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.
*hb0333*
HOUSE BILL 333
J3, Q7 3lr0720
CF SB 404
By: Delegate Charkoudian Delegates Charkoudian, Pena –Melnyk, Cullison,
Alston, Bagnall, Bhandari, Guzzone, Hill, S. Johnson, Kaiser, Kerr,
R. Lewis, Lopez, Martinez, Rosenberg, Taveras, White, and Woods
Introduced and read first time: January 25, 2023
Assigned to: Health and Government Operations
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 5, 2023
CHAPTER ______
AN ACT concerning 1
Hospitals – Financial Assistance – Medical Bill Reimbursement Process 2
FOR the purpose of establishing requirements related to the reimbursement of 3
out–of–pocket costs paid by certain hospital patients who were eligible for free care, 4
including requirements related to the consideration of data and the reporting and 5
disclosure of certain information; modifying the process the Health Services Cost 6
Review Commission is required to develop for identifying and reimbursing certain 7
patients of hospitals; providing that a hospital is not required to provide certain 8
reimbursements under certain circumstances; requiring the implementation of a 9
certain option from a certain report under certain circumstances; requiring a 10
hospital to reimburse certain State government entities for certain costs; making a 11
violation of this Act an unfair, abusive, or deceptive trade practice that is subject to 12
enforcement and penalties under the Maryland Consumer Protection Act; 13
authorizing the State Department of Assessments and Taxation and the Office of the 14
Comptroller to disclose tax information to hospitals and certain units for a certain 15
purpose; and generally relating to hospitals, financial assistance policies, and 16
reimbursement for paid bills. 17
BY repealing and reenacting, with amendments, 18
Article – Commercial Law 19
Section 13–301(14)(xxxv) 20
Annotated Code of Maryland 21
(2013 Replacement Volume and 2022 Supplement) 22 2 HOUSE BILL 333
BY repealing and reenacting, without amendments, 1
Article – Commercial Law 2
Section 13–301(14)(xxxvi) 3
Annotated Code of Maryland 4
(2013 Replacement Volume and 2022 Supplement) 5
BY adding to 6
Article – Commercial Law 7
Section 13–301(14)(xxxvii) 8
Annotated Code of Maryland 9
(2013 Replacement Volume and 2022 Supplement) 10
BY repealing and reenacting, with amendments, 11
Article – Health – General 12
Section 19–214.4 13
Annotated Code of Maryland 14
(2019 Replacement Volume and 2022 Supplement) 15
BY repealing and reenacting, with amendments, 16
Article – Tax – General 17
Section 13–203(c) 18
Annotated Code of Maryland 19
(2022 Replacement Volume) 20
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 21
That the Laws of Maryland read as follows: 22
Article – Commercial Law 23
13–301. 24
Unfair, abusive, or deceptive trade practices include any: 25
(14) Violation of a provision of: 26
(xxxv) Section 11–210 of the Education Article; [or] 27
(xxxvi) Title 14, Subtitle 44 of this article; or 28
(XXXVII) SECTION 19–214.4 OF THE HEALTH – GENERAL 29
ARTICLE BY A HOSPITAL ; OR 30
Article – Health – General 31
19–214.4. 32
HOUSE BILL 333 3
(a) The Commission, in coordination with the DEPARTMENT , THE Department 1
of Human Services, [the State designated exchange,] the Office of the Comptroller, THE 2
STATE DEPARTMENT OF EDUCATION, THE HEALTH EDUCATION AND ADVOCACY 3
UNIT, and the Maryland Hospital Association, shall develop a process that: 4
(1) Identifies the patients who paid MORE THAN $25 for hospital services 5
who may have qualified for free care under § 19–214.1 of this subtitle [at the time of care] 6
ON THE DATE THE HOSP ITAL SERVICE WAS PRO VIDED during calendar years 2017 7
through 2021; 8
(2) Provides reimbursement to the patients identified under item (1) of this 9
subsection, which may be applied incrementally; 10
(3) Ensures that a patient’s alternate address is used if the patient 11
requested an alternate address for safety reasons; and 12
(4) Determines how the Commission, THE DEPARTMENT , the 13
Department of Human Services, [and] the Office of the Comptroller , 14
AND THE STATE DEPARTMENT OF EDUCATION should share with or disclose relevant 15
information, including tax information, to the minimum extent necessary, to the hospital 16
and in accordance with federal and State confidentiality laws for the purpose of carrying 17
out the process developed under this subsection. 18
(B) THE HEALTH EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE 19
ATTORNEY GENERAL SHALL ASSIST PATIENTS IDENTIFIED UNDER SUBSECTION (A) 20
OF THIS SECTION IN O BTAINING REIMBURSEME NT UNDER THIS SECTION . 21
(C) (1) THE PROCESS DEVELOPED UNDER SUBSECTION (A) OF THIS 22
SECTION: 23
(I) SHALL REQUIRE EACH HO SPITAL TO CONSIDER : 24
1. TAX DATA FROM THE OFFICE OF THE COMPTROLLER 25
AS DE FACTO EVIDENCE OF A PATIENT’S INCOME; AND 26
2. DATA FROM THE DEPARTMENT , THE DEPARTMENT 27
OF HUMAN SERVICES, AND THE STATE DEPARTMENT OF EDUCATION AS DE FACTO 28
EVIDENCE OF A PATIEN T’S PRESUMPTIVE ELIGIB ILITY FOR FREE CARE ; 29
(II) SHALL REQUIRE EACH HO SPITAL TO PROVIDE RE FUNDS TO 30
PATIENTS WHO QUALIFY UNDER SUBSECTION (G)(2) OF THIS SECTION; AND 31
(III) MAY NOT REQUIRE A HOS PITAL TO PROVIDE A P ATIENT 32
WITH A REFUND IF THE PATIENT PREVIOUSLY W AS DENIED FREE CARE BECAUSE OF 33
A FAILED ASSET TEST FOR THE IDENTIFIED D ATE OF SERVICE. 34 4 HOUSE BILL 333
(2) EACH HOSPITAL SHALL C REATE A WEBPAGE THAT IN CLUDES: 1
(I) INFORMATION ABOUT THE REIMBURSEMENT PROVID ED IN 2
ACCORDANCE WITH THIS SECTION, INCLUDING THE PROCES S TO BE FOLLOWED BY 3
A PATIENT AND RELEVA NT TIMELINES; AND 4
(II) A TELEPHONE NUMBER AND E–MAIL ADDRESS THAT A 5
PATIENT MA Y USE TO SUBMIT QUES TIONS ABOUT THE REIM BURSEMENT PROCESS 6
DEVELOPED UNDER THIS SECTION. 7
(3) IF A PATIENT IS ENTITLED TO A SINGLE REFU ND PER YEAR UNDER 8
SUBSECTION (A) OF THIS SECTION IN A N AMOUNT OF $25 OR LESS, THE HOSPITAL 9
MAY BUT IS NOT REQUI RED TO PROVIDE THE REIMBURSEM ENT. 10
[(b)] (D) (1) The Commission may modify the process developed under 11
subsection (a) of this section as necessary. 12
(2) IF REIMBURSEMENTS ARE PROVIDED INCREMENTAL LY AND LESS 13
THAN 10% 5% OF THE ESTIMATED REI MBURSEMENTS ARE MADE EACH YEAR DURING 14
THE FIRST INCREMENT , THE COMMISSION IS NOT REQ UIRED TO IMPLEMENT 15
ADDITIONAL INCREMENT S OF THE PROCESS . 16
(E) THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE 17
OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND 18
EACH HOSPI TAL SHALL REPORT INF ORMATION ON THE PROC ESS DEVELOPED 19
UNDER THIS SECTION T O THE COMMISSION, IN THE TIME AND MANN ER 20
DETERMINED BY THE COMMISSION. 21
(F) (1) NOTWITHSTANDING ANY O THER PROVISION OF LA W, THE 22
COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE 23
OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND 24
EACH HOSPITAL SHALL DISCLOSE TO EACH: 25
(I) EACH OTHER, TO THE MINIMUM EXTEN T NECESSARY , 26
RELEVANT INFORMATION , INCLUDING TAX INFORM ATION, NECESSARY FOR 27
IMPLEMENTATION OF TH E PROCESS DEVELOPED UND ER SUBSECTION (A) OF THIS 28
SECTION; AND 29
(II) THE HEALTH EDUCATION AND ADVOCACY UNIT RELEVANT 30
INFORMATION NECESSAR Y FOR THE HEALTH EDUCATION AND ADVOCACY UNIT TO 31
ASSIST PATIENTS IN O BTAINING REIMBURSEME NT UNDER SUBSECTION (A) OF THIS 32
SECTION, ON RECEIPT OF THE PA TIENT’S EXECUTED AUTHORIZA TION FOR RELEASE 33
OF MEDICAL INFORMATI ON FORM PROVIDED BY THE HEALTH EDUCATION AND 34 HOUSE BILL 333 5
ADVOCACY UNIT OR OTHER AUTHORI ZATION FORM REQUIRED BY THE 1
DEPARTMENT OF HUMAN SERVICES, THE OFFICE OF THE COMPTROLLER , OR THE 2
STATE DEPARTMENT OF EDUCATION. 3
(2) IF THE HEALTH EDUCATION AND ADVOCACY UNIT REQUESTS 4
INFORMATION FROM THE COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF 5
HUMAN SERVICES, THE OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT 6
OF EDUCATION, OR A HOSPIT AL TO ASSIST A PATIE NT IN OBTAINING 7
REIMBURSEMENT UNDER SUBSECTION (A) OF THIS SECTION, THE COMMISSION, THE 8
DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE OFFICE OF THE 9
COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, OR THE HOSPITAL 10
SHALL PROVIDE THE IN FORMATION TO THE HEALTH EDUCATION AND ADVOCACY 11
UNIT WITHIN 10 BUSINESS DAYS AFTER THE DATE OF THE RECE IPT OF THE 12
REQUEST. 13
(2) (3) THIS SECTION MAY NOT BE CONSTRUED TO MAKE A 14
HOSPITAL RESPONSIBLE FOR THE CONFIDENTIAL ITY OF THE INFORMATI ON IN 15
POSSESSION OF EACH STATE ENTITY LISTED I N PARAGRAPH (1) OF THIS 16
SUBSECTION. 17
[(c)] (G) (1) (I) On or before January 1, 2023, and [January 1] OCTOBER 18
1, 2024, the Commission shall report to the Senate Finance Committee and the House 19
Health and Government Operations Committee, in accordance with § 2–1257 of the State 20
Government Article, on the development and implementation by hospitals of the process 21
required under subsection (a) of this section. 22
[(2)] (II) If the process developed under subsection (a) of this section 23
requires legislation for implementation, the Commission shall include the legislative 24
recommendations in the report required on or before January 1, 2023, under [paragraph 25
(1)] SUBPARAGRAPH (I) of this [subsection] PARAGRAPH . 26
[(3)] (III) If the process established under subsection (a) of this section does 27
not require legislation, each hospital shall implement the process developed under 28
subsection (a) of this section on or before January 1, 2023. 29
(2) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGR APH, 30
EACH HOSPITAL THE COMMISSION, THE OFFICE OF THE COMPTROLLER , THE 31
DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, AND THE STATE 32
DEPARTMENT OF EDUCATION SHALL IMPLE MENT OPTION 3 FROM THE “FREE 33
HOSPITAL CARE REFUND PROCESS” REPORT SUBMITTED BY THE COMMISSION IN 34
DECEMBER 2022 AS REQUIRED UNDER PA RAGRAPH (1)(I) OF THIS SUBSECTION A ND 35
IN ACCORDANCE WITH T HIS SECTION AND § 12–203(C) § 13–203(C) OF THE TAX – 36
GENERAL ARTICLE. 37
6 HOUSE BILL 333
(II) UNDER THE PROCESS REQ UIRED UNDER SUBPARAG RAPH 1
(I) OF THIS PARAGRAPH , A PATIENT SHALL QUALIFY FOR RE FUNDS WHO PAID AN 2
OUT–OF–POCKET EXPENSE FOR S ERVICES BASED ON THE FOLLOWING: 3
1. THE OFFICE OF THE COMPTROLLER DETERMINI NG 4
THAT THE PATIENT ’S FAMILY INCOME WAS AT OR BELOW 200% OF THE FEDERAL 5
POVERTY LEVEL DURING THE YEAR OF SERVICE DATE OR DATES ; OR 6
2. THE DEPARTMENT OF HUMAN SERVICES, THE 7
DEPARTMENT , OR THE STATE DEPARTMENT OF EDUCATION DETERMINING THAT 8
DURING THE YEAR OF S ERVICE DATE OR DATES , THE PATIENT: 9
A. RECEIVED BENEFITS THR OUGH THE FEDERAL 10
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM; 11
B. RECEIVED BENEFITS THR OUGH THE STATE’S 12
ENERGY ASSISTANCE PROGRAM; 13
C. RECEIVED BENEFITS THR OUGH THE FEDERAL 14
SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND CHILDREN; 15
OR 16
D. LIVED IN A HOUSEHOLD WITH CHILDREN ENROLL ED 17
IN THE FREE AND REDU CED–COST MEAL PROGRAM . 18
(3) THE OFFICE OF THE COMPTROLLER , THE DEPARTMENT OF 19
HUMAN SERVICES, THE DEPARTMENT , THE STATE DEPARTMENT OF EDUCATION, 20
THE COMMISSION, AND EACH HOSPITAL MAY NOT IMPLEMENT THE ALTERN ATIVE 21
APPROACH INCLUDED WI TH OPTION 3 IN THE REPORT IDENTI FIED UNDER 22
PARAGRAPH (2)(I) OF THIS SUBSECTION . 23
(H) (1) EACH HOSPITAL SHALL R EIMBURSE THE COMMISSION, THE 24
OFFICE OF THE COMPTROLLER , THE DEPARTMENT , THE DEPARTMENT OF HUMAN 25
SERVICES, THE STATE DEPARTMENT OF EDUCATION, AND THE HEALTH 26
EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE ATTORNEY GENERAL FOR THE 27
COSTS INCURRED BY EA CH STATE ENTITY IN COMPL YING WITH THIS SECTI ON. 28
(2) (I) REIMBURSEMENT REQUIRE D UNDER PARAGRAPH (1) OF 29
THIS SUBSECTION SHAL L BE BASED ON THE HO SPITAL’S PROPORTION OF THE TOTAL 30
NUMBER OF PATIENTS W HO WERE IDENTIFIED B Y THE STATE ENTITY AS 31
POTENTIALLY ELIGIBLE FOR REIMBURSEMENT IN A DESIGNATED YEAR , AS 32
DETERMINED BY THE COMMISSION. 33
HOUSE BILL 333 7
(II) FOR THE PURPOSE OF DE TERMINING THE REIMBU RSEMENT 1
DUE UNDER SUBPARAGRA PH (I) OF THIS PARAGRAPH , THE STATE ENTITIES 2
IDENTIFIED UNDER PAR AGRAPH (1) OF THIS SUBSECTION S HALL PROVIDE 3
QUARTERLY COST INFOR MATION TO THE COMMISSION. 4
(3) THE COMMISSION SHALL PROV IDE EACH HOSPITAL WIT H THE 5
REIMBURSEMENT AMOUNT DUE TO THE APPROPRIA TE STATE ENTITY BASED ON THE 6
COSTS INCURRED BY TH E ENTITY IN COMPLYIN G WITH THIS SECTION . 7
(I) (1) (I) IF A HOSPITAL FAILS T O PROVIDE REFUNDS TO PATIENTS 8
WHO QUALIFY UNDER SU BSECTION (G)(2) OF THIS SECTION AS R EQUIRED, THE 9
COMMISSION MAY IMPOSE A FINE NOT EXCEEDING $50,000 PER VIOLATION. 10
(II) IN DETERMINING THE AM OUNT OF A FINE TO BE IMPOSED 11
UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH , THE COMMISSION SHALL 12
CONSIDER THE APPROPR IATENESS OF THE FINE IN RELAT ION TO THE SEVERITY OF 13
THE VIOLATION. 14
(2) A VIOLATION OF THIS SE CTION BY A HOSPITAL IS: 15
(I) AN UNFAIR, ABUSIVE, OR DECEPTIVE TRADE P RACTICE, AS 16
DEFINED UNDER TITLE 13 OF THE COMMERCIAL LAW ARTICLE; AND 17
(II) SUBJECT TO ENFORCEMENT AND PENA LTY PROVISIONS OF 18
TITLE 13 OF THE COMMERCIAL LAW ARTICLE. 19
Article – Tax – General 20
13–203. 21
(c) Tax information may be disclosed to: 22
(1) an employee or officer of the State who, by reason of that employment 23
or office, has the right to the tax information; 24
(2) another tax collector; 25
(3) the Maryland Tax Court; 26
(4) a legal representative of the State, to review the tax information about 27
a taxpayer: 28
(i) who applies for review under this title; 29
(ii) who appeals from a determination under this title; or 30 8 HOUSE BILL 333
(iii) against whom an action to recover tax or a penalty is pending or 1
will be initiated under this title; 2
(5) any license issuing authority of the State required by State law to verify 3
through the Comptroller that an applicant has paid all undisputed taxes and 4
unemployment insurance contributions payable to the Comptroller or the Secretary of 5
Labor or that the applicant has provided for payment in a manner satisfactory to the unit 6
responsible for collection; 7
(6) a local official as defined in § 13–925 of this title to the extent necessary 8
to administer Subtitle 9, Part V of this title; 9
(7) a federal official as defined in § 13–930 of this title to the extent 10
necessary to administer Subtitle 9, Part VI of this title; 11
(8) the Maryland Department of Health in accordance with the federal 12
Children’s Health Insurance Program Reauthorization Act of 2009; 13
(9) the State Board of Individual Tax Preparers; 14
(10) the Alcohol and Tobacco Commission; 15
(11) the Maryland 9–1–1 Board; [and] 16
(12) a person or governmental entity authorized by the Comptroller in 17
writing to receive tax information for the purpose of identifying, preventing, or responding 18
to fraud, provided that the tax information is: 19
(i) anonymized to the extent possible consistent with the 20
information’s intended use; and 21
(ii) in addition to any other protections and safeguards under law, 22
subject to any protections and safeguards set forth by the Comptroller in the written 23
authorization; [and] 24
(13) the Maryland Higher Education Commission; AND 25
(14) A HOSPITAL, THE HEALTH SERVICES COST REVIEW COMMISSION, 26
THE DEPARTMENT OF HUMAN SERVICES, THE MARYLAND DEPARTMENT OF 27
HEALTH, AND THE STATE DEPARTMENT OF EDUCATION, TO THE EXTENT 28
NECESSARY TO ADMI NISTER § 19–214.4 OF THE HEALTH – GENERAL ARTICLE. 29
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July 30
1, 2023. It shall remain effective until the taking effect of the termination provision 31
specified in Section 2 of Chapter 683 of the Acts of the General Assembly of 2022. If that 32 HOUSE BILL 333 9
termination provision takes effect, this Act shall be abrogated and of no further force and 1
effect. This Act may not be interpreted to have any effect on that termination provision. 2
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.