N.Y. Public Health Law § 4608: Contracts

§ 4608. Contracts. A continuing care retirement contract or continuing

care at home contract shall contain all of the following information in

no less than twelve point type and in plain language, in addition to any

other terms or matter as may be required by regulations adopted by the

council and issued by the superintendent:

1. The amount of all money 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 or continuing

care at home contract holder or holders;

2. A description of all services which are to be furnished by the

operator, a description of any fees in addition to the entrance fee and

periodic charges provided for in the contract, and the conditions under

which the fees may be adjusted, provided that an operator shall not

charge any non-refundable application fee to a prospective resident who

has paid a non-refundable priority reservation agreement application

fee;

3. The procedures of the community relating to a resident's or

contract holder's failure to pay the required monthly fees;

4. A statement of the figures and terms concerning the entry of a

spouse to the community and the consequences if the spouse does not meet

the requirements for entry;

5. A statement of the terms and conditions under which a contract may

be cancelled by the operator or by a resident or contract holder and the

conditions under which all or any portion of the entrance fee will be

refunded by the operator, including the mandatory refund provisions set

forth in sections forty-six hundred nine and forty-six hundred ten of

this article;

6. a. The procedures and conditions under which a resident may be

transferred from his or her living unit or home including a statement

that, at the time of transfer, the resident will be given the reasons

for the transfer; the process by which a transfer decision is made; the

persons with the authority to make the decision to transfer; a

description of any change in charges to be paid by the resident for

services not covered by the contract fees as a result of the transfer;

and a statement regarding the disposition of and the right to return to

the living unit in cases of temporary and permanent transfers.

b. For continuing care retirement contracts, the circumstances under

which a living unit may be considered vacant and eligible for transfer

or resale to a new resident, either due to the permanent transfer of a

resident to the community's nursing or other specialized facility or due

to the permanent transfer of a resident to a hospital or other facility

outside of the community; provided, however, that nothing therein shall

relieve a community from its obligations to provide or to insure

provision of all contractually required care pursuant to the terms of a

continuing care retirement contract. Should a resident's chronic

condition require placement in a more specialized chronic care facility

that provides services beyond those provided through the community's

nursing facility, the liability of the community pursuant to the terms

of a continuing care retirement contract shall be equal to the current

per diem rate of the nursing facility minus the pro rata apportionment

of the resident's monthly fee for the period of care required by the

contract. Nothing herein shall obligate a continuing care retirement

community which does not have a life care contract with a resident to

provide or pay for a level of nursing facility services nor for any

duration beyond what is specifically described in its continuing care

retirement contract with that resident. This section shall not affect

the operator's obligation under subdivision two of section forty-six

hundred twenty-four of this article;

7. For continuing care retirement contracts, a statement that, if the

resident dies prior to occupancy date or, through illness, injury, or

incapacity is precluded from becoming a resident under the terms of the

contract, the contract is automatically rescinded and the resident or

his or her legal representative shall receive a full refund of all

moneys paid to the facility, except for those costs specifically

incurred by the facility at the request of the resident and set forth in

writing in a separate addendum, signed by the parties to the contract;

8. For continuing care at home contracts, a statement that, if the

resident dies prior to the effective start date of services or, through

illness, injury, or incapacity is precluded from meeting the eligibility

terms of the contract, the contract is automatically rescinded and the

resident or his or her legal representative shall receive a full refund

of all moneys paid to the facility, except for those costs specifically

incurred by the facility at the request of the resident and set forth in

writing in a separate addendum, signed by the parties to the contract;

9. For continuing care retirement contracts, a statement of the

conditions under which all or any portion of the entrance fee will be

released to the operator before the living unit becomes available for

occupancy, and a statement of the conditions under which all or any

portion of that fee will be refunded in the event of the death of the

resident and/or spouse following occupancy of a living unit, including

the mandatory refund provisions set forth in section forty-six hundred

nine of this article;

10. A statement of the advance notice to be provided the resident or

contract holder, of not less than sixty days, of any change in fees or

charges or scope of care or services;

11. A statement that no act, agreement, or statement of any resident

or contract holder, or of an individual purchasing care for a resident

or contract holder under any agreement to furnish care to the resident

or contract holder, shall constitute a valid waiver of any provision of

this article or of any regulation enacted pursuant thereto intended for

the benefit or protection of the resident or contract holder or the

individual purchasing care for the resident or contract holder;

12. For continuing care retirement contracts, a description of the

reinstatement policies if a resident leaves the facility or the contract

is cancelled; and for continuing care at home contracts, a description

of policies if the home resident relocates their private residence or

the contract is cancelled.

13. A statement that internal procedures to resolve disputes and

grievances have been established, and residents and contract holders

notified of them;

14. A statement of the grace period, if any, for the payment of

periodic fees without a penalty, and the extent of any penalty for the

late payment thereof;

15. A statement that: a. the resident or contract holder, as

applicable shall, if eligible, enroll in medicare parts a and b or the

equivalent and shall continue to maintain that coverage, together with

medicare supplement coverage at least equivalent in benefits to those

established by the superintendent as minimum benefits for medicare

supplement policies;

b. if the resident or contract holder fails to maintain medicare

coverage and a medicare supplement coverage, or is ineligible for such

coverage and fails to purchase the equivalent of such coverage, the

community shall purchase the coverage or equivalent coverage on behalf

and at the expense of the resident or contract holder and shall have the

authority to require an appropriate adjustment in payments by the

resident or contract holder to the community;

c. if the community cannot purchase medicare coverage and medicare

supplement coverage or the equivalent, the community shall have the

authority to require an adjustment in monthly fees, subject to the

approval of the superintendent, to fund the additional risk to the

facility; and

d. if the resident or contract holder fails to purchase or maintain

medicare coverage and medicare supplement coverage or the equivalent,

and the community has not purchased such coverage, the community will be

responsible for any expenses which would have been covered by medicare

and medicare supplement coverage. The community may add the amount of

such expenses to the resident's or contract holder's monthly fees.

16. A statement that any amendment to the contract and any change in

fees or charges, other than those within the guidelines of an approved

rating system, must be approved by the superintendent of financial

services;

17. A statement that property shall not be substituted as payment for

either the entrance fee or monthly fee;

18. A statement describing the method by which the community will

determine priority for access to available adult care facility or

nursing facility beds between a continuing care retirement contract

holder and a continuing care at home contract holder;

19. For continuing care retirement contracts, a statement whether the

continuing care retirement contract includes any ownership, beneficial

or trust interest in the assets of the operator, the assets of the

facility, or both. Assets shall include, but are not limited to,

property, trusts, reserves, interest and other assets; and

20. Continuing care at home contracts shall include the following:

a. a statement describing the circumstances under which a contract

holder may move into a campus independent living unit, adult care

facility or nursing home;

b. a statement as to whether and under what circumstances

transportation will be provided to continuing care at home contract

holders;

c. a statement describing the mechanism for monitoring continuing care

at home contract holders;

d. a statement describing the method by which the community will

determine priority for access to available ILUs between a continuing

care at home contract holder who wishes to convert the contract to a

continuing care retirement contract and a continuing care retirement

contract holder;

e. a statement describing any applicable geographical limits of the

continuing care at home services, and the policy that will be followed

in the event that a continuing care at home contract holder relocates to

a different residence outside the geographical limits covered by the

continuing care at home contract; and

f. a statement describing any applicable policy that would entitle a

continuing care at home contract holder to select adult care facility or

skilled nursing facility placement in a facility that is not part of the

continuing care retirement community.