Which Texas continuing-care retirement facilities needed certificates of authority, qualified for transition rules, or fell within the new 1987 regulatory act?
Apply this to your situation
This page answers the general question as of 1988. Ezel answers yours: what it means for your facts, under current Texas law, with citations.
Texas AG Opinion JM-895: Who Fell Under Texas's 1987 Continuing-Care Facility Law?
Plain-English summary
State Board of Insurance Chairman Edwin Smith asked how the new Texas Continuing Care Facility Disclosure and Rehabilitation Act applied to facilities that existed or were being developed when the statute took effect on September 1, 1987. He also asked how the statute's definitions treated renewable agreements and different forms of entrance fees.
Section 4(g) directed the commissioner to issue a certificate of authority to a facility that already had residents, was under construction, or had incurred substantial development obligations by the effective date. Those facilities did not have to satisfy section 4(c)'s substantive criteria concerning financial soundness, management competence, and ability to comply. They remained subject to the rest of the act, including suspension and revocation provisions, and generally to board rules other than rules implementing section 4(c).
Section 20 provided delayed disclosure and escrow compliance only for a provider operating a continuing-care facility on September 1, 1987. A facility merely under construction, or one for which the provider had only incurred development obligations, was not yet operating and did not receive that transition treatment. A facility with residents could qualify under both section 4(g) and section 20.
Whether pre-effective-date financial obligations were "substantial" was a fact question for the commissioner. The decision had to be made through the information, hearing, and administrative-law procedures supplied by the statute, not through unfettered discretion.
The agreement's substance determined whether the definition applied. A nominally short or month-to-month agreement could function as a lifetime agreement if its renewal terms effectively produced that result. A payment greater than three months' rent could be an entrance fee even if called a deposit, application fee, or initial fee and even if refundable. A smaller initial payment plus a deferred annual lump sum could also count if the combined payment was consideration for accepting the resident.
Finally, all five elements listed in the statutory definitions had to be present: board, lodging, specified personal and health-related services, an agreement lasting for life or more than one year, and an entrance fee exceeding three months' rent. Form or relabeling could not avoid the act when the substance met the definition.
Currency note
This opinion was issued in 1988. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.
Common questions
Did an existing or partly developed facility automatically receive a certificate of authority?
Section 4(g) required issuance to a facility with residents, under construction, or backed by substantial development obligations by September 1, 1987. The facility did not have to prove the section 4(c) criteria, but its certificate could still be suspended or revoked under the act.
Did section 4(g) exempt those facilities from the whole statute?
No. It exempted them only from section 4(c)'s substantive certificate criteria. The remaining provisions and generally applicable board rules still applied.
Which facilities received section 20's delayed disclosure and escrow deadlines?
Only facilities already operating and providing continuing care on the effective date. Construction or financial commitments alone did not qualify.
Who decided whether development obligations were substantial?
The insurance commissioner, as a factual determination made through the application information and hearing process required by the statute and administrative procedure law.
Could a month-to-month contract fall under the act?
Possibly. The commissioner or board had to examine the renewal language and the whole agreement. Automatic renewal could make a nominally short agreement function as one lasting for the resident's life.
Did calling a large upfront payment a deposit avoid the entrance-fee definition?
No. If the payment met section 2(3)'s definition, its label and refundability did not remove it from the statute.
Could deferred annual lump sums count toward an entrance fee?
Yes, if they were part of the consideration for accepting the individual as a resident. The definition included an initial or deferred transfer.
Did a facility need every statutory element to be regulated?
Yes. The opinion said all five elements in the definitions had to be present, based on all relevant facts and the agreement's substance.
Background and statutory framework
House Bill 677 of the 70th Legislature enacted article 8876 to regulate continuing-care providers and protect elderly consumers who paid substantial entrance fees for long-term housing and care. The act applied to continuing-care contracts entered on or after September 1, 1987.
Section 3 directed the State Board of Insurance to regulate providers and authorized rules and enforcement actions. Section 4 required certificates of authority. Sections 6 through 9 addressed disclosure statements and entrance-fee and reserve-fund escrow accounts. Other provisions addressed financial supervision, statutory resident rights, civil and criminal penalties, investigations, and equitable enforcement.
Section 4(c) required a hearing and findings on financial soundness, competence, experience, integrity, public interest, and ability to comply. Section 4(g) used mandatory language for facilities occupied, under construction, or supported by substantial development obligations by the effective date. The opinion treated that subsection as a narrow exception from the section 4(c) criteria.
Section 20 applied to a provider operating an existing facility and delayed specified disclosure and escrow requirements. The opinion relied on the statutory definitions of "continuing care facility" and "operate" to limit that transition provision to facilities actually providing care.
The final set of questions turned on section 2. "Continuing care" required board and lodging, personal-care services plus nursing, medical, or other health-related services, an entrance fee, and an agreement effective for life or more than one year. An entrance fee was an initial or deferred transfer of money or property worth more than three months' rent as consideration for accepting a specified resident.
Citations
Statutory authority:
- V.T.C.S. article 8876, sections 2 through 4, 6 through 9, 11, 13, 15 through 18, 20, and 23
- V.T.C.S. article 6252-13a, Administrative Procedure and Texas Register Act
Legislative materials:
- House Bill No. 677, 70th Legislature (1987)
- Texas House Committee on Human Services, Interim Report to the 70th Texas Legislature, "Continuing Care Communities"
- House Human Services Committee, Bill Analysis, H.B. No. 677, 70th Legislature (1987)
Source
- Landing page: https://www.texasattorneygeneral.gov/opinions/jim-mattox/jm-895
- Original PDF: https://www.texasattorneygeneral.gov/sites/default/files/opinion-files/opinion/1988/jm0895.pdf
Original opinion text
Best-effort transcription from a scanned PDF. Obvious character-level OCR errors have been corrected, but minor errors may remain; the linked PDF is authoritative.
THE ATTORNEY GENERAL
OF TEXAS
April 15, 1988
Mr. Edwin J. Smith, Jr. Opinion No. JM-895
Chairman
State Board of Insurance Re: Requirements of House Bill
1110 San Jacinto Blvd. No. 677 of the 70th Legisla-
Austin, Texas 78701 ture, the Texas Continuing
Care Facility Disclosure and
Rehabilitation Act (RQ-1227)
Dear Mr. Smith:
You ask several questions concerning the Texas
Continuing Care Facility Disclosure and Rehabilitation
Act, which was adopted by House Bill No. 677 of the 70th
Legislature and codified as article 8876, V.T.C.S. It
applies to contracts for continuing care entered into on
or after September 1, 1987. V.T.C.S. art. 8876, §23. The
statute authorizes the State Board of Insurance to
regulate continuing care providers. V.T.C.S. art. 8876, §3. A continuing care retirement community provides
housing, board, care, and health related services to
elderly people who do not want to maintain their own homes
but do not need nursing home care. Texas House of
Representatives, Committee on Human Services, Interim
Report to the 70th Texas Legislature, "Continuing Care
Communities," 119, 124. It generally consists of
residential facilities and a health care center and
requires a substantial entrance fee in addition to other
monthly fees in return for an assurance of a continuing
living arrangement throughout retirement. House Human
Services Committee, Bill Analysis, H.B. No. 677, 70th Leg.
(1987). Because of the considerable investment which
continuing care centers require from the elderly, House
Bill No. 677 was written to protect the consumer from loss
of his investment through fraud or mismanagement. Id.
The statute defines "continuing care" as follows:
[T]he furnishing, to an individual who is not
related by consanguinity or affinity to the
person furnishing the care, of board and
lodging, together with personal care
services, and nursing services, medical
p. 4397
Mr. Edwin J. Smith, Jr. - Page 2 (JM-895)
services, or other health-related services,
regardless of whether or not the services
and the lodging are provided at the same
location, under an agreement that requires
the payment of an entrance fee and that is
effective either for the life of the indivi-
dual or for a period of more than one year.
V.T.C.S. art. 8876, §2(2). The article authorizes the
State Board of Insurance to regulate continuing care
providers and to adopt rules and take other action
necessary to administer and enforce the act. V.T.C.S.
art. 8876, 53. Continuing care providers are required to
receive a certificate of authority from the board.
V.T.C.S. art. 8876, §4. Providers must deliver a
disclosure statement to prospective residents before
entering into a contract to provide continuing care and
must also establish an entrance fee escrow account. Id. §§6-9. The commissioner of insurance may place a provider
under supervision if it is bankrupt or otherwise is
financially unable to meet its obligations for continuing
care. Id. §11. There are provisions for rehabilitation
or liquidation. Section 13 gives to
[e]ach resident receiving care in a portion
of a facility licensed to provide nursing
home care, personal care, or custodial
care . . . all statutory rights provided to
nursing home, personal care, or custodial
care residents.
The substantive requirements may be enforced by civil and
criminal penalties and by equitable proceedings. Id. §§15-18.
You first ask about the applicability of the certi-
ficate of authority requirement. This provision states as
follows:
Sec. 4. (a) After September 1, 1987, no
provider shall offer to the public a con-
tract for continuing care, or construct or
acquire a facility for the purpose of
providing continuing care, without obtaining
a certificate of authority from the board. ?
(b) The commissioner shall promulgate
rules and regulations setting forth the
information to be submitted by an applicant
for a certificate of authority.
p. 4398
Mr. Edwin J. Smith, Jr. - Page 3 (JM-895)
(c) The commissioner, upon receipt of an
application for a certificate of authority,
shall conduct a hearing on the application
in accordance with the Administrative
Procedure and Texas Register Act (Article
6252-13a, Vernon's Texas Civil Statutes).
The commissioner shall grant the application
if he finds that the applicant or the facil-
ity is financially sound: that the comp-
etence, experience, and integrity of the
applicant, its board of directors, its
officers or its management is such that it
would be in the interest of the public to
issue a certificate of authority; and that
the applicant is capable of complying with
the provisions of this Act. The commis-
sioner may limit issuance of certificates of
authority to incorporated entities. The
commissioner shall issue an order approving
or disapproving the application within 180
days of filing.
(d) No certificate of authority issued
P by the commissioner shall be transferred to
a third party except upon approval by the
commissioner.
.(e) No holder of a certificate of
authority shall enter into a contract with a
third party for management of the facility
unless the commissioner is notified of such
contract.
(f) If a provider: (1) draws upon its
entrance fee escrow in an amount greater
than provided for in Section 8 of this Act:
(2) draws upon its reserve fund escrow in an
amount greater than provided for in Section
9 of this Act; or (3) engages in a wilful
and intentional violation of this Act, the
commissioner, after notice and hearing, may
suspend or revoke the provider's certificate
of authority, in addition to any other
remedies provided for in this Act.
(g) The commissioner shall issue a cer-
tificate of authority to any facility which
is occupied by one or more residents on
September 1, 1987, which is under con-
P struction on September 1, 1987, or which,
p. 4399
Mr. Edwin J. Smith, Jr. - Page 4 (JM-895)
prior to September 1, 1987, had incurred
substantial financial obligations related to
the development of a facility. Such
certificates shall be subject to revocation
or suspension as provided for in this
section.
V.T.C.S. art. 8876.
Section 4(a) of article 8876, V.T.C.S., requires a
provider to obtain a certificate of authority if he offers
a contract for continuing care or constructs or acquires a
facility for that purpose after September 1, 1987.
Section 4(c) establishes procedures and substantive
requirements governing issuance of certificates of
authority by the insurance commissioner. Section 4(g),
however, states that "the commissioner shall issue a
certificate of authority" (emphasis added) to any facility
which is occupied, under construction, or is the subject
of substantial financial obligations by September 1, 1987.
You ask whether a facility described in section 4(g)
is required to meet the criteria of section 4(c) or
whether instead the commissioner must issue a certificate
of authority to such a facility without considering those
criteria.
Section 4(g) provides an exception from the criteria
in section 4(c) for the three categories of continuing
care facilities it describes. In each category there has
been considerable investment in a facility prior to the
effective date of article 8876. V.T.C.S. art. 8876, §23.
As shown by the use of the mandatory "shall" in section
4(g), these facilities are entitled to receive a certi-
ficate of authority from the commissioner without meeting
the substantive requirements set out in section 4(c).
Your next question involves the relationship between
section 4(g) of article 8876, V.T.C.S., and section 20,
the transition provision. Section 20 provides as follows:
Sec. 20. (a) A provider who operates a
continuing care facility that is in exis-
tence on the effective date of this Act must
comply with the disclosure and escrow
requirements imposed under this Act as
provided by this section.
(b) A provider subject to Subsection (a)
of this section must file annual revised
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Mr. Edwin J. Smith, Jr. - Page 5 (JM-895)
disclosure statements with the board as
provided by Section 7 of this Act beginning
P with a statement that covers the provider's
most recent fiscal year that begins on or
after September 1, 1987.
(c) A provider subject to Subsection (a)
of this section must comply with the escrow
requirements imposed under Sections 8 and 9
of this Act not later than September 1,
1990. If the commissioner determines that a
provider subject to Subsection (a) of this
section is unable to comply with this
section after making a good faith effort to
do so, the commissioner may extend the time
for compliance for a reasonable period of
time.
(d) Failure to comply with the require-
ments of this section constitutes a criminal
offense under Section 18 of this Act.
You ask whether the entire act as well as the rules
adopted by the State Board of Insurance apply to
facilities described by section 4(g), or only those
delayed requirements listed in section 20.
Section 20 applies to continuing care facilities that
are in existence and are being operated on September 1,
1987, the effective date of the act. House Bill No. 677
as introduced did not include the requirement that con-
tinuing care facilities obtain a certificate of authority
from the State Board of Insurance. Bill Analysis, H.B.
No. 677, m. Thus, the bill as introduced did not
include any provision like subsection 4(g) that allowed
certain facilities to receive a certificate of authority
without making the showing required by section 4(c). The
provision enacted as section 20 of article 8876, V.T.C.S.,
provided the only exception in the original bill from
compliance with the act's requirements on its effective
date. Section 4 was added as part of the Committee
Substitute to House Bill No. 677, supra. Section 4(g)
excepts the facilities it describes only from the
substantive requirements of section 4(c); it does not
authorize those facilities to meet the statutory
requirements on the delayed basis outlined in section 20.
Section 4(g) expressly states that certificates of
authority given under its provisions "shall be subject to
revocation or suspension as provided for in this section."
p. 4401
Mr. Edwin J. Smith, Jr. - Page 6 (JM-895)
V.T.C.S. art. 8876, §4(g). Subsection 4(f) provides for
suspension or revocation of a certificate of authority as
follows:
(f) If a provider: (1) draws upon its
entrance fee escrow in an amount greater
than provided for in Section 8 of this Act:
(2) draws upon its reserve fund escrow in
an amount greater than provided for in
Section 9 of this Act: or (3) engages in
wilful and intentional violation of this Act the commissioner, after notice and
hearing, may suspend or revoke the pro-
vider's certificate of authority, '
addition to any other remedies provided f:z
in this Act. (Emphasis added.)
V.T.C.S. art. 8876, §4(f). This provision makes clear the
legislature's intent that subsection 4(g) not exempt
facilities from provisions of the act other than that
describing the criteria for a certificate of authority.
You have not submitted any rules to us, and we can
consider the application of rules to section 4(g) faci-
lities only in general terms. Ordinarily, your rules
applicable to other continuing care facilities would also
apply to section 4(g) facilities, except for rules imple-
menting section 4(c).
Your third question recognizes that some facilities
will be covered by both the exception in section 4(g) and
the exception in section 20. If a facility is occupied by
one or more residents on September 1, 1987, it will be "in
existence on the effective date" of the act and thus will
be entitled to a certificate of authority under section
4(g) and will also have the benefit of the transition
provision: section 20. You ask whether a facility
described in section 20 includes only a facility occupied
by one or more residents on September 1, 1987, or also
includes a facility which is under construction on
September 1, 1987 and one which, prior to September 1,
1987, had incurred substantial financial obligations
related to the development of the facility.
Section 20(a) applies to "[a] provider who operates a
continuing care facility that is in existence on the
effective date of this Act. . . .I A "continuing care
facility" is "a place in which a person undertakes to
provide continuing care to an individual.* V.T.C.S. art.
8876, §§2(2), (4). "Operate"is defined as "to perform a
p. 4402
,
Mr. Edwin J. Smith, Jr. - Page 7 (JM-895)
function." Webster's Ninth New Collegiate Dictionary.
Section 20(a) applies to a facility where a person is
already providing continuing care as of September 1, 1987.
If the facility is merely under construction, or if the
provider has done no more than incur substantial financial
obligations toward construction of a facility, the
facility cannot be used to provide continuing care and is
not even in existence. Section 20(a) does not apply to
the latter two categories of "facility."
You next ask whether the commissioner, in imple-
menting section 4(g), has discretion to determine whether
the financial obligations related to the development of a
facility incurred prior to September 1, 1987, are "sub-
stantial." V.T.C.S. art. 8876, §4(g). Whether financial
obligations incurred are "substantial" is a fact question,
which must be answered in relevant cases before a
certificate can be issued. Section 4(b) of article 8876,
V.T.C.S., authorizes the commissioner to "promulgate rules
and regulations setting forth the information to be
submitted by an applicant for a certificate of authority."
He is to conduct a hearing on the applications submitted.
V.T.C.S. art. 8876. The commissioner has access to the
- information and the procedural framework for deciding
whether an applicant for a certificate of authority has
incurred substantial financial obligations toward the
development of a facility. This determination is not a
matter for the commissioner's unfettered discretion but
must be made in accordance with the Administrative
Procedure and Texas Register Act, article 6252-13a,
V.T.C.S. V.T.C.S. art. 8876, §4 (c) : see also V.T.C.S.
art. 6252-13a, §§3(2), (13).You finally ask several questions about the defini-tions of "entrance fee" and "continuing care" in the
statute. Section 2 provides as follows:(2) 'Continuing care' means the fur- nishing, to an individual who is not related by consanguinity or affinity to the person furnishing the care, of board and lodging, together with personal care services, and nursing services, medical services, or other health-related services, regardless of whether or not the services and the lodging are provided at the same location, under an agreement that requires the payment of an entrance fee and that is effective either for the life of the individual or for a period of more than one year. p. 4403
Mr. Edwin J. Smith, Jr. - Page 8 (JM-895)
-,
(3) 'Entrance fee' means an initial or
deferred transfer of money, other
property valued at an amount in excess of
three months' rent, made, or promised to be
made as full or partial consideration for
acceptance by a provider of a specified
individual as a resident in a facility.
(Emphasis added.)
V.T.C.S. art. 8876, 52.
You ask:
Does the use of an agreement that is of
less than one year's duration, including a
month-to-month contract, but which is
guaranteed renewable by the resident,
subject a facility to regulation under the
act?
Any renewal provision must be evaluated according to its
language and its function in the context of the whole
contract. For example, a renewal provision which provides
for automatic renewal every month in the absence of notice ?
by the resident or one which provides for renewal on the
receipt of each rent check could in effect be a contract
for the life of the resident. The significance of such
provisions should be determined on a case by case basis by
the commissioner or the board in the exercise of their
enforcement powers under the statute. See V.T.C.S. art.
8876, §§16, 17.
You next ask:
Does the charging of an upfront fee
greater than the amount of three months'
rent, but which is called an 'initial fee,'
'deposit,' or 'application fee' and is fully
or partially refundable, subject a facility
to regulation under the act?
If the fee fits the definition found in section 2(3), it
is an entrance fee, even though the provider calls it
something else. The fact that a fee is refundable does
not remove it from the definition of "entrance fee."
Article 8876, V.T.C.S., contemplates that some providers
might charge an entrance fee that is fully or partly
refundable. Section 6(g)(4) requires that a disclosure
statement set out
p. 4404
a
Mr. Edwin J. Smith, Jr. - Page 9 (JM-895)
P
the conditions, if any, under which all or
part of the entrance fee is refundable on
-
cancellation of the contract by the provider
or by the resident, or in the event of the
death of the resident. . . .V.T.C.S. art. 8876, §6(g)(4).
You next ask: Does the charging of an entrance fee less than the amount of three months' rent with an additional lump sum fee payable annually, the aggregate of which would be greater than three months' rent, subject a facility to regulation under the act? An entrance fee includes an "initial or deferredtransfer" of money or other property as consideration for
acceptance of a specified individual as a resident in a
facility. If the additional lump sum fee is part of the
consideration for accepting the individual as a resident,
it is an "entrance fee" even though its payment is
deferred.You next ask: Does the act impose any duty on the State Board of Insurance or the commissioner to review a facility's arrangements for the purpose of determining applicability of the act to that facility? We understand your question to relate to financialand contractual arrangements of continuing care providers,
and not to the physical premises of continuing care
facilities. The statute imposes the following duty on the
State Board of Insurance:Sec. 3. The State Board of Insurance shall regulate continuing care providers as provided by this Act. The board may adopt rules and take other action as necessary to administer and enforce this Act. (Emphasis added.)V.T.C.S. art. 8876, §3. The board has a mandatory duty to
enforce this statute to protect consumers from the loss of
investment that might occur through fraud or mismanage-
ment. We cannot tell you, as a matter of law, how top. 4405
Mr. Edwin J. Smith, Jr. - Page 10 (JM-895)
exercise your powers and carry out your duties under
article 8876, V.T.C.S. That is a matter for the board's
discretion. We note, however, that the board has been
given power to make rules and regulations, as well as
considerable authority to require the submission of
information necessary to carry out its responsibilities.
See. e.g., V.T.C.S. art. 8876, §4(c) (information to be
submitted by an applicant for a certificate of authority):
§§5-7 (recording requirements); §16 (conduct of investiga-
tions, subpoena power). See also V.T.C.S. art. 8876, §§11, 17 (power to act on investigation prompted by complaint).
We also point out that some provisions state how
particular powers shall be exercised. For example, the
commissioner shall conduct a hearing on an application for
a certificate of authority in accordance with the Adminis-
trative Procedure and Texas Register Act, and shall grant
the certificate on certain fact findings. V.T.C.S. art.
8876, 54(c). In addition, with respect to the requirement
that providers file a disclosure statement and revised
disclosure statements with the State Board of Insurance,
[t]he commissioner shall review the dis-
closure statement for completeness but shall
not be required to review the disclosure
statement for accuracy.
V.T.C.S. art. 8876, 57(c).
Your last question is as follows:
The definitions of 'continuing care' and
'entrance fee' state five elements that
describe the type of facilities to be regu-
lated under the Act. These five elements are
as follows:
(1) furnishing board:
(2) furnishing lodging:
(3) furnishing personal care services,
and either nursing services, medical ser-
vices, or other health-related services:
(4) an agreement that is effective
either for the life of an individual or for
a period of more than one year; and
p. 4406
,
c,
Mr. Edwin J. Smith, Jr. - Page 11 (JM-895)
,
(5) requirements of an entrance fee
(money or property of value in excess of
three months' rent) in the agreement.
Must a facility meet all five requirements in
order to be subject to this act?
Your question essentially tracks the definitions of
"continuing care" and "entrance fee" that are set out in
the statute. See V.T.C.S. art. 8876, §2(2), (3). We
therefore answer your question in the affirmative: the
five elements you set out must be present for a facility
to be a continuing care facility subject to regulation
under the statute. Whether those five elements are
present in a given facility must be decided in the context
of all relevant facts and circumstances. Of course, it is
the substance of the agreement, not the form, that is
determined, and subterfuges will not avoid the statute.
SUMMARY
A continuing care facility described in
section 4(g) of article 8876, V.T.C.S., is
entitled to receive a certificate of authority
without meeting the criteria found in section
4(c) of that statute. Except for the section
4(c) criteria, the entire statute becomes
applicable on its effective date to section
4(g) facilities. If a facility is merely
under construction on September 1, 1987, or if
the provider has done no more than incur sub-
stantial financial obligations toward con-
struction of a facility, the transition
provision found in section 20 is not applic-
able to it. The commissioner has authority to
make the fact findings necessary to implement
section 4(g) of article 8876, V.T.C.S.
JIM MATTOX
Attorney General of Texas
MARY KELLER
First Assistant Attorney General
LOU MCCREARY
- Executive Assistant Attorney General
p. 4407
Mr. Edwin J. Smith, Jr. - Page 12 (JM-895)
JUDGE ZOLLIE STEAKLEY
Special Assistant Attorney General
RICK GILPIN
Chairman, Opinion Committee
Prepared by Susan L. Garrison
Assistant Attorney General
p. 4408
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