Register, August, 1993, No. 452
Chapter Ins 10
CONTINUING CARE FACILITIES
Ins 10.10 Continuing care contracts.
Ins 10.10
Ins 10.10
Continuing care contracts. Ins 10.10(1)
(1)
Purpose. The purpose of this section is to interpret
s. 100.18 and
ch. 647, Stats., by establishing guidelines and standards for the filing and review of continuing care contracts.
Ins 10.10(2)
(2) Scope. This section applies to all contracts entered into by providers subject to
ch. 647, Stats.
Ins 10.10(3)
(3) Definitions. The definitions in
s. 647.01, Stats., apply to this section.
Ins 10.10(4)
(4) Filing and approval of continuing care contract forms. Ins 10.10(4)(a)(a) No provider may enter into a continuing care contract with any resident or prospective resident unless the contract form prepared for general use has been filed with and approved by the commissioner. A contract form filed with the commissioner need not include the rules, regulations and procedures the provider uses for the day-to-day operation of the facility. The filing shall be deemed approved if it is not disapproved within 30 days after filing. The commissioner may disapprove a contract form upon a finding that it violates a statute or a rule promulgated by the commissioner.
Ins 10.10(4)(b)
(b) A provider shall file each amended contract form with the commissioner within 30 days after any change is made in that contract.
Ins 10.10(5)(a)(a) No continuing care contract may contain any agreement or incorporate any provision not fully set forth in the contract or in an application or other document attached to and made part of the contract at the time of its delivery.
Ins 10.10(5)(b)
(b) The text of a continuing care contract shall be printed in not less than 10 point type of a style in general use. Captions and summary paragraphs shall be printed in not less than 12 point type of a style in general use.
Ins 10.10(5)(c)
(c) A continuing care contract may not be deceptive or obscure, encourage misrepresentation or in any other way be contrary to
ss. 100.18 and
647.05, Stats.
Ins 10.10(6)
(6) Contract provisions. Each contract and any amendment of the contract, in addition to compliance with
s. 647.05, Stats., shall do all of the following:
Ins 10.10(6)(a)
(a) Clearly identify the entities who are party to the contract and the entities who may be providing the services under the contract.
Ins 10.10(6)(b)
(b) Contain a schedule clearly setting forth all fees including, without limitation by reason of enumeration, advance fees, entrance fees, periodic service fees and any other charges or costs to be assumed by the resident under the contract. The contract shall also contain an explanation of the manner in which the amount of any refundable portion of the entrance or advance fee will be determined and an explanation of those fees and charges which are nonrefundable.
Ins 10.10(6)(c)
(c) Contain a summary description in a format substantially the same as that shown in Appendix A, of the maintenance, medical, nursing and personal care services that are provided to the resident under the contract at no additional cost and also a description of any other such services that are to be available to the resident at an additional cost. The summary description may also contain a listing of other significant services.
Ins 10.10(6)(d)
(d) Under a separate and appropriate heading, contain a description of the resident's right, if any, to nursing home care or access to a nursing home and, if known, the name of the nursing home, the conditions under which the care or access will be available, a description of the care and benefits to be provided and the manner in which the charge for the service is to be determined.
Ins 10.10(6)(e)
(e) Contain a notice on the first page of the contract in not less than 12 point bold face type that the contract does not include any purchase of insurance or real estate.
Ins 10.10(6)(f)
(f) Be complete and contain a clear statement of the obligations and responsibilities of each of the parties to the contract including, if any, the obligations and responsibilities for future services and future payments. The effective dates and termination dates of the contract shall be clearly described.
Ins 10.10(7)
(7) Grievance procedures. If not contained in the continuing care contract, the provider shall file with the commissioner for approval the internal grievance procedure established pursuant to
s. 647.04 (7), Stats. The filing shall be deemed approved if not disapproved within 30 days after filing. The commissioner may disapprove the filing upon a finding that it violates a statute or a rule promulgated by the commissioner.
Ins 10.10(8)
(8) Advertising, brochures and promotional material. Ins 10.10(8)(a)(a) No continuing care contract advertisement, brochure or promotional material may be delivered or issued for delivery in this state unless it is not misleading, deceptive or obscure, does not encourage misrepresentation or is not in any other way contrary to this section or
s. 100.18 or
ch. 647, Stats.
Ins 10.10(8)(b)
(b) Each provider shall maintain at its principal office a complete file containing every printed, published or prepared advertisement of its contracts, including the script of any advertisement used in broadcast media, disseminated in this or any other state, whether or not licensed in the other state. A notation shall be attached to each advertisement in the file indicating the manner and extent of distribution and the form number of any contract form advertised. A copy of the contract advertised shall be included in the file with each advertisement. The file shall be subject to regular and periodic inspection by the office of the commissioner. All advertisements subject to this paragraph shall be maintained in the file for 3 years.
Ins 10.10(9)
(9) Applicability. This section applies to all contracts and amendments of contracts, and to advertisements, brochures and promotional material issued or used on and after July 1, 1991.
Ins 10.10 History
History: Cr.
Register, April, 1991, No. 424, eff. 5-1-91. -
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