EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0404*
SENATE BILL 404
J3, Q7 3lr2544
CF HB 333
By: Senators Hershey and Hayes
Introduced and read first time: February 1, 2023
Assigned to: Finance
A BILL ENTITLED
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; authorizing 11
the State Department of Assessments and Taxation and the Office of the Comptroller 12
to disclose tax information to hospitals and certain units for a certain purpose; and 13
generally relating to hospitals, financial assistance policies, and reimbursement for 14
paid bills. 15
BY repealing and reenacting, with amendments, 16
Article – Health – General 17
Section 19–214.4 18
Annotated Code of Maryland 19
(2019 Replacement Volume and 2022 Supplement) 20
BY repealing and reenacting, with amendments, 21
Article – Tax – General 22
Section 13–203(c) 23
Annotated Code of Maryland 24
(2022 Replacement Volume) 25
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 26
That the Laws of Maryland read as follows: 27
2 SENATE BILL 404
Article – Health – General 1
19–214.4. 2
(a) The Commission, in coordination with the DEPARTMENT , THE Department 3
of Human Services, [the State designated exchange,] the Office of the Comptroller, THE 4
STATE DEPARTMENT OF EDUCATION, and the Maryland Hospital Association, shall 5
develop a process that: 6
(1) Identifies the patients who paid MORE THAN $25 for hospital services 7
who may have qualified for free care under § 19–214.1 of this subtitle [at the time of care] 8
ON THE DATE THE HOSP ITAL SERVICE WAS PRO VIDED during calendar years 2017 9
through 2021; 10
(2) Provides reimbursement to the patients identified under item (1) of this 11
subsection, which may be applied incrementally; 12
(3) Ensures that a patient’s alternate address is used if the patient 13
requested an alternate address for safety reasons; and 14
(4) Determines how the Commission, THE DEPARTMENT , the 15
Department of Human Services, [and] the Office of the Comptroller , 16
AND THE STATE DEPARTMENT OF EDUCATION should share with or disclose relevant 17
information, including tax information, to the minimum extent necessary, to the hospital 18
and in accordance with federal and State confidentiality laws for the purpose of carrying 19
out the process developed under this subsection. 20
(B) THE HEALTH EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE 21
ATTORNEY GENERAL SHALL ASSIST PATIENTS IDENTIFIED UNDER SUBSECTION (A) 22
OF THIS SECTION IN O BTAINING REIMBURSEME NT UNDER THIS SECTIO N. 23
(C) (1) THE PROCESS DEVELOPED UNDER SUBSECTION (A) OF THIS 24
SECTION: 25
(I) SHALL REQUIRE EACH HO SPITAL TO CONSIDER : 26
1. TAX DATA FROM THE OFFICE OF THE COMPTROLLER 27
AS DE FACTO EVIDENCE OF A PATIENT’S INCOME; AND 28
2. DATA FROM THE DEPARTMENT , THE DEPARTMENT 29
OF HUMAN SERVICES, AND THE STATE DEPARTMENT OF EDUCATION AS DE FACTO 30
EVIDENCE OF A PATIEN T’S PRESUMPTIVE ELIGIB ILITY FOR FREE CARE ; 31
(II) SHALL REQUIRE EACH HO SPITAL TO PROVIDE RE FUNDS TO 32
PATIENTS WHO QUALIFY UNDER SUBSECTION (G)(2) OF THIS SECTION; AND 33 SENATE BILL 404 3
(III) MAY NOT REQUIRE A HOS PITAL TO PROVIDE A PATIE NT 1
WITH A REFUND IF THE PATIENT PREVIOUSLY W AS DENIED FREE CARE BECAUSE OF 2
A FAILED ASSET TEST . 3
(2) EACH HOSPITAL SHALL C REATE A WEBPAGE THAT INCLUDES: 4
(I) INFORMATION ABOUT THE REIMBURSEMENT PROVID ED IN 5
ACCORDANCE WITH THIS SECTION, INCLUDING THE PROCES S TO BE FOLLOWED BY 6
A PATIENT AND RELEVA NT TIMELINES; AND 7
(II) A TELEPHONE NUMBER AND E–MAIL ADDRESS THAT A 8
PATIENT MAY USE TO S UBMIT QUESTIONS ABOU T THE REIMBURSEMENT PROCESS 9
DEVELOPED UNDER THIS SECTION. 10
(3) IF A PATIENT IS ENTITLED TO A SING LE REFUND PER YEAR U NDER 11
SUBSECTION (A) OF THIS SECTION IN A N AMOUNT OF $25 OR LESS, THE HOSPITAL 12
MAY BUT IS NOT REQUI RED TO PROVIDE THE R EIMBURSEMENT . 13
[(b)] (D) (1) The Commission may modify the process developed under 14
subsection (a) of this section as necessary. 15
(2) IF REIMBURSEMENTS ARE PROVIDED INCREMENTAL LY AND LESS 16
THAN 10% OF THE ESTIMATED REI MBURSEMENTS ARE MADE EACH YEAR DURING 17
THE FIRST INCREMENT , THE COMMISSION IS NOT REQ UIRED TO IMPLEMENT 18
ADDITIONAL INCREMENT S OF THE PROCESS. 19
(E) THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE 20
OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND 21
EACH HOSPITAL SHALL REPORT INFORMATION O N THE PROCESS DEVELO PED 22
UNDER THIS SECTION T O THE COMMISSION, IN THE TIME AND MANN ER 23
DETERMINED BY THE COMMISSION. 24
(F) (1) NOTWITHSTANDING ANY O THER PROVISION OF LA W, THE 25
COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE 26
OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND 27
EACH HOSPITAL SHALL DISCLOSE TO EAC H OTHER, TO THE MINIMUM EXTEN T 28
NECESSARY, RELEVANT INFORMATION , INCLUDING TAX INFORM ATION, NECESSARY 29
FOR IMPLEMENTATION O F THE PROCESS DEVELO PED UNDER SUBSECTION (A) OF 30
THIS SECTION. 31
(2) THIS SECTION MAY NOT BE CONSTRUED TO MAKE A HOSPITAL 32
RESPONSIBLE F OR THE CONFIDENTIALI TY OF THE INFORMATIO N IN POSSESSION OF 33
EACH STATE ENTITY LISTED I N PARAGRAPH (1) OF THIS SUBSECTION . 34 4 SENATE BILL 404
[(c)] (G) (1) (I) On or before January 1, 2023, and [January 1] OCTOBER 1
1, 2024, the Commission shall report to the Senate Finance Committee and the House 2
Health and Government Operations Committee, in accordance with § 2–1257 of the State 3
Government Article, on the development and implementation by hospitals of the process 4
required under subsection (a) of this section. 5
[(2)] (II) If the process developed under subsection (a) of this section 6
requires legislation for implementation, the Commission shall include the legislative 7
recommendations in the report required on or before January 1, 2023, under [paragraph 8
(1)] SUBPARAGRAPH (I) of this [subsection] PARAGRAPH . 9
[(3)] (III) If the process established under subsection (a) of this section does 10
not require legislation, each hospital shall implement the process developed under 11
subsection (a) of this section on or before January 1, 2023. 12
(2) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH , 13
EACH HOSPITAL THE COMMISSION, THE OFFICE OF THE COMPTROLLER , THE 14
DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, AND THE STATE 15
DEPARTMENT OF EDUCATION SHALL IMPLE MENT OPTION 3 FROM THE “FREE 16
HOSPITAL CARE REFUND PROCESS” REPORT SUBMITTED BY THE COMMISSION IN 17
DECEMBER 2022 AS REQUIRED UNDER PA RAGRAPH (1)(I) OF THIS SUBSECTION A ND 18
IN ACCORDANCE WITH T HIS SECTION AND § 12–203(C) OF THE TAX – GENERAL 19
ARTICLE. 20
(II) UNDER THE PROCESS REQ UIRED UNDER SUBPARAGRAPH 21
(I) OF THIS PARAGRAPH , A PATIENT SHALL QUAL IFY FOR REFUNDS WHO PAID AN 22
OUT–OF–POCKET EXPENSE FOR S ERVICES BASED ON THE FOLLOWING: 23
1. THE OFFICE OF THE COMPTROLLER DETERMINI NG 24
THAT THE PATIENT ’S FAMILY INCOME WAS AT OR BELOW 200% OF THE FEDERAL 25
POVERTY LEVEL DURING THE YEAR OF SERVICE DATE OR DATES ; OR 26
2. THE DEPARTMENT OF HUMAN SERVICES, THE 27
DEPARTMENT , OR THE STATE DEPARTMENT OF EDUCATION DETERMINING THAT 28
DURING THE YEAR OF S ERVICE DATE OR DATES , THE PATIENT: 29
A. RECEIVED BENEFI TS THROUGH THE FEDER AL 30
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM; 31
B. RECEIVED BENEFITS THR OUGH THE STATE’S 32
ENERGY ASSISTANCE PROGRAM; 33
C. RECEIVED BENEFITS THR OUGH THE FEDERAL 34 SENATE BILL 404 5
SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND CHILDREN; 1
OR 2
D. LIVED IN A HOUSEHOLD WITH CHILDREN ENROLL ED 3
IN THE FREE AND REDU CED–COST MEAL PROGRAM . 4
(3) THE OFFICE OF THE COMPTROLLER , THE DEPARTMENT OF 5
HUMAN SERVICES, THE DEPARTMENT , THE STATE DEPARTMENT OF EDUCATION, 6
THE COMMISSION, AND EACH HOSPITAL MA Y NOT IMPLEMENT THE ALTERNATIVE 7
APPROACH INCLUDED WI TH OPTION 3 IN THE REPORT IDENTI FIED UNDER 8
PARAGRAPH (2)(I) OF THIS SUBSECTION . 9
(H) (1) EACH HOSPITAL SHALL R EIMBURSE THE COMMISSION, THE 10
OFFICE OF THE COMPTROLLER , THE DEPARTMENT , THE DEPARTMENT OF HUMAN 11
SERVICES, THE STATE DEPARTMENT OF EDUCATION, AND THE HEALTH 12
EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE ATTORNEY GENERAL FOR THE 13
COSTS INCURRED BY EA CH STATE ENTITY IN COMPL YING WITH THIS SECTI ON. 14
(2) (I) REIMBURSEMENT REQUIRE D UNDER PARAGRAPH (1) OF 15
THIS SUBSECTION SHAL L BE BASED ON THE HO SPITAL’S PROPORTION OF THE TOTAL 16
NUMBER OF PATIENTS W HO WERE I DENTIFIED BY THE STATE ENTITY AS 17
POTENTIALLY ELIGIBLE FOR REIMBURSEMENT IN A DESIGNATED YEAR , AS 18
DETERMINED BY THE COMMISSION. 19
(II) FOR THE PURPOSE OF DE TERMINING THE REIMBU RSEMENT 20
DUE UNDER SUBPARAGRA PH (I) OF THIS PARAGRAPH , THE STATE ENTITIES 21
IDENTIFIED UNDER PARAGRAPH (1) OF THIS SUBSECTION S HALL PROVIDE 22
QUARTERLY COST INFOR MATION TO THE COMMISSION. 23
(3) THE COMMISSION SHALL PROV IDE EACH HOSPITAL WI TH THE 24
REIMBURSEMENT AMOUNT DUE TO THE APPROPRIA TE STATE ENTITY BASED ON THE 25
COSTS INCURRED BY TH E ENTITY IN COMPLYING W ITH THIS SECTION. 26
Article – Tax – General 27
13–203. 28
(c) Tax information may be disclosed to: 29
(1) an employee or officer of the State who, by reason of that employment 30
or office, has the right to the tax information; 31
(2) another tax collector; 32
6 SENATE BILL 404
(3) the Maryland Tax Court; 1
(4) a legal representative of the State, to review the tax information about 2
a taxpayer: 3
(i) who applies for review under this title; 4
(ii) who appeals from a determination under this title; or 5
(iii) against whom an action to recover tax or a penalty is pending or 6
will be initiated under this title; 7
(5) any license issuing authority of the State required by State law to verify 8
through the Comptroller that an applicant has paid all undisputed t axes and 9
unemployment insurance contributions payable to the Comptroller or the Secretary of 10
Labor or that the applicant has provided for payment in a manner satisfactory to the unit 11
responsible for collection; 12
(6) a local official as defined in § 13–925 of this title to the extent necessary 13
to administer Subtitle 9, Part V of this title; 14
(7) a federal official as defined in § 13–930 of this title to the extent 15
necessary to administer Subtitle 9, Part VI of this title; 16
(8) the Maryland Department of Health in accordance with the federal 17
Children’s Health Insurance Program Reauthorization Act of 2009; 18
(9) the State Board of Individual Tax Preparers; 19
(10) the Alcohol and Tobacco Commission; 20
(11) the Maryland 9–1–1 Board; [and] 21
(12) a person or governmental entity authorized by the Comptroller in 22
writing to receive tax information for the purpose of identifying, preventing, or responding 23
to fraud, provided that the tax information is: 24
(i) anonymized to the extent possible consistent with the 25
information’s intended use; and 26
(ii) in addition to any other protections and safeguards under law, 27
subject to any protections and safeguards set forth by the Comptroller in the written 28
authorization; [and] 29
(13) the Maryland Higher Education Commission; AND 30
(14) A HOSPITAL, THE HEALTH SERVICES COST REVIEW COMMISSION, 31 SENATE BILL 404 7
THE DEPARTMENT OF HUMAN SERVICES, THE MARYLAND DEPARTMENT OF 1
HEALTH, AND THE STATE DEPARTMENT OF EDUCATION, TO THE EXTENT 2
NECESSARY TO ADMINIS TER § 19–214.4 OF THE HEALTH – GENERAL ARTICLE. 3
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July 4
1, 2023. It shall remain effective until the taking effect of the termination provision 5
specified in Section 2 of Chapter 683 of the Acts of the General Assembly of 2022. If that 6
termination provision takes effect, this Act shall be abrogated and of no further force and 7
effect. This Act may not be interpreted to have any effect on that termination provision. 8