LAWRENCE J. HOGAN, JR., Governor Ch. 683
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Chapter 683
(House Bill 694)
AN ACT concerning
Hospitals – Financial Assistance – Medical Bill Reimbursement
FOR the purpose of establishing requirements and prohibitions related to the
reimbursement of out–of–pocket costs paid by hospital patients who were eligible for
free care, including a requirement that the Health Services Cost Review
Commission, the Office of the Comptroller, and the Department of Human Services
develop a process for identifying and informing patients who qualify for
reimbursement and that hospitals reimburse certain patients; authorizing the Office
of the Comptroller to share or disclose certain information under certain
circumstances requiring the Health Services Cost Review Commission, in
coordination with the Department of Human Services, the State designated
exchange, the Office of the Comptroller, and the Maryland Hospital Association, to
develop a process for identifying and reimbursing certain patients of hospitals;
requiring hospitals to implement the process under certain circumstances; and
generally relating to hospitals, financial assistance policies, and reimbursement for
paid bills.
BY repealing and reenacting, with amendments,
Article – Health – General
Section 19–214.1(b)(1)
Annotated Code of Maryland
(2019 Replacement Volume and 2021 Supplement)
BY adding to
Article – Health – General
Section 19–214.4
Annotated Code of Maryland
(2019 Replacement Volume and 2021 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Health – General
19–214.1.
(b) (1) (I) The Commission shall require each acute care hospital and each
chronic care hospital in the State under the jurisdiction of the Commission to develop a
financial assistance policy for providing free and reduced–cost care to patients who lack
health care coverage or whose health care coverage does not pay the full cost of the hospital
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(II) IF NECESSARY TO MEET TH E REQUIREMENTS OF TH IS
SECTION, THE OFFICE OF THE COMPTROLLER MAY SHARE OR DISCLOSE RELEVANT
TAX INFORMATION .
19–214.4.
(A) THE COMMISSION, IN COORDINATION WITH THE DEPARTMENT OF
HUMAN SERVICES, THE STATE DESIGNATED EXCH ANGE, THE OFFICE OF THE
COMPTROLLER , AND THE MARYLAND HOSPITAL ASSOCIATION, SHALL DEVELOP A
PROCESS THAT :
(1) IDENTIFIES THE PATIEN TS WHO PAID FOR HOSP ITAL SERVICES
WHO MAY HAVE QUALIFI ED FOR FREE CARE UND ER § 19–214.1 OF THIS SUBTITLE AT
THE TIME OF CARE IN DURING CALENDAR YEARS 2017, 2018, 2019, 2020, AND
THROUGH 2021;
(2) PROVIDES REIMBURSEMEN T TO THE PATIENTS ID ENTIFIED
UNDER ITEM (1) OF THIS SUBSECTION , WHICH MAY BE APPLIED INCREMENTALLY ;
(3) ENSURES THAT A PATIEN T’S ALTERNATE ADDRESS IS USED IF THE
PATIENT REQUESTED AN AL TERNATE ADDRESS FOR SAFETY REASONS ; AND
(4) DETERMINES HOW THE COMMISSION, THE DEPARTMENT OF
HUMAN SERVICES, AND THE OFFICE OF THE COMPTROLLER SHOULD SH ARE WITH
OR DISCLOSE RELEVANT INFORMATION , INCLUDING TAX INFORM ATION, TO THE
MINIMUM EXTENT NECESSARY , TO THE HOSPITAL AND IN ACCORDANCE WITH
FEDERAL AND STATE CONFIDENTIALITY LAWS FOR THE PURPOSE OF CARRYING OUT
THE PROCESS DEVELOPE D UNDER THIS SUBSECT ION.
(B) THE COMMISSION MAY MODIFY THE PROCESS DEVELOPE D UNDER
SUBSECTION (A) OF THIS SECTION AS NECES SARY.
(B) (C) (1) ON OR BEFORE JANUARY 1, 2023, AND JANUARY 1, 2024,
THE COMMISSION SHALL REPO RT TO THE SENATE FINANCE COMMITTEE AND THE
HOUSE HEALTH AND GOVERNMENT OPERATIONS COMMITTEE, IN ACCORDANCE
WITH § 2–1257 OF THE STATE GOVERNMENT ARTICLE, ON THE DEVELOPMENT A ND
IMPLEMENTATION BY HO SPITALS OF THE PROCE SS REQUIRED UNDER SU BSECTION
(A) OF THIS SECTION.
(2) IF THE PROCESS DEVELO PED UNDER SUBSECTION (A) OF THIS
SECTION REQUIRES LEG ISLATION FOR IMPLEME NTATION, THE COMMISSION SHALL LAWRENCE J. HOGAN, JR., Governor Ch. 683
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INCLUDE THE LEGISLAT IVE RECOMMENDATIONS IN THE REPORT REQUIR ED ON OR
BEFORE JANUARY 1, 2023, UNDER PARAGRAPH (1) OF THIS SUBSECTION .
(3) IF THE PROCESS ESTABL ISHED UNDER SUBSECTI ON (A) OF THIS
SECTION DOES NOT REQ UIRE LEGISLATION , EACH HOSPITAL SHALL IMPLEMENT
THE PROCESS DEVELOPE D UNDER SUBSECTION (A) OF THIS SECTION ON O R BEFORE
JANUARY 1, 2023.
(A) IN THIS SECTION , “OFFICE” MEANS THE OFFICE OF THE
COMPTROLLER .
(B) THE PURPOSE OF THIS S ECTION IS:
(1) TO INFORM A PATIENT T HAT THE PATIENT MAY HAVE QUALIFIED
FOR FREE CARE UNDER § 19–214.1 OF THIS SUBTITLE AT THE TIME OF CARE AT A
HOSPITAL REGULATED B Y THE COMMISSION; AND
(2) PROVIDE THE PATIENT W ITH AN OPPORTUNITY T O OBTAIN
REIMBURSEMENT FOR PA ID SERVICES RECEIVED FROM THE HOSPITAL .
(C) (1) (I) SUBJECT TO SUBSECTION (D) OF THIS SECTION , THE
COMMISSION, THE OFFICE, AND THE DEPARTMENT OF HUMAN SERVICES SHALL
DEVELOP A PROCESS TO IDENTIFY AND INFORM PATIENTS WHO MAY HAV E
QUALIFIED FOR FREE C ARE WHILE RECEIVING INPATIENT OR OUTPATI ENT
SERVICES FROM A HOSPITAL .
(II) TO ACCOMPLISH THE PUR POSE OF THIS SECTION , THE
OFFICE MAY SHARE OR D ISCLOSE RELEVANT TAX INFORMATION .
(2) THE PROCESS TO IDENTI FY PATIENTS UNDER PA RAGRAPH (1) OF
THIS SUBSECTION SHAL L INCLUDE:
(I) DATA SHARING BETWEEN THE COMMISSION AND THE
OFFICE;
(II) PROTECTING PERSONAL I NFORMATION ;
(III) MATCHING PATIENT DATA FROM THE COMMISSION WITH
TAX DATA FROM THE OFFICE; AND
(IV) ANALYZING THE MATCHED DATA TO DETERMINE A LIST OF
PATIENTS WHO MAY BE ELIGIBLE FOR A R EFUND FOR PAID CARE UNDER THIS
SECTION.
Ch. 683 2022 LAWS OF MARYLAND
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(3) THE COMMISSION, THE OFFICE, AND THE DEPARTMENT OF
HUMAN SERVICES SHALL MAKE A DETERMINATION THAT T HE PATIENT WAS
ELIGIBLE FOR FREE CA RE AT THE TIME OF SE RVICE BASED ON WHETH ER:
(I) THE PATIENT’S INCOME WAS AT OR BELOW 200% OF THE
FEDERAL POVERTY LEVE L; OR
(II) THE PATIENT WAS DETER MINED TO BE PRESUMPT IVELY
ELIGIBLE UNDER § 2–214.1(B)(7) OF THIS TITLE.
(4) (I) 1. IF A PATIENT WAS DETE RMINED TO BE ELIGIBL E FOR
FREE CARE AND THE PA TIENT’S INCOME WAS AT OR BELOW 200% OF THE FEDERAL
POVERTY LEVEL , THE PATIENT SHALL BE NOTIFIED BY THE OFFICE BY FIRST–CLASS
MAIL IN THE FORM SPE CIFIED UNDER SUBSUBP ARAGRAPH 2 OF THIS
SUBPARAGRAPH .
2. THE OFFICE SHALL SEND THE ELIGIBLE PATIENT A
POSTCARD THAT :
A. INCLUDES THE OFFICIAL SE AL OF THE
COMPTROLLER ;
B. IS ON COLORED CARDSTO CK; AND
C. INCLUDES THE FOLLOWIN G STATEMENT :
“OUR RECORDS INDICATE THAT YOU PAID FOR CA RE AT (HOSPITAL’S NAME)
IN (YEAR), WERE ELIGIBLE FOR FR EE CARE, AND MAY BE ENTITLED TO A REFUND.
TO LEARN MORE , GO TO (COMMISSION’S WEBSITE). TO APPLY FOR A REFUND , GO TO
(HOSPITAL’S WEBSITE), OR CALL (HOSPITAL’S PHONE NUMBER )”.
3. THE STATEMENT REQUIRE D TO BE INCLUDED ON THE
POSTCARD UNDER SUBSU BPARAGRAPH 2 OF THIS SUBPARAGRAPH SHALL BE IN:
A. 12 POINT FONT; AND
B. EACH LANGUAGE SPOKEN BY THE POPULATION TH AT
CONSTITUTES AT LEAST 5% OF THE OVERALL POPUL ATION WITHIN THE COU NTY IN
WHICH THE HOSPITAL I S LOCATED AS MEASURE D BY THE MOST RECENT CENSUS.
(II) 1. IF A PATIENT WAS DETE RMINED TO BE ELIGIBL E FOR
FREE CARE AND THE PA TIENT WAS DETERMINED TO BE PRESUMPTIVELY ELIGIBLE
UNDER § 2–214.1(B)(7) OF THIS TITLE, THE PATIENT SHALL BE NOTIFIED BY THE LAWRENCE J. HOGAN, JR., Governor Ch. 683
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DEPARTMENT OF HUMAN SERVICES BY FIRST–CLASS MAIL IN THE FO RM SPECIFIED
UNDER SUBSUBPARAGRAP H 2 OF THIS SUBPARAGRAPH .
2. THE DEPARTMENT OF HUMAN SERVICES SHALL
SEND THE ELIGIBLE PA TIENT A POSTCARD THA T:
A. INCLUDES THE OFFICIAL SEAL OF THE DEPARTMENT
OF HUMAN SERVICES;
B. IS ON COLORED CARDSTO CK; AND
C. INCLUDES THE FOLLOWIN G STATEMENT :
“OUR RECORDS INDICATE THAT YOU PAID FOR CA RE AT (HOSPITAL’S NAME)
IN (YEAR), WERE ELIGIBLE FOR FR EE CARE, AND MAY BE ENTITLED TO A REFUND.
TO LEARN MORE GO TO (COMMISSION’S WEBSITE). TO APPLY FOR A REFUND , GO TO
(HOSPITAL’S WEBSITE), OR CALL (HOSPITAL’S PHONE NUMBER )”.
3. THE STATEMENT REQUIRE D TO BE INCLUDED ON THE
POSTCARD UNDER SUBSU BPARAGRAPH 2 OF THIS SUBPARAGRAPH SHALL BE IN:
A. 12 POINT FONT; AND
B. EACH LANGUAGE SPOKEN BY THE POPULATION TH AT
CONSTITUTES AT LEAST 5% OF THE OVERALL POPUL ATION WITHIN THE COU NTY IN
WHICH THE HOSPITAL I S LOCATED AS MEASURE D BY THE MOST RECENT CENSUS.
(III) THE LINKS IDENTIFIED ON THE POSTCARDS SEN T UNDER
THIS PARAGRAPH SHALL BE PROMINENTLY DISPL AYED ON THE MAIN PAGE OF THE
COMMISSION’S WEBSITE AND ON EAC H HOSPITAL’S WEBSITE.
(5) EACH HOSPITAL SHALL :
(I) CREATE A WEBPAGE THAT INCLUDES:
1. INFORMATION ABOUT REF UNDS FOR CHARGES PAI D
IF THE PATIENT QUALI FIED FOR FREE CARE A T THE TIME OF SERVIC E;
2. A PROCESS TO APPLY FOR A REFUND, INCLUDING
RELEVANT TIMELINES F OR APPLYING FOR A RE FUND; AND
3. A DESIGNATED SINGLE PO INT OF CONTACT AT TH E
HOSPITAL, INCLUDING THE CONTAC T’S NAME, E–MAIL ADDRESS , AND TELEPHONE
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(II) WHEN CONTACTED BY A P ATIENT WHO RECEIVED WRI TTEN
NOTIFICATION FROM TH E OFFICE OR THE DEPARTMENT OF HUMAN SERVICES:
1. DETERMINE WHETHER THE PATIENT PAID A BILL
DURING THE DESIGNATE D YEAR AND WAS NOT D ISQUALIFIED FROM FRE E CARE
BASED ON THE USE OF AN ASSET TEST UNDER § 19–214.1(B)(8) OF THIS TITLE; AND
2. IF THE PATIENT PAID A BILL AND WAS NOT
DISQUALIFIED, REIMBURSE THE PATIEN T FOR THE AMOUNT THE PATIENT PAID FOR
CARE OUT OF POCKET .
(6) (I) THE COMMISSION MAY NOT RA ISE HOSPITAL RATES , AS
PART OF THE ANNUAL U PDATE FACTOR, TO OFFSET THE HOSPIT AL’S DIRECT
REFUNDS TO PATIENTS UNDER PARAGRAPH (5) OF THIS SUBSECTION .
(II) 1. EACH HOSPITAL SHALL R EIMBURSE THE
COMMISSION, THE OFFICE, AND THE DEPARTMENT OF HUMAN SERVICES FOR THE
COSTS INCURRED IN CO MPLYING WITH THIS SE CTION.
2. REIMBURSEMENT FROM A HOSPITAL UNDER THIS
SUBPARAGRAPH SHALL B E BASED ON THE NUMBE R OF PATIENTS IN THE
DESIGNATED YEAR THAT WERE BILLED BY THE H OSPITAL, AS DETERMINED BY THE
COMMISSION.
(D) (1) (I) BEGINNING JULY 1, 2022, THE COMMISSION SHAL L
IMPLEMENT THE PROCES S DEVELOPED UNDER SU BSECTION (C) OF THIS SECTION
FOR PATIENTS WHO REC EIVED CARE DURING CA LENDAR YEARS 2017 AND 2018.
(II) ON OR BEFORE JULY 1, 2023, THE COMMISSION SHALL
DETERMINE, OF THE NUMBER OF PAT IENTS WHO RECEIVED C ARE DURIN G
CALENDAR YEARS 2017 AND 2018 AND WERE SENT WRITTE N NOTIFICATION UNDER
THIS SECTION, THE TOTAL NUMBER OF PATIENTS WHO CONTACT ED EACH HOSPITAL .
(2) IF THE TOTAL NUMBER O F PATIENTS WHO CONTA CTED EACH
HOSPITAL, AS DETERMINED UNDER PARAGRAPH (1)(II) OF THIS SUBSECTION , WAS
AT LEAST 5% OF THOSE WHO RECEIVE D THE WRITTEN NOTICE , BEGINNING ON JULY
1, 2023, THE COMMISSION SHALL IMPL EMENT THE PROCESS DE VELOPED UNDER
SUBSECTION (C) OF THE SECTION FOR P ATIENTS WHO RECEIVED CARE DURING
CALENDAR YEARS 2019, 2020, AND 2021.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July
1, 2022. It shall remain effective for a period of 5 2 3 years and, at the end of June 30, 2027 LAWRENCE J. HOGAN, JR., Governor Ch. 683
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2024 2025, this Act, with no further action required by the General Assembly, shall be
abrogated and of no further force and effect.
Enacted under Article II, § 17(c) of the Maryland Constitution, May 29, 2022.