Current through August 26, 2024
(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.
(2) SCOPE. This section applies to all
contracts entered into by providers subject to ch. 647, Stats.
(3) DEFINITIONS. The definitions in s.
647.01, Stats., apply
to this section.
(4) FILING AND
APPROVAL OF CONTINUING CARE CONTRACT FORMS.
(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.
(b) A provider
shall file each amended contract form with the commissioner within 30 days
after any change is made in that contract.
(5) CONTRACT FORMAT AND STYLE; PROHIBITIONS.
(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.
(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.
(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.
(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:
(a)
Clearly identify the entities who are party to the contract and the entities
who may be providing the services under the contract.
(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.
(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.
(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.
(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.
(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.
(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.
(8) ADVERTISING, BROCHURES AND PROMOTIONAL
MATERIAL.
(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.
(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.
(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.
