EXPLANATION: CAPITALS INDICATE MATTER ADDE D TO EXISTING LAW .
[Brackets] indicate matter deleted from existing law.
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HOUSE BILL 694
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By: Delegate Charkoudian
Introduced and read first time: January 31, 2022
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Hospitals – Financial Assistance – Medical Bill Reimbursement 2
FOR the purpose of establishing requirements and prohibitions related to the 3
reimbursement of out–of–pocket costs paid by hospital patients who were eligible for 4
free care, including a requirement that the Health Services Cost Review 5
Commission, the Office of the Comptroller, and the Department of Human Services 6
develop a process for identifying and informing patients who qualify for 7
reimbursement and that hospitals reimburse certain patients; authorizing the Office 8
of the Comptroller to share or disclose certain information under certain 9
circumstances; and generally relating to hospitals, financial assistance policies, and 10
reimbursement for paid bills. 11
BY repealing and reenacting, with amendments, 12
Article – Health – General 13
Section 19–214.1(b)(1) 14
Annotated Code of Maryland 15
(2019 Replacement Volume and 2021 Supplement) 16
BY adding to 17
Article – Health – General 18
Section 19–214.4 19
Annotated Code of Maryland 20
(2019 Replacement Volume and 2021 Supplement) 21
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 22
That the Laws of Maryland read as follows: 23
Article – Health – General 24
19–214.1. 25 2 HOUSE BILL 694
(b) (1) (I) The Commission shall require each acute care hospital and each 1
chronic care hospital in the State under the jurisdiction of the Commission to develop a 2
financial assistance policy for providing free and reduced–cost care to patients who lack 3
health care coverage or whose health care coverage does not pay the full cost of the hospital 4
bill. 5
(II) IF NECESSARY TO MEET THE REQUIREMENTS OF THIS 6
SECTION, THE OFFICE OF THE COMPTROLLER MAY SHARE OR DISCLOS E RELEVANT 7
TAX INFORMATION . 8
19–214.4. 9
(A) IN THIS SECTION , “OFFICE” MEANS THE OFFICE OF THE 10
COMPTROLLER . 11
(B) THE PURPOSE OF THIS S ECTION IS: 12
(1) TO INFORM A PATIENT THAT THE PATIENT MAY HAVE QUALIFIED 13
FOR FREE CARE UNDER § 19–214.1 OF THIS SUBTITLE AT THE TIME OF CARE AT A 14
HOSPITAL REGULATED B Y THE COMMISSION; AND 15
(2) PROVIDE THE PATIENT W ITH AN OPPORTUNITY T O OBTAIN 16
REIMBURSEMENT FOR PA ID SERVICES RECEIVED FROM THE HOSPITAL . 17
(C) (1) (I) SUBJECT TO SUBSECTION (D) OF THIS SECTION , THE 18
COMMISSION, THE OFFICE, AND THE DEPARTMENT OF HUMAN SERVICES SHALL 19
DEVELOP A PROCESS TO IDENTIFY AND INFORM PATIENTS WHO MAY HAV E 20
QUALIFIED FOR FREE C ARE WHILE RECEIVING INPA TIENT OR OUTPATIENT 21
SERVICES FROM A HOSPITA L. 22
(II) TO ACCOMPLISH THE PUR POSE OF THIS SECTION , THE 23
OFFICE MAY SHARE OR DISCLOSE RELEVANT TAX INFORMATION . 24
(2) THE PROCESS TO IDENTIFY PATIENTS UN DER PARAGRAPH (1) OF 25
THIS SUBSECTION SHALL INCLUDE: 26
(I) DATA SHARING BETWEEN THE COMMISSION AND THE 27
OFFICE; 28
(II) PROTECTING PERSONAL I NFORMATION ; 29
(III) MATCHING PATIENT DATA FROM THE COMMISSION WITH 30
TAX DATA FROM THE OFFICE; AND 31 HOUSE BILL 694 3
(IV) ANALYZING THE MATCHED DATA TO DETE RMINE A LIST OF 1
PATIENTS WHO MAY BE ELIGIBLE FOR A REFUN D FOR PAID CARE UNDE R THIS 2
SECTION. 3
(3) THE COMMISSION, THE OFFICE, AND THE DEPARTMENT OF 4
HUMAN SERVICES SHALL MAKE A DETERMINATION THAT T HE PATIENT WAS 5
ELIGIBLE FOR FREE CA RE AT THE TIME OF SE RVICE BASED ON WHETHER: 6
(I) THE PATIENT’S INCOME WAS AT OR B ELOW 200% OF THE 7
FEDERAL POVERTY LEVE L; OR 8
(II) THE PATIENT WAS DETER MINED TO BE PRESUMPTIVE LY 9
ELIGIBLE UNDER § 2–214.1(B)(7) OF THIS TITLE. 10
(4) (I) 1. IF A PATIENT WAS DETE RMINED TO BE ELIGIBL E FOR 11
FREE CARE AND THE PATIENT’S INCOME WAS AT OR B ELOW 200% OF THE FEDERAL 12
POVERTY LEVEL , THE PATIENT SHALL BE NOTIFIED BY THE OFFICE BY FIRST–CLASS 13
MAIL IN THE FORM SPECIFIE D UNDER SUBSUBPARAGRAPH 2 OF THIS 14
SUBPARAGRAPH . 15
2. THE OFFICE SHALL SEND THE ELIGIBLE PATIENT A 16
POSTCARD THAT : 17
A. INCLUDES THE OFFICIAL SEAL OF THE 18
COMPTROLLER ; 19
B. IS ON COLORED CARDSTO CK; AND 20
C. INCLUDES THE FOLLOWIN G STATEMENT: 21
“OUR RECORDS INDICATE THAT YOU PAID FOR CA RE AT (HOSPITAL’S NAME) 22
IN (YEAR), WERE ELIGIBLE FOR FR EE CARE, AND MAY BE ENTITLED TO A REFUND . 23
TO LEARN MORE , GO TO (COMMISSION’S WEBSITE). TO APPLY FOR A REFUND , GO TO 24
(HOSPITAL’S WEBSITE), OR CALL (HOSPITAL’S PHONE NUMBER )”. 25
3. THE STATEMENT REQUIRE D TO BE INCLUDED ON THE 26
POSTCARD UNDER SUBSUBPARAGRAPH 2 OF THIS SUBPARAGRAPH SHALL B E IN: 27
A. 12 POINT FONT; AND 28
4 HOUSE BILL 694
B. EACH LANGUAGE SPOKEN BY THE POPULATION TH AT 1
CONSTITUTES AT LEAST 5% OF THE OVERALL POPUL ATION WITHIN THE COU NTY IN 2
WHICH THE HOSPITAL I S LOCATED AS MEASURE D BY THE MOST RECENT CENSUS. 3
(II) 1. IF A PATIENT WAS DETE RMINED TO BE ELIGIBL E FOR 4
FREE CARE AND THE PATIENT WAS DETE RMINED TO BE PRESUMP TIVELY ELIGIBLE 5
UNDER § 2–214.1(B)(7) OF THIS TITLE, THE PATIENT SHALL BE NOTIFIED BY THE 6
DEPARTMENT OF HUMAN SERVICES BY FIRST–CLASS MAIL IN THE FORM SPECIFIED 7
UNDER SUBSUBPARAGRAPH 2 OF THIS SUBPARAGRAPH . 8
2. THE DEPARTMENT OF HUMAN SERVICES SHALL 9
SEND THE ELIGIBLE PA TIENT A POSTCARD THA T: 10
A. INCLUDES THE OFFICIAL SEAL OF THE DEPARTMENT 11
OF HUMAN SERVICES; 12
B. IS ON COLORED CARDSTO CK; AND 13
C. INCLUDES THE FOLLOWIN G STATEMENT : 14
“OUR RECORDS INDICATE THAT YOU PAID FOR CA RE AT (HOSPITAL’S NAME) 15
IN (YEAR), WERE ELIGIBLE FOR FR EE CARE, AND MAY BE ENTITLED TO A REFUND . 16
TO LEARN MORE GO TO (COMMISSION’S WEBSITE). TO APPLY FOR A REFUND , GO TO 17
(HOSPITAL’S WEBSITE), OR CALL (HOSPITAL’S PHONE NUMBER )”. 18
3. THE STATEMENT REQUIRE D TO BE INCLUDED ON THE 19
POSTCARD UNDER SUBSUBPARAGRAPH 2 OF THIS SUBPARAGRAPH SHALL BE I N: 20
A. 12 POINT FONT; AND 21
B. EACH LANGUAGE SPOKEN BY THE POPULATION THAT 22
CONSTITUTES AT LEAST 5% OF THE OVERALL POPUL ATION WITHIN THE COU NTY IN 23
WHICH THE HOSPITAL I S LOCATED AS MEASURE D BY THE MOST RECENT CENSUS. 24
(III) THE LINKS IDENTIFIED ON THE POSTCARD S SENT UNDER 25
THIS PARAGRAPH SHALL BE PROMINENTLY DISPL AYED ON THE MAIN PAGE OF THE 26
COMMISSION’S WEBSITE AND ON EACH HOSPITAL’S WEBSITE. 27
(5) EACH HOSPITAL SHALL : 28
(I) CREATE A WEBPAGE THAT INCLUDES: 29
HOUSE BILL 694 5
1. INFORMATION ABOUT REF UNDS FOR CHARGES PAI D 1
IF THE PATIENT QUALI FIED FOR FREE CARE A T THE TIME OF SERVICE; 2
2. A PROCESS TO APPLY FOR A REFUND, INCLUDING 3
RELEVANT TIMELINES F OR APPLYING FOR A RE FUND; AND 4
3. A DESIGNATED SINGLE PO INT OF CONTACT AT TH E 5
HOSPITAL, INCLUDING THE CONTAC T’S NAME, E–MAIL ADDRESS , AND TELEPHONE 6
NUMBER. 7
(II) WHEN CONTACTED BY A P ATIENT WHO RECEIVED WRITTEN 8
NOTIFICATION FROM TH E OFFICE OR THE DEPARTMENT OF HUMAN SERVICES: 9
1. DETERMINE WHETHER THE PATIENT PAID A BILL 10
DURING THE DESIGNATED YEAR AND WAS NOT DISQUALI FIED FROM FREE CARE 11
BASED ON THE USE OF AN ASSET TEST UNDER § 19–214.1(B)(8) OF THIS TITLE; AND 12
2. IF THE PATIENT PAID A BILL AND WAS NOT 13
DISQUALIFIED, REIMBURSE THE PATIENT FOR THE AMOUNT THE P ATIENT PAID FOR 14
CARE OUT OF POCKET. 15
(6) (I) THE COMMISSION MAY NOT RAISE HOSPIT AL RATES, AS 16
PART OF THE ANNUAL U PDATE FACTOR , TO OFFSET THE HOSPIT AL’S DIRECT 17
REFUNDS TO PATIENTS UNDER PARAGRAPH (5) OF THIS SUBSECTION . 18
(II) 1. EACH HOSPITAL SHALL R EIMBURSE THE 19
COMMISSION, THE OFFICE, AND THE DEPARTMENT OF HUMAN SERVICES FOR THE 20
COSTS INCURRED IN COMPLYING WITH THIS SECTION. 21
2. REIMBURSEMENT FROM A HOSPITAL UNDER THIS 22
SUBPARAGRAPH SHALL BE BASED ON THE NUMBER OF PATIENTS IN THE 23
DESIGNATED YEAR THAT WERE BILLED BY THE HOSPITAL, AS DETERMINED BY THE 24
COMMISSION. 25
(D) (1) (I) BEGINNING JULY 1, 2022, THE COMMISSION SHALL 26
IMPLEMENT THE PROCES S DEVELOPED UNDER SUBSECTION (C) OF THIS SECTION 27
FOR PATIENTS WHO RECEIVED CARE DURING CALENDAR YEARS 2017 AND 2018. 28
(II) ON OR BEFORE JULY 1, 2023, THE COMMISSION SHALL 29
DETERMINE, OF THE NUMBER OF PAT IENTS WHO RECEIVED CARE DURING 30
CALENDAR YEARS 2017 AND 2018 AND WERE SENT WRITTEN NO TIFICATION UNDER 31
THIS SECTION, THE TOTAL NUMBER OF PATIENTS WHO CONTACTED EACH HOSPI TAL. 32
6 HOUSE BILL 694
(2) IF THE TOTAL NUMBER O F PATIENTS WHO CONTACTED EACH 1
HOSPITAL, AS DETERMINED UNDER PARAGRAPH (1)(II) OF THIS SUBSECTION , WAS 2
AT LEAST 5% OF THOSE WHO RECEIVE D THE WRITTEN NOTICE , BEGINNING ON JULY 3
1, 2023, THE COMMISSION SHALL IMPL EMENT THE PROCESS DEVELOPED UNDER 4
SUBSECTION (C) OF THE SECTION FOR P ATIENTS WHO RECEIVED CARE DURING 5
CALENDAR YEARS 2019, 2020, AND 2021. 6
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect on 7
July 1, 2022. It shall remain effective for a period of 5 years and, at the end of June 30, 8
2027, this Act, with no further action required by the General Assembly, shall be abrogated 9
and of no further force and effect. 10