Ga. Comp. R. & Regs. R. 120-2-51-.03 - Definitions
As used in this Regulation, the term:
(1) "Continuing care" means furnishing
pursuant to a continuing care agreement:
(a)
Lodging that is not:
(i) In a skilled nursing
facility, as such term is defined in O.C.G.A. Section
31-6-2(34);
(ii) An intermediate care facility, as such
term is defined in O.C.G.A. Section
31-6-2(22);
(iii) An assisted living community, as such
term is defined in O.C.G.A. Section
31-7-12.2; or
(iv) A personal care home, as such term is
defined in O.C.G.A. Section
31-7-12;
(b) Food; and
(c) Nursing care provided in a facility or in
another setting designated by the agreement for continuing care to an
individual not related by consanguinity or affinity to the provider furnishing
such care upon payment of an entrance fee including skilled or intermediate
nursing services and, at the discretion of the continuing care provider,
personal care services including, without limitation, assisted living care
services designated by the continuing care agreement, including such services
being provided pursuant to a contract to ensure the availability of such
services to an individual not related by consanguinity or affinity to the
provider furnishing such care upon payment of an entrance fee.
The term "continuing care" shall not include continuing care at home.
(2)
"Continuing care agreement" means a contract or agreement to provide continuing
care, continuing care at home, or limited continuing care. Continuing care
agreements include agreements to provide care for any duration, including
agreements that are terminable by either party.
(2.1)"Continuing care at home" means the
furnishing of services pursuant to a continuing care agreement at a location
other than at a facility and which includes the obligation to provide nursing
care, assisted living care, or personal care home services. A continuing care
at home agreement may, but is not required to, include an obligation to provide
food.
(3) "Entrance fee" means an
initial or deferred payment of a sum of money or property made as full or
partial payment to assure the resident continuing care, limited continuing
care, or continuing care upon the purchase of a resident owned living unit;
provided, however, that any such initial or deferred payment which is greater
than or equal to 12 times the monthly care fee shall be presumed to be an
entrance fee so long as such payment is intended to be a full or partial
payment to assure the resident lodging in a residential unit. An accommodation
fee, admission fee, or other fee of similar form and application greater than
or equal to 12 times the monthly care fee shall be considered to be an entrance
fee. Such term shall not include any portion of the purchase or sale of a
resident owned living unit, including, but not limited to, any down payment or
earnest money payment for the purchase and sale of a resident owned living
unit.
(4) "Facility" means a place
which is owned or operated by a provider and provides continuing care or
limited continuing care. Such term includes a facility which contains resident
owned living units.
(5) "Licensed"
means that the provider has obtained a Certificate of Authority from the
Department.
(6) "Limited continuing
care" means furnishing pursuant to a continuing care agreement:
(a) Lodging that is not:
(i) In a skilled nursing facility, as such
term is defined in O.C.G.A. Section
31-6-2(34);
(ii) An intermediate care facility, as such
term is defined in O.C.G.A. Section
31-6-2(22);
(iii) An assisted living community, as such
term is defined in O.C.G.A. Section
31-7-12.2; or
(iv) A personal care home, as such term is
defined in O.C.G.A. Section
31-7-12;
(b) Food; and
(c) Personal services, whether such personal
services are provided in a facility such as a personal care home or an assisted
living community or in another setting designated by the continuing care
agreement, to an individual not related by consanguinity or affinity to the
provider furnishing such care upon payment of an entrance fee.
Such term shall not include continuing care at home.
(7) "Monthly care fee"
means the fee charged to a resident for continuing care or limited continuing
care on a monthly or periodic basis. Monthly care fees may be increased by the
provider to provide care to the resident as outlined in the continuing care
agreement. Periodic fee payments or other prepayments shall not be monthly care
fees.
(8) "Nursing care" means
services which are provided to residents of skilled nursing facilities or
intermediate care facilities.
(9)
"Personal services" means, but is not limited to, such services as individual
assistance with eating, bathing, grooming, dressing, ambulation, and
housekeeping; supervision of self-administered medication; arrangement for or
provision of social and leisure services; arrangement for appropriate medical,
dental, nursing, or mental health services; and other similar services which
the department may define. Personal services may be provided at a facility or
at a home on or off site of a facility. Personal services shall not be
construed to mean the provision of medical, nursing, dental, or mental health
services. Personal services provided, if any, shall be designated in the
continuing care agreement.
(10)
"Provider" means the owner or operator, whether a natural person, partnership,
or other unincorporated association, however organized, trust, or corporation,
of an institution, building, residence, or other place, whether operated for
profit or not, which owner or operator undertakes to provide continuing care,
limited continuing care, or continuing care at home for a fixed or variable
fee, or for any other remuneration of any type for the period of care, payable
in a lump sum or lump sum and monthly maintenance charges or in
installments.
(11) "Resident" means
a purchaser of or a nominee of or a subscriber to a continuing care agreement.
Such an agreement may permit a resident to live at a home on or off site of a
facility but shall not be construed to give the resident a part ownership of
the facility in which the resident is to reside unless expressly provided for
in the agreement.
(12) "Resident
owned living unit" means a residence or apartment, the purchase or sale of
which is not included in an entrance fee, which is a component part of a
facility and in which the resident has an individual real property ownership
interest.
(13) "Residential unit"
means a residence or apartment in which a resident lives that is not a skilled
nursing facility as defined in O.C.G.A. Section
31-6-2(34), an
intermediate care facility as defined in O.C.G.A. Section
31-6-2(22), an
assisted living community as defined in O.C.G.A. Section
31-7-12.2, or a personal care home
as defined in O.C.G.A. Section
31-7-12.
(14) Unless the context otherwise requires,
terms found in this Regulation shall be used as defined in O.C.G.A. Sections
33-1-2 and
33-45-1et seq.
Other terminology shall be used in accordance with the Georgia Insurance Code
or industry usage, if not otherwise defined in the Georgia Insurance
Code.
Notes
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