EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
Italics indicate opposite chamber/conference committee amendments.
*hb0694*
HOUSE BILL 694
J3 (2lr1776)
ENROLLED BILL
— Health and Government Operations/Finance —
Introduced by Delegate Charkoudian Delegates Charkoudian, Pendergrass,
Pena–Melnyk, Bagnall, Belcastro, Bhandari, Carr, Cullison, Hill, Johnson,
Kaiser, Kelly, Kerr, Landis, R. Lewis, Rosenberg, Sample –Hughes, and
K. Young
Read and Examined by Proofreaders:
_______________________________________________
Proofreader.
_______________________________________________
Proofreader.
Sealed with the Great Seal and presented to the Governor, for his approval this
_______ day of _______________ at ________________________ o’clock, ________M.
______________________________________________
Speaker.
CHAPTER ______
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 requiring the Health Services Cost Review Commission, in 10
coordination with the Department of Human Services, the State designated 11
exchange, the Office of the Comptroller, and the Maryland Hospital Association, to 12 2 HOUSE BILL 694
develop a process for identifying and reimbursing certain patients of hospitals; 1
requiring hospitals to implement the process under certain circumstances; and 2
generally relating to hospitals, financial assistance policies, and reimbursement for 3
paid bills. 4
BY repealing and reenacting, with amendments, 5
Article – Health – General 6
Section 19–214.1(b)(1) 7
Annotated Code of Maryland 8
(2019 Replacement Volume and 2021 Supplement) 9
BY adding to 10
Article – Health – General 11
Section 19–214.4 12
Annotated Code of Maryland 13
(2019 Replacement Volume and 2021 Supplement) 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Health – General 17
19–214.1. 18
(b) (1) (I) The Commission shall require each acute care hospital and each 19
chronic care hospital in the State under the jurisdiction of the Commission to develop a 20
financial assistance policy for providing free and reduced–cost care to patients who lack 21
health care coverage or whose health care coverage does not pay the full cost of the hospital 22
bill. 23
(II) IF NECESSARY TO MEET THE REQUIREMENTS OF THIS 24
SECTION, THE OFFICE OF THE COMPTROLLER MAY SHARE OR DISCLOSE RELEVANT 25
TAX INFORMATION . 26
19–214.4. 27
(A) THE COMMISSION, IN COORDINATION WITH THE DEPARTMENT OF 28
HUMAN SERVICES, THE STATE DESIGNATED EXCH ANGE, THE OFFICE OF THE 29
COMPTROLLER , AND THE MARYLAND HOSPITAL ASSOCIATION, SHALL DEVELOP A 30
PROCESS THAT : 31
(1) IDENTIFIES THE PATIEN TS WHO PAID FOR HOSP ITAL SERVICES 32
WHO MAY HAVE QUALIFI ED FOR FREE CARE UND ER § 19–214.1 OF THIS SUBTITLE AT 33
THE TIME OF CARE IN DURING CALENDAR YEARS 2017, 2018, 2019, 2020, AND 34
THROUGH 2021; 35
HOUSE BILL 694 3
(2) PROVIDES REIMBURSEMEN T TO THE PATIENTS ID ENTIFIED 1
UNDER ITEM (1) OF THIS SUBSECTION , WHICH MAY BE APPLIED INCREMENTALLY ; 2
(3) ENSURES THAT A PATIEN T’S ALTERNATE ADDRESS IS USED IF THE 3
PATIENT REQUESTED AN ALTERNATE ADDRESS FO R SAFETY REASONS ; AND 4
(4) DETERMINES HOW THE COMMISSION, THE DEPARTMENT OF 5
HUMAN SERVICES, AND THE OFFICE OF THE COMPTROLLER SHOULD SH ARE WITH 6
OR DISCLOSE RELEVANT INFORMATION , INCLUDING TAX INFORM ATION, TO THE 7
MINIMUM EXTENT NECES SARY, TO THE HOSPITAL AND IN ACCORDANCE WITH 8
FEDERAL AND STATE CONFIDENTIALITY LAWS FOR THE PURPOSE OF CARRYING OUT 9
THE PROCESS DEVELOPE D UNDER THIS SUBSECT ION. 10
(B) THE COMMISSION MAY MODIFY THE PROCESS DEVELOPE D UNDER 11
SUBSECTION (A) OF THIS SECTION AS N ECESSARY. 12
(B) (C) (1) ON OR BEFORE JANUARY 1, 2023, AND JANUARY 1, 2024, 13
THE COMMISSION SHALL REPO RT TO THE SENATE FINANCE COMMITTEE AND THE 14
HOUSE HEALTH AND GOVERNMENT OPERATIONS COMMITTEE, IN ACCORDANCE 15
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON THE DEVELOPMENT A ND 16
IMPLEMENTATION BY HO SPITALS OF THE PROCESS R EQUIRED UNDER SUBSEC TION 17
(A) OF THIS SECTION. 18
(2) IF THE PROCESS DEVELO PED UNDER SUBSECTION (A) OF THIS 19
SECTION REQUIRES LEG ISLATION FOR IMPLEME NTATION, THE COMMISSION SHALL 20
INCLUDE THE LEGISLAT IVE RECOMMENDATIONS IN THE REPORT REQUIRED ON OR 21
BEFORE JANUARY 1, 2023, UNDER PARAGRAPH (1) OF THIS SUBSECTION . 22
(3) IF THE PROCESS ESTABL ISHED UNDER SUBSECTI ON (A) OF THIS 23
SECTION DOES NOT REQ UIRE LEGISLATION , EACH HOSPITAL SHALL IMPLEMENT 24
THE PROCESS DEVELOPE D UNDER SUBSECTION (A) OF THIS SECTION ON OR B EFORE 25
JANUARY 1, 2023. 26
(A) IN THIS SECTION , “OFFICE” MEANS THE OFFICE OF THE 27
COMPTROLLER . 28
(B) THE PURPOSE OF THIS S ECTION IS: 29
(1) TO INFORM A PATIENT T HAT THE PATIENT MAY HAVE QUALIFIED 30
FOR FREE CARE UNDER § 19–214.1 OF THIS SUBTITLE AT THE TIME OF CARE AT A 31
HOSPITAL REGULATED B Y THE COMMISSION; AND 32
(2) PROVIDE THE PATIENT W ITH AN OPPORTUNITY T O OBTAIN 33
REIMBURSEMENT FOR PA ID SERVICES RECEIVED FROM THE HOSPITAL . 34 4 HOUSE BILL 694
(C) (1) (I) SUBJECT TO SUBSECTION (D) OF THIS SECTION , THE 1
COMMISSION, THE OFFICE, AND THE DEPARTMENT OF HUMAN SERVICES SHALL 2
DEVELOP A PROCESS TO IDENTIFY AND INFORM PATIENTS WHO MAY HAV E 3
QUALIFIED FOR FREE C ARE WHILE RECEIVING INPATIENT OR OUTPATI ENT 4
SERVICES FROM A HOSP ITAL. 5
(II) TO ACCOMPLISH THE PUR POSE OF THIS SECTION, THE 6
OFFICE MAY SHARE OR D ISCLOSE RELEVANT TAX INFORMATION . 7
(2) THE PROCESS TO IDENTI FY PATIENTS UNDER PA RAGRAPH (1) OF 8
THIS SUBSECTION SHAL L INCLUDE: 9
(I) DATA SHARING BETWEEN THE COMMISSION AND THE 10
OFFICE; 11
(II) PROTECTING PERSONA L INFORMATION ; 12
(III) MATCHING PATIENT DATA FROM THE COMMISSION WITH 13
TAX DATA FROM THE OFFICE; AND 14
(IV) ANALYZING THE MATCHED DATA TO DETERMINE A LIST OF 15
PATIENTS WHO MAY BE ELIGIBLE FOR A REFUN D FOR PAID CARE UNDE R THIS 16
SECTION. 17
(3) THE COMMISSION, THE OFFICE, AND THE DEPARTMENT OF 18
HUMAN SERVICES SHALL MAKE A DETERMINATION THAT T HE PATIENT WAS 19
ELIGIBLE FOR FREE CA RE AT THE TIME OF SE RVICE BASED ON WHETH ER: 20
(I) THE PATIENT’S INCOME WAS AT OR B ELOW 200% OF THE 21
FEDERAL POVERTY LEVE L; OR 22
(II) THE PATIENT WAS DETER MINED TO BE PRESUMPT IVELY 23
ELIGIBLE UNDER § 2–214.1(B)(7) OF THIS TITLE. 24
(4) (I) 1. IF A PATIENT WAS DETE RMINED TO BE ELIGIBL E FOR 25
FREE CARE AND THE PA TIENT’S INCOME WAS AT OR B ELOW 200% OF THE FEDERAL 26
POVERTY LEVEL , THE PATIENT SHALL BE NOTIFI ED BY THE OFFICE BY FIRST–CLASS 27
MAIL IN THE FORM SPE CIFIED UNDER SUBSUBP ARAGRAPH 2 OF THIS 28
SUBPARAGRAPH . 29
2. THE OFFICE SHALL SEND THE ELIGIBLE PATIENT A 30
POSTCARD THAT : 31
HOUSE BILL 694 5
A. INCLUDES THE OFFICIAL SEAL OF THE 1
COMPTROLLER ; 2
B. IS ON COLORED CARDSTO CK; AND 3
C. INCLUDES THE FOLLOWIN G STATEMENT : 4
“OUR RECORDS INDICATE THAT YOU PAID FOR CA RE AT (HOSPITAL’S NAME) 5
IN (YEAR), WERE ELIGIBLE FOR FR EE CARE, AND MAY BE ENTITLED TO A REFUND. 6
TO LEARN MORE , GO TO (COMMISSION’S WEBSITE). TO APPLY FOR A REFUND , GO TO 7
(HOSPITAL’S WEBSITE), OR CALL (HOSPITAL’S PHONE NUMBER )”. 8
3. THE STATEMENT REQUIRE D TO BE INCLUDED ON THE 9
POSTCARD UNDER SUBSU BPARAGRAPH 2 OF THIS SUBPARAGRAPH SHALL BE IN: 10
A. 12 POINT FONT; AND 11
B. EACH LANGUAGE SPOKEN BY THE POPULA TION THAT 12
CONSTITUTES AT LEAST 5% OF THE OVERALL POPUL ATION WITHIN THE COU NTY IN 13
WHICH THE HOSPITAL I S LOCATED AS MEASURE D BY THE MOST RECENT CENSUS. 14
(II) 1. IF A PATIENT WAS DETE RMINED TO BE ELIGIBL E FOR 15
FREE CARE AND THE PA TIENT WAS DETERMINED TO BE PRESUMPTIVELY ELIGIB LE 16
UNDER § 2–214.1(B)(7) OF THIS TITLE, THE PATIENT SHALL BE NOTIFIED BY THE 17
DEPARTMENT OF HUMAN SERVICES BY FIRST–CLASS MAIL IN THE FO RM SPECIFIED 18
UNDER SUBSUBPARAGRAP H 2 OF THIS SUBPARAGRAPH . 19
2. THE DEPARTMEN T OF HUMAN SERVICES SHALL 20
SEND THE ELIGIBLE PA TIENT A POSTCARD THA T: 21
A. INCLUDES THE OFFICIAL SEAL OF THE DEPARTMENT 22
OF HUMAN SERVICES; 23
B. IS ON COLORED CARDSTO CK; AND 24
C. INCLUDES THE FOLLOWIN G STATEMENT : 25
“OUR RECORDS INDICATE THAT YOU PAID FOR CARE AT (HOSPITAL’S NAME) 26
IN (YEAR), WERE ELIGIBLE FOR FR EE CARE, AND MAY BE ENTITLED TO A REFUND. 27
TO LEARN MORE GO TO (COMMISSION’S WEBSITE). TO APPLY FOR A REFUND , GO TO 28
(HOSPITAL’S WEBSITE), OR CALL (HOSPITAL’S PHONE NUMBER )”. 29
3. THE STATEMENT REQUIRED T O BE INCLUDED ON THE 30
POSTCARD UNDER SUBSU BPARAGRAPH 2 OF THIS SUBPARAGRAPH SHALL BE IN: 31 6 HOUSE BILL 694
A. 12 POINT FONT; AND 1
B. EACH LANGUAGE SPOKEN BY THE POPULATION TH AT 2
CONSTITUTES AT LEAST 5% OF THE OVERALL POPUL ATION WITHIN THE COU NTY IN 3
WHICH THE HOSPITAL I S LOCATED AS MEASURE D BY THE MOST RECENT CENSUS. 4
(III) THE LINKS IDENTIFIED ON THE POSTCARDS SEN T UNDER 5
THIS PARAGRAPH SHALL BE PROMINENTLY DISPL AYED ON THE MAIN PAG E OF THE 6
COMMISSION’S WEBSITE AND ON EAC H HOSPITAL’S WEBSITE. 7
(5) EACH HOSPITAL SHALL : 8
(I) CREATE A WEBPAGE THAT INCLUDES: 9
1. INFORMATION ABOUT REF UNDS FOR CHARGES PAI D 10
IF THE PATIENT QUALI FIED FOR FREE CARE A T THE TIME OF SERVIC E; 11
2. A PROCESS TO APPLY FOR A REFUND, INCLUDING 12
RELEVANT TIMELINES F OR APPLYING FOR A REFUND ; AND 13
3. A DESIGNATED SINGLE PO INT OF CONTACT AT TH E 14
HOSPITAL, INCLUDING THE CONTAC T’S NAME, E–MAIL ADDRESS , AND TELEPHONE 15
NUMBER. 16
(II) WHEN CONTACTED BY A P ATIENT WHO RECEIVED WRITTEN 17
NOTIFICATION FROM TH E OFFICE OR THE DEPARTME NT OF HUMAN SERVICES: 18
1. DETERMINE WHETHER THE PATIENT PAID A BILL 19
DURING THE DESIGNATE D YEAR AND WAS NOT D ISQUALIFIED FROM FRE E CARE 20
BASED ON THE USE OF AN ASSET TEST UNDER § 19–214.1(B)(8) OF THIS TITLE; AND 21
2. IF THE PATIENT PAID A BILL AND WAS NOT 22
DISQUALIFIED, REIMBURSE THE PATIEN T FOR THE AMOUNT THE PATIENT PAID FOR 23
CARE OUT OF POCKET . 24
(6) (I) THE COMMISSION MAY NOT RA ISE HOSPITAL RATES , AS 25
PART OF THE ANNUAL U PDATE FACTOR , TO OFFSET THE HOSPIT AL’S DIRECT 26
REFUNDS TO PATIENTS UNDER PARAGRAPH (5) OF THIS SUBSECTION . 27
(II) 1. EACH HOSPITAL SHALL R EIMBURSE THE 28
COMMISSION, THE OFFICE, AND THE DEPARTMENT OF HUMAN SERVICES FOR THE 29
COSTS INCURRED IN CO MPLYING WITH THIS SE CTION. 30
HOUSE BILL 694 7
2. REIMBURSEMENT FROM A HOSPITAL UNDER THIS 1
SUBPARAGRAPH SHALL B E BASED ON THE NUMBE R OF PATIENTS IN THE 2
DESIGNATED YEAR THAT WERE BILLED BY THE H OSPITAL, AS DETERMINED BY THE 3
COMMISSION. 4
(D) (1) (I) BEGINNING JULY 1, 2022, THE COMMISSION SHALL 5
IMPLEMENT THE PROCES S DEVELOPED UNDER SUBSECTION (C) OF THIS SECTION 6
FOR PATIENTS WHO REC EIVED CARE DURING CA LENDAR YEARS 2017 AND 2018. 7
(II) ON OR BEFORE JULY 1, 2023, THE COMMISSION SHALL 8
DETERMINE, OF THE NUMBER OF PAT IENTS WHO RECEIVED C ARE DURING 9
CALENDAR YEARS 2017 AND 2018 AND WERE SENT WRITTEN NOTIFIC ATION UNDER 10
THIS SECTION, THE TOTAL NUMBER OF PATIENTS WHO CONTACT ED EACH HOSPITAL . 11
(2) IF THE TOTAL NUMBER O F PATIENTS WHO CONTA CTED EACH 12
HOSPITAL, AS DETERMINED UNDER PARAGRAPH (1)(II) OF THIS SUBSECTION , WAS 13
AT LEAST 5% OF THOSE WHO RECEIVED THE WRI TTEN NOTICE, BEGINNING ON JULY 14
1, 2023, THE COMMISSION SHALL IMPL EMENT THE PROCESS DE VELOPED UNDER 15
SUBSECTION (C) OF THE SECTION FOR P ATIENTS WHO RECEIVED CARE DURING 16
CALENDAR YEARS 2019, 2020, AND 2021. 17
SECTION 2. AND BE IT FURTHER E NACTED, That this Act shall take effect July 18
1, 2022. It shall remain effective for a period of 5 2 3 years and, at the end of June 30, 2027 19
2024 2025, this Act, with no further action required by the General Assembly, shall be 20
abrogated and of no further force and effect. 21
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.