New York Codes, Rules and Regulations › Title 10 - DEPARTMENT OF HEALTH › Chapter VII - Life Care Communities › Part 901 - Organization And Administration › Section 901.2 - Life care contract

Current through Register Vol. 46, No. 28, July 10, 2024
(a) The
				life care contract shall be written in plain language and printed in no less
				than 12 point type. In addition, the following statement shall be printed in
				bold 12 point type on the cover or top of the first page: "This matter involves
				a substantial financial investment and a legally binding contract. In
				evaluating the disclosure statement and the contract prior to any commitment,
				it is recommended that you consult with an attorney and financial advisor of
				your choice, if you so elect, who can review these documents with
				you."
(b) The life care contract
				shall include, but not be limited to, all of the following information:
(1) the amount of all money transferred or to
				be transferred, including, but not limited to, donations, subscriptions,
				deposits, fees, and any other amounts paid or payable by, or on behalf of, the
				resident or residents;
(2) a
				description of all services which are to be provided to the resident. The
				contract must clearly identify those services which are provided as part of the
				entrance fee and those services which are provided as part of the monthly care
				fee and those which are not included in such fees and in the case of a long
				term care security program for long term care model community, those services
				which are paid in whole or in part through a long term care insurance policy
				and medical assistance payments;
(3) a description of the entrance fee,
				monthly care fee and any other fees provided for in the contract and the
				conditions under which any of the fees may be adjusted, provided that an
				operator shall not charge a non-refundable application fee to a prospective
				resident who has already paid a non-refundable priority reservation agreement
				application fee;
(4) a description
				of any late penalties which will be imposed and the grace period, if any,
				during which no penalties will be imposed, due to late payment of monthly care
				fees, and the community's policies and procedures regarding nonpayment of the
				monthly care fees;
(5) the
				community's policies and procedures, including dollar amounts and terms,
				regarding the subsequent entry of a spouse into the community and the
				consequences of the spouse's failure to meet the entrance criteria;
(6) the terms and conditions under which the
				contract may be cancelled by the operator or by the resident;
(7) the entrance fee refund policy which must
				be consistent with the provisions set forth in section
				901.4 of this Part;
(8) the conditions under which an independent
				living unit will be determined to be vacant either due to the resident's
				permanent transfer to the community's nursing home, adult care facility or
				other specialized facility within the community or due to the permanent
				transfer of the resident to a hospital or other facility outside of the
				community, provided that nothing therein shall relieve the community of its
				obligations to provide or to insure provision of lifetime care;
(9) a statement of the community's liability
				in the event that a resident's chronic condition requires placement in a more
				specialized chronic care facility that provides services beyond those provided
				by the community's nursing home. The liability of the community shall be equal
				to the excess of the community's nursing home private pay per diem over the
				resident's monthly care fee on a per diem basis. In the event that the
				community's nursing home is no longer serving the outside community, a
				reasonable cost based per diem shall be established for the community's nursing
				home for the purpose of establishing the community's liability;
(10) a statement indicating that in the event
				that a resident dies prior to occupancy in the community, or due to illness,
				injury or incapacity is no longer eligible for occupancy in the community under
				the terms of the contract, the contract is automatically rescinded upon written
				notice to the sponsor by the prospective resident or his or her legal
				representative and the resident or his or her legal representative shall
				receive a full refund of all moneys paid to the community, except for those
				costs specifically incurred by the community at the request of the resident and
				set forth in writing in a separate addendum, signed by the parties to the
				contract. In the event of a multiple party contract, the contract may remain in
				effect at the option of the remaining prospective residents subject to the
				terms of the contract;
(11) a
				statement of the community's policy regarding advance notice to be provided to
				the resident of any changes in fees or charges or scope of care or services.
				Such notice must be made at least 60 days in advance of such change;
(12) a statement that no act, agreement or
				statement of any resident, or of an individual purchasing care for a resident
				under any agreement to furnish care to the resident, shall constitute a valid
				waiver of any provision of article 46 of the Public Health Law or of any rules
				and regulations enacted pursuant thereto intended for the benefit or protection
				of the resident or the individual purchasing care for the resident;
(13) a description of the community's
				reinstatement policy in the event that the contract is cancelled by the
				community or the resident;
(14) a
				statement indicating that internal procedures have been established to address
				and resolve disputes and grievances of the residents and that a copy of such
				procedures shall be provided to each resident;
(15) a statement of Medicare Parts A and B
				and supplement coverage requirements which shall specify that:
(i) the resident shall, if eligible, enroll
				in and continue to maintain Medicare Parts A and B coverage or the equivalent
				and Medicare supplement coverage as defined by the New York State Insurance
				Department pursuant to 11 NYCRR sections 52.11 and 52.22;
(ii) the community shall maintain a system to
				monitor residents' coverage and if the resident fails to maintain or is
				ineligible for Medicare Parts A and B and supplement coverage, and the resident
				fails to purchase the equivalent of such coverage, the community shall purchase
				such coverage on behalf of and at the expense of the resident and shall have
				the authority to require appropriate adjustment to the resident's monthly care
				fee;
(iii) if the community cannot
				purchase such coverage, the community shall have the authority to require an
				adjustment to the resident's monthly care fee, subject to the approval of the
				Superintendent of Insurance, to fund the additional risk to the community;
				and
(iv) the community shall be
				responsible for any expense incurred which would have been covered by Medicare
				Parts A and B and Medicare supplement or equivalent coverage during a lapse in
				coverage due to failure or inability of the resident and the community to
				secure coverage. The community may add the amount of such expenses to the
				resident's monthly care fee if the community has not funded this additional
				risk pursuant to subparagraph (iii) of this paragraph;
(16) if the community is operated as a long
				term care security program for long term care model, a statement of the
				community's policies regarding that program which must include the following:
(i) with regard to any nursing home or home
				health care services provided pursuant to the life care contract, any
				elimination or waiting periods and any deductibles, co-payments or other
				amounts not paid for through a long term care insurance policy or medical
				assistance payment shall be the responsibility of the community, and the
				resident shall not be liable for such amounts;
(ii) the operator shall not require that the
				long term care insurance policy be purchased from a specific insurer or group
				of insurers and shall not require a minimum benefit level in excess of that
				required pursuant to section
				367
				(f) of the Social Services Law and section
				3229 of the
				Insurance Law; and
(iii) the
				community shall maintain a system to monitor residents' coverage and if the
				resident fails to maintain the minimum required coverage, the operator shall
				purchase, if possible, such coverage on behalf and at the expense of the
				resident and may require an appropriate adjustment to the resident's monthly
				fees to reflect the cost of the coverage;
(a)
				if the operator cannot purchase such coverage, the operator may require an
				adjustment of the resident's monthly fees to fund the additional risk to the
				community, subject to the superintendent's approval; and
(b) if the resident fails to maintain the
				required coverage and the operator has not purchased such coverage, the
				operator shall be responsible for any expenses which would have otherwise been
				covered under such a policy. The operator may add the amount of actual expenses
				incurred to the resident's monthly fees;
(17) a statement that any amendment to the
				contract and any change in entrance and/or monthly care fees other than those
				within the guidelines of a previously approved rating system or which do not
				exceed the change in the consumer price index, or other index as determined by
				the Superintendent of Insurance, must be approved by the
				superintendent;
(18) a statement
				that property may not be substituted as payment for either the entrance fee or
				the monthly care fee; and
(19) a
				statement of the conditions under which a resident will be admitted to or
				discharged from the various components of the community.