by this subparagraph as a clarification of the residents existing contract.
(E)For all contracts with a repayment of all or a portion of the entrance fee conditioned upon the resale of the unit, the provider shall state the average and longest amount of time that it has taken to resell a unit within the last five calendar years.
(34)The following notice at the bottom of the signatory page:
NOTICE | (date) |
This is a continuing care contract as defined by paragraph (8) of subdivision (c), or subdivision (l) of Section 1771 of the California Health and Safety Code. This continuing care contract form has been approved by the State Department of Social Services as required by subdivision (b) of Section 1787 of the California Health and Safety Code. The basis for this approval was a determination that (provider name) has submitted a contract that complies with the minimum statutory requirements applicable to continuing care contracts. The department does not approve or disapprove any of the financial or health care coverage provisions in this contract. Approval by the department is NOT a guaranty of performance or an endorsement of any continuing care contract provisions. Prospective transferors and residents are strongly encouraged to carefully consider the benefits and risks of this continuing care contract and to seek financial and legal advice before signing.
(35)The provider may not attempt to absolve itself in the continuing care contract from liability for its negligence by any statement to that effect, and shall include the following statement in the contract: Nothing in this continuing care contract limits either the providers obligation to provide adequate care and supervision for the resident or any liability on the part of the provider which may result from the providers failure to provide this care and supervision.
(36)Provisions describing how the provider will proceed in the event of a closure, including an explanation of how the provider will comply with Sections 1793.80, 1793.81, 1793.82, and 1793.83.
(b)A life care contract shall also provide that:
(1)All levels of care, including acute care and physicians and surgeons services, will be provided to a resident.
(2)Care will be provided for the duration of the residents life unless the life care contract is canceled or terminated by the provider during the cancellation period or after the cancellation period for good cause.
(3)A comprehensive continuum of care will be provided to the resident, including skilled nursing, in a facility under the ownership and supervision of the provider on, or adjacent to, the continuing care retirement community premises.
(4)Monthly care fees will not be changed based on the residents level of care or service.
(5)A resident who becomes financially unable to pay his or her monthly care fees shall be subsidized provided the residents financial need does not arise from action by the resident to divest the resident of his or her assets.
(c)Continuing care contracts may include provisions that do any of the following:
(1)Subsidize a resident who becomes financially unable to pay for his or her monthly care fees at some future date. If a continuing care contract provides for subsidizing a resident, it may also provide for any of the following:
(A)The resident shall apply for any public assistance or other aid for which he or she is eligible and that the provider may apply for assistance on behalf of the resident.
(B)The providers decision shall be final and conclusive regarding any adjustments to be made or any action to be taken regarding any charitable consideration extended to any of its residents.
(C)The provider is entitled to payment for the actual costs of care out of any property acquired by the resident subsequent to any adjustment extended to the resident under this paragraph, or from any other property of the resident that the resident failed to disclose.
(D)The provider may pay the monthly premium of the residents health insurance coverage under Medicare to ensure that those payments will be made.
(E)The provider may receive an assignment from the resident of the right to apply for and to receive the benefits, for and on behalf of the resident.
(F)The provider is not responsible for the costs of furnishing the resident with any services, supplies, and medication, when reimbursement is reasonably available from any governmental agency, or any private insurance.
(G)Any refund due to the resident at the termination of the continuing care contract may be offset by any prior subsidy to the resident by the provider.
(2)Limit responsibility for costs associated with the treatment or medication of an ailment or illness existing prior to the date of admission. In these cases, the medical or surgical exceptions, as disclosed by the medical entrance examination, shall be listed in the continuing care contract or in a medical report attached to and made a part of the continuing care contract.
(3)Identify legal remedies that may be available to the provider if the resident makes any material misrepresentation or omission pertaining to the residents assets or health.
(4)Restrict transfer or assignments of the residents rights and privileges under a continuing care contract due to the personal nature of the continuing care contract.
(5)Protect the providers ability to waive a residents breach of the terms or provisions of the continuing care contract in specific instances without relinquishing its right to insist upon full compliance by the resident with all terms or provisions in the contract.
(6)Provide that the resident shall reimburse the provider for any uninsured loss or damage to the residents unit, beyond normal wear and tear, resulting from the residents carelessness or negligence.
(7)Provide that the resident agrees to observe the off-limit areas of the continuing care retirement community designated by the provider for safety reasons. The provider may not include any provision in a continuing care contract that absolves the provider from liability for its negligence.
(8)Provide for the subrogation to the provider of the residents rights in the case of injury to a resident caused by the acts or omissions of a third party, or for the assignment of the residents recovery or benefits in this case to the provider, to the extent of the value of the goods and services furnished by the provider to or on behalf of the resident as a result of the injury.
(9)Provide for a lien on any judgment, settlement, or recovery for any additional expense incurred by the provider in caring for the resident as a result of injury.
(10)Require the residents cooperation and assistance in the diligent prosecution of any claim or action against any third party.
(11)Provide for the appointment of a conservator or guardian by a court with jurisdiction in the event a resident becomes unable to handle his or her personal or financial affairs.
(12)Allow a provider, whose property is tax exempt, to charge the resident, on a pro rata basis, property taxes, or in-lieu taxes, that the provider is required to pay.
(13)Make any other provision approved by the department.
(d)A copy of the residents rights as described in Section 1771.7 shall be attached to every continuing care contract.
(e)A copy of the current audited financial statement of the provider shall be attached to every continuing care contract. For a provider whose current audited financial statement does not accurately reflect the financial ability of the provider to fulfill the continuing care contract obligations, the financial statement attached to the continuing care contract shall include all of the following:
(1)A disclosure that the reserve requirement has not yet been determined or met, and that entrance fees will not be held in escrow.
(2)A disclosure that the ability to provide the services promised in the continuing care contract will depend on successful compliance with the approved financial plan.
(3)A copy of the approved financial plan for meeting the reserve requirements.
(4)Any other supplemental statements or attachments necessary to accurately represent the providers financial ability to fulfill its continuing care contract obligations.
(f)A schedule of the average monthly care fees charged to residents for each type of residential living unit for each of the five years preceding execution of the continuing care contract shall be attached to every continuing care contract. The provider shall update this schedule annually at the end of each fiscal year. If the continuing care retirement community has not been in existence for five years, the information shall be provided for each of the years the continuing care retirement community has been in existence.
(g)If any continuing care contract provides for a health insurance policy for the benefit of the resident, the provider shall attach to the continuing care contract a binder complying with Sections 382 and 382.5 of the Insurance Code.
(h)The provider shall attach to every continuing care contract a completed form in duplicate, captioned Notice of Cancellation. The notice shall be easily detachable, and shall contain, in at least 10-point boldface type, the following statement:
NOTICE OF CANCELLATION | (date) |
Your first date of occupancy under this contract | |
is: _____________________________________________ | |
You may cancel this transaction, without any penalty within 90 calendar days from the above date.
If you cancel, any property transferred, any payments made by you under the contract, and any negotiable instrument executed by you will be returned within 14 calendar days after making possession of the living unit available to the provider. Any security interest arising out of the transaction will be canceled.
If you cancel, you are obligated to pay a reasonable processing fee to cover costs and to pay for the reasonable value of the services received by you from the provider up to the date you canceled or made available to the provider the possession of any living unit delivered to you under this contract, whichever is later.
If you cancel, you must return possession of any living unit delivered to you under this contract to the provider in substantially the same condition as when you took possession.
Possession of the living unit must be made available to the provider within 20 calendar days of your notice of cancellation. If you fail to make the possession of any living unit available to the provider, then you remain liable for performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice, or send a telegram
to | |
(Name of provider) | |
|---|---|
at | |
(Address of providers place of business) | |
not later than midnight of_____________(date). | |
I hereby cancel this | |
(Residentsor | |
(a)A continuing care contract shall contain all of the following:
(1)The legal name and address of each provider.
(2)The name and address of the continuing care retirement community.
(3)The residents name and the identity of the unit the resident will occupy.
(4)If there is a transferor other than the resident, the transferor shall be a party to the contract and the transferors name and address shall be specified.
(5)If the provider has used the name of any charitable or religious or nonprofit organization in its title before January 1, 1979, and continues to use that name, and that organization is not responsible for the financial and contractual obligations of the provider or the obligations specified in the continuing care contract, the provider shall include in every continuing care contract a conspicuous statement that clearly informs the resident that the organization is not financially responsible.
(6)The date the continuing care contract is signed by the resident and, where applicable, any other transferor.
(7)The duration of the continuing care contract.
(8)A list of the services that will be made available to the resident as required to provide the appropriate level of care. The list of services shall include the services required as a condition for licensure as a residential care facility for the elderly, including all of the following:
(A)Regular observation of the residents health status to ensure that his or her dietary needs, social needs, and needs for special services are satisfied.
(B)Safe and healthful living accommodations, including housekeeping services and utilities.
(C)Maintenance of house rules for the protection of residents.
(D)A planned activities program, which includes social and recreational activities appropriate to the interests and capabilities of the resident.
(E)Three balanced, nutritious meals and snacks made available daily, including special diets prescribed by a physician as a medical necessity.
(F)Assisted living services.
(G)Assistance with taking medications.
(H)Central storing and distribution of medications.
(I)Arrangements to meet health needs, including arranging transportation.
(9)An itemization of the services that are included in the monthly fee and the services that are available at an extra charge. The provider shall attach a current fee schedule to the continuing care contract. The schedule shall state that a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(10)The procedures and conditions under which a resident may be voluntarily and involuntarily transferred from a designated living unit. The transfer procedures, at a minimum, shall include provisions addressing all of the following circumstances under which a transfer may be authorized:
(A)A continuing care retirement community may transfer a resident under the following conditions, taking into account the appropriateness and necessity of the transfer and the goal of promoting resident independence:
(i)The resident is nonambulatory. The definition of nonambulatory, as provided in Section 13131, shall either be stated in full in the continuing care contract or be cited. If Section 13131 is cited, a copy of the statute shall be made available to the resident, either as an attachment to the continuing care contract or by specifying that it will be provided upon request. If a nonambulatory resident occupies a room that has a fire clearance for nonambulatory residents, transfer shall not be necessary.
(ii)The resident develops a physical or mental condition that is detrimental to or endangers the health, safety, or well-being of the resident or another person.
(iii)The residents condition or needs require the residents transfer to an assisted living care unit or skilled nursing facility, because the level of care required by the resident exceeds that which may be lawfully appropriately provided in the living unit.
(iv)The residents condition or needs require the residents transfer to a nursing facility, hospital, or other facility, and the provider has no facilities available to provide that level of care.
(B)Before the continuing care retirement community transfers a resident under any of the conditions set forth in subparagraph (A), the community shall satisfy all of the following requirements:
(i)Involve the resident and the residents responsible person, as defined in paragraph (6) of subdivision (r) of Section 87101 of Title 22 of the California Code of Regulations, and upon the residents or responsible persons request, family members, or the residents physician or other appropriate health professional, in the assessment process that forms the basis for the level of care transfer decision by the provider. The provider shall offer an explanation of the assessment process, which shall include, but not be limited to, an evaluation of the physical and cognitive capacities of the resident. An assessment tool or tools, including scoring and evaluating criteria, shall be used in the determination of the appropriateness of the transfer, and the transfer. The provider shall make copies of the completed assessment to be shared share with the resident or the residents responsible person.
(ii)Prior to sending a formal notification of transfer, the provider shall conduct a care conference with the resident and the residents responsible person, and, upon the residents or responsible persons request, family members, and the residents health care professionals, to explain the reasons for transfer.
(iii)Notify the resident and the residents responsible person of the reasons for the transfer in writing.
(iv)Notwithstanding any other provision of this subparagraph, if the resident does not have impairment of cognitive abilities, the resident may request that his or her responsible person not be involved in the transfer process.
(v)The notice of transfer shall be made at least 30 days before the transfer is expected to occur, except when the health or safety of the resident or other residents is in danger, or the transfer is required by the residents urgent medical needs. Under those circumstances, the written notice shall be made as soon as practicable before the transfer.
(vi)The written notice shall contain the reasons for the transfer, the effective date, the designated level of care or location to which the resident will be transferred, a statement of the residents right to a review of the transfer decision at a care conference, as provided for in subparagraph (C), and for disputed transfer decisions, the right to review by the Continuing Care Contracts Branch of the State Department of Social Services, as provided for in subparagraph (D). The notice shall also contain the name, address, and telephone number of the departments Continuing Care Contracts Branch.
(vii)The continuing care retirement community shall provide sufficient preparation and orientation to the resident to ensure a safe and orderly transfer and to minimize trauma.
(viii)For disputed transfer decisions, the provider shall provide documentation of the residents medical reports, other documents showing the residents current mental and physical function, the prognosis, and the expected duration of relevant conditions, if applicable. The documentation shall include an explanation of how the criteria set out in subparagraph (A) are met. The provider shall make copies of the completed report to share with the resident or the residents responsible person.
(C)The resident has the right to review and dispute the transfer decision at a subsequent care conference that shall include the resident, the residents responsible person, and, upon the residents or responsible persons request, family members, the residents physician or other appropriate health care professional, and members of the providers interdisciplinary team. The local ombudsperson may also be included in the care conference, upon the request of the resident, the residents responsible person, or the provider.
(D)For disputed transfer decisions, the resident or the residents responsible person has the right to a prompt and timely review of the transfer process by the Continuing Care Contracts Branch of the State Department of Social Services. The branch of the department shall provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
(E)The decision of the departments Continuing Care Contracts Branch shall be in writing and shall determine whether the provider failed to comply with the transfer process pursuant to subparagraphs (A) to (C), inclusive, and whether the transfer is appropriate and necessary. Pending the decision of the Continuing Care Contracts Branch, the provider shall specify any additional care the provider believes is necessary in order for the resident to remain in his or her unit. The resident may be required to pay for the extra care, as provided in the contract.
(F)Transfer of a second resident when a shared accommodation arrangement is terminated.
(11)Provisions describing any changes in the residents monthly fee and any changes in the entrance fee refund payable to the resident that will occur if the resident transfers from any unit, including, but not limited to, terminating his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Unless the fee is part of an equity interest contract, a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident.
(12)The providers continuing obligations, if any, in the event a resident is transferred from the continuing care retirement community to another facility.
(13)The providers obligations, if any, to resume care upon the residents return after a transfer from the continuing care retirement community.
(14)The providers obligations to provide services to the resident while the resident is absent from the continuing care retirement community.
(15)The conditions under which the resident must permanently release his or her living unit.
(16)If real or personal properties are transferred in lieu of cash, a statement specifying each items value at the time of transfer, and how the value was ascertained.
(A)An itemized receipt that includes the information described above is acceptable if incorporated as a part of the continuing care contract.
(B)When real property is or will be transferred, the continuing care contract shall include a statement that the deed or other instrument of conveyance shall specify that the real property is conveyed pursuant to a continuing care contract and may be subject to rescission by the transferor within 90 days from the date that the resident first occupies the residential unit.
(C)The failure to comply with this paragraph shall not affect the validity of title to real property transferred pursuant to this chapter.
(17)The amount of the entrance fee.
(18)In the event two parties have jointly paid the entrance fee or other payment that allows them to occupy the unit, the continuing care contract shall describe how any refund of entrance fees is allocated.
(19)The amount of any processing fee.
(20)The amount of any monthly care fee.
(21)For continuing care contracts that require a monthly care fee or other periodic payment, the continuing care contract shall include the following:
(A)A statement that the occupancy and use of the accommodations by the resident is contingent upon the regular payment of the fee.
(B)The regular rate of payment agreed upon (per day, week, or month).
(C)A provision specifying whether payment will be made in advance or after services have been provided.
(D)A provision specifying the provider will adjust monthly care fees for the residents support, maintenance, board, or lodging, when a resident requires medical attention while away from the continuing care retirement community.
(E)A provision specifying whether a credit or allowance will be given to a resident who is absent from the continuing care retirement community or from meals. This provision shall also state, when applicable, that the credit may be permitted at the discretion or by special permission of the provider.
(F)A statement of billing practices, procedures, and timelines. A provider shall allow a minimum of 14 days between the date a bill is sent and the date payment is due. A charge for a late payment may only be assessed if the amount and any condition for the penalty is stated on the bill.
(G)A statement that the provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(22)All continuing care contracts that include monthly care fees shall address changes in monthly care fees by including either of the following provisions:
(A)For prepaid continuing care contracts, which include monthly care fees, one of the following methods:
(i)Fees shall not be subject to change during the lifetime of the agreement.
(ii)Fees shall not be increased by more than a specified number of dollars in any one year and not more than a specified number of dollars during the lifetime of the agreement.
(iii)Fees shall not be increased in excess of a specified percentage over the preceding year and not more than a specified percentage during the lifetime of the agreement.
(B)For monthly fee continuing care contracts, except prepaid contracts, changes in monthly care fees shall be based on projected costs, prior year per capita costs, and economic indicators.
(23)A provision requiring that the provider give written notice to the resident at least 30 days in advance of any change in the residents monthly care fees or in the price or scope of any component of care or other services.
(24)A provision indicating whether the residents rights under the continuing care contract include any proprietary interests in the assets of the provider or in the continuing care retirement community, or both. Any statement in a contract concerning an ownership interest shall appear in a large-sized font or print.
(25)If the continuing care retirement community property is encumbered by a security interest that is senior to any claims the residents may have to enforce continuing care contracts, a provision shall advise the residents that any claims they may have under the continuing care contract are subordinate to the rights of the secured lender. For equity projects, the continuing care contract shall specify the type and extent of the equity interest and whether any entity holds a security interest.
(26)Notice that the living units are part of a continuing care retirement community that is licensed as a residential care facility for the elderly and, as a result, any duly authorized agent of the department may, upon proper identification and upon stating the purpose of his or her visit, enter and inspect the entire premises at any time, without advance notice.
(27)A conspicuous statement, in at least 10-point boldface type in immediate proximity to the space reserved for the signatures of the resident and, if applicable, the transferor, that provides as follows: You, the resident or transferor, may cancel the transaction without cause at any time within 90 days from the date you first occupy your living unit. See the attached notice of cancellation form for an explanation of this right.
(28)Notice that during the cancellation period, the continuing care contract may be canceled upon 30 days written notice by the provider without cause, or that the provider waives this right.
(29)The terms and conditions under which the continuing care contract may be terminated after the cancellation period by either party, including any health or financial conditions.
(30)A statement that, after the cancellation period, a provider may unilaterally terminate the continuing care contract only if the provider has good and sufficient cause.
(A)Any continuing care contract containing a clause that provides for a continuing care contract to be terminated for just cause, good cause, or other similar provision, shall also include a provision that none of the following activities by the resident, or on behalf of the resident, constitutes just cause, good cause, or otherwise activates the termination provision:
(i)Filing or lodging a formal complaint with the department or other appropriate authority.
(ii)Participation in an organization or affiliation of residents, or other similar lawful activity.
(B)The provision required by this paragraph shall also state that the provider shall not discriminate or retaliate in any manner against any resident of a continuing care retirement community for contacting the department, or any other state, county, or city agency, or any elected or appointed government official to file a complaint or for any other reason, or for participation in a residents organization or association.
(C)Nothing in this paragraph diminishes the providers ability to terminate the continuing care contract for good and sufficient cause.
(31)A statement that at least 90 days written notice to the resident is required for a unilateral termination of the continuing care contract by the provider.
(32)A statement concerning the length of notice that a resident is required to give the provider to voluntarily terminate the continuing care contract after the cancellation period.
(33)The policy or terms for refunding or repaying a lump sum of any portion of the entrance fee, in the event of cancellation, termination, or death. Every continuing care contract that provides for a refund or repaying a lump sum of all or a part of the entrance fee shall also do all of the following:
(A)Specify the amount, if any, the resident has paid or will pay for upgrades, special features, or modifications to the residents unit.
(B)State that if the continuing care contract is canceled or terminated by the provider, the provider shall do both of the following:
(i)Amortize the specified amount at the same rate as the residents entrance fee.
(ii)Refund the unamortized balance to the resident at the same time the provider pays the residents entrance fee refund.
(C)State that the resident has a right to terminate his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Provisions for refunds due to cancellation pursuant to this subparagraph shall be set forth in the contract.
(D)State the provider shall make a good-faith effort to reoccupy or resell a unit for which a lump-sum payment is conditioned upon resale of the unit. No later than July 1, 2017, a provider shall provide notice to all current residents with contracts applicable to this subparagraph regarding the statement required by this subparagraph as a clarification of the residents existing contract.
(E)For all contracts with a repayment of all or a portion of the entrance fee conditioned upon the resale of the unit, the provider shall state the average and longest amount of time that it has taken to resell a unit within the last five calendar years.
(34)The following notice at the bottom of the signatory page:
NOTICE | (date) |
This is a continuing care contract as defined by paragraph (8) of subdivision (c), or subdivision (l) of Section 1771 of the California Health and Safety Code. This continuing care contract form has been approved by the State Department of Social Services as required by subdivision (b) of Section 1787 of the California Health and Safety Code. The basis for this approval was a determination that (provider name) has submitted a contract that complies with the minimum statutory requirements applicable to continuing care contracts. The department does not approve or disapprove any of the financial or health care coverage provisions in this contract. Approval by the department is NOT a guaranty of performance or an endorsement of any continuing care contract provisions. Prospective transferors and residents are strongly encouraged to carefully consider the benefits and risks of this continuing care contract and to seek financial and legal advice before signing.
(35)The provider may not attempt to absolve itself in the continuing care contract from liability for its negligence by any statement to that effect, and shall include the following statement in the contract: Nothing in this continuing care contract limits either the providers obligation to provide adequate care and supervision for the resident or any liability on the part of the provider which may result from the providers failure to provide this care and supervision.
(36)Provisions describing how the provider will proceed in the event of a closure, including an explanation of how the provider will comply with Sections 1793.80, 1793.81, 1793.82, and 1793.83.
(b)A life care contract shall also provide that:
(1)All levels of care, including acute care and physicians and surgeons services, will be provided to a resident.
(2)Care will be provided for the duration of the residents life unless the life care contract is canceled or terminated by the provider during the cancellation period or after the cancellation period for good cause.
(3)A comprehensive continuum of care will be provided to the resident, including skilled nursing, in a facility under the ownership and supervision of the provider on, or adjacent to, the continuing care retirement community premises.
(4)Monthly care fees will not be changed based on the residents level of care or service.
(5)A resident who becomes financially unable to pay his or her monthly care fees shall be subsidized provided the residents financial need does not arise from action by the resident to divest the resident of his or her assets.
(c)Continuing care contracts may include provisions that do any of the following:
(1)Subsidize a resident who becomes financially unable to pay for his or her monthly care fees at some future date. If a continuing care contract provides for subsidizing a resident, it may also provide for any of the following:
(A)The resident shall apply for any public assistance or other aid for which he or she is eligible and that the provider may apply for assistance on behalf of the resident.
(B)The providers decision shall be final and conclusive regarding any adjustments to be made or any action to be taken regarding any charitable consideration extended to any of its residents.
(C)The provider is entitled to payment for the actual costs of care out of any property acquired by the resident subsequent to any adjustment extended to the resident under this paragraph, or from any other property of the resident that the resident failed to disclose.
(D)The provider may pay the monthly premium of the residents health insurance coverage under Medicare to ensure that those payments will be made.
(E)The provider may receive an assignment from the resident of the right to apply for and to receive the benefits, for and on behalf of the resident.
(F)The provider is not responsible for the costs of furnishing the resident with any services, supplies, and medication, when reimbursement is reasonably available from any governmental agency, or any private insurance.
(G)Any refund due to the resident at the termination of the continuing care contract may be offset by any prior subsidy to the resident by the provider.
(2)Limit responsibility for costs associated with the treatment or medication of an ailment or illness existing prior to the date of admission. In these cases, the medical or surgical exceptions, as disclosed by the medical entrance examination, shall be listed in the continuing care contract or in a medical report attached to and made a part of the continuing care contract.
(3)Identify legal remedies that may be available to the provider if the resident makes any material misrepresentation or omission pertaining to the residents assets or health.
(4)Restrict transfer or assignments of the residents rights and privileges under a continuing care contract due to the personal nature of the continuing care contract.
(5)Protect the providers ability to waive a residents breach of the terms or provisions of the continuing care contract in specific instances without relinquishing its right to insist upon full compliance by the resident with all terms or provisions in the contract.
(6)Provide that the resident shall reimburse the provider for any uninsured loss or damage to the residents unit, beyond normal wear and tear, resulting from the residents carelessness or negligence.
(7)Provide that the resident agrees to observe the off-limit areas of the continuing care retirement community designated by the provider for safety reasons. The provider may not include any provision in a continuing care contract that absolves the provider from liability for its negligence.
(8)Provide for the subrogation to the provider of the residents rights in the case of injury to a resident caused by the acts or omissions of a third party, or for the assignment of the residents recovery or benefits in this case to the provider, to the extent of the value of the goods and services furnished by the provider to or on behalf of the resident as a result of the injury.
(9)Provide for a lien on any judgment, settlement, or recovery for any additional expense incurred by the provider in caring for the resident as a result of injury.
(10)Require the residents cooperation and assistance in the diligent prosecution of any claim or action against any third party.
(11)Provide for the appointment of a conservator or guardian by a court with jurisdiction in the event a resident becomes unable to handle his or her personal or financial affairs.
(12)Allow a provider, whose property is tax exempt, to charge the resident, on a pro rata basis, property taxes, or in-lieu taxes, that the provider is required to pay.
(13)Make any other provision approved by the department.
(d)A copy of the residents rights as described in Section 1771.7 shall be attached to every continuing care contract.
(e)A copy of the current audited financial statement of the provider shall be attached to every continuing care contract. For a provider whose current audited financial statement does not accurately reflect the financial ability of the provider to fulfill the continuing care contract obligations, the financial statement attached to the continuing care contract shall include all of the following:
(1)A disclosure that the reserve requirement has not yet been determined or met, and that entrance fees will not be held in escrow.
(2)A disclosure that the ability to provide the services promised in the continuing care contract will depend on successful compliance with the approved financial plan.
(3)A copy of the approved financial plan for meeting the reserve requirements.
(4)Any other supplemental statements or attachments necessary to accurately represent the providers financial ability to fulfill its continuing care contract obligations.
(f)A schedule of the average monthly care fees charged to residents for each type of residential living unit for each of the five years preceding execution of the continuing care contract shall be attached to every continuing care contract. The provider shall update this schedule annually at the end of each fiscal year. If the continuing care retirement community has not been in existence for five years, the information shall be provided for each of the years the continuing care retirement community has been in existence.
(g)If any continuing care contract provides for a health insurance policy for the benefit of the resident, the provider shall attach to the continuing care contract a binder complying with Sections 382 and 382.5 of the Insurance Code.
(h)The provider shall attach to every continuing care contract a completed form in duplicate, captioned Notice of Cancellation. The notice shall be easily detachable, and shall contain, in at least 10-point boldface type, the following statement:
NOTICE OF CANCELLATION | (date) |
Your first date of occupancy under this contract | |
is: _____________________________________________ | |
You may cancel this transaction, without any penalty within 90 calendar days from the above date.
If you cancel, any property transferred, any payments made by you under the contract, and any negotiable instrument executed by you will be returned within 14 calendar days after making possession of the living unit available to the provider. Any security interest arising out of the transaction will be canceled.
If you cancel, you are obligated to pay a reasonable processing fee to cover costs and to pay for the reasonable value of the services received by you from the provider up to the date you canceled or made available to the provider the possession of any living unit delivered to you under this contract, whichever is later.
If you cancel, you must return possession of any living unit delivered to you under this contract to the provider in substantially the same condition as when you took possession.
Possession of the living unit must be made available to the provider within 20 calendar days of your notice of cancellation. If you fail to make the possession of any living unit available to the provider, then you remain liable for performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice, or send a telegram
to | |
(Name of provider) | |
|---|---|
at | |
(Address of providers place of business) | |
not later than midnight of_____________(date). | |
I hereby cancel this | |
(Residentsor | |
(a)A continuing care contract shall contain all of the following:
(1)The legal name and address of each provider.
(2)The name and address of the continuing care retirement community.
(3)The residents name and the identity of the unit the resident will occupy.
(4)If there is a transferor other than the resident, the transferor shall be a party to the contract and the transferors name and address shall be specified.
(5)If the provider has used the name of any charitable or religious or nonprofit organization in its title before January 1, 1979, and continues to use that name, and that organization is not responsible for the financial and contractual obligations of the provider or the obligations specified in the continuing care contract, the provider shall include in every continuing care contract a conspicuous statement that clearly informs the resident that the organization is not financially responsible.
(6)The date the continuing care contract is signed by the resident and, where applicable, any other transferor.
(7)The duration of the continuing care contract.
(8)A list of the services that will be made available to the resident as required to provide the appropriate level of care. The list of services shall include the services required as a condition for licensure as a residential care facility for the elderly, including all of the following:
(A)Regular observation of the residents health status to ensure that his or her dietary needs, social needs, and needs for special services are satisfied.
(B)Safe and healthful living accommodations, including housekeeping services and utilities.
(C)Maintenance of house rules for the protection of residents.
(D)A planned activities program, which includes social and recreational activities appropriate to the interests and capabilities of the resident.
(E)Three balanced, nutritious meals and snacks made available daily, including special diets prescribed by a physician as a medical necessity.
(F)Assisted living services.
(G)Assistance with taking medications.
(H)Central storing and distribution of medications.
(I)Arrangements to meet health needs, including arranging transportation.
(9)An itemization of the services that are included in the monthly fee and the services that are available at an extra charge. The provider shall attach a current fee schedule to the continuing care contract. The schedule shall state that a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(10)The procedures and conditions under which a resident may be voluntarily and involuntarily transferred from a designated living unit. The transfer procedures, at a minimum, shall include provisions addressing all of the following circumstances under which a transfer may be authorized:
(A)A continuing care retirement community may transfer a resident under the following conditions, taking into account the appropriateness and necessity of the transfer and the goal of promoting resident independence:
(i)The resident is nonambulatory. The definition of nonambulatory, as provided in Section 13131, shall either be stated in full in the continuing care contract or be cited. If Section 13131 is cited, a copy of the statute shall be made available to the resident, either as an attachment to the continuing care contract or by specifying that it will be provided upon request. If a nonambulatory resident occupies a room that has a fire clearance for nonambulatory residents, transfer shall not be necessary.
(ii)The resident develops a physical or mental condition that endangers the health, safety, or well-being of the resident or another person.
(iii)The residents condition or needs require the residents transfer to an assisted living care unit or skilled nursing facility, because the level of care required by the resident exceeds that which may be lawfully provided in the living unit.
(iv)The residents condition or needs require the residents transfer to a nursing facility, hospital, or other facility, and the provider has no facilities available to provide that level of care.
(B)Before the continuing care retirement community transfers a resident under any of the conditions set forth in subparagraph (A), the community shall satisfy all of the following requirements:
(i)Involve the resident and the residents responsible person, as defined in paragraph (6) of subdivision (r) of Section 87101 of Title 22 of the California Code of Regulations, and upon the residents or responsible persons request, family members, or the residents physician or other appropriate health professional, in the assessment process that forms the basis for the level of care transfer decision by the provider. The provider shall offer an explanation of the assessment process. process, which shall include, but not be limited to, an evaluation of the physical and cognitive capacities of the resident. An assessment tool or tools, including scoring and evaluating criteria, shall be used in the determination of the appropriateness of the transfer, and the provider shall make copies of the completed assessment to be shared with the resident or the residents responsible person.
(ii)Prior to sending a formal notification of transfer, the provider shall conduct a care conference with the resident and the residents responsible person, and and, upon the residents or responsible persons request, family members, and the residents health care professionals, to explain the reasons for transfer.
(iii)Notify the resident and the residents responsible person of the reasons for the transfer in writing.
(iv)Notwithstanding any other provision of this subparagraph, if the resident does not have impairment of cognitive abilities, the resident may request that his or her responsible person not be involved in the transfer process.
(v)The notice of transfer shall be made at least 30 days before the transfer is expected to occur, except when the health or safety of the resident or other residents is in danger, or the transfer is required by the residents urgent medical needs. Under those circumstances, the written notice shall be made as soon as practicable before the transfer.
(vi)The written notice shall contain the reasons for the transfer, the effective date, the designated level of care or location to which the resident will be transferred, a statement of the residents right to a review of the transfer decision at a care conference, as provided for in subparagraph (C), and for disputed transfer decisions, the right to review by the Continuing Care Contracts Branch of the State Department of Social Services, as provided for in subparagraph (D). The notice shall also contain the name, address, and telephone number of the departments Continuing Care Contracts Branch.
(vii)The continuing care retirement community shall provide sufficient preparation and orientation to the resident to ensure a safe and orderly transfer and to minimize trauma.
(C)The resident has the right to review and dispute the transfer decision at a subsequent care conference that shall include the resident, the residents responsible person, and and, upon the residents or responsible persons request, family members, the residents physician or other appropriate health care professional, and members of the providers interdisciplinary team. The local ombudsperson may also be included in the care conference, upon the request of the resident, the residents responsible person, or the provider.
(D)For disputed transfer decisions, the resident or the residents responsible person has the right to a prompt and timely review of the transfer process by the Continuing Care Contracts Branch of the State Department of Social Services. The branch of the department shall consider the appropriateness and necessity of the transfer, including the physical, cognitive, mental, and emotional functional abilities of the resident, and provide an explanation of the assessment, including provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
(E)The decision of the departments Continuing Care Contracts Branch shall be in writing and shall determine whether the provider failed to comply with the transfer process pursuant to subparagraphs (A) to (C), inclusive, and whether the transfer is appropriate and necessary. Pending the decision of the Continuing Care Contracts Branch, the provider shall specify any additional care the provider believes is necessary in order for the resident to remain in his or her unit. The resident may be required to pay for the extra care, as provided in the contract.
(F)Transfer of a second resident when a shared accommodation arrangement is terminated.
(11)Provisions describing any changes in the residents monthly fee and any changes in the entrance fee refund payable to the resident that will occur if the resident transfers from any unit, including, but not limited to, terminating his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Unless the fee is part of an equity interest contract, a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident.
(12)The providers continuing obligations, if any, in the event a resident is transferred from the continuing care retirement community to another facility.
(13)The providers obligations, if any, to resume care upon the residents return after a transfer from the continuing care retirement community.
(14)The providers obligations to provide services to the resident while the resident is absent from the continuing care retirement community.
(15)The conditions under which the resident must permanently release his or her living unit.
(16)If real or personal properties are transferred in lieu of cash, a statement specifying each items value at the time of transfer, and how the value was ascertained.
(A)An itemized receipt that includes the information described above is acceptable if incorporated as a part of the continuing care contract.
(B)When real property is or will be transferred, the continuing care contract shall include a statement that the deed or other instrument of conveyance shall specify that the real property is conveyed pursuant to a continuing care contract and may be subject to rescission by the transferor within 90 days from the date that the resident first occupies the residential unit.
(C)The failure to comply with this paragraph shall not affect the validity of title to real property transferred pursuant to this chapter.
(17)The amount of the entrance fee.
(18)In the event two parties have jointly paid the entrance fee or other payment that allows them to occupy the unit, the continuing care contract shall describe how any refund of entrance fees is allocated.
(19)The amount of any processing fee.
(20)The amount of any monthly care fee.
(21)For continuing care contracts that require a monthly care fee or other periodic payment, the continuing care contract shall include the following:
(A)A statement that the occupancy and use of the accommodations by the resident is contingent upon the regular payment of the fee.
(B)The regular rate of payment agreed upon (per day, week, or month).
(C)A provision specifying whether payment will be made in advance or after services have been provided.
(D)A provision specifying the provider will adjust monthly care fees for the residents support, maintenance, board, or lodging, when a resident requires medical attention while away from the continuing care retirement community.
(E)A provision specifying whether a credit or allowance will be given to a resident who is absent from the continuing care retirement community or from meals. This provision shall also state, when applicable, that the credit may be permitted at the discretion or by special permission of the provider.
(F)A statement of billing practices, procedures, and timelines. A provider shall allow a minimum of 14 days between the date a bill is sent and the date payment is due. A charge for a late payment may only be assessed if the amount and any condition for the penalty is stated on the bill.
(G)A statement that the provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(22)All continuing care contracts that include monthly care fees shall address changes in monthly care fees by including either of the following provisions:
(A)For prepaid continuing care contracts, which include monthly care fees, one of the following methods:
(i)Fees shall not be subject to change during the lifetime of the agreement.
(ii)Fees shall not be increased by more than a specified number of dollars in any one year and not more than a specified number of dollars during the lifetime of the agreement.
(iii)Fees shall not be increased in excess of a specified percentage over the preceding year and not more than a specified percentage during the lifetime of the agreement.
(B)For monthly fee continuing care contracts, except prepaid contracts, changes in monthly care fees shall be based on projected costs, prior year per capita costs, and economic indicators.
(23)A provision requiring that the provider give written notice to the resident at least 30 days in advance of any change in the residents monthly care fees or in the price or scope of any component of care or other services.
(24)A provision indicating whether the residents rights under the continuing care contract include any proprietary interests in the assets of the provider or in the continuing care retirement community, or both. Any statement in a contract concerning an ownership interest shall appear in a large-sized font or print.
(25)If the continuing care retirement community property is encumbered by a security interest that is senior to any claims the residents may have to enforce continuing care contracts, a provision shall advise the residents that any claims they may have under the continuing care contract are subordinate to the rights of the secured lender. For equity projects, the continuing care contract shall specify the type and extent of the equity interest and whether any entity holds a security interest.
(26)Notice that the living units are part of a continuing care retirement community that is licensed as a residential care facility for the elderly and, as a result, any duly authorized agent of the department may, upon proper identification and upon stating the purpose of his or her visit, enter and inspect the entire premises at any time, without advance notice.
(27)A conspicuous statement, in at least 10-point boldface type in immediate proximity to the space reserved for the signatures of the resident and, if applicable, the transferor, that provides as follows: You, the resident or transferor, may cancel the transaction without cause at any time within 90 days from the date you first occupy your living unit. See the attached notice of cancellation form for an explanation of this right.
(28)Notice that during the cancellation period, the continuing care contract may be canceled upon 30 days written notice by the provider without cause, or that the provider waives this right.
(29)The terms and conditions under which the continuing care contract may be terminated after the cancellation period by either party, including any health or financial conditions.
(30)A statement that, after the cancellation period, a provider may unilaterally terminate the continuing care contract only if the provider has good and sufficient cause.
(A)Any continuing care contract containing a clause that provides for a continuing care contract to be terminated for just cause, good cause, or other similar provision, shall also include a provision that none of the following activities by the resident, or on behalf of the resident, constitutes just cause, good cause, or otherwise activates the termination provision:
(i)Filing or lodging a formal complaint with the department or other appropriate authority.
(ii)Participation in an organization or affiliation of residents, or other similar lawful activity.
(B)The provision required by this paragraph shall also state that the provider shall not discriminate or retaliate in any manner against any resident of a continuing care retirement community for contacting the department, or any other state, county, or city agency, or any elected or appointed government official to file a complaint or for any other reason, or for participation in a residents organization or association.
(C)Nothing in this paragraph diminishes the providers ability to terminate the continuing care contract for good and sufficient cause.
(31)A statement that at least 90 days written notice to the resident is required for a unilateral termination of the continuing care contract by the provider.
(32)A statement concerning the length of notice that a resident is required to give the provider to voluntarily terminate the continuing care contract after the cancellation period.
(33)The policy or terms for refunding or repaying a lump sum of any portion of the entrance fee, in the event of cancellation, termination, or death. Every continuing care contract that provides for a refund or repaying a lump sum of all or a part of the entrance fee shall also do all of the following:
(A)Specify the amount, if any, the resident has paid or will pay for upgrades, special features, or modifications to the residents unit.
(B)State that if the continuing care contract is canceled or terminated by the provider, the provider shall do both of the following:
(i)Amortize the specified amount at the same rate as the residents entrance fee.
(ii)Refund the unamortized balance to the resident at the same time the provider pays the residents entrance fee refund.
(C)State that the resident has a right to terminate his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Provisions for refunds due to cancellation pursuant to this subparagraph shall be set forth in the contract.
(D)State the provider shall make a good-faith effort to reoccupy or resell a unit for which a lump-sum payment is conditioned upon resale of the unit. No later than July 1, 2017, a provider shall provide notice to all current residents with contracts applicable to this subparagraph regarding the statement required by this subparagraph as a clarification of the residents existing contract.
(E)For all contracts with a repayment of all or a portion of the entrance fee conditioned upon the resale of the unit, the provider shall state the average and longest amount of time that it has taken to resell a unit within the last five calendar years.
(34)The following notice at the bottom of the signatory page:
NOTICE | (date) |
This is a continuing care contract as defined by paragraph (8) of subdivision (c), or subdivision (l) of Section 1771 of the California Health and Safety Code. This continuing care contract form has been approved by the State Department of Social Services as required by subdivision (b) of Section 1787 of the California Health and Safety Code. The basis for this approval was a determination that (provider name) has submitted a contract that complies with the minimum statutory requirements applicable to continuing care contracts. The department does not approve or disapprove any of the financial or health care coverage provisions in this contract. Approval by the department is NOT a guaranty of performance or an endorsement of any continuing care contract provisions. Prospective transferors and residents are strongly encouraged to carefully consider the benefits and risks of this continuing care contract and to seek financial and legal advice before signing.
(35)The provider may not attempt to absolve itself in the continuing care contract from liability for its negligence by any statement to that effect, and shall include the following statement in the contract: Nothing in this continuing care contract limits either the providers obligation to provide adequate care and supervision for the resident or any liability on the part of the provider which may result from the providers failure to provide this care and supervision.
(36)Provisions describing how the provider will proceed in the event of a closure, including an explanation of how the provider will comply with Sections 1793.80, 1793.81, 1793.82, and 1793.83.
(b)A life care contract shall also provide that:
(1)All levels of care, including acute care and physicians and surgeons services, will be provided to a resident.
(2)Care will be provided for the duration of the residents life unless the life care contract is canceled or terminated by the provider during the cancellation period or after the cancellation period for good cause.
(3)A comprehensive continuum of care will be provided to the resident, including skilled nursing, in a facility under the ownership and supervision of the provider on, or adjacent to, the continuing care retirement community premises.
(4)Monthly care fees will not be changed based on the residents level of care or service.
(5)A resident who becomes financially unable to pay his or her monthly care fees shall be subsidized provided the residents financial need does not arise from action by the resident to divest the resident of his or her assets.
(c)Continuing care contracts may include provisions that do any of the following:
(1)Subsidize a resident who becomes financially unable to pay for his or her monthly care fees at some future date. If a continuing care contract provides for subsidizing a resident, it may also provide for any of the following:
(A)The resident shall apply for any public assistance or other aid for which he or she is eligible and that the provider may apply for assistance on behalf of the resident.
(B)The providers decision shall be final and conclusive regarding any adjustments to be made or any action to be taken regarding any charitable consideration extended to any of its residents.
(C)The provider is entitled to payment for the actual costs of care out of any property acquired by the resident subsequent to any adjustment extended to the resident under this paragraph, or from any other property of the resident that the resident failed to disclose.
(D)The provider may pay the monthly premium of the residents health insurance coverage under Medicare to ensure that those payments will be made.
(E)The provider may receive an assignment from the resident of the right to apply for and to receive the benefits, for and on behalf of the resident.
(F)The provider is not responsible for the costs of furnishing the resident with any services, supplies, and medication, when reimbursement is reasonably available from any governmental agency, or any private insurance.
(G)Any refund due to the resident at the termination of the continuing care contract may be offset by any prior subsidy to the resident by the provider.
(2)Limit responsibility for costs associated with the treatment or medication of an ailment or illness existing prior to the date of admission. In these cases, the medical or surgical exceptions, as disclosed by the medical entrance examination, shall be listed in the continuing care contract or in a medical report attached to and made a part of the continuing care contract.
(3)Identify legal remedies that may be available to the provider if the resident makes any material misrepresentation or omission pertaining to the residents assets or health.
(4)Restrict transfer or assignments of the residents rights and privileges under a continuing care contract due to the personal nature of the continuing care contract.
(5)Protect the providers ability to waive a residents breach of the terms or provisions of the continuing care contract in specific instances without relinquishing its right to insist upon full compliance by the resident with all terms or provisions in the contract.
(6)Provide that the resident shall reimburse the provider for any uninsured loss or damage to the residents unit, beyond normal wear and tear, resulting from the residents carelessness or negligence.
(7)Provide that the resident agrees to observe the off-limit areas of the continuing care retirement community designated by the provider for safety reasons. The provider may not include any provision in a continuing care contract that absolves the provider from liability for its negligence.
(8)Provide for the subrogation to the provider of the residents rights in the case of injury to a resident caused by the acts or omissions of a third party, or for the assignment of the residents recovery or benefits in this case to the provider, to the extent of the value of the goods and services furnished by the provider to or on behalf of the resident as a result of the injury.
(9)Provide for a lien on any judgment, settlement, or recovery for any additional expense incurred by the provider in caring for the resident as a result of injury.
(10)Require the residents cooperation and assistance in the diligent prosecution of any claim or action against any third party.
(11)Provide for the appointment of a conservator or guardian by a court with jurisdiction in the event a resident becomes unable to handle his or her personal or financial affairs.
(12)Allow a provider, whose property is tax exempt, to charge the resident, on a pro rata basis, property taxes, or in-lieu taxes, that the provider is required to pay.
(13)Make any other provision approved by the department.
(d)A copy of the residents rights as described in Section 1771.7 shall be attached to every continuing care contract.
(e)A copy of the current audited financial statement of the provider shall be attached to every continuing care contract. For a provider whose current audited financial statement does not accurately reflect the financial ability of the provider to fulfill the continuing care contract obligations, the financial statement attached to the continuing care contract shall include all of the following:
(1)A disclosure that the reserve requirement has not yet been determined or met, and that entrance fees will not be held in escrow.
(2)A disclosure that the ability to provide the services promised in the continuing care contract will depend on successful compliance with the approved financial plan.
(3)A copy of the approved financial plan for meeting the reserve requirements.
(4)Any other supplemental statements or attachments necessary to accurately represent the providers financial ability to fulfill its continuing care contract obligations.
(f)A schedule of the average monthly care fees charged to residents for each type of residential living unit for each of the five years preceding execution of the continuing care contract shall be attached to every continuing care contract. The provider shall update this schedule annually at the end of each fiscal year. If the continuing care retirement community has not been in existence for five years, the information shall be provided for each of the years the continuing care retirement community has been in existence.
(g)If any continuing care contract provides for a health insurance policy for the benefit of the resident, the provider shall attach to the continuing care contract a binder complying with Sections 382 and 382.5 of the Insurance Code.
(h)The provider shall attach to every continuing care contract a completed form in duplicate, captioned Notice of Cancellation. The notice shall be easily detachable, and shall contain, in at least 10-point boldface type, the following statement:
NOTICE OF CANCELLATION | (date) |
Your first date of occupancy under this contract | |
is: _____________________________________________ | |
You may cancel this transaction, without any penalty within 90 calendar days from the above date.
If you cancel, any property transferred, any payments made by you under the contract, and any negotiable instrument executed by you will be returned within 14 calendar days after making possession of the living unit available to the provider. Any security interest arising out of the transaction will be canceled.
If you cancel, you are obligated to pay a reasonable processing fee to cover costs and to pay for the reasonable value of the services received by you from the provider up to the date you canceled or made available to the provider the possession of any living unit delivered to you under this contract, whichever is later.
If you cancel, you must return possession of any living unit delivered to you under this contract to the provider in substantially the same condition as when you took possession.
Possession of the living unit must be made available to the provider within 20 calendar days of your notice of cancellation. If you fail to make the possession of any living unit available to the provider, then you remain liable for performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice, or send a telegram
to | |
(Name of provider) | |
|---|---|
at | |
(Address of providers place of business) | |
not later than midnight of_____________(date). | |
I hereby cancel this | |
(Residentsor | |
(a)A continuing care contract shall contain all of the following:
(1)The legal name and address of each provider.
(2)The name and address of the continuing care retirement community.
(3)The residents name and the identity of the unit the resident will occupy.
(4)If there is a transferor other than the resident, the transferor shall be a party to the contract and the transferors name and address shall be specified.
(5)If the provider has used the name of any charitable or religious or nonprofit organization in its title before January 1, 1979, and continues to use that name, and that organization is not responsible for the financial and contractual obligations of the provider or the obligations specified in the continuing care contract, the provider shall include in every continuing care contract a conspicuous statement that clearly informs the resident that the organization is not financially responsible.
(6)The date the continuing care contract is signed by the resident and, where applicable, any other transferor.
(7)The duration of the continuing care contract.
(8)A list of the services that will be made available to the resident as required to provide the appropriate level of care. The list of services shall include the services required as a condition for licensure as a residential care facility for the elderly, including all of the following:
(A)Regular observation of the residents health status to ensure that his or her dietary needs, social needs, and needs for special services are satisfied.
(B)Safe and healthful living accommodations, including housekeeping services and utilities.
(C)Maintenance of house rules for the protection of residents.
(D)A planned activities program, which includes social and recreational activities appropriate to the interests and capabilities of the resident.
(E)Three balanced, nutritious meals and snacks made available daily, including special diets prescribed by a physician as a medical necessity.
(F)Assisted living services.
(G)Assistance with taking medications.
(H)Central storing and distribution of medications.
(I)Arrangements to meet health needs, including arranging transportation.
(9)An itemization of the services that are included in the monthly fee and the services that are available at an extra charge. The provider shall attach a current fee schedule to the continuing care contract. The schedule shall state that a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(10)The procedures and conditions under which a resident may be voluntarily and involuntarily transferred from a designated living unit. The transfer procedures, at a minimum, shall include provisions addressing all of the following circumstances under which a transfer may be authorized:
(A)A continuing care retirement community may transfer a resident under the following conditions, taking into account the appropriateness and necessity of the transfer and the goal of promoting resident independence:
(i)The resident is nonambulatory. The definition of nonambulatory, as provided in Section 13131, shall either be stated in full in the continuing care contract or be cited. If Section 13131 is cited, a copy of the statute shall be made available to the resident, either as an attachment to the continuing care contract or by specifying that it will be provided upon request. If a nonambulatory resident occupies a room that has a fire clearance for nonambulatory residents, transfer shall not be necessary.
(ii)The resident develops a physical or mental condition that endangers the health, safety, or well-being of the resident or another person.
(iii)The residents condition or needs require the residents transfer to an assisted living care unit or skilled nursing facility, because the level of care required by the resident exceeds that which may be lawfully provided in the living unit.
(iv)The residents condition or needs require the residents transfer to a nursing facility, hospital, or other facility, and the provider has no facilities available to provide that level of care.
(B)Before the continuing care retirement community transfers a resident under any of the conditions set forth in subparagraph (A), the community shall satisfy all of the following requirements:
(i)Involve the resident and the residents responsible person, as defined in paragraph (6) of subdivision (r) of Section 87101 of Title 22 of the California Code of Regulations, and upon the residents or responsible persons request, family members, or the residents physician or other appropriate health professional, in the assessment process that forms the basis for the level of care transfer decision by the provider. The provider shall offer an explanation of the assessment process. If an An assessment tool or tools, including scoring and evaluating criteria, are shall be used in the determination of the appropriateness of the transfer, the provider shall make copies of the completed assessment available upon the request of to be shared with the resident or the residents responsible person.
(ii)Prior to sending a formal notification of transfer, the provider shall conduct a care conference with the resident and the residents responsible person, and upon the residents or responsible persons request, family members, and the residents health care professionals, to explain the reasons for transfer.
(iii)Notify the resident and the residents responsible person of the reasons for the transfer in writing.
(iv)Notwithstanding any other provision of this subparagraph, if the resident does not have impairment of cognitive abilities, the resident may request that his or her responsible person not be involved in the transfer process.
(v)The notice of transfer shall be made at least 30 days before the transfer is expected to occur, except when the health or safety of the resident or other residents is in danger, or the transfer is required by the residents urgent medical needs. Under those circumstances, the written notice shall be made as soon as practicable before the transfer.
(vi)The written notice shall contain the reasons for the transfer, the effective date, the designated level of care or location to which the resident will be transferred, a statement of the residents right to a review of the transfer decision at a care conference, as provided for in subparagraph (C), and for disputed transfer decisions, the right to review by the Continuing Care Contracts Branch of the State Department of Social Services, as provided for in subparagraph (D). The notice shall also contain the name, address, and telephone number of the departments Continuing Care Contracts Branch.
(vii)The continuing care retirement community shall provide sufficient preparation and orientation to the resident to ensure a safe and orderly transfer and to minimize trauma.
(C)The resident has the right to review and dispute the transfer decision at a subsequent care conference that shall include the resident, the residents responsible person, and upon the residents or responsible persons request, family members, the residents physician or other appropriate health care professional, and members of the providers interdisciplinary team. The local ombudsperson may also be included in the care conference, upon the request of the resident, the residents responsible person, or the provider.
(D)For disputed transfer decisions, the resident or the residents responsible person has the right to a prompt and timely review of the transfer process by the Continuing Care Contracts Branch of the State Department of Social Services. The branch of the department shall consider the appropriateness and necessity of the transfer, including the physical, cognitive, mental, and emotional functional abilities of the resident, and provide an explanation of the assessment, including the scoring and evaluating criteria used by the provider to justify the transfer.
(E)The decision of the departments Continuing Care Contracts Branch shall be in writing and shall determine whether the provider failed to comply with the transfer process pursuant to subparagraphs (A) to (C), inclusive. inclusive, and whether the transfer is appropriate and necessary. Pending the decision of the Continuing Care Contracts Branch, the provider shall specify any additional care the provider believes is necessary in order for the resident to remain in his or her unit. The resident may be required to pay for the extra care, as provided in the contract.
(F)Transfer of a second resident when a shared accommodation arrangement is terminated.
(11)Provisions describing any changes in the residents monthly fee and any changes in the entrance fee refund payable to the resident that will occur if the resident transfers from any unit, including, but not limited to, terminating his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Unless the fee is part of an equity interest contract, a provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident.
(12)The providers continuing obligations, if any, in the event a resident is transferred from the continuing care retirement community to another facility.
(13)The providers obligations, if any, to resume care upon the residents return after a transfer from the continuing care retirement community.
(14)The providers obligations to provide services to the resident while the resident is absent from the continuing care retirement community.
(15)The conditions under which the resident must permanently release his or her living unit.
(16)If real or personal properties are transferred in lieu of cash, a statement specifying each items value at the time of transfer, and how the value was ascertained.
(A)An itemized receipt that includes the information described above is acceptable if incorporated as a part of the continuing care contract.
(B)When real property is or will be transferred, the continuing care contract shall include a statement that the deed or other instrument of conveyance shall specify that the real property is conveyed pursuant to a continuing care contract and may be subject to rescission by the transferor within 90 days from the date that the resident first occupies the residential unit.
(C)The failure to comply with this paragraph shall not affect the validity of title to real property transferred pursuant to this chapter.
(17)The amount of the entrance fee.
(18)In the event two parties have jointly paid the entrance fee or other payment that allows them to occupy the unit, the continuing care contract shall describe how any refund of entrance fees is allocated.
(19)The amount of any processing fee.
(20)The amount of any monthly care fee.
(21)For continuing care contracts that require a monthly care fee or other periodic payment, the continuing care contract shall include the following:
(A)A statement that the occupancy and use of the accommodations by the resident is contingent upon the regular payment of the fee.
(B)The regular rate of payment agreed upon (per day, week, or month).
(C)A provision specifying whether payment will be made in advance or after services have been provided.
(D)A provision specifying the provider will adjust monthly care fees for the residents support, maintenance, board, or lodging, when a resident requires medical attention while away from the continuing care retirement community.
(E)A provision specifying whether a credit or allowance will be given to a resident who is absent from the continuing care retirement community or from meals. This provision shall also state, when applicable, that the credit may be permitted at the discretion or by special permission of the provider.
(F)A statement of billing practices, procedures, and timelines. A provider shall allow a minimum of 14 days between the date a bill is sent and the date payment is due. A charge for a late payment may only be assessed if the amount and any condition for the penalty is stated on the bill.
(G)A statement that the provider is prohibited from charging the resident or his or her estate a monthly fee once a unit has been permanently vacated by the resident, unless the fee is part of an equity interest contract.
(22)All continuing care contracts that include monthly care fees shall address changes in monthly care fees by including either of the following provisions:
(A)For prepaid continuing care contracts, which include monthly care fees, one of the following methods:
(i)Fees shall not be subject to change during the lifetime of the agreement.
(ii)Fees shall not be increased by more than a specified number of dollars in any one year and not more than a specified number of dollars during the lifetime of the agreement.
(iii)Fees shall not be increased in excess of a specified percentage over the preceding year and not more than a specified percentage during the lifetime of the agreement.
(B)For monthly fee continuing care contracts, except prepaid contracts, changes in monthly care fees shall be based on projected costs, prior year per capita costs, and economic indicators.
(23)A provision requiring that the provider give written notice to the resident at least 30 days in advance of any change in the residents monthly care fees or in the price or scope of any component of care or other services.
(24)A provision indicating whether the residents rights under the continuing care contract include any proprietary interests in the assets of the provider or in the continuing care retirement community, or both. Any statement in a contract concerning an ownership interest shall appear in a large-sized font or print.
(25)If the continuing care retirement community property is encumbered by a security interest that is senior to any claims the residents may have to enforce continuing care contracts, a provision shall advise the residents that any claims they may have under the continuing care contract are subordinate to the rights of the secured lender. For equity projects, the continuing care contract shall specify the type and extent of the equity interest and whether any entity holds a security interest.
(26)Notice that the living units are part of a continuing care retirement community that is licensed as a residential care facility for the elderly and, as a result, any duly authorized agent of the department may, upon proper identification and upon stating the purpose of his or her visit, enter and inspect the entire premises at any time, without advance notice.
(27)A conspicuous statement, in at least 10-point boldface type in immediate proximity to the space reserved for the signatures of the resident and, if applicable, the transferor, that provides as follows: You, the resident or transferor, may cancel the transaction without cause at any time within 90 days from the date you first occupy your living unit. See the attached notice of cancellation form for an explanation of this right.
(28)Notice that during the cancellation period, the continuing care contract may be canceled upon 30 days written notice by the provider without cause, or that the provider waives this right.
(29)The terms and conditions under which the continuing care contract may be terminated after the cancellation period by either party, including any health or financial conditions.
(30)A statement that, after the cancellation period, a provider may unilaterally terminate the continuing care contract only if the provider has good and sufficient cause.
(A)Any continuing care contract containing a clause that provides for a continuing care contract to be terminated for just cause, good cause, or other similar provision, shall also include a provision that none of the following activities by the resident, or on behalf of the resident, constitutes just cause, good cause, or otherwise activates the termination provision:
(i)Filing or lodging a formal complaint with the department or other appropriate authority.
(ii)Participation in an organization or affiliation of residents, or other similar lawful activity.
(B)The provision required by this paragraph shall also state that the provider shall not discriminate or retaliate in any manner against any resident of a continuing care retirement community for contacting the department, or any other state, county, or city agency, or any elected or appointed government official to file a complaint or for any other reason, or for participation in a residents organization or association.
(C)Nothing in this paragraph diminishes the providers ability to terminate the continuing care contract for good and sufficient cause.
(31)A statement that at least 90 days written notice to the resident is required for a unilateral termination of the continuing care contract by the provider.
(32)A statement concerning the length of notice that a resident is required to give the provider to voluntarily terminate the continuing care contract after the cancellation period.
(33)The policy or terms for refunding or repaying a lump sum of any portion of the entrance fee, in the event of cancellation, termination, or death. Every continuing care contract that provides for a refund or repaying a lump sum of all or a part of the entrance fee shall also do all of the following:
(A)Specify the amount, if any, the resident has paid or will pay for upgrades, special features, or modifications to the residents unit.
(B)State that if the continuing care contract is canceled or terminated by the provider, the provider shall do both of the following:
(i)Amortize the specified amount at the same rate as the residents entrance fee.
(ii)Refund the unamortized balance to the resident at the same time the provider pays the residents entrance fee refund.
(C)State that the resident has a right to terminate his or her contract after 18 months of residential temporary relocation, as defined in paragraph (8) of subdivision (r) of Section 1771. Provisions for refunds due to cancellation pursuant to this subparagraph shall be set forth in the contract.
(D)State the provider shall make a good-faith effort to reoccupy or resell a unit for which a lump-sum payment is conditioned upon resale of the unit. No later than July 1, 2017, a provider shall provide notice to all current residents with contracts applicable to this subparagraph regarding the statement required by this subparagraph as a clarification of the residents existing contract.
(E)For all contracts with a repayment of all or a portion of the entrance fee conditioned upon the resale of the unit, the provider shall state the average and longest amount of time that it has taken to resell a unit within the last five calendar years.
(34)The following notice at the bottom of the signatory page:
NOTICE | (date) |
This is a continuing care contract as defined by paragraph (8) of subdivision (c), or subdivision (l) of Section 1771 of the California Health and Safety Code. This continuing care contract form has been approved by the State Department of Social Services as required by subdivision (b) of Section 1787 of the California Health and Safety Code. The basis for this approval was a determination that (provider name) has submitted a contract that complies with the minimum statutory requirements applicable to continuing care contracts. The department does not approve or disapprove any of the financial or health care coverage provisions in this contract. Approval by the department is NOT a guaranty of performance or an endorsement of any continuing care contract provisions. Prospective transferors and residents are strongly encouraged to carefully consider the benefits and risks of this continuing care contract and to seek financial and legal advice before signing.
(35)The provider may not attempt to absolve itself in the continuing care contract from liability for its negligence by any statement to that effect, and shall include the following statement in the contract: Nothing in this continuing care contract limits either the providers obligation to provide adequate care and supervision for the resident or any liability on the part of the provider which may result from the providers failure to provide this care and supervision.
(36)Provisions describing how the provider will proceed in the event of a closure, including an explanation of how the provider will comply with Sections 1793.80, 1793.81, 1793.82, and 1793.83.
(b)A life care contract shall also provide that:
(1)All levels of care, including acute care and physicians and surgeons services, will be provided to a resident.
(2)Care will be provided for the duration of the residents life unless the life care contract is canceled or terminated by the provider during the cancellation period or after the cancellation period for good cause.
(3)A comprehensive continuum of care will be provided to the resident, including skilled nursing, in a facility under the ownership and supervision of the provider on, or adjacent to, the continuing care retirement community premises.
(4)Monthly care fees will not be changed based on the residents level of care or service.
(5)A resident who becomes financially unable to pay his or her monthly care fees shall be subsidized provided the residents financial need does not arise from action by the resident to divest the resident of his or her assets.
(c)Continuing care contracts may include provisions that do any of the following:
(1)Subsidize a resident who becomes financially unable to pay for his or her monthly care fees at some future date. If a continuing care contract provides for subsidizing a resident, it may also provide for any of the following:
(A)The resident shall apply for any public assistance or other aid for which he or she is eligible and that the provider may apply for assistance on behalf of the resident.
(B)The providers decision shall be final and conclusive regarding any adjustments to be made or any action to be taken regarding any charitable consideration extended to any of its residents.
(C)The provider is entitled to payment for the actual costs of care out of any property acquired by the resident subsequent to any adjustment extended to the resident under this paragraph, or from any other property of the resident that the resident failed to disclose.
(D)The provider may pay the monthly premium of the residents health insurance coverage under Medicare to ensure that those payments will be made.
(E)The provider may receive an assignment from the resident of the right to apply for and to receive the benefits, for and on behalf of the resident.
(F)The provider is not responsible for the costs of furnishing the resident with any services, supplies, and medication, when reimbursement is reasonably available from any governmental agency, or any private insurance.
(G)Any refund due to the resident at the termination of the continuing care contract may be offset by any prior subsidy to the resident by the provider.
(2)Limit responsibility for costs associated with the treatment or medication of an ailment or illness existing prior to the date of admission. In these cases, the medical or surgical exceptions, as disclosed by the medical entrance examination, shall be listed in the continuing care contract or in a medical report attached to and made a part of the continuing care contract.
(3)Identify legal remedies that may be available to the provider if the resident makes any material misrepresentation or omission pertaining to the residents assets or health.
(4)Restrict transfer or assignments of the residents rights and privileges under a continuing care contract due to the personal nature of the continuing care contract.
(5)Protect the providers ability to waive a residents breach of the terms or provisions of the continuing care contract in specific instances without relinquishing its right to insist upon full compliance by the resident with all terms or provisions in the contract.
(6)Provide that the resident shall reimburse the provider for any uninsured loss or damage to the residents unit, beyond normal wear and tear, resulting from the residents carelessness or negligence.
(7)Provide that the resident agrees to observe the off-limit areas of the continuing care retirement community designated by the provider for safety reasons. The provider may not include any provision in a continuing care contract that absolves the provider from liability for its negligence.
(8)Provide for the subrogation to the provider of the residents rights in the case of injury to a resident caused by the acts or omissions of a third party, or for the assignment of the residents recovery or benefits in this case to the provider, to the extent of the value of the goods and services furnished by the provider to or on behalf of the resident as a result of the injury.
(9)Provide for a lien on any judgment, settlement, or recovery for any additional expense incurred by the provider in caring for the resident as a result of injury.
(10)Require the residents cooperation and assistance in the diligent prosecution of any claim or action against any third party.
(11)Provide for the appointment of a conservator or guardian by a court with jurisdiction in the event a resident becomes unable to handle his or her personal or financial affairs.
(12)Allow a provider, whose property is tax exempt, to charge the resident, on a pro rata basis, property taxes, or in-lieu taxes, that the provider is required to pay.
(13)Make any other provision approved by the department.
(d)A copy of the residents rights as described in Section 1771.7 shall be attached to every continuing care contract.
(e)A copy of the current audited financial statement of the provider shall be attached to every continuing care contract. For a provider whose current audited financial statement does not accurately reflect the financial ability of the provider to fulfill the continuing care contract obligations, the financial statement attached to the continuing care contract shall include all of the following:
(1)A disclosure that the reserve requirement has not yet been determined or met, and that entrance fees will not be held in escrow.
(2)A disclosure that the ability to provide the services promised in the continuing care contract will depend on successful compliance with the approved financial plan.
(3)A copy of the approved financial plan for meeting the reserve requirements.
(4)Any other supplemental statements or attachments necessary to accurately represent the providers financial ability to fulfill its continuing care contract obligations.
(f)A schedule of the average monthly care fees charged to residents for each type of residential living unit for each of the five years preceding execution of the continuing care contract shall be attached to every continuing care contract. The provider shall update this schedule annually at the end of each fiscal year. If the continuing care retirement community has not been in existence for five years, the information shall be provided for each of the years the continuing care retirement community has been in existence.
(g)If any continuing care contract provides for a health insurance policy for the benefit of the resident, the provider shall attach to the continuing care contract a binder complying with Sections 382 and 382.5 of the Insurance Code.
(h)The provider shall attach to every continuing care contract a completed form in duplicate, captioned Notice of Cancellation. The notice shall be easily detachable, and shall contain, in at least 10-point boldface type, the following statement:
NOTICE OF CANCELLATION | (date) |
Your first date of occupancy under this contract | |
is: _____________________________________________ | |
You may cancel this transaction, without any penalty within 90 calendar days from the above date.
If you cancel, any property transferred, any payments made by you under the contract, and any negotiable instrument executed by you will be returned within 14 calendar days after making possession of the living unit available to the provider. Any security interest arising out of the transaction will be canceled.
If you cancel, you are obligated to pay a reasonable processing fee to cover costs and to pay for the reasonable value of the services received by you from the provider up to the date you canceled or made available to the provider the possession of any living unit delivered to you under this contract, whichever is later.
If you cancel, you must return possession of any living unit delivered to you under this contract to the provider in substantially the same condition as when you took possession.
Possession of the living unit must be made available to the provider within 20 calendar days of your notice of cancellation. If you fail to make the possession of any living unit available to the provider, then you remain liable for performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice, or any other written notice, or send a telegram
to | |
(Name of provider) | |
|---|---|
at | |
(Address of providers place of business) | |
not later than midnight
of_____________(date). | |
I hereby cancel this | |
(Residentsor | |
|
Date
|
Status
|
|---|---|
| Oct 9, 2017 | Chaptered by Secretary of State - Chapter 613, Statutes of 2017. |
| Oct 9, 2017 | Approved by the Governor. |
| Sep 25, 2017 | Enrolled and presented to the Governor at 12 p.m. |
| Sep 14, 2017 | Senate amendments concurred in. To Engrossing and Enrolling. |
| Sep 14, 2017 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 71. Noes 5. Page 3388.). |
| Sep 13, 2017 | Assembly Rule 77(a) suspended. |
| Sep 13, 2017 | In Assembly. Concurrence in Senate amendments pending. May be considered on or after September 15 pursuant to Assembly Rule 77. |
| Sep 12, 2017 | Read third time. Passed. Ordered to the Assembly. |
| Sep 11, 2017 | Read second time. Ordered to third reading. |
| Sep 8, 2017 | Read third time and amended. Ordered to second reading. |
| Sep 5, 2017 | Read second time. Ordered to third reading. |
| Sep 1, 2017 | From committee: Do pass. (Ayes 6. Noes 0.) (September 1). |
| Jul 10, 2017 | In committee: Referred to APPR. suspense file. |
| Jun 28, 2017 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 5. Noes 0.) (June 27). Re-referred to Com. on APPR. |
| Jun 14, 2017 | Referred to Com. on HUMAN S. |
| Jun 1, 2017 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 31, 2017 | Read third time. Passed. Ordered to the Senate. (Ayes 62. Noes 14. Page 1912.) |
| May 30, 2017 | Read second time. Ordered to third reading. |
| May 26, 2017 | From committee: Do pass. (Ayes 13. Noes 3.) (May 26). |
| May 10, 2017 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr 5, 2017 | From committee: Do pass and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (April 4). Re-referred to Com. on APPR. |
| Mar 27, 2017 | Re-referred to Com. on AGING & L.T.C. |
| Mar 23, 2017 | Read second time and amended. |
| Mar 22, 2017 | From committee: Amend, and do pass as amended and re-refer to Com. on AGING & L.T.C. (Ayes 7. Noes 0.) (March 21). |
| Mar 2, 2017 | Referred to Coms. on HUM. S. and AGING & L.T.C. |
| Feb 16, 2017 | From printer. May be heard in committee March 18. |
| Feb 15, 2017 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Sep 14, 2017 | AB 713 CHU Concurrence in Senate Amendments | Assembly Floor |
Passed |
|
| Sep 12, 2017 | Assembly 3rd Reading AB713 Chu By Newman | Senate Floor |
Passed |
|
| Sep 1, 2017 | Do pass | Senate Standing Committee on Appropriations |
Passed |
|
| Jul 10, 2017 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jun 27, 2017 | Do pass, but first be re-referred to the Committee on [Appropriations] | Senate Standing Committee on Human Services |
Passed |
|
| May 31, 2017 | AB 713 CHU Assembly Third Reading | Assembly Floor |
Passed |
|
| May 26, 2017 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 4, 2017 | Do pass and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Aging and Long-Term Care |
Passed |
|
| Mar 21, 2017 | Do pass as amended and be re-referred to the Committee on [Aging and Long-Term Care] | Assembly Standing Committee on Human Services |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| 12 individuals | ** Support | Sep 11, 2017 |
| 152 Individuals | ** Support | Mar 17, 2017 |
| California Advocates for Nursing Home Reform | ** Support | Sep 11, 2017 |
| California Alliance For Retired Americans | ** Support | Sep 11, 2017 |
| California Continuing Care Residents Association | ** Support | Sep 11, 2017 |
| California Continuing Care Residents Association - | ** Support | Mar 17, 2017 |
| california continuing care residents association calcra | ** Support | Jun 23, 2017 |
| california long -term care ombudsman association | ** Support | Sep 11, 2017 |
| California Retired Teachers Association | ** Support | Sep 11, 2017 |
| Consumer Federation Of California | ** Support | Sep 11, 2017 |
| Several individuals . | ** Support | Mar 30, 2017 |
CONCURRENCE IN SENATE AMENDMENTS
CSA1 Bill Id:AB 713
Author:(Chu)
As Amended Ver:September 8, 2017
Majority vote
ASSEMBLY: | 62-14 | (May 31, 2017) | SENATE: | 39-0 | (September 12, 2017) |
Original Committee Reference: HUM. S.
SUMMARY: Allows a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision, and requires the Continuing Care Contracts Branch of the Department of Social Services (DSS) to review a disputed transfer decision and make a determination as to whether or not the transfer was appropriate and necessary.
Specifically, this bill:
- Allows a CCRC to transfer a resident under certain circumstances, including if a resident develops a physical or mental condition that is detrimental to the well-being of the resident or another person, as specified.
- Deletes provisions stating that, if an assessment tool or tools is used in the determination of a transfer, the provider must provide copies to the resident or resident's responsible person upon request, and instead requires an assessment tool or tools, which shall include but not be limited to, an evaluation of the physical and cognitive capacities of the resident, be used in the determination of the appropriateness of a resident's transfer and copies of the completed assessment be made available to the resident or resident's responsible person.
- Grants a resident the right to dispute a transfer decision, as specified.
- Requires a provider, for disputed transfer decisions, to provide documentation of the resident's medical reports, other documents showing the resident's current mental and physical function, the prognosis, and the expected duration of relevant conditions, and further, requires the documentation to include an explanation of how certain criteria outlined in current law are met, and the provider to make copies of the completed report to be shared with the resident or the resident's responsible person.
- Requires the Continuing Care Contracts Branch of DSS to provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
- Directs the Continuing Care Contracts Branch to, in addition to determinations it is already required by law to make regarding disputed transfer decisions, determine whether the disputed transfer is appropriate and necessary.
- Makes technical changes.
The Senate amendments:
- Add language that allows a CCRC to transfer a resident is the resident develops a physical or mental condition that is detrimental to the health, safety, or well-being of the resident or another person.
- Add language that requires a provider to provide documentation of the resident's medical reports, other documents showing the resident's current mental and physical function, the prognosis, and the expected duration of relevant conditions, and further, that requires the documentation to include an explanation of how certain criteria outlined in current law are met, and the provider to make copies of the completed report to be shared with the resident or the resident's responsible person.
- Make technical changes.
EXISTING LAW:
- Establishes the California Residential Care Facilities for the Elderly Act to provide for the licensure and regulation of Residential Care Facilities for the Elderly (RCFEs) as a separate category within the existing licensing structure of DSS. (Health and Safety Code (HSC) Section 1569 et seq.)
- Provides for the licensure and regulation of Skilled Nursing Facilities (SNFs) by the Department of Public Health. (HSC Section 1250 et seq.)
- Defines a "continuing care contract" to mean a contract that includes a promise by a provider to provide one or more elements of care to an elderly resident, as specified, in exchange for an entrance fee and/or the payment of periodic charges. (HSC Section 1771(c)(8))
- Defines a "continuing care retirement community" (CCRC) to mean a facility located in the state where services promised in a continuing care contract are provided. Further allows that, when services are provided in residents' own homes, the homes into which the provider takes those services are to be considered a part of the CCRC. (HSC Section 1771(c)(10))
- Provides for the certification and regulation of CCRCs by DSS. (HSC Section 1770 et seq.)
- Authorizes the Continuing Care Contracts Branch of DSS to enforce certain health and safety regulations, as specified. (HSC Section 1771.1)
- Requires a continuing care contract to include the procedures and conditions under which a resident may be voluntarily or involuntarily transferred from a designated living unit, as specified. (HSC Section 1788 (a) (10) )
- Details the conditions under which a CCRC may transfer a resident, while taking into account the appropriateness and necessity of the transfer, as specified. (HSC Section 1788 (a) (10))
- Requires a CCRC to involve the resident and the resident's responsible person in the assessment process, as specified. (HSC Section 1788 (i))
FISCAL EFFECT: According to the Senate Appropriations Committee on July 10, 2017, this bill may result in the following costs:
- One-time costs of $75,000 to $100,000 to DSS for increased workload to develop an evaluation process and provide policy guidance (General Fund);
- Potential ongoing, significant costs to DSS, ranging from $110,000 to $140,000 for additional personnel to evaluate and make determinations on transfers. The number and necessity of additional personnel would be dependent on whether the frequency of transfer review requests remains stable or increases (General Fund); and
- Minor and absorbable costs to DSS for enforcement (General Fund).
COMMENTS:
Continuing Care Retirement Communities: As California's population ages, seniors are faced with a variety of options for retirement living. Continuing Care Retirement Communities may be an attractive option for individuals and provide long-term care contracts that offer housing, residential services, and nursing care, often in one location and often for a resident's lifetime. Currently, California has approximately 107 CCRCs with over 20,000 units. Of those, roughly 65% of CCRCs are non-profit. Under DSS, the Community Care Licensing Division (CCLD) is responsible for the oversight of these facilities and ensuring compliance with regulations. Specifically, the Continuing Care Branch is responsible for reviewing and approving applications to operate a CCRC and monitoring the ongoing financial condition of all CCRC providers and their ability to fulfill the long-term contractual obligations to residents.
CCRCs offer a variety of contracts, some of which are refundable, while others are non-refundable. These contracts typically require residents to pay a substantial entrance fee, which can often range from $100,000 to $1 million, as well as ongoing monthly fees. CCRCs are referred to by three "types":
- Type A contracts, also known as life care contracts, are often the most expensive contract type, but also the most inclusive as they cover all housing, services, and healthcare needs of a resident. Under Type A contracts, a CCRC absorbs the cost of increased care residents may need as they age.
- Type B contracts, often called modified contracts, typically offer lower entrance and monthly fees and offer limited health care services that may be accessed without any increase in a resident's monthly fee. For example, if a resident needs skilled nursing services for a limited amount of time, they may stay in a skilled-nursing facility for a certain duration of time and not experience an increase in costs; an extended stay, however, could result in increased costs to the resident under this contract type.
- Type C contracts, also known as fee-for-service contracts, include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts typically offer lower entrance fees and monthly fees but the risk of large long-term-care expenses remain with the resident such that risk of increased care expenses are not shifted to the facility.
Types of facilities: CCRCs are comprised of several living arrangements that focus on providing services for retired individuals moving through the aging process. CCRCs are part independent living, part assisted living, and part skilled nursing homes. Upon entering a CCRC, and depending on the type of contract under which a resident enters the facility, a resident can live independently in single-family homes, apartments, or condominiums. When a resident later requires assistance with daily living, CCRCs offer assisted living or nursing care settings.
Resident transfers: As a CCRC resident ages, his or her needs often change such that he or she may eventually transition from independent living settings to settings that offer more assistance in daily living. Residents may transfer voluntarily or be transferred involuntarily, and current law provides CCRCs with the ability to determine if a resident transfer is necessary. Current law requires that a CCRC take into account certain criteria when determining if a resident should be transferred, including: whether a resident is nonambulatory; if the resident has developed a physical or mental condition that endangers the health, safety, or well-being of the resident or another individual; and if the resident's condition warrants a transfer to an assisted living facility due to a need for an increased level of care. Currently, CCRCs are required to include the resident or resident's responsible person in the assessment process which determines whether or not a resident is transferred, however current law does not require CCRCs to use a uniform assessment tool that considers certain criteria when determining if a transfer is appropriate. At present, the Continuing Care Contracts Branch is able to review a resident-disputed transfer to ensure that the provider adequately complied with the transfer process; however, current law is silent on whether the Continuing Care Contracts Branch must determine the appropriateness and necessity of the transfer based on the evaluating criteria used by the CCRC when making the decision to transfer a resident.
Fiscal impact of transfers: Because CCRCs utilize the three aforementioned contract types, certain individuals who are transferred to a higher level of care stand to incur increased monthly fees as a result of the move. For individuals who are involuntarily transferred, these increased costs may be unexpected and unmanageable. In addition to this, because CCRCs are an attractive retirement option for many individuals, CCRCs can quickly resell vacant units, often for very large entrance fees. Because a resident who is transferred to a higher level of care is still a resident of the CCRC, he or she is not entitled to a refund on his or her initial entrance fee and, therefore, a CCRC may be allowed to sell a vacant unit without refunding the entrance fee to the original resident as it is specified in the resident's contract because the resident has not yet terminated his or her contract, but simply moved to another setting within the CCRC.
Need for this bill: According to the author's office, "CCRCs provide an attractive 'age in place' model for seniors, guaranteeing a long-term care contract that provides housing, residential services, and nursing care in one location and usually for the resident's lifetime. In return, residents pay an entry fee and an adjustable monthly fee based on the services used that month. California's aging population, and the attractiveness of the CCRC model, has led to a high demand in retirement living and a growth in the CCRC industry. [This bill] ensures that high demand and financial interests of the retirement community are not putting pressure on providers to accelerate the transfer process for current residents.
Without a requirement for the CCRC to conduct an assessment of the resident, prior to an involuntary transfer, there is no documented justification for the necessity and appropriateness of that transfer. An assessment ensures that the provider is putting the resident's wellbeing and health ahead of any other consideration for the involuntary transfer. If disputed, it is essential that the department is able to consider all of the factors weighing the provider's decision for the transfer, including whether or not the residents physical or cognitive condition warrants an involuntary transfer that will result in reduced independence and higher fees to the resident."
PRIOR LEGISLATION:
SB 939 (Monning), Chapter 112, Statutes of 2016, was similar to SB 475 and requires continuing care contracts that contain lump sum contract termination payments conditioned on resale of the unit must meet a series of requirements and timelines, must pay interest after a special period of vacancy, and must meet other requirements.
SB 475 (Monning) of 2015, would have required that continuing care contracts which condition lump sum contract termination payments on resale of a unit to meet a series of requirements and timelines, to pay interest after a specified period of vacancy, and to meet other requirements. The bill would have also created a complaint process for residents if the repayment has not been made within 12 months. It was vetoed by the Governor.0002313
Analysis Prepared by: Kelsy Castillo / HUM. S. / (916) 319-2089 FN: 0002313
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 713
: 9/8/17
SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/27/17
AYES: Wiener, Berryhill, Glazer, Newman, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 6-0, 9/1/17
AYES: Lara, Beall, Bradford, Hill, Nielsen, Wiener
NO VOTE RECORDED: Bates
ASSEMBLY FLOOR: 62-14, 5/31/17 - See last page for vote
SOURCE: California Continuing Care Residents Association
DIGEST:
This bill allows a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision, and requires the Continuing Care Contracts Branch of the California Department of Social Services (CDSS) to review a disputed transfer decision, as specified, and make a determination as to whether or not the transfer was appropriate and necessary.
Senate Floor Amendments of 9/8/17 authorize a CCRC to transfer a resident if he or she develops a physical or mental condition that is detrimental to the health, safety, or well-being of the resident or another person. Amendments also require, for disputed transfers, CCRC provider to provide specified documentation to the resident or the resident’s responsible person regarding the resident’s medical condition safety, or wellbeing of the resident or another person, without being a danger. The documentation must include an explanation of how the transfer criteria were met.
Existing law:
- Establishes the Residential Care Facilities for the Elderly Act (RCFE) Act, which requires facilities that provide personal care and supervision, protective supervision or health related services for persons 60 years of age or older who voluntarily choose to reside in that facility to be licensed by CDSS. Provides for the licensure and regulation of Skilled Nursing Facilities by the Department of Public Health.
- Defines a "continuing care contract" to mean a contract that includes a promise by a provider to provide one or more elements of care to an elderly resident, as specified, in exchange for an entrance fee and/or the payment of periodic charges.
- Defines a "continuing care retirement community" to mean a facility located in the state where services promised in a continuing care contract are provided. Further allows that, when services are provided in residents' own homes, the homes into which the provider takes those services are to be considered a part of the CCRC.
- Authorizes the Continuing Care Contracts Branch of CDSS to enforce certain health and safety regulations, as specified.
- Requires a CCRC provider to hold a certificate of authority from CDSS permitting the provider to contract for the provision of continuing care, including medical care, in which a resident over the age of 60 has paid in advance for more than one year for that care.
- Requires the components of care provided by the facility must be separately licensed as otherwise required by state law, including RCFE and Skilled Nursing care.
- Defines the conditions under which a CCRC may voluntarily or involuntarily transfer a resident, including when the resident develops a physical or mental condition that endangers the health, safety, or well-being of the resident or another person, while taking into account the appropriateness and necessity of the transfer, as specified.
- Provides a resident’s right to a prompt and timely review of disputed transfers by CDSS’ Continuing Care Contracts Branch and requires the branch’s decision to be issued in writing and to determine whether the provider failed to comply with the transfer process.
- Requires a CCRC to involve the resident and the resident's responsible person in the assessment process, as specified.
This bill:
- Authorizes a CCRC to voluntarily or involuntarily transfer a resident if he or she develops a physical or mental condition that is detrimental to or endangers the health, safety, or well-being of the resident or another person.
- Authorizes a CCRC to voluntarily or involuntary transfer a resident if the resident’s condition or needs require the resident’s transfer to an assisted living care unit or skilled nursing facility because the level of care required by the resident exceeds that which may be appropriately provided in the living unit.
- Deletes the option for a provider to use an assessment tool or tools in the determination of a transfer and associated requirement to provide copies to the resident or resident's responsible person upon request.
- Requires, instead, an assessment tool or tools, which shall include, but not be limited to, an evaluation of the physical and cognitive capacities of the resident, to be used in the determination of the appropriateness of a resident's transfer and requires copies of the completed assessment be made available to the resident or resident's responsible person.
- Requires, for disputed transfers, a CCRC provider to provide specified documentation to the resident or the resident’s responsible person regarding the resident’s current medical and physical function, the prognosis, and the expected duration of relevant conditions, if applicable. The documentation must include an explanation of how the transfer criteria were met.
- Grants a resident the right to dispute a transfer decision, as specified.
- Requires the Continuing Care Contracts Branch of CDSS to provide a description of the steps a provider took for a disputed transfer decision, and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
- Directs the Continuing Care Contracts Branch to determine whether a disputed transfer is appropriate and necessary, in addition to determinations it is already required by law to make regarding disputed transfer decisions.
Background
According to the author, “California's aging population, and the attractiveness of the CCRC model, has led to a high demand in retirement living and a growth in the CCRC industry. [This bill] ensures that high demand and financial interests of the retirement community are not putting pressure on providers to accelerate the transfer process for current residents.”
Currently, CCRCs are not required to conduct an assessment of a resident prior to an involuntary transfer. This bill requires such an assessment, requires documentation of the assessment and establishes authority for CDSS to determine if a disputed transfer is appropriate and necessary. If a transfer is disputed, “it is essential that the department is able to consider all of the factors weighing the provider's decision for the transfer, including whether or not the residents physical or cognitive condition warrants an involuntary transfer that will result in reduced independence and higher fees to the resident," per the author. According to the author, AB 713 “ensures that the provider is putting the residents’ wellbeing and health ahead of any other consideration for the involuntary transfer.”
CCRCs
As Californians age, they have a variety of residential options to choose from. Among those options are CCRCs, which provide long-term care in the form of housing, residential services, and nursing care, often in one location and often for a resident's lifetime. CCRCs are comprised of several living arrangements that focus on providing services for retired individuals moving through the aging process. CCRCs offer people 60 years of age and older a long-term housing option that pairs their current health and resources with individualized contracts that provide a range of levels-of-care. Typically this is offered in a campus-like community setting, and usually for a resident’s lifetime, and always for at least one year. Part independent living, part assisted living and part skilled nursing home, CCRCs offer a tiered approach to services that can accommodate residents’ changing needs. Upon entering, healthy adults can reside independently in single-family homes, apartments or condominiums. When assistance with everyday activities becomes necessary, residents may move into assisted living or nursing care facilities. These communities give older adults the option to live in one location for the duration of their life, with plans for much of their future care already defined in continuing care contracts.
Currently, California has approximately 107 CCRCs with more than 20,000 units. Of those, roughly 65 percent of CCRCs are non-profit. CDSS is responsible for the oversight of these facilities and ensuring compliance with regulations. Specifically, the Continuing Care Contracts Branch is responsible for reviewing and approving applications to operate a CCRC and monitoring the ongoing financial condition of all CCRC providers and their ability to fulfill the long-term contractual obligations to residents.
Continuing care contracts vary. Each potential consumer has different health and long-term care risks and needs, financial risks and needs, and other factors that require contract flexibility, and each CCRC offers differing provisions on costs, payment methods, services provided, and other elements. A continuing care contract may consist of one agreement for continuous care, or a series of agreements describing care, conditions for that care, and payment of it, if and when it becomes necessary. These contracts typically require residents to pay a substantial entrance fee, which can range from $2,000 to over $3 million, as well as ongoing monthly fees, which range from under $1,000 to over $10,000.
There are three “types” of CCRC contracts. Monthly fees vary depending on the level of services included in the contract and other factors associated with location, exclusivity, business plan variations, and more.
- Type A contracts, also known as life care contracts, are often the most expensive and the most inclusive as they cover all housing, services, and healthcare needs of a resident. Under Type A contracts, a CCRC absorbs the cost of increased care as residents’ needs change.
- Type B contracts, often called modified contracts, typically offer lower entrance and monthly fees and limited health care services that may be accessed without any increase in a resident's monthly fee. For example, if a resident needs skilled nursing services for a limited amount of time, they may stay in a skilled-nursing facility for a certain duration of time and not experience an increase in costs. An extended stay, however, could result in increased costs to the resident under this contract type.
- Type C contracts, also known as fee-for-service contracts, include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts typically offer lower entrance fees and monthly fees but the risk of large long-term-care expenses remain with the resident such that risk of increased care expenses are not shifted to the facility.
Resident transfers
As CCRC residents age, their needs change and they may eventually need to transition from independent living settings to settings that offer more assistance with daily living. Residents may transfer voluntarily or be transferred involuntarily, and current law permits CCRCs to determine if a resident transfer is necessary. However, a CCRC must take into account certain criteria when determining if a resident should be transferred, including:
- Whether a resident is nonambulatory;
- If the resident has developed a physical or mental condition that endangers the health, safety, or well-being of the resident or another individual; and
- If the resident's condition warrants a transfer to an assisted living facility due to a need for an increased level of care.
CCRCs are required to include the resident or resident's responsible person in the assessment process when they determine whether or not a resident should be transferred. They are not required to use an assessment tool when determining if a transfer is appropriate. CDDS’ Continuing Care Contracts Branch is able to review a resident-disputed transfer to ensure that the provider adequately complied with the transfer process, which requires an assessment, a care conference, and written notice, as specified. But the law does not require the Continuing Care Contracts Branch to determine the appropriateness and necessity of the transfer. If it is determined that the facility did not follow established protocols, the facility may be required to conduct the transfer assessment all over again. CDSS reports having conducted eight such transfer reviews in the past six years.
Depending upon the CCRC contract type, some residents who are transferred to a higher level of care will incur increased monthly fees. These increased costs may be unexpected and unmanageable. Additionally, because a resident who is transferred to a higher level of care is still a resident of the CCRC, he or she is not entitled to a refund of his or her initial entrance fee. Therefore, a CCRC may sell the newly vacant unit without refunding the entrance fee to the original resident because the resident has not terminated his or her contract, but simply moved to another setting within the CCRC.
Related/Prior Legislation
SB 939 (Monning, Chapter 112, Statutes of 2016) required continuing care contracts that contain lump sum contract termination payments conditioned on resale of the unit must meet a series of requirements and timelines, must pay interest after a special period of vacancy, and must meet other requirements.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee, this bill will likely have the following fiscal effect:
- One-time costs of $75,000 to $100,000 to CDSS for increased workload to develop an evaluation process and provide policy guidance. (GF)
- Potential ongoing, significant costs to CDSS, ranging from $110,000 to $140,000 for additional personnel to evaluate and make determinations on transfers. The number and necessity of additional personnel would be dependent on whether the frequency of transfer review requests remains stable or increases. (GF)
- Minor and absorbable costs to CDSS for enforcement. (GF)
California Continuing Care Residents Association (source)
California Advocates for Nursing Home Reform
California Alliance for Retired Americans
California Long -Term Care Ombudsman Association
California Retired Teachers Association
Consumer Federation of California
12 individuals
OPPOSITION: (Verified 8/31/17)
None received
ASSEMBLY FLOOR: 62-14, 5/31/17
AYES: Acosta, Aguiar-Curry, Arambula, Berman, Bigelow, Bloom, Bocanegra, Bonta, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Frazier, Friedman, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Lackey, Levine, Limón, Low, Maienschein, McCarty, Medina, Mullin, Muratsuchi, Nazarian, O'Donnell, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Waldron, Weber, Wood, Rendon
NOES: Travis Allen, Baker, Brough, Chen, Dahle, Flora, Gallagher, Harper, Kiley, Mathis, Mayes, Obernolte, Patterson, Voepel
NO VOTE RECORDED: Choi, Eggman, Fong, Melendez
9/11/17 11:24:48
**** END ****
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | AB |
THIRD READING
Bill No: AB 713
:
SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/27/17
AYES: Wiener, Berryhill, Glazer, Newman, Nguyen
SENATE APPROPRIATIONS COMMITTEE: 6-0, 9/1/17
AYES: Lara, Beall, Bradford, Hill, Nielsen, Wiener
NO VOTE RECORDED: Bates
ASSEMBLY FLOOR: 62-14, 5/31/17 - See last page for vote
SOURCE: California Continuing Care Residents Association
DIGEST:
This bill allows a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision, and requires the Continuing Care Contracts Branch of the California Department of Social Services (CDSS) to review a disputed transfer decision and make a determination as to whether or not the transfer was appropriate and necessary.
Existing law:
- Establishes the Residential Care Facilities for the Elderly Act (RCFE) Act, which requires facilities that provide personal care and supervision, protective supervision or health related services for persons 60 years of age or older who voluntarily choose to reside in that facility to be licensed by CDSS. Provides for the licensure and regulation of Skilled Nursing Facilities by the Department of Public Health.
- Defines a "continuing care contract" to mean a contract that includes a promise by a provider to provide one or more elements of care to an elderly resident, as specified, in exchange for an entrance fee and/or the payment of periodic charges.
- Defines a "continuing care retirement community" to mean a facility located in the state where services promised in a continuing care contract are provided. Further allows that, when services are provided in residents' own homes, the homes into which the provider takes those services are to be considered a part of the CCRC.
- Authorizes the Continuing Care Contracts Branch of CDSS to enforce certain health and safety regulations, as specified.
- Requires a CCRC provider to hold a certificate of authority from CDSS permitting the provider to contract for the provision of continuing care, including medical care, in which a resident over the age of 60 has paid in advance for more than one year for that care.
- Requires the components of care provided by the facility must be separately licensed as otherwise required by state law, including RCFE and Skilled Nursing care.
- Defines the conditions under which a CCRC may voluntarily or involuntarily transfer a resident, while taking into account the appropriateness and necessity of the transfer, as specified. Further provides a resident’s right to a prompt and timely review of disputed transfers by CDSS’ Continuing Care Contracts Branch and requires the branch’s decision to be issued in writing and to determine whether the provider failed to comply with the transfer process.
- Requires a CCRC to involve the resident and the resident's responsible person in the assessment process, as specified.
This bill:
- Deletes the option for a provider to use an assessment tool or tools in the determination of a transfer and associated requirement to provide copies to the resident or resident's responsible person upon request.
- Requires, instead, an assessment tool or tools, which shall include, but not be limited to, an evaluation of the physical and cognitive capacities of the resident, to be used in the determination of the appropriateness of a resident's transfer and requires copies of the completed assessment be made available to the resident or resident's responsible person.
- Grants a resident the right to dispute a transfer decision, as specified.
- Requires the Continuing Care Contracts Branch of CDSS to provide a description of the steps a provider took for a disputed transfer decision, and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
- Directs the Continuing Care Contracts Branch to determine whether a disputed transfer is appropriate and necessary, in addition to determinations it is already required by law to make regarding disputed transfer decisions.
Background
According to the author, “California's aging population, and the attractiveness of the CCRC model, has led to a high demand in retirement living and a growth in the CCRC industry. [This bill] ensures that high demand and financial interests of the retirement community are not putting pressure on providers to accelerate the transfer process for current residents.”
Currently, CCRCs are not required to conduct an assessment of a resident prior to an involuntary transfer. This bill requires such an assessment, requires documentation of the assessment and establishes authority for CDSS to determine if a disputed transfer is appropriate and necessary. If a transfer is disputed, “it is essential that the department is able to consider all of the factors weighing the provider's decision for the transfer, including whether or not the residents physical or cognitive condition warrants an involuntary transfer that will result in reduced independence and higher fees to the resident," per the author. According to the author, AB 713 “ensures that the provider is putting the residents’ wellbeing and health ahead of any other consideration for the involuntary transfer.”
CCRCs
As Californians age, they have a variety of residential options to choose from. Among those options are CCRCs, which provide long-term care in the form of housing, residential services, and nursing care, often in one location and often for a resident's lifetime. CCRCs are comprised of several living arrangements that focus on providing services for retired individuals moving through the aging process. CCRCs offer people 60 years of age and older a long-term housing option that pairs their current health and resources with individualized contracts that provide a range of levels-of-care. Typically this is offered in a campus-like community setting, and usually for a resident’s lifetime, and always for at least one year. Part independent living, part assisted living and part skilled nursing home, CCRCs offer a tiered approach to services that can accommodate residents’ changing needs. Upon entering, healthy adults can reside independently in single-family homes, apartments or condominiums. When assistance with everyday activities becomes necessary, residents may move into assisted living or nursing care facilities. These communities give older adults the option to live in one location for the duration of their life, with plans for much of their future care already defined in continuing care contracts.
Currently, California has approximately 107 CCRCs with more than 20,000 units. Of those, roughly 65 percent of CCRCs are non-profit. CDSS is responsible for the oversight of these facilities and ensuring compliance with regulations. Specifically, the Continuing Care Contracts Branch is responsible for reviewing and approving applications to operate a CCRC and monitoring the ongoing financial condition of all CCRC providers and their ability to fulfill the long-term contractual obligations to residents.
Continuing care contracts vary. Each potential consumer has different health and long-term care risks and needs, financial risks and needs, and other factors that require contract flexibility, and each CCRC offers differing provisions on costs, payment methods, services provided, and other elements. A continuing care contract may consist of one agreement for continuous care, or a series of agreements describing care, conditions for that care, and payment of it, if and when it becomes necessary. These contracts typically require residents to pay a substantial entrance fee, which can range from $2,000 to over $3 million, as well as ongoing monthly fees, which range from under $1,000 to over $10,000.
There are three “types” of CCRC contracts. Monthly fees vary depending on the level of services included in the contract and other factors associated with location, exclusivity, business plan variations, and more.
- Type A contracts, also known as life care contracts, are often the most expensive and the most inclusive as they cover all housing, services, and healthcare needs of a resident. Under Type A contracts, a CCRC absorbs the cost of increased care as residents’ needs change.
- Type B contracts, often called modified contracts, typically offer lower entrance and monthly fees and limited health care services that may be accessed without any increase in a resident's monthly fee. For example, if a resident needs skilled nursing services for a limited amount of time, they may stay in a skilled-nursing facility for a certain duration of time and not experience an increase in costs. An extended stay, however, could result in increased costs to the resident under this contract type.
- Type C contracts, also known as fee-for-service contracts, include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts typically offer lower entrance fees and monthly fees but the risk of large long-term-care expenses remain with the resident such that risk of increased care expenses are not shifted to the facility.
Resident transfers
As CCRC residents age, their needs change and they may eventually need to transition from independent living settings to settings that offer more assistance with daily living. Residents may transfer voluntarily or be transferred involuntarily, and current law permits CCRCs to determine if a resident transfer is necessary. However, a CCRC must take into account certain criteria when determining if a resident should be transferred, including:
- Whether a resident is nonambulatory;
- If the resident has developed a physical or mental condition that endangers the health, safety, or well-being of the resident or another individual; and
- If the resident's condition warrants a transfer to an assisted living facility due to a need for an increased level of care.
CCRCs are required to include the resident or resident's responsible person in the assessment process when they determine whether or not a resident should be transferred. They are not required to use an assessment tool when determining if a transfer is appropriate. CDDS’ Continuing Care Contracts Branch is able to review a resident-disputed transfer to ensure that the provider adequately complied with the transfer process, which requires an assessment, a care conference, and written notice, as specified. But the law does not require the Continuing Care Contracts Branch to determine the appropriateness and necessity of the transfer. If it is determined that the facility did not follow established protocols, the facility may be required to conduct the transfer assessment all over again. CDSS reports having conducted eight such transfer reviews in the past six years.
Depending upon the CCRC contract type, some residents who are transferred to a higher level of care will incur increased monthly fees. These increased costs may be unexpected and unmanageable. Additionally, because a resident who is transferred to a higher level of care is still a resident of the CCRC, he or she is not entitled to a refund of his or her initial entrance fee. Therefore, a CCRC may sell the newly vacant unit without refunding the entrance fee to the original resident because the resident has not terminated his or her contract, but simply moved to another setting within the CCRC.
Related/Prior Legislation
SB 939 (Monning, Chapter 112, Statutes of 2016) required continuing care contracts that contain lump sum contract termination payments conditioned on resale of the unit must meet a series of requirements and timelines, must pay interest after a special period of vacancy, and must meet other requirements.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee, this bill will likely have the following fiscal effect:
- One-time costs of $75,000 to $100,000 to CDSS for increased workload to develop an evaluation process and provide policy guidance. (GF)
- Potential ongoing, significant costs to CDSS, ranging from $110,000 to $140,000 for additional personnel to evaluate and make determinations on transfers. The number and necessity of additional personnel would be dependent on whether the frequency of transfer review requests remains stable or increases. (GF)
- Minor and absorbable costs to CDSS for enforcement. (GF)
California Continuing Care Residents Association (source)
California Advocates for Nursing Home Reform
California Alliance for Retired Americans
California Long -Term Care Ombudsman Association
California Retired Teachers Association
Consumer Federation of California
12 individuals
OPPOSITION: (Verified 8/31/17)
None received
ASSEMBLY FLOOR: 62-14, 5/31/17
AYES: Acosta, Aguiar-Curry, Arambula, Berman, Bigelow, Bloom, Bocanegra, Bonta, Burke, Caballero, Calderon, Cervantes, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Cunningham, Dababneh, Daly, Frazier, Friedman, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gomez, Gonzalez Fletcher, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Lackey, Levine, Limón, Low, Maienschein, McCarty, Medina, Mullin, Muratsuchi, Nazarian, O'Donnell, Quirk, Quirk-Silva, Reyes, Ridley-Thomas, Rodriguez, Rubio, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Waldron, Weber, Wood, Rendon
NOES: Travis Allen, Baker, Brough, Chen, Dahle, Flora, Gallagher, Harper, Kiley, Mathis, Mayes, Obernolte, Patterson, Voepel
NO VOTE RECORDED: Choi, Eggman, Fong, Melendez
9/4/17 12:19:18
**** END ****
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2017 - 2018 Regular Session
AB 713 (Chu) - Continuing care retirement facilities: transfers of residents
Version: March 23, 2017 | Policy Vote: HUMAN S. 5 - 0 |
Urgency: No | Mandate: No |
Hearing Date: July 10, 2017 | Consultant: Debra Cooper |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
AB 713 would allow a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision and would require the Continuing Care Contracts Branch of the California Department of Social Services (CDSS) to review a disputed transfer decision and make a determination as to whether or not the transfer was appropriate and necessary.
Fiscal Impact:
- One-time costs of $75,000 to $100,000 to CDSS for increased workload to develop an evaluation process and provide policy guidance. (GF)
- Potential ongoing, significant costs to CDSS, ranging from $110,000 to $140,000 for additional personnel to evaluate and make determinations on transfers. The number and necessity of additional personnel would be dependent on whether the frequency of transfer review requests remains stable or increases. (GF)
- Minor and absorbable costs to CDSS for enforcement. (GF)
Background:
CCRCs provide long-term care for elderly Californians in the form of housing, residential services, and nursing care, often in one location and often for a resident’s lifetime. CCRC’s are partly independent living, partly assisted living, and partly skilled nursing home and offer a tiered approach to services that accommodate their residents’ changing needs. California currently has approximately 107 CCRCs with over 20,000 units. Approximately 65% of the CCRCs are non-profit.
CDSS is responsible for the oversight of these facilities and for ensuring compliance with regulations. CDSS’s Continuing Care Contracts Branch reviews and approves applications to operate a CCRC and monitors the ongoing financial condition of all CCRC providers and their ability to fulfill the long-term contractual obligations to residents.
As CCRC residents age, their needs change and they may eventually need to transition from independent living settings to settings that offer more assistance with daily living. Residents may transfer voluntarily or be transferred involuntarily, and current law provides CCRCs with the ability to determine if a resident transfer is necessary. However, a CCRC must take into account certain criteria when determining if a resident should be transferred, including whether a resident is non-ambulatory, if the resident has developed a physical or mental condition that endangers anyone’s health and safety, and if the resident’s condition warrants an increased level of care. CCRCs are required to include the resident or resident’s responsible person in the assessment process when they determine whether or not a resident should be transferred; however, they are not required to use an assessment tool in this determination. The Continuing Care Contracts Branch can review a resident-disputed transfer, but is not required to determine the appropriateness and necessity of the transfer. CDSS reports having conducted eight transfer reviews in the past six years.
Proposed Law:
This bill would:
- Require, rather than authorize, a provider to use an assessment tool or tools in the determination of the appropriateness of a resident’s transfer and to make available copies of the completed assessment to the resident or resident’s responsible person;
- Clarify that a resident has a right to dispute a CCRC transfer decision;
- Require the Continuing Care Contracts Branch of CDSS to provide a description of the steps a provider took for a disputed transfer decision and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer;
- Direct the Continuing Care Contracts Branch to determine whether a disputed transfer is appropriate and necessary, in addition to its existing requirements.
-- END --
SENATE COMMITTEE ON HUMAN SERVICES
Senator Wiener, Chair
2017 - 2018 Regular
Bill No: AB 713
Author: | Chu | ||
Version: | March 23, 2017 | Hearing Date: | June 27, 2017 |
Urgency: | No | Fiscal: | Yes |
Consultant: | Taryn Smith | ||
Subject: Continuing care retirement facilities: transfers of residents
SUMMARY
This bill allows a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision, and requires the Continuing Care Contracts Branch of the California Department of Social Services (CDSS) to review a disputed transfer decision and make a determination as to whether or not the transfer was appropriate and necessary.
ABSTRACT
Existing law:
- Establishes the Residential Care Facilities for the Elderly Act (RCFE) Act, which requires facilities that provide personal care and supervision, protective supervision or health related services for persons 60 years of age or older who voluntarily choose to reside in that facility to be licensed by CDSS. (HSC 1569 and 1569.1)
- Provides for the licensure and regulation of Skilled Nursing Facilities (SNFs) by the Department of Public Health. (HSC 1250, et seq.)
- Provides for the certification and regulation of CCRCs by CDSS. (HSC 1770, et seq.)
- Defines a "continuing care contract" to mean a contract that includes a promise by a provider to provide one or more elements of care to an elderly resident, as specified, in exchange for an entrance fee and/or the payment of periodic charges. (HSC 1771(c)(8))
- Defines a "continuing care retirement community" to mean a facility located in the state where services promised in a continuing care contract are provided. Further allows that, when services are provided in residents' own homes, the homes into which the provider takes those services are to be considered a part of the CCRC. (HSC 1771(c)(10))
- Authorizes the Continuing Care Contracts Branch of CDSS to enforce certain health and safety regulations, as specified. (HSC 1771.1)
- Requires a CCRC provider to hold a certificate of authority from CDSS permitting the provider to contract for the provision of continuing care, including medical care, in which a resident over the age of 60 has paid in advance for more than one year for that care. (HSC 1771.2)
- Requires the components of care provided by the facility must be separately licensed as otherwise required by state law, including Residential Care Facilities for the Elderly and Skilled Nursing care. (HSC 1771.5)
- Defines the conditions under which a CCRC may voluntarily or involuntarily transfer a resident, while taking into account the appropriateness and necessity of the transfer, as specified. Further provides a resident’s right to a prompt and timely review of disputed transfers by CDSS’ Continuing Care Contracts Branch and requires the branch’s decision to be issued in writing and to determine whether the provider failed to comply with the transfer process. (HSC 1788(a)(10))
- Requires a CCRC to involve the resident and the resident's responsible person in the assessment process, as specified. (HSC 1788 (i))
This bill:
- Deletes the option for a provider to use an assessment tool or tools in the determination of a transfer and associated requirement to provide copies to the resident or resident's responsible person upon request.
- Instead requires an assessment tool or tools, which shall include but not be limited to, an evaluation of the physical and cognitive capacities of the resident, to be used in the determination of the appropriateness of a resident's transfer and requires copies of the completed assessment be made available to the resident or resident's responsible person.
- Grants a resident the right to dispute a transfer decision, as specified.
- Requires the Continuing Care Contracts Branch of CDSS to provide a description of the steps a provider took for a disputed transfer decision, and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
- Directs the Continuing Care Contracts Branch to determine whether a disputed transfer is appropriate and necessary, in addition to determinations it is already required by law to make regarding disputed transfer decisions.
FISCAL IMPACT
According to the Assembly Appropriations Committee, this bill may result in one-time costs to CDSS in the range of $50,000 to $75,000 (General Fund) for two years to develop an evaluation process and provide policy guidance; and minor and absorbable enforcement costs.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, "California's aging population, and the attractiveness of the CCRC model, has led to a high demand in retirement living and a growth in the CCRC industry. [This bill] ensures that high demand and financial interests of the retirement community are not putting pressure on providers to accelerate the transfer process for current residents.”
Currently, CCRCs are not required to conduct an assessment of a resident prior to an involuntary transfer. This bill requires such an assessment, requires documentation of the assessment and establishes authority for CDSS to determine if a disputed transfer is appropriate and necessary. If a transfer is disputed, “it is essential that the department is able to consider all of the factors weighing the provider's decision for the transfer, including whether or not the residents physical or cognitive condition warrants an involuntary transfer that will result in reduced independence and higher fees to the resident," per the author. According to the author, AB 713 “ensures that the provider is putting the residents’ wellbeing and health ahead of any other consideration for the involuntary transfer.”
Continuing Care Retirement Communities
As Californians age, residents have a variety of options to choose from when planning their retirement. Among those options are CCRCs, which provide long-term care in the form of housing, residential services, and nursing care, often in one location and often for a resident's lifetime. CCRCs are comprised of several living arrangements that focus on providing services for retired individuals moving through the aging process. CCRCs offer people 60 years of age and older a long-term housing option that pairs their current health and resources with individualized contracts that provide a range of levels-of-care. Typically this is offered in a campus-like community setting, and usually for a resident’s lifetime, and always for at least one year. Part independent living, part assisted living and part skilled nursing home, CCRCs offer a tiered approach to services that accommodate residents’ changing needs. Upon entering, healthy adults can reside independently in single-family homes, apartments or condominiums. When assistance with everyday activities becomes necessary, they can move into assisted living or nursing care facilities. These communities give older adults the option to live in one location for the duration of their life, with much of their future care already figured out.
Currently, California has approximately 107 CCRCs with over 20,000 units. Of those, roughly 65 percent of CCRCs are non-profit. CDSS is responsible for the oversight of these facilities and ensuring compliance with regulations. Specifically, the Continuing Care Branch is responsible for reviewing and approving applications to operate a CCRC and monitoring the ongoing financial condition of all CCRC providers and their ability to fulfill the long-term contractual obligations to residents.
Continuing care contracts vary. Each potential consumer has different health and long-term care risks and needs, financial risks and needs, and other factors that require contract flexibility, and each CCRC offers differing provisions on costs, payment methods, services provided, and other elements. A continuing care contract may consist of one agreement for continuous care, or a series of agreements describing care, conditions for that care, and payment of it, if and when it becomes necessary. These contracts typically require residents to pay a substantial entrance fee, which can range from $2,000 to over $3 million, as well as ongoing monthly fees, which range from under $1,000 to over $10,000. There are three “types” of CCRC contracts. Monthly fees vary depending on the level of services included in the contract and other factors associated with location, exclusivity, business plan variations, and more.
- Type A contracts, also known as life care contracts, are often the most expensive and the most inclusive as they cover all housing, services, and healthcare needs of a resident. Under Type A contracts, a CCRC absorbs the cost of increased care as residents’ needs change.
- Type B contracts, often called modified contracts, typically offer lower entrance and monthly fees and limited health care services that may be accessed without any increase in a resident's monthly fee. For example, if a resident needs skilled nursing services for a limited amount of time, they may stay in a skilled-nursing facility for a certain duration of time and not experience an increase in costs. An extended stay, however, could result in increased costs to the resident under this contract type.
- Type C contracts, also known as fee-for-service contracts, include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts typically offer lower entrance fees and monthly fees but the risk of large long-term-care expenses remain with the resident such that risk of increased care expenses are not shifted to the facility.
Resident transfers
As CCRC residents age, their needs change and they may eventually need to transition from independent living settings to settings that offer more assistance with daily living. Residents may transfer voluntarily or be transferred involuntarily, and current law provides CCRCs with the ability to determine if a resident transfer is necessary. However, a CCRC must take into account certain criteria when determining if a resident should be transferred, including:
- whether a resident is nonambulatory;
- if the resident has developed a physical or mental condition that endangers the health, safety, or well-being of the resident or another individual; and
- if the resident's condition warrants a transfer to an assisted living facility due to a need for an increased level of care.
CCRCs are required to include the resident or resident's responsible person in the assessment process when they determine whether or not a resident should be transferred. They are not required to use an assessment tool when determining if a transfer is appropriate. At present, CDDS’ Continuing Care Contracts Branch is able to review a resident-disputed transfer to ensure that the provider adequately complied with the transfer process, which requires an assessment, a care conference, and written notice, as specified. But the law does not require the Continuing Care Contracts Branch to determine the appropriateness and necessity of the transfer. If it is determined that the facility did not follow established protocols, the facility may be required to conduct the transfer assessment all over again. CDSS reports having conducted eight such transfer reviews in the past six years.
Because CCRCs utilize the three aforementioned contract types, some individuals who are transferred to a higher level of care will incur increased monthly fees. These increased costs may be unexpected and unmanageable. Additionally, because a resident who is transferred to a higher level of care is still a resident of the CCRC, he or she is not entitled to a refund of his or her initial entrance fee. Therefore, a CCRC may sell the newly vacant unit without refunding the entrance fee to the original resident because the resident has not terminated his or her contract, but simply moved to another setting within the CCRC.
Related legislation:
SB 939 (Monning, Chapter 112, Statutes of 2016) requires continuing care contracts that contain lump sum contract termination payments conditioned on resale of the unit must meet a series of requirements and timelines, must pay interest after a special period of vacancy, and must meet other requirements.
SB 475 (Monning, 2015) would have required that continuing care contracts that condition lump sum contract termination payments on resale of a unit to meet a series of requirements and timelines, to pay interest after a specified period of vacancy, and to meet other requirements. The bill would have also created a complaint process for residents if the repayment has not been made within 12 months. It was vetoed by the Governor.
PRIOR VOTES
Assembly Floor: | 62 - 14 |
Assembly Appropriations Committee: | 13 - 3 |
Assembly Human Services Committee: | 7 - 0 |
POSITIONS
Support:
California Continuing Care Residents Association CALCRA (Sponsor)
California Advocates for Nursing Home Reform
California Alliance for Retired Americans
California Long -Term Care Ombudsman Association
California Retired Teachers Association
Consumer Federation of California
12 (individuals)
Oppose:
None received.
-- END --
ASSEMBLY THIRD READING
ATR Bill Id:AB 713
Author:(Chu)
As Amended Ver:March 23, 2017
Majority vote
Committee | Votes | Ayes | Noes |
Human Services | 7-0 | Rubio, Choi, Arambula, Gonzalez Fletcher, Maienschein, Mark Stone, Thurmond | |
Aging | 7-0 | Kalra, Voepel, Acosta, Caballero, Gipson, Gloria, Gray | |
Appropriations | 13-3 | Gonzalez Fletcher, Bigelow, Bloom, Bocanegra, Bonta, Calderon, McCarty, Quirk, Friedman, Eduardo Garcia, Gray, Muratsuchi, Reyes | Brough, Gallagher, Obernolte |
SUMMARY: Allows a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision, and requires the Continuing Care Contracts Branch of the Department of Social Services (DSS) to review a disputed transfer decision and make a determination as to whether or not the transfer was appropriate and necessary. Specifically, this bill:
- Deletes provisions stating that, if an assessment tool or tools is used in the determination of a transfer, the provider must provide copies to the resident or resident's responsible person upon request, and instead requires an assessment tool or tools, which shall include but not be limited to, an evaluation of the physical and cognitive capacities of the resident, be used in the determination of the appropriateness of a resident's transfer and copies of the completed assessment be made available to the resident or resident's responsible person.
- Grants a resident the right to dispute a transfer decision, as specified.
- Requires the Continuing Care Contracts Branch of DSS, for disputed transfer decisions, to provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
- Directs the Continuing Care Contracts Branch to, in addition to determinations it is already required by law to make regarding disputed transfer decisions, determine whether the disputed transfer is appropriate and necessary.
EXISTING LAW:
- Establishes the California Residential Care Facilities for the Elderly Act to provide for the licensure and regulation of Residential Care Facilities for the Elderly (RCFEs) as a separate category within the existing licensing structure of DSS. (Health and Safety Code (HSC) Section 1569 et seq.)
- Provides for the licensure and regulation of Skilled Nursing Facilities (SNFs) by the Department of Public Health. (HSC Section 1250 et seq.)
- Defines a "continuing care contract" to mean a contract that includes a promise by a provider to provide one or more elements of care to an elderly resident, as specified, in exchange for an entrance fee and/or the payment of periodic charges. (HSC Section 1771(c)(8))
- Defines a "continuing care retirement community" (CCRC) to mean a facility located in the state where services promised in a continuing care contract are provided. Further allows that, when services are provided in residents' own homes, the homes into which the provider takes those services are to be considered a part of the CCRC. (HSC Section 1771(c)(10))
- Provides for the certification and regulation of CCRCs by DSS. (HSC Section 1770 et seq.)
- Authorizes the Continuing Care Contracts Branch of DSS to enforce certain health and safety regulations, as specified. (HSC Section 1771.1)
- Requires a continuing care contract to include the procedures and conditions under which a resident may be voluntarily or involuntarily transferred from a designated living unit, as specified. (HSC Section 1788 (a) (10) )
- Details the conditions under which a CCRC may transfer a resident, while taking into account the appropriateness and necessity of the transfer, as specified. (HSC Section 1788 (a) (10))
- Requires a CCRC to involve the resident and the resident's responsible person in the assessment process, as specified. (HSC Section 1788 (i))
FISCAL EFFECT: According to the Assembly Appropriations Committee, this bill may result in the following costs:
- One-time costs to DSS in the range of $50,000 to $75,000 (General Fund) for two years to develop an evaluation process and provide policy guidance; and
- Enforcement costs that are minor and absorbable.
COMMENTS:
Continuing Care Retirement Communities: As California's population ages, seniors are faced with a variety of options for retirement living. Continuing Care Retirement Communities may be an attractive option for individuals and provide long-term care contracts that offer housing, residential services, and nursing care, often in one location and often for a resident's lifetime. Currently, California has approximately 107 CCRCs with over 20,000 units. Of those, roughly 65% of CCRCs are non-profit. Under DSS, the Community Care Licensing Division (CCLD) is responsible for the oversight of these facilities and ensuring compliance with regulations. Specifically, the Continuing Care Branch is responsible for reviewing and approving applications to operate a CCRC and monitoring the ongoing financial condition of all CCRC providers and their ability to fulfill the long-term contractual obligations to residents.
CCRCs offer a variety of contracts, some of which are refundable, while others are non-refundable. These contracts typically require residents to pay a substantial entrance fee, which can often range from $100,000 to $1 million, as well as ongoing monthly fees. CCRCs are referred to by three "types":
- Type A contracts, also known as life care contracts, are often the most expensive contract type, but also the most inclusive as they cover all housing, services, and healthcare needs of a resident. Under Type A contracts, a CCRC absorbs the cost of increased care residents may need as they age.
- Type B contracts, often called modified contracts, typically offer lower entrance and monthly fees and offer limited health care services that may be accessed without any increase in a resident's monthly fee. For example, if a resident needs skilled nursing services for a limited amount of time, they may stay in a skilled-nursing facility for a certain duration of time and not experience an increase in costs; an extended stay, however, could result in increased costs to the resident under this contract type.
- Type C contracts, also known as fee-for-service contracts, include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts typically offer lower entrance fees and monthly fees but the risk of large long-term-care expenses remain with the resident such that risk of increased care expenses are not shifted to the facility.
Types of facilities: CCRCs are comprised of several living arrangements that focus on providing services for retired individuals moving through the aging process. CCRCs are part independent living, part assisted living, and part skilled nursing homes. Upon entering a CCRC, and depending on the type of contract under which a resident enters the facility, a resident can live independently in single-family homes, apartments, or condominiums. When a resident later requires assistance with daily living, CCRCs offer assisted living or nursing care settings.
Resident transfers: As a CCRC resident ages, his or her needs often change such that he or she may eventually transition from independent living settings to settings that offer more assistance in daily living. Residents may transfer voluntarily or be transferred involuntarily, and current law provides CCRCs with the ability to determine if a resident transfer is necessary. Current law requires that a CCRC take into account certain criteria when determining if a resident should be transferred, including: whether a resident is nonambulatory; if the resident has developed a physical or mental condition that endangers the health, safety, or well-being of the resident or another individual; and if the resident's condition warrants a transfer to an assisted living facility due to a need for an increased level of care. Currently, CCRCs are required to include the resident or resident's responsible person in the assessment process which determines whether or not a resident is transferred, however current law does not require CCRCs to use a uniform assessment tool that considers certain criteria when determining if a transfer is appropriate. At present, the Continuing Care Contracts Branch is able to review a resident-disputed transfer to ensure that the provider adequately complied with the transfer process; however, current law is silent on whether the Continuing Care Contracts Branch must determine the appropriateness and necessity of the transfer based on the evaluating criteria used by the CCRC when making the decision to transfer a resident.
Fiscal impact of transfers: Because CCRCs utilize the three aforementioned contract types, certain individuals who are transferred to a higher level of care stand to incur increased monthly fees as a result of the move. For individuals who are involuntarily transferred, these increased costs may be unexpected and unmanageable. In addition to this, because CCRCs are an attractive retirement option for many individuals, CCRCs can quickly resell vacant units, often for very large entrance fees. Because a resident who is transferred to a higher level of care is still a resident of the CCRC, he or she is not entitled to a refund on his or her initial entrance fee and, therefore, a CCRC may be allowed to sell a vacant unit without refunding the entrance fee to the original resident as it is specified in the resident's contract because the resident has not yet terminated his or her contract, but simply moved to another setting within the CCRC.
Need for this bill: According to the author's office, "CCRCs provide an attractive 'age in place' model for seniors, guaranteeing a long-term care contract that provides housing, residential services, and nursing care in one location and usually for the resident's lifetime. In return, residents pay an entry fee and an adjustable monthly fee based on the services used that month. California's aging population, and the attractiveness of the CCRC model, has led to a high demand in retirement living and a growth in the CCRC industry. [This bill] ensures that high demand and financial interests of the retirement community are not putting pressure on providers to accelerate the transfer process for current residents.
Without a requirement for the CCRC to conduct an assessment of the resident, prior to an involuntary transfer, there is no documented justification for the necessity and appropriateness of that transfer. An assessment ensures that the provider is putting the resident's wellbeing and health ahead of any other consideration for the involuntary transfer. If disputed, it is essential that the department is able to consider all of the factors weighing the provider's decision for the transfer, including whether or not the residents physical or cognitive condition warrants an involuntary transfer that will result in reduced independence and higher fees to the resident."
PRIOR LEGISLATION:
SB 939 (Monning), Chapter 112, Statutes of 2016, was similar to SB 475 and requires continuing care contracts that contain lump sum contract termination payments conditioned on resale of the unit must meet a series of requirements and timelines, must pay interest after a special period of vacancy, and must meet other requirements.
SB 475 (Monning) of 2015, would have required that continuing care contracts which condition lump sum contract termination payments on resale of a unit to meet a series of requirements and timelines, to pay interest after a specified period of vacancy, and to meet other requirements. The bill would have also created a complaint process for residents if the repayment has not been made within 12 months. It was vetoed by the Governor.
Analysis Prepared by: Kelsy Castillo / HUM. S. / (916) 319-2089 FN: 0000774
Date of Hearing: May 10, 2017
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 713
Author:(Chu) – As Amended Ver:March 23, 2017
Policy Committee: | Human Services | Vote: | 7 - 0 |
Aging and Long Term Care | 7 - 0 | ||
|
|
Urgency: No State Mandated Local Program: No Reimbursable: No
SUMMARY:
This bill allows a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision, and requires the Continuing Care Contracts Branch (CCC Branch) of the Department of Social Services (DSS) to review a disputed transfer and determine if the transfer was appropriate and necessary. Specifically, this bill:
- Requires a CCRC, prior to any transfer decision, to use an assessment tool or tools to determine the appropriateness of the transfer, to offer an explanation of the assessment process which includes an evaluation of the physical and cognitive capacities of the resident, and to share copies of the completed assessment with the resident or the resident’s responsible person.
- Clarifies that a resident has a right to dispute a CCRC transfer decision.
- Requires the CCC Branch, when reviewing a disputed transfer, to provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
- Directs the CCC Branch to, in addition to its existing requirements regarding a disputed transfer, to also determine whether the disputed transfer is "appropriate and necessary."
FISCAL EFFECT:
- Ongoing costs to DSS, estimated in the range of $110,000 to $220,000 (GF) per year, to hire or contract to fill one position sufficiently qualified to evaluate as "appropriate and necessary," the medical factors used in the transfer determination decision. This type of evaluation is not within the scope of DSS's existing oversight function of CCRCs.
DSS anticipates needing only one part-time position if the transfer review requests remain at their current level of 2 or 3 per year. If the number of these requests increases, as could be reasonably expected under this bill, DSS would require two or more additional positions, depending on the increased workload.
- Onetime costs to DSS in the range of $75,000 to $100,000 (GF) for two years, for one limited term position to develop an evaluation process and provide policy guidance.
- Enforcement costs are minor and absorbable.
COMMENTS:
- Purpose. This bill intends to give residents of CCRCs an additional tool to dispute involuntary transfers to higher levels of care. According to the author, "Without a requirement for the CCRC to conduct an assessment of the resident, prior to an involuntary transfer, there is no documented justification for the necessity and appropriateness of that transfer. An assessment ensures that the provider is putting the resident’s wellbeing and health ahead of any other consideration for the involuntary transfer. If disputed, it is essential that the department is able to consider all of the factors weighing the provider’s decision for the transfer, including whether or not the residents physical or cognitive condition warrants an involuntary transfer that will result in reduced independence and higher fees to the resident….[This bill] ensures that high demand and financial interests of the retirement community are not putting pressure on providers to accelerate the transfer process for current residents."
- Background. CCRCs are comprised of several living arrangements that focus on providing services for retired individuals moving through the aging process. CCRCs typically offer a combination of independent living, assisted living and skilled nursing units. California has approximately 107 CCRCs with over 20,000 units. Of those, roughly 65% of CCRCs are non-profit. Under DSS, the Community Care Licensing Division is responsible for the oversight of these facilities and ensuring compliance with regulations.
CCRCs offer a variety of contracts to residents. These contracts typically require residents to pay an entrance fee, which often ranges from $100,000 to $1 million, as well as ongoing monthly fees. As CCRC residents age or their needs change, they may transfer from independent living to higher levels of care. They may transfer voluntarily or be transferred involuntarily. Depending on the resident's contract, transferring to a higher level of care often results in increased monthly fees.
Existing law allows CCRCs to determine if a resident transfer is necessary and requires them to consider certain criteria regarding the resident's physical and mental condition when determining the transfer decision. CCRCs are required to include the resident or resident’s responsible person in the transfer assessment process. They also must share copies of the completed assessment upon request of the resident, if an assessment tool was used. This bill would instead require CCRCs to use assessment tools and to always share the completed assessment with a resident or a resident's responsible person, not just upon request.
If a resident disputes a transfer decision, the CCC Branch must provide a timely review of the disputed transfer to ensure that the provider adequately complied with the transfer process. This bill would additionally require the CCC Branch to consider the appropriateness and necessity of the transfer based on the evaluating criteria, including medical criteria, used by the CCRC.
Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081
Date of Hearing: April 4, 2017
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Ash Kalra, Chair
ABPCA Bill Id:AB 713 (
Author:Chu) – As Amended Ver:March 23, 2017
SUBJECT: Continuing care retirement facilities: transfers of residents
SUMMARY: Allows a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision, and requires the Continuing Care Contracts Branch of the Department of Social Services (DSS) to review a disputed transfer and determine if the transfer was appropriate and necessary. Specifically, this bill:
- Allows a resident of a Continuing Care Retirement Community to dispute a transfer decision.
- Requires the Continuing Care Contracts Branch to provide a description of the steps a provider took and the factors a provider considered in deciding to transfer a resident, including the assessment tool or tools and the scoring and evaluating criteria used by the provider to justify the transfer.
- Directs the Continuing Care Contracts Branch to, in addition to determinations it is already required to make regarding a disputed transfer, to also determine whether the disputed transfer is appropriate and necessary.
- Requires a continuing care retirement community, prior to any transfer decision in the assessment process that forms the basis for the level of care transfer decision, to offer an explanation of the assessment process.
- Requires the assessment to include, but not be limited to, an evaluation of the physical and cognitive capacities of the resident including scoring and evaluating criteria, which must be used in the determination of the appropriateness of the transfer.
- Requires copies of the completed assessment to be shared with the resident or the resident’s responsible person.
EXISTING LAW:
- Requires a continuing care retirement facility, as defined, to possess a certificate of authority issued by the State Department of Social Services before it can enter into a continuing care contract with a resident and that a continuing care contract be in writing and contain specified information.
- Defines a “continuing care contract” to mean a contract that includes a promise by a provider to provide one or more elements of care to an elderly resident, in exchange for an entrance fee and/or the payment of periodic charges.
- Defines a “continuing care retirement community” (CCRC) to mean a facility located in the state where services promised in a continuing care contract are provided. Further allows that, when services are provided in residents’ own homes, the homes into which the provider takes those services are to be considered a part of the CCRC.
- Requires a continuing care contract to include the procedures and conditions under which a resident may be voluntarily or involuntarily transferred from a designated living unit, while taking into account the appropriateness and necessity of the transfer.
- Authorizes the resident or the resident’s responsible person to dispute a transfer decision, and requires a timely review of transfer disputes by the Continuing Care Contracts Branch and requires any transfer decision to be in writing.
- Requires, prior to any transfer under those provisions, the continuing care retirement community to satisfy certain requirements, including, but not limited to, involving the resident and the resident’s responsible person in the assessment process that forms the basis for the transfer and providing an explanation of the assessment process and provide copies of the completed assessment if requested.
FISCAL EFFECT: Unknown.
COMMENTS:
Author’s Statement: According to the author’s office, “CCRCs provide an attractive ‘age in place’ model for seniors, guaranteeing a long-term care contract that provides housing, residential services, and nursing care in one location and usually for the resident’s lifetime. In return, residents pay an entry fee and an adjustable monthly fee based on the services used that month. California’s aging population, and the attractiveness of the CCRC model, has led to a high demand in retirement living and a growth in the CCRC industry. [This bill] ensures that high demand and financial interests of the retirement community are not putting pressure on providers to accelerate the transfer process for current residents.
Without a requirement for the CCRC to conduct an assessment of the resident, prior to an involuntary transfer, there is no documented justification for the necessity and appropriateness of that transfer. An assessment ensures that the provider is putting the resident’s wellbeing and health ahead of any other consideration for the involuntary transfer. If disputed, it is essential that the department is able to consider all of the factors weighing the provider’s decision for the transfer, including whether or not the residents physical or cognitive condition warrants an involuntary transfer that will result in reduced independence and higher fees to the resident.”
Continuing Care Retirement Communities: As California’s population ages, seniors are faced with a variety of options for retirement living. Continuing Care Retirement Communities may be an attractive option for individuals and provide long-term care contracts that offer housing, residential services, and nursing care, often in one location and often for a resident’s lifetime. Currently, California has approximately 107 CCRCs with over 20,000 units. Of those, roughly 65% of CCRCs are non-profit. Under DSS, the Community Care Licensing Division (CCLD) is responsible for the oversight of these facilities and ensuring compliance with regulations. Specifically, the Continuing Care Branch is responsible for reviewing and approving applications to operate a CCRC and monitoring the ongoing financial condition of all CCRC providers and their ability to fulfill the long-term contractual obligations to residents.
CCRCs offer a variety of contracts, some of which are refundable, while others are non-refundable. These contracts typically require residents to pay a substantial entrance fee, which can often range from $100,000 to $1 million, as well as ongoing monthly fees. CCRCs are referred to by three “types”:
- Type A contracts, also known as life care contracts, are often the most expensive contract type, but also the most inclusive as they cover all housing, services, and healthcare needs of a resident. Under Type A contracts, a CCRC absorbs the cost of increased care residents may need as they age.
- Type B contracts, often called modified contracts, typically offer lower entrance and monthly fees and offer limited health care services that may be accessed without any increase in a resident’s monthly fee. For example, if a resident needs skilled nursing services for a limited amount of time, they may stay in a skilled-nursing facility for a certain duration of time and not experience an increase in costs; an extended stay, however, could result in increased costs to the resident under this contract type.
- Type C contracts, also known as fee-for-service contracts, include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts typically offer lower entrance fees and monthly fees but the risk of large long-term-care expenses remain with the resident such that risk of increased care expenses are not shifted to the facility.
Types of facilities: CCRCs are comprised of several living arrangements that focus on providing services for retired individuals moving through the aging process. CCRCs are part independent living, part assisted living, and part skilled nursing homes. Upon entering a CCRC, and depending on the type of contract under which a resident enters the facility, a resident can live independently in single-family homes, apartments, or condominiums. When a resident later requires assistance with daily living, CCRCs offer assisted living or nursing care settings.
Resident transfers: As a CCRC resident ages, his or her needs often change such that he or she may eventually transition from independent living settings to settings that offer more assistance in daily living. Residents may transfer voluntarily or be transferred involuntarily, and current law provides CCRCs with the ability to determine if a resident transfer is necessary. Current law requires that a CCRC take into account certain criteria when determining if a resident should be transferred, including: whether a resident is nonambulatory; if the resident has developed a physical or mental condition that endangers the health, safety, or well-being of the resident or another individual; and if the resident’s condition warrants a transfer to an assisted living facility due to a need for an increased level of care. Currently, CCRCs are required to include the resident or resident’s responsible person in the assessment process which determines whether or not a resident is transferred, however current law does not require CCRCs to use a uniform assessment tool that considers certain criteria when determining if a transfer is appropriate. At present, the Continuing Care Contracts Branch is able to review a resident-disputed transfer to ensure that the provider adequately complied with the transfer process; however, current law is silent on whether the Continuing Care Contracts Branch must determine the appropriateness and necessity of the transfer based on the evaluating criteria used by the CCRC when making the decision to transfer a resident.
Fiscal impact of transfers: Because CCRCs utilize the three aforementioned contract types, certain individuals who are transferred to a higher level of care stand to incur increased monthly fees as a result of the move. For individuals who are involuntarily transferred, these increased costs may be unexpected and unmanageable. In addition to this, because CCRCs are an attractive retirement option for many individuals, CCRCs can quickly resell vacant units, often for very large entrance fees. Because a resident who is transferred to a higher level of care is still a resident of the CCRC, he or she is not entitled to a refund on his or her initial entrance fee and, therefore, a CCRC may be allowed to sell a vacant unit without refunding the entrance fee to the original resident as it is specified in the resident’s contract because the resident has not yet terminated his or her contract, but simply moved to another setting within the CCRC.
Arguments in Support: According to the California Continuing Care Residents Association (CALCRA), who is a sponsor of this bill, “There are a number of factors a provider must consider when deciding to initiate a resident transfer, including the president’s health, physical and cognitive abilities, availability of services, and whether or not the resident’s unit can be quickly re-occupied by a new resident. An assessment tool to determine the state of the president’s health, including the physical, cognitive, mental and emotional functional abilities of the individual, must be conducted by the provider. Without it, the department has nothing to justify the medical necessity of the transfer…then residents are left to wonder if the decision to transfer them to a higher level of care was driven by the provider’s financial interest in raising their costs and bringing in new resident entrance fees.”
Arguments in Opposition: None.
REGISTERED SUPPORT / OPPOSITION:
Support
California Continuing Care Residents Association (CALCRA) – Sponsor
California Advocates for Nursing Home Reform (CANHR)
California Long-Term Care Ombudsman Association (CLTCOA)
California Retired Teachers Association (CalRTA)
Consumer Federation of California (CFC)
Several individuals (100+).
Opposition
None on file.
Analysis Prepared by: Barry Brewer / AGING & L.T.C. / (916) 319-3990
Date of Hearing: March 21, 2017
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Blanca Rubio, Chair
ABPCA Bill Id:AB 713 (
Author:Chu) – As Introduced Ver:February 15, 2017
SUBJECT: Continuing care retirement facilities: transfers of residents
SUMMARY: Allows a resident of a Continuing Care Retirement Community (CCRC) to dispute a transfer decision, and requires the Continuing Care Contracts Branch of the Department of Social Services (DSS) to review a disputed transfer decision and make a determination as to whether or not the transfer was appropriate and necessary.
Specifically, this bill:
- Deletes provisions stating that, if an assessment tool or tools is used in the determination of a transfer, the provider must provide copies to the resident or resident’s responsible person upon request, and instead requires an assessment tool or tools be used in the determination of the appropriateness of a resident’s transfer and copies of the completed assessment be made available to the resident or resident’s responsible person.
- Grants a resident the right to dispute a transfer decision, as specified.
- Requires the Continuing Care Contracts Branch of DSS, for disputed transfer decisions, to consider the appropriateness and necessity of a resident’s transfer, as specified, and to provide an explanation of the assessment, including the scoring and evaluating criteria used by the provider to justify the transfer.
- Directs the Continuing Care Contracts Branch to, in addition to determinations it is already required by law to make regarding disputed transfer decisions, determine whether the disputed transfer is appropriate and necessary.
EXISTING LAW:
- Establishes the California Residential Care Facilities for the Elderly Act to provide for the licensure and regulation of Residential Care Facilities for the Elderly (RCFEs) as a separate category within the existing licensing structure of DSS. (HSC 1569 et seq.)
- Provides for the licensure and regulation of Skilled Nursing Facilities (SNFs) by the Department of Public Health. (HSC 1250 et seq.)
- Defines a “continuing care contract” to mean a contract that includes a promise by a provider to provide one or more elements of care to an elderly resident, as specified, in exchange for an entrance fee and/or the payment of periodic charges. (HSC 1771(c)(8))
- Defines a “continuing care retirement community” (CCRC) to mean a facility located in the state where services promised in a continuing care contract are provided. Further allows that, when services are provided in residents’ own homes, the homes into which the provider takes those services are to be considered a part of the CCRC. (HSC 1771(c)(10))
- Provides for the certification and regulation of CCRCs by DSS. (HSC 1770 et seq.)
- Authorizes the Continuing Care Contracts Branch of DSS to enforce certain health and safety regulations, as specified. (HSC 1771.1)
- Requires a continuing care contract to include the procedures and conditions under which a resident may be voluntarily or involuntarily transferred from a designated living unit, as specified. (HSC 1788 (a) (10) )
- Details the conditions under which a CCRC may transfer a resident, while taking into account the appropriateness and necessity of the transfer, as specified. (HSC 1788 (a) (10))
- Requires a CCRC to involve the resident and the resident’s responsible person in the assessment process, as specified. (HSC 1788 (i))
FISCAL EFFECT: Unknown.
COMMENTS:
Continuing Care Retirement Communities: As California’s population ages, seniors are faced with a variety of options for retirement living. Continuing Care Retirement Communities may be an attractive option for individuals and provide long-term care contracts that offer housing, residential services, and nursing care, often in one location and often for a resident’s lifetime. Currently, California has approximately 107 CCRCs with over 20,000 units. Of those, roughly 65% of CCRCs are non-profit. Under DSS, the Community Care Licensing Division (CCLD) is responsible for the oversight of these facilities and ensuring compliance with regulations. Specifically, the Continuing Care Branch is responsible for reviewing and approving applications to operate a CCRC and monitoring the ongoing financial condition of all CCRC providers and their ability to fulfill the long-term contractual obligations to residents.
CCRCs offer a variety of contracts, some of which are refundable, while others are non-refundable. These contracts typically require residents to pay a substantial entrance fee, which can often range from $100,000 to $1 million, as well as ongoing monthly fees. CCRCs are referred to by three “types”:
- Type A contracts, also known as life care contracts, are often the most expensive contract type, but also the most inclusive as they cover all housing, services, and healthcare needs of a resident. Under Type A contracts, a CCRC absorbs the cost of increased care residents may need as they age.
- Type B contracts, often called modified contracts, typically offer lower entrance and monthly fees and offer limited health care services that may be accessed without any increase in a resident’s monthly fee. For example, if a resident needs skilled nursing services for a limited amount of time, they may stay in a skilled-nursing facility for a certain duration of time and not experience an increase in costs; an extended stay, however, could result in increased costs to the resident under this contract type.
- Type C contracts, also known as fee-for-service contracts, include similar housing, residential services and amenities as Type A and B contracts but require residents to pay market rates for any health-related services under an as needed arrangement. Type C contracts typically offer lower entrance fees and monthly fees but the risk of large long-term-care expenses remain with the resident such that risk of increased care expenses are not shifted to the facility.
Types of facilities: CCRCs are comprised of several living arrangements that focus on providing services for retired individuals moving through the aging process. CCRCs are part independent living, part assisted living, and part skilled nursing homes. Upon entering a CCRC, and depending on the type of contract under which a resident enters the facility, a resident can live independently in single-family homes, apartments, or condominiums. When a resident later requires assistance with daily living, CCRCs offer assisted living or nursing care settings.
Resident transfers: As a CCRC resident ages, his or her needs often change such that he or she may eventually transition from independent living settings to settings that offer more assistance in daily living. Residents may transfer voluntarily or be transferred involuntarily, and current law provides CCRCs with the ability to determine if a resident transfer is necessary. Current law requires that a CCRC take into account certain criteria when determining if a resident should be transferred, including: whether a resident is nonambulatory; if the resident has developed a physical or mental condition that endangers the health, safety, or well-being of the resident or another individual; and if the resident’s condition warrants a transfer to an assisted living facility due to a need for an increased level of care. Currently, CCRCs are required to include the resident or resident’s responsible person in the assessment process which determines whether or not a resident is transferred, however current law does not require CCRCs to use a uniform assessment tool that considers certain criteria when determining if a transfer is appropriate. At present, the Continuing Care Contracts Branch is able to review a resident-disputed transfer to ensure that the provider adequately complied with the transfer process; however, current law is silent on whether the Continuing Care Contracts Branch must determine the appropriateness and necessity of the transfer based on the evaluating criteria used by the CCRC when making the decision to transfer a resident.
Fiscal impact of transfers: Because CCRCs utilize the three aforementioned contract types, certain individuals who are transferred to a higher level of care stand to incur increased monthly fees as a result of the move. For individuals who are involuntarily transferred, these increased costs may be unexpected and unmanageable. In addition to this, because CCRCs are an attractive retirement option for many individuals, CCRCs can quickly resell vacant units, often for very large entrance fees. Because a resident who is transferred to a higher level of care is still a resident of the CCRC, he or she is not entitled to a refund on his or her initial entrance fee and, therefore, a CCRC may be allowed to sell a vacant unit without refunding the entrance fee to the original resident as it is specified in the resident’s contract because the resident has not yet terminated his or her contract, but simply moved to another setting within the CCRC.
Need for this bill: According to the author’s office, “CCRCs provide an attractive ‘age in place’ model for seniors, guaranteeing a long-term care contract that provides housing, residential services, and nursing care in one location and usually for the resident’s lifetime. In return, residents pay an entry fee and an adjustable monthly fee based on the services used that month. California’s aging population, and the attractiveness of the CCRC model, has led to a high demand in retirement living and a growth in the CCRC industry. [This bill] ensures that high demand and financial interests of the retirement community are not putting pressure on providers to accelerate the transfer process for current residents.
Without a requirement for the CCRC to conduct an assessment of the resident, prior to an involuntary transfer, there is no documented justification for the necessity and appropriateness of that transfer. An assessment ensures that the provider is putting the resident’s wellbeing and health ahead of any other consideration for the involuntary transfer. If disputed, it is essential that the department is able to consider all of the factors weighing the provider’s decision for the transfer, including whether or not the residents physical or cognitive condition warrants an involuntary transfer that will result in reduced independence and higher fees to the resident.”
According to the California Continuing Care Residents Association (CALCRA), who is a sponsor of this bill, “There are a number of factors a provider must consider when deciding to initiate a resident transfer, including the resident’s health, physical and cognitive abilities, availability of services, and whether or not the resident’s unit can be quickly re-occupied by a new resident. An assessment tool to determine the state of the resident’s health, including the physical, cognitive, mental and emotional functional abilities of the individual, must be conducted by the provider. Without it, the department has nothing to justify the medical necessity of the transfer…then residents are left to wonder if the decision to transfer them to a higher level of care was driven by the provider’s financial interest in raising their costs and bringing in new resident entrance fees.”
Suggested amendments: In order to clarify the duties of continuing care retirement communities and DSS, committee staff recommends the following technical amendments:
- On line 27 on page 4 of the bill, make the following changes:
18
(i) Involve the resident and the resident’s responsible person,
19
as defined in paragraph (6) of subdivision (r) of Section 87101 of
20
Title 22 of the California Code of Regulations, and upon the
21
resident’s or responsible person’s request, family members, or the
22
resident’s physician or other appropriate health professional, in
23
the assessment process that forms the basis for the level of care
24
transfer decision by the provider. The provider shall offer an
25
explanation of the assessment process, which shall include but not be limited to an evaluation of the physical and cognitive capacities of the resident. If an An assessment tool
26
or tools, including scoring and evaluating criteria, are shall be used
27
in the determination of the appropriateness of the transfer, and the
28
provider shall make copies of the completed assessment available
29
upon the request of to be shared with the resident or the resident’s
30
responsible person.
- On page 5, lines 34-39, make the following changes:
37
emotional functional abilities of the resident, and provide an
38
explanation a description of the assessment, steps a provider took and factors a provider considered in deciding to transfer a resident including the assessment tool or tool(s) and the scoring and evaluating
PRIOR LEGISLATION:
SB 939 (Monning), Chapter 112, Statutes of 2016, was similar to SB 475 and requires continuing care contracts that contain lump sum contract termination payments conditioned on resale of the unit must meet a series of requirements and timelines, must pay interest after a special period of vacancy, and must meet other requirements.
SB 475 (Monning), 2015, would have required that continuing care contracts which condition lump sum contract termination payments on resale of a unit to meet a series of requirements and timelines, to pay interest after a specified period of vacancy, and to meet other requirements. The bill would have also created a complaint process for residents if the repayment has not been made within 12 months. It was vetoed by the Governor.
DOUBLE REFERRAL. This bill has been double-referred. Should this bill pass out of this committee, it will be referred to the Assembly Committee Aging and Long Term Care Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
California Continuing Care Residents Association (CALCRA) - (Sponsor)
California Advocates for Nursing Home Reform (CANHR)
California Long-Term Care Ombudsman Association
Consumer Federation of California (CFC)
152 Individuals
Opposition
None on file.
Analysis Prepared by: Kelsy Castillo / HUM. S. / (916) 319-2089
Discussed in Hearing
2MIN
Assembly Floor
3MIN
Senate Floor
1H
Senate Standing Committee on Appropriations
2MIN
Assembly Floor
1H
Assembly Standing Committee on Appropriations
15MIN
Assembly Standing Committee on Aging and Long-Term Care
11MIN
Assembly Standing Committee on Human Services
Bill Author
Bill Co-Author(s):