Maryland 2023 Regular Session

Maryland Senate Bill SB404 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	WES MOORE, Governor Ch. 311
2	1
3		-	– 1 –
4		-	Chapter 311
5		-	(Senate Bill 404)
6	2
7		-	AN ACT concerning
	3	+	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
	4	+	[Brackets] indicate matter deleted from existing law.
	5	+	Underlining indicates amendments to bill.
	6	+	Strike out indicates matter stricken from the bill by amendment or deleted from the law by
	7	+	amendment.
	8	+	sb0404
8	9
9		-	Hospitals – Financial Assistance – Medical Bill Reimbursement Process
	10	+	SENATE BILL 404
	11	+	J3, Q7 3lr2544
	12	+	CF HB 333
	13	+	By: Senators Hershey and Hayes
	14	+	Introduced and read first time: February 1, 2023
	15	+	Assigned to: Finance
	16	+	Committee Report: Favorable with amendments
	17	+	Senate action: Adopted
	18	+	Read second time: March 7, 2023
10	19
11		-	FOR the purpose of establishing requirements related to the reimbursement of
12		-	out–of–pocket costs paid by certain hospital patients who were eligible for free care,
13		-	including requirements related to the consideration of data and the reporting and
14		-	disclosure of certain information; modifying the process the Health Services Cost
15		-	Review Commission is required to develop for identifying and reimbursing certain
16		-	patients of hospitals; providing that a hospital is not required to provide certain
17		-	reimbursements under certain circumstances; requiring the implementation of a
18		-	certain option from a certain report under certain circumstances; requiring a
19		-	hospital to reimburse certain State government entities for certain costs; making a
20		-	violation of this Act an unfair, abusive, or deceptive trade practice that is subject to
21		-	enforcement and penalties under the Maryland Consumer Protection Act;
22		-	authorizing the State Department of Assessments and Taxation and the Office of the
23		-	Comptroller to disclose tax information to hospitals and certain units for a certain
24		-	purpose; and generally relating to hospitals, financial assistance policies, and
25		-	reimbursement for paid bills.
	20	+	CHAPTER ______
26	21
27		-	BY repealing and reenacting, with amendments,
28		-	Article – Commercial Law
29		-	Section 13–301(14)(xxxv)
30		-	Annotated Code of Maryland
31		-	(2013 Replacement Volume and 2022 Supplement)
	22	+	AN ACT concerning 1
32	23
33		-	BY repealing and reenacting, without amendments,
34		-	Article – Commercial Law
35		-	Section 13–301(14)(xxxvi)
36		-	Annotated Code of Maryland
37		-	(2013 Replacement Volume and 2022 Supplement)
	24	+	Hospitals – Financial Assistance – Medical Bill Reimbursement Process 2
38	25
39		-	BY adding to
40		-	Article – Commercial Law
41		-	Section 13–301(14)(xxxvii)
42		-	Annotated Code of Maryland
43		-	(2013 Replacement Volume and 2022 Supplement)
	26	+	FOR the purpose of establishing requirements related to the reimbursement of 3
	27	+	out–of–pocket costs paid by certain hospital patients who were eligible for free care, 4
	28	+	including requirements related to the consideration of data and the reporting and 5
	29	+	disclosure of certain information; modifying the process the Health Services Cost 6
	30	+	Review Commission is required to develop for identifying and reimbursing certain 7
	31	+	patients of hospitals; providing that a hospital is not required to provide certain 8
	32	+	reimbursements under certain circumstances; requiring the implementation of a 9
	33	+	certain option from a certain report under certain circumstances; requiring a 10
	34	+	hospital to reimburse certain State government entities for certain costs; making a 11
	35	+	violation of this Act an unfair, abusive, or deceptive trade practice that is subject to 12
	36	+	enforcement and penalties under the Maryland Consumer Protection Act; 13
	37	+	authorizing the State Department of Assessments and Taxation and the Office of the 14
	38	+	Comptroller to disclose tax information to hospitals and certain units for a certain 15
	39	+	purpose; and generally relating to hospitals, financial assistance policies, and 16
	40	+	reimbursement for paid bills. 17
44	41
45		-	BY repealing and reenacting, with amendments,
46		-	Article – ~~Health – General~~
47		-	Section 19–~~214.4~~
48		-	Annotated Code of Maryland
49		-	(~~2019~~ Replacement Volume and 2022 Supplement) ~~Ch. 311 2023 LAWS OF MARYLAND~~
	42	+	BY repealing and reenacting, with amendments, 18
	43	+	Article – Commercial Law 19
	44	+	Section 13–301(14)(xxxv) 20
	45	+	Annotated Code of Maryland 21
	46	+	(2013 Replacement Volume and 2022 Supplement) 22
50	47
51		-	– 2 –
	48	+	BY repealing and reenacting, without amendments, 23 2 SENATE BILL 404
52	49
53		-	BY repealing and reenacting, with amendments,
54		-	Article – Tax – General
55		-	Section 13–203(c)
56		-	Annotated Code of Maryland
57		-	(2022 Replacement Volume)
58	50
59		-	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
60		-	That the Laws of Maryland read as follows:
	51	+	Article – Commercial Law 1
	52	+	Section 13–301(14)(xxxvi) 2
	53	+	Annotated Code of Maryland 3
	54	+	(2013 Replacement Volume and 2022 Supplement) 4
61	55
62		-	Article – Commercial Law
	56	+	BY adding to 5
	57	+	Article – Commercial Law 6
	58	+	Section 13–301(14)(xxxvii) 7
	59	+	Annotated Code of Maryland 8
	60	+	(2013 Replacement Volume and 2022 Supplement) 9
63	61
64		-	13–301.
	62	+	BY repealing and reenacting, with amendments, 10
	63	+	Article – Health – General 11
	64	+	Section 19–214.4 12
	65	+	Annotated Code of Maryland 13
	66	+	(2019 Replacement Volume and 2022 Supplement) 14
65	67
66		-	Unfair, abusive, or deceptive trade practices include any:
	68	+	BY repealing and reenacting, with amendments, 15
	69	+	Article – Tax – General 16
	70	+	Section 13–203(c) 17
	71	+	Annotated Code of Maryland 18
	72	+	(2022 Replacement Volume) 19
67	73
68		-	(14) Violation of a provision of:
	74	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLA ND, 20
	75	+	That the Laws of Maryland read as follows: 21
69	76
70		-	~~(xxxv) Section 11–210 of the Education Article; [or]~~
	77	+	Article – Commercial Law 22
71	78
72		-	~~(xxxvi) Title 14, Subtitle 44 of this article; or~~
	79	+	13–301. 23
73	80
74		-	(XXXVII) SECTION 19–214.4 OF THE HEALTH – GENERAL
75		-	ARTICLE BY A HOSPITAL ; OR
	81	+	Unfair, abusive, or deceptive trade practices include any: 24
76	82
77		-	~~Article – Health – General~~
	83	+	(14) Violation of a provision of: 25
78	84
79		-	19–~~214.4.~~
	85	+	(xxxv) Section 11–210 of the Education Article; [or] 26
80	86
81		-	(a) The Commission, in coordination with the DEPARTMENT , THE Department
82		-	of Human Services, [the State designated exchange,] the Office of the Comptroller, THE
83		-	STATE DEPARTMENT OF EDUCATION, THE HEALTH EDUCATION AND ADVOCACY
84		-	UNIT, and the Maryland Hospital Association, shall develop a process that:
	87	+	(xxxvi) Title 14, Subtitle 44 of this article; or 27
85	88
86		-	(1) Identifies the patients who paid MORE THAN $25 for hospital services
87		-	who may have qualified for free care under § 19–214.1 of this subtitle [at the time of care]
88		-	ON THE DATE THE HOSP ITAL SERVICE WAS PRO VIDED during calendar years 2017
89		-	through 2021;
	89	+	(XXXVII) SECTION 19–214.4 OF THE HEALTH – GENERAL 28
	90	+	ARTICLE BY A HOSPITAL ; OR 29
90	91
91		-	(2) Provides reimbursement to the patients identified under item (1) of this
92		-	subsection, which may be applied incrementally;
	92	+	Article – Health – General 30
93	93
94		-	(3) Ensures that a patient’s alternate address is used if the patient
95		-	requested an alternate address for safety reasons; and
96		-	WES MOORE, Governor Ch. 311
	94	+	19–214.4. 31
97	95
98		-	– 3 –
99		-	(4) Determines how the Commission, THE DEPARTMENT, the
100		-	Department of Human Services, [and] the Office of the Comptroller ,
101		-	AND THE STATE DEPARTMENT OF EDUCATION should share with or disclose relevant
102		-	information, including tax information, to the minimum extent necessary, to the hospital
103		-	and in accordance with federal and State confidentiality laws for the purpose of carrying
104		-	out the process developed under this subsection.
	96	+	(a) The Commission, in coordination with the DEPARTMENT , THE Department 32
	97	+	of Human Services, [the State designated exchange,] the Office of the Comptroller, THE 33 SENATE BILL 404 3
105	98
106		-	(B) THE HEALTH EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE
107		-	ATTORNEY GENERAL SHALL ASSIST PATIENTS IDENTIFIED UNDER SUBSECTION (A)
108		-	OF THIS SECTION IN O BTAINING REIMBURSEME NT UNDER THIS SECTIO N.
109	99
110		-	~~(C) (1)~~ THE ~~PROCESS DEVELOPED UNDER SUBSECTION (A) OF THIS~~
111		-	~~SECTION~~:
	100	+	STATE DEPARTMENT OF EDUCATION, THE HEALTH EDUCATION AND ADVOCACY 1
	101	+	UNIT, and the Maryland Hospital Association, shall develop a process that: 2
112	102
113		-	(I) SHALL REQUIRE EACH HO SPITAL TO CONSIDER :
	103	+	(1) Identifies the patients who paid MORE THAN $25 for hospital services 3
	104	+	who may have qualified for free care under § 19–214.1 of this subtitle [at the time of care] 4
	105	+	ON THE DATE THE HOSP ITAL SERVICE WAS PRO VIDED during calendar years 2017 5
	106	+	through 2021; 6
114	107
115		-	~~1. TAX DATA FROM~~ THE ~~OFFICE~~ OF ~~THE COMPTROLLER~~
116		-	~~AS DE FACTO EVIDENC E OF A PATIENT’S INCOME~~; ~~AND~~
	108	+	(2) Provides reimbursement to the patients identified under item (1) of this 7
	109	+	subsection, which may be applied incrementally; 8
117	110
118		-	2. DATA FROM THE DEPARTMENT , THE DEPARTMENT
119		-	OF HUMAN SERVICES, AND THE STATE DEPARTMENT OF EDUCATION AS DE FACTO
120		-	EVIDENCE OF A PATIEN T’S PRESUMPTIVE ELIGIB ILITY FOR FREE CARE ;
	111	+	(3) Ensures that a patient’s alternate address is used if the patient 9
	112	+	requested an alternate address for safety reasons; and 10
121	113
122		-	(II) SHALL REQUIRE EACH HO SPITAL TO PROVIDE REFUNDS TO
123		-	PATIENTS WHO QUALIFY UNDER SUBSECTION (G)(2) OF THIS SECTION; AND
	114	+	(4) Determines how the Commission, THE DEPARTMENT , the 11
	115	+	Department of Human Services, [and] the Office of the Comptroller , 12
	116	+	AND THE STATE DEPARTMENT OF EDUCATION should share with or disclose relevant 13
	117	+	information, including tax information, to the minimum extent necessary, to the hospital 14
	118	+	and in accordance with federal and State confidentiality laws for the purpose of carrying 15
	119	+	out the process developed under this subsection. 16
124	120
125		-	(~~III~~) ~~MAY NOT REQUIRE A HOS PITAL TO PROVIDE A P ATIENT~~
126		-	~~WITH~~ A ~~REFUND IF THE PATIENT PREVIOUSLY W AS DENIED FREE CARE BECAUSE OF~~
127		-	~~A FAILED ASSET TEST FOR THE IDENTIFIED D ATE~~ OF ~~SERVICE~~.
	121	+	(B) THE HEALTH EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE 17
	122	+	ATTORNEY GENERAL SHALL ASSIST PATIENTS IDENTIFIED UNDER SUBSECTION (A) 18
	123	+	OF THIS SECTION IN O BTAINING REIMBURSEME NT UNDER THIS SECTIO N. 19
128	124
129		-	(2) EACH HOSPITAL SHALL C REATE A WEBPAGE THAT INCLUDES:
	125	+	(C) (1) THE PROCESS DEVELOPED UNDER SUBSECTION (A) OF THIS 20
	126	+	SECTION: 21
130	127
131		-	(I) INFORMATION ABOUT THE REIMBURSEMENT PROVID ED IN
132		-	ACCORDANCE WITH THIS SECTION, INCLUDING THE PROCES S TO BE FOLLOWED BY
133		-	A PATIENT AND RELEVA NT TIMELINES; AND
	128	+	(I) SHALL REQUIRE EACH HO SPITAL TO CONSIDER : 22
134	129
135		-	(II) A TELEPHONE NUMBER AND E–MAIL ADDRESS THAT A
136		-	PATIENT MAY USE TO S UBMIT QUESTIONS ABOU T THE REIMBURSEMENT PROCESS
137		-	DEVELOPED UNDER THIS SECTION.
	130	+	1. TAX DATA FROM THE OFFICE OF THE COMPTROLLER 23
	131	+	AS DE FACTO EVIDENCE OF A PATIENT’S INCOME; AND 24
138	132
139		-	(3) IF A PATIENT IS ENTITLED TO A SINGLE REFU ND PER YEAR UNDER
140		-	SUBSECTION (A) OF THIS SECTION IN A N AMOUNT OF $25 OR LESS, THE HOSPITAL
141		-	MAY BUT IS NOT REQUI RED TO PROVIDE THE R EIMBURSEMENT .
142		-	Ch. 311 2023 LAWS OF MARYLAND
	133	+	2. DATA FROM THE DEPARTMENT , THE DEPARTMENT 25
	134	+	OF HUMAN SERVICES, AND THE STATE DEPARTMENT OF EDUCATION AS DE FACTO 26
	135	+	EVIDENCE OF A PATIEN T’S PRESUMPTIVE ELIGIB ILITY FOR FREE CARE ; 27
143	136
144		-	– 4 –
145		-	[(b)] (D) (1) The Commission may modify the process developed under
146		-	subsection (a) of this section as necessary.
	137	+	(II) SHALL REQUIRE EACH HO SPITAL TO PROVIDE REFUNDS TO 28
	138	+	PATIENTS WHO QUALIFY UNDER SUBSECTION (G)(2) OF THIS SECTION; AND 29
147	139
148		-	(2) IF REIMBURSEMENTS ARE PROVIDED INCREMENTAL LY AND LESS
149		-	THAN 10% 5% OF THE ESTIMATED REI MBURSEMENTS ARE MADE EACH YEAR DURING
150		-	THE FIRST INCREMENT , THE COMMISSION IS NOT REQ UIRED TO IMPLEMENT
151		-	ADDITIONAL INCREMENT S OF THE PROCESS .
	140	+	(III) MAY NOT REQUIRE A HOS PITAL TO PROVIDE A P ATIENT 30
	141	+	WITH A REFUND IF THE PATIENT PREVIOUSLY W AS DENIED FREE CARE BECAUSE OF 31
	142	+	A FAILED ASSET TEST FOR THE IDENTIFIED D ATE OF SERVICE. 32
152	143
153		-	(E) THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE
154		-	OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND
155		-	EACH HOSPITAL SHALL REPORT INFORMATION O N THE PROCESS DEVELO PED
156		-	UNDER THIS SECTION T O THE COMMISSION, IN THE TIME AND MANN ER
157		-	DETERMINED BY THE COMMISSION.
	144	+	(2) EACH HOSPITAL SHALL C REATE A WEBPAGE THAT INCLUDES: 33 4 SENATE BILL 404
158	145
159		-	(F) (1) NOTWITHSTANDING ANY O THER PROVISION OF LAW, THE
160		-	COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE
161		-	OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND
162		-	EACH HOSPITAL SHALL DISCLOSE TO EACH:
163	146
164		-	(I) EACH OTHER, TO THE MINIMUM EXTEN T NECESSARY ,
165		-	RELEVANT INFORMATION , INCLUDING TAX INFORMAT ION, NECESSARY FOR
166		-	IMPLEMENTATION OF TH E PROCESS DEVELOPED UNDER SUBSECTION (A) OF THIS
167		-	SECTION; AND
168	147
169		-	(II) THE HEALTH EDUCATION AND ADVOCACY UNIT RELEVANT
170		-	INFORMATION NECESSAR Y FOR THE HEALTH EDUCATION AND ADVOCACY UNIT TO
171		-	ASSIST PATIENTS IN OBTAINING R EIMBURSEMENT UNDER S UBSECTION (A) OF THIS
172		-	SECTION, ON RECEIPT OF THE PA TIENT’S EXECUTED AUTHORIZA TION FOR RELEASE
173		-	OF MEDICAL INFORMATI ON FORM PROVIDED BY THE HEALTH EDUCATION AND
174		-	ADVOCACY UNIT OR OTHER AUTHORI ZATION FORM REQUIRED BY THE
175		-	DEPARTMENT OF HUMAN SERVICES, THE OFFICE OF THE COMPTROLLER , OR THE
176		-	STATE DEPARTMENT OF EDUCATION.
	148	+	(I) INFORMATION ABOUT THE REIMBURSEMENT PROVID ED IN 1
	149	+	ACCORDANCE WITH THIS SECTION, INCLUDING THE PROCES S TO BE FOLLOWED BY 2
	150	+	A PATIENT AND RELEVA NT TIMELINES; AND 3
177	151
178		-	(2) IF THE HEALTH EDUCATION AND ADVOCACY UNIT REQUESTS
179		-	INFORMATION FROM THE COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF
180		-	HUMAN SERVICES, THE OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT
181		-	OF EDUCATION, OR A HOSPITAL TO ASS IST A PATIENT IN OBT AINING
182		-	REIMBURSEMENT UNDER SUBSECTION (A) OF THIS SECTION, THE COMMISSION, THE
183		-	DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE OFFICE OF THE
184		-	COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, OR THE HOSPITAL
185		-	SHALL PROVIDE THE IN FORMATION TO THE HEALTH EDUCATION AND ADVOCACY
186		-	UNIT WITHIN 10 BUSINESS DAYS AFTER THE DATE OF THE RECE IPT OF THE
187		-	REQUEST. WES MOORE, Governor Ch. 311
	152	+	(II) A TELEPHONE NUMBE R AND E–MAIL ADDRESS THAT A 4
	153	+	PATIENT MAY USE TO S UBMIT QUESTIONS ABOU T THE REIMBURSEMENT PROCESS 5
	154	+	DEVELOPED UNDER THIS SECTION. 6
188	155
189		-	– 5 –
	156	+	(3) IF A PATIENT IS ENTITLED TO A SINGLE REFU ND PER YEAR UNDER 7
	157	+	SUBSECTION (A) OF THIS SECTION IN A N AMOUNT OF $25 OR LESS, THE HOSPITAL 8
	158	+	MAY BUT IS NOT REQUI RED TO PROVIDE THE R EIMBURSEMENT . 9
190	159
191		-	(2) (3) THIS SECTION MAY NOT BE CONSTRUED TO MAKE A
192		-	HOSPITAL RESPONSIBLE FOR THE CONFIDENTIALITY OF T HE INFORMATION IN
193		-	POSSESSION OF EACH STATE ENTITY LISTED I N PARAGRAPH (1) OF THIS
194		-	SUBSECTION.
	160	+	[(b)] (D) (1) The Commission may modify the process developed under 10
	161	+	subsection (a) of this section as necessary. 11
195	162
196		-	[(c)] (G) (1) (I) On or before January 1, 2023, and [January 1] OCTOBER
197		-	1, 2024, the Commission shall report to the Senate Finance Committee and the House
198		-	Health and Government Operations Committee, in accordance with § 2–1257 of the State
199		-	Government Article, on the development and implementation by hospitals of the process
200		-	required under subsection (a) of this section.
	163	+	(2) IF REIMBURSEMENTS ARE PROVIDED INCREMENTAL LY AND LESS 12
	164	+	THAN 10% 5% OF THE ESTIMATED REIMBU RSEMENTS ARE MADE EA CH YEAR DURING 13
	165	+	THE FIRST INCREMENT , THE COMMISSION IS NOT REQ UIRED TO IMPLEMENT 14
	166	+	ADDITIONAL INCREMENT S OF THE PROCESS . 15
201	167
202		-	[(2)] (II) If the process developed under subsection (a) of this section
203		-	requires legislation for implementation, the Commission shall include the legislative
204		-	recommendations in the report required on or before January 1, 2023, under [paragraph
205		-	(1)] SUBPARAGRAPH (I) of this [subsection] PARAGRAPH .
	168	+	(E) THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE 16
	169	+	OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND 17
	170	+	EACH HOSPITAL SHALL REPORT INFORMATION O N THE PROCESS DEVELO PED 18
	171	+	UNDER THIS SECTION T O THE COMMISSION, IN THE TIME AND MANN ER 19
	172	+	DETERMINED BY THE COMMISSION. 20
206	173
207		-	[(3)] (III) If the process established under subsection (a) of this section does
208		-	not require legislation, each hospital shall implement the process developed under
209		-	subsection (a) of this section on or before January 1, 2023.
	174	+	(F) (1) NOTWITHSTANDING ANY O THER PROVISION OF LA W, THE 21
	175	+	COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE 22
	176	+	OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND 23
	177	+	EACH HOSPITAL SHALL DISCLOSE TO EACH: 24
210	178
211		-	(2) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH ,
212		-	EACH HOSPITAL THE COMMISSION, THE OFFICE OF THE COMPTROLLER , THE
213		-	DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, AND THE STATE
214		-	DEPARTMENT OF EDUCATION SHALL IMPLE MENT OPTION 3 FROM THE “FREE
215		-	HOSPITAL CARE REFUND PROCESS” REPORT SUBMITTED BY THE COMMISSION IN
216		-	DECEMBER 2022 AS REQUIRED UNDER PA RAGRAPH (1)(I) OF THIS SUBSECTION A ND
217		-	IN ACCORDANCE WITH T HIS SECTION AND § 12–203(C) § 13–203(C) OF THE TAX –
218		-	GENERAL ARTICLE.
	179	+	(I) EACH OTHER, TO THE MINIMUM EXT ENT NECESSARY , 25
	180	+	RELEVANT INFORMATION , INCLUDING TAX INFORM ATION, NECESSARY FOR 26
	181	+	IMPLEMENTATION OF TH E PROCESS DEVELOPED UNDER SUBSECTION (A) OF THIS 27
	182	+	SECTION; AND 28
219	183
220		-	(II) UNDER THE PROCESS REQ UIRED UNDER SUBPARAGRAPH
221		-	(I) OF THIS PARAGRAPH , A PATIENT SHALL QUAL IFY FOR REFUNDS WHO PAID AN
222		-	OUT–OF–POCKET EXPENSE FOR S ERVICES BASED ON THE FOLLOWING:
	184	+	(II) THE HEALTH EDUCATION AND ADVOCACY UNIT RELEVANT 29
	185	+	INFORMATION NECESSAR Y FOR THE HEALTH EDUCATION AND ADVOCACY UNIT TO 30
	186	+	ASSIST PATIENTS IN O BTAINING REIMBURSEME NT UNDER SUBSECTION (A) OF THIS 31
	187	+	SECTION, ON RECEIPT OF THE PA TIENT’S EXECUTED AUTHORIZA TION FOR RELEASE 32
	188	+	OF MEDICAL INFORMATI ON FORM PROVIDED BY THE HEALTH EDUCATION AND 33
	189	+	ADVOCACY UNIT OR O THER AUTHORIZATION F ORM REQUIRED BY THE 34 SENATE BILL 404 5
223	190
224		-	1. THE OFFICE OF THE COMPTROLLER DETERMINI NG
225		-	THAT THE PATIENT ’S FAMILY INCOME WAS AT OR BELOW 200% OF THE FEDERAL
226		-	POVERTY LEVEL DURING THE YEAR OF SERVICE DATE OR DATES ; OR
227	191
228		-	2. THE DEPARTMENT OF HUMAN SERVICES, THE
229		-	DEPARTMENT , OR THE STATE DEPARTMENT OF EDUCATION DETERMINING THAT
230		-	DURING THE YEAR OF S ERVICE DATE OR DATES , THE PATIENT:
	192	+	DEPARTMENT OF HUMAN SERVICES, THE OFFICE OF THE COMPTROLLER , OR THE 1
	193	+	STATE DEPARTMENT OF EDUCATION. 2
231	194
232		-	A. RECEIVED BENEFI TS THROUGH THE FEDER AL
233		-	SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM; Ch. 311 2023 LAWS OF MARYLAND
	195	+	(2) IF THE HEALTH EDUCATION AND ADVOCACY UNIT REQUESTS 3
	196	+	INFORMATION FROM THE COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF 4
	197	+	HUMAN SERVICES, THE OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT 5
	198	+	OF EDUCATION, OR A HOSPITAL TO ASS IST A PATIENT IN OBT AINING 6
	199	+	REIMBURSEMENT UNDER SUBSECTION (A) OF THIS SECTION, THE COMMISSION, THE 7
	200	+	DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE OFFICE OF THE 8
	201	+	COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, OR THE HOSPITAL 9
	202	+	SHALL PROVIDE THE IN FORMATION TO THE HEALTH EDUCATION AND ADVOCACY 10
	203	+	UNIT WITHIN 10 BUSINESS DAYS AFTER THE DATE OF THE RECE IPT OF THE 11
	204	+	REQUEST. 12
234	205
235		-	– 6 –
	206	+	(2) (3) THIS SECTION MAY NOT BE CONSTRUED TO MAKE A 13
	207	+	HOSPITAL RESPONSIBLE FOR THE CONFIDENTIAL ITY OF THE INFORMATI ON IN 14
	208	+	POSSESSION OF EACH STATE ENTITY LISTED I N PARAGRAPH (1) OF THIS 15
	209	+	SUBSECTION. 16
236	210
237		-	B. RECEIVED BENEFITS THR OUGH THE STATE’S
238		-	ENERGY ASSISTANCE PROGRAM;
	211	+	[(c)] (G) (1) (I) On or before January 1, 2023, and [January 1] OCTOBER 17
	212	+	1, 2024, the Commission shall report to the Senate Finance Committee and the House 18
	213	+	Health and Government Operations Committee, in accordance with § 2–1257 of the State 19
	214	+	Government Article, on the development and implementation by hospitals of the process 20
	215	+	required under subsection (a) of this section. 21
239	216
240		-	C. RECEIVED BENEFITS THR OUGH THE FEDERAL
241		-	SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND CHILDREN;
242		-	OR
	217	+	[(2)] (II) If the process developed under subsection (a) of this section 22
	218	+	requires legislation for implementation, the Commission shall include the legislative 23
	219	+	recommendations in the report required on or before January 1, 2023, under [paragraph 24
	220	+	(1)] SUBPARAGRAPH (I) of this [subsection] PARAGRAPH . 25
243	221
244		-	D. LIVED IN A HOUSEHOLD WITH CHILDREN ENROLL ED
245		-	IN THE FREE AND REDU CED–COST MEAL PROGRAM .
	222	+	[(3)] (III) If the process established under subsection (a) of this section does 26
	223	+	not require legislation, each hospital shall implement the process developed under 27
	224	+	subsection (a) of this section on or before January 1, 2023. 28
246	225
247		-	(3) THE OFFICE OF THE COMPTROLLER , THE DEPARTMENT OF
248		-	HUMAN SERVICES, THE DEPARTMENT , THE STATE DEPARTMENT OF EDUCATION,
249		-	THE COMMISSION, AND EACH HOSPITAL MA Y NOT IMPLEMENT THE ALTERNATIVE
250		-	APPROACH INCLUDED WI TH OPTION 3 IN THE REPORT IDENTI FIED UNDER
251		-	PARAGRAPH (2)(I) OF THIS SUBSECTION .
	226	+	(2) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH , 29
	227	+	EACH HOSPITAL THE COMMISSION, THE OFFICE OF THE COMPTROLLER , THE 30
	228	+	DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, AND THE STATE 31
	229	+	DEPARTMENT OF EDUCATION S HALL IMPLEMENT OPTION 3 FROM THE “FREE 32
	230	+	HOSPITAL CARE REFUND PROCESS” REPORT SUBMITTED BY THE COMMISSION IN 33
	231	+	DECEMBER 2022 AS REQUIRED UNDER PA RAGRAPH (1)(I) OF THIS SUBSECTION A ND 34
	232	+	IN ACCORDANCE WITH T HIS SECTION AND § 12–203(C) § 13–203(C) OF THE TAX – 35
	233	+	GENERAL ARTICLE. 36
	234	+	6 SENATE BILL 404
252	235
253		-	(H) (1) EACH HOSPITAL SHALL R EIMBURSE THE COMMISSION, THE
254		-	OFFICE OF THE COMPTROLLER , THE DEPARTMENT , THE DEPARTMENT OF HUMAN
255		-	SERVICES, THE STATE DEPARTMENT OF EDUCATION, AND THE HEALTH
256		-	EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE ATTORNEY GENERAL FOR THE
257		-	COSTS INCURRED BY EA CH STATE ENTITY IN COMPL YING WITH THIS SECTI ON.
258	236
259		-	(2) (I) REIMBURSEMENT REQUIRE D UNDER PARAGRAPH (1) OF
260		-	THIS SUBSECTION SHAL L BE BASED ON THE HO SPITAL’S PROPORTION OF THE TOTAL
261		-	NUMBER OF PATIENTS W HO WERE IDENTIFIED B Y THE STATE ENTITY AS
262		-	POTENTIALLY ELIGIBLE FOR REIMBURSEMENT IN A DESIGNATED YEAR , AS
263		-	DETERMINED BY THE COMMISSION.
	237	+	(II) UNDER THE PROCESS REQ UIRED UNDER SUBPARAG RAPH 1
	238	+	(I) OF THIS PARAGRAPH , A PATIENT SHALL QUAL IFY FOR REFUNDS WHO PAID AN 2
	239	+	OUT–OF–POCKET EXPENSE FOR S ERVICES BASED ON THE FOLLOWING: 3
264	240
265		-	(II) FOR THE PURPOSE OF DETERMINING THE R EIMBURSEMENT
266		-	DUE UNDER SUBPARAGRA PH (I) OF THIS PARAGRAPH , THE STATE ENTITIES
267		-	IDENTIFIED UNDER PAR AGRAPH (1) OF THIS SUBSECTION S HALL PROVIDE
268		-	QUARTERLY COST INFOR MATION TO THE COMMISSION.
	241	+	1. THE OFFICE OF THE COMPTROLLER DETERMINI NG 4
	242	+	THAT THE PATIENT’S FAMILY INCOME WAS AT OR BELOW 200% OF THE FEDERAL 5
	243	+	POVERTY LEVEL DURING THE YEAR OF SERVICE DATE OR DATES ; OR 6
269	244
270		-	~~(3)~~ THE ~~COMMISSION SHALL PROV IDE EACH HOSPITA L WITH~~ THE
271		-	~~REIMBURSEMENT AMOUNT DUE TO~~ THE ~~APPROPRIA TE~~ STATE ~~ENTITY BASED ON THE~~
272		-	~~COSTS INCURRED BY TH E ENTITY IN COMPLYIN G WITH THIS SECTION .~~
	245	+	2. THE DEPARTMENT OF HUMAN SERVICES, THE 7
	246	+	DEPARTMENT , OR THE STATE DEPARTMENT OF EDUCATION DETERMINING THAT 8
	247	+	DURING THE YEAR OF SERVICE DATE OR DATE S, THE PATIENT: 9
273	248
274		-	(I) (1) (I) IF A HOSPITAL FAILS T O PROVIDE REFUNDS TO PATIENTS
275		-	WHO QUALIFY UNDER SU BSECTION (G)(2) OF THIS SECTION AS REQUIRED , THE
276		-	COMMISSION MAY IMPOSE A FINE NOT EXCEEDING $50,000 PER VIOLATION.
277		-	WES MOORE, Governor Ch. 311
	249	+	A. RECEIVED BENEFITS THR OUGH THE FEDERAL 10
	250	+	SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM; 11
278	251
279		-	– 7 –
280		-	(II) IN DETERMINING THE AM OUNT OF A FINE TO BE IMPOSED
281		-	UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH , THE COMMISSION SHALL
282		-	CONSIDER THE APPROPR IATENESS OF THE FINE IN RELATION TO THE SEVE RITY OF
283		-	THE VIOLATION.
	252	+	B. RECEIVED BENEFITS THR OUGH THE STATE’S 12
	253	+	ENERGY ASSISTANCE PROGRAM; 13
284	254
285		-	(2) A VIOLATION OF THIS SE CTION BY A HOSPITAL IS:
	255	+	C. RECEIVED BENEFITS THR OUGH THE FEDERAL 14
	256	+	SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND CHILDREN; 15
	257	+	OR 16
286	258
287		-	~~(I) AN UNFAIR,~~ ~~ABUSIVE, OR DECEPTIVE TRADE P RACTICE,~~ AS
288		-	~~DEFINED UNDER TITLE 13 OF~~ THE ~~COMMERCIAL LAW ARTICLE;~~ AND
	259	+	D. LIVED IN A HOUSEHOLD WITH CHILDREN ENROLL ED 17
	260	+	IN THE FREE AND REDU CED–COST MEAL PROGRAM . 18
289	261
290		-	(II) SUBJECT TO ENFORCEMEN T AND PENAL TY PROVISIONS OF
291		-	TITLE 13 OF THE COMMERCIAL LAW ARTICLE.
	262	+	(3) THE OFFICE OF THE COMPTROLLER , THE DEPARTMENT OF 19
	263	+	HUMAN SERVICES, THE DEPARTMENT , THE STATE DEPARTMENT OF EDUCATION, 20
	264	+	THE COMMISSION, AND EACH HOSPITAL MA Y NOT IMPLEMENT THE ALTERNATIVE 21
	265	+	APPROACH INCLUDED WI TH OPTION 3 IN THE REPORT IDENTI FIED UNDER 22
	266	+	PARAGRAPH (2)(I) OF THIS SUBSECTION . 23
292	267
293		-	Article – Tax – General
	268	+	(H) (1) EACH HOSPITAL SHALL R EIMBURSE THE COMMISSION, THE 24
	269	+	OFFICE OF THE COMPTROLLER , THE DEPARTMENT , THE DEPARTMENT OF HUMAN 25
	270	+	SERVICES, THE STATE DEPARTMENT OF EDUCATION, AND THE HEALTH 26
	271	+	EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE ATTORNEY GENERAL FOR THE 27
	272	+	COSTS INCURRED BY EA CH STATE ENTITY IN COMPL YING WITH THIS SEC TION. 28
294	273
295		-	13–203.
	274	+	(2) (I) REIMBURSEMENT REQUIRE D UNDER PARAGRAPH (1) OF 29
	275	+	THIS SUBSECTION SHAL L BE BASED ON THE HO SPITAL’S PROPORTION OF THE TOTAL 30
	276	+	NUMBER OF PATIENTS W HO WERE IDENTIFIED B Y THE STATE ENTITY AS 31
	277	+	POTENTIALLY ELIGIBLE FOR REIMBURSEMENT IN A DESIGNATED YEA R, AS 32
	278	+	DETERMINED BY THE COMMISSION. 33
	279	+	SENATE BILL 404 7
296	280
297		-	(c) Tax information may be disclosed to:
298	281
299		-	(1) an employee or officer of the State who, by reason of that employment
300		-	or office, has the right to the tax information;
	282	+	(II) FOR THE PURPOSE OF DE TERMINING THE REIMBU RSEMENT 1
	283	+	DUE UNDER SUBPARAGRA PH (I) OF THIS PARAGRAPH , THE STATE ENTITIES 2
	284	+	IDENTIFIED UNDER PAR AGRAPH (1) OF THIS SUBSECTION S HALL PROVIDE 3
	285	+	QUARTERLY COST INFOR MATION TO THE COMMISSION. 4
301	286
302		-	(2) another tax collector;
	287	+	(3) THE COMMISSION SHALL PROV IDE EACH HOSPITAL WI TH THE 5
	288	+	REIMBURSEMENT AMOUNT DUE TO THE APPROPRIA TE STATE ENTITY BASED ON THE 6
	289	+	COSTS INCURRED BY TH E ENTITY IN COMPLYIN G WITH THIS SECTION . 7
303	290
304		-	(3) the Maryland Tax Court;
	291	+	(I) (1) (I) IF A HOSPITAL FAILS T O PROVIDE REFUNDS TO PATIENTS 8
	292	+	WHO QUALIFY UNDER SU BSECTION (G)(2) OF THIS SECTION AS R EQUIRED, THE 9
	293	+	COMMISSION MAY IMPOSE A FINE NOT EXCEEDING $50,000 PER VIOLATION. 10
305	294
306		-	(4) a legal representative of the State, to review the tax information about
307		-	a taxpayer:
	295	+	(II) IN DETERMINING THE AM OUNT OF A FINE TO BE IMPOSED 11
	296	+	UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH , THE COMMISSION SHALL 12
	297	+	CONSIDER THE APPROPR IATENESS OF THE FINE IN RELATION TO THE S EVERITY OF 13
	298	+	THE VIOLATION. 14
308	299
309		-	(i) ~~who applies for review under~~ this ~~title;~~
	300	+	(2) A VIOLATION OF THIS SE CTION BY A HOSPITAL IS: 15
310	301
311		-	(ii) who appeals from a determination under this title; or
	302	+	(I) AN UNFAIR, ABUSIVE, OR DECEPTIVE TRADE P RACTICE, AS 16
	303	+	DEFINED UNDER TITLE 13 OF THE COMMERCIAL LAW ARTICLE; AND 17
312	304
313		-	(~~iii~~) ~~against whom an action~~ to ~~recover tax or a~~ penalty ~~is pending or~~
314		-	~~will be initiated under this title;~~
	305	+	(II) SUBJECT TO ENFORCEMEN T AND PENALTY PROVIS IONS OF 18
	306	+	TITLE 13 OF THE COMMERCIAL LAW ARTICLE. 19
315	307
316		-	(5) any license issuing authority of the State required by State law to verify
317		-	through the Comptroller that an applicant has paid all undisputed taxes and
318		-	unemployment insurance contributions payable to the Comptroller or the Secretary of
319		-	Labor or that the applicant has provided for payment in a manner satisfactory to the unit
320		-	responsible for collection;
	308	+	Article – Tax – General 20
321	309
322		-	(6) a local official as defined in § 13–925 of this title to the extent necessary
323		-	to administer Subtitle 9, Part V of this title;
324		-	Ch. 311 2023 LAWS OF MARYLAND
	310	+	13–203. 21
325	311
326		-	– 8 –
327		-	(7) a federal official as defined in § 13–930 of this title to the extent
328		-	necessary to administer Subtitle 9, Part VI of this title;
	312	+	(c) Tax information may be disclosed to: 22
329	313
330		-	(8) the ~~Maryland Department~~ of ~~Health in accordance with the federal~~
331		-	~~Children’s Health Insurance Program Reauthorization Act of 2009~~;
	314	+	(1) an employee or officer of the State who, by reason of that employment 23
	315	+	or office, has the right to the tax information; 24
332	316
333		-	(9) ~~the State Board of Individual~~ Tax ~~Preparers~~;
	317	+	(2) another tax collector; 25
334	318
335		-	(10) the ~~Alcohol and Tobacco Commission~~;
	319	+	(3) the Maryland Tax Court; 26
336	320
337		-	(11) the Maryland 9–1–1 Board; [and]
	321	+	(4) a legal representative of the State, to review the tax information about 27
	322	+	a taxpayer: 28
338	323
339		-	(12) a person or governmental entity authorized by the Comptroller in
340		-	writing to receive tax information for the purpose of identifying, preventing, or responding
341		-	to fraud, provided that the tax information is:
	324	+	(i) who applies for review under this title; 29
342	325
343		-	(i) anonymized to the extent pos sible consistent with the
344		-	information’s intended use; and
	326	+	(ii) who appeals from a determination under this title; or 30 8 SENATE BILL 404
345	327
346		-	(ii) in addition to any other protections and safeguards under law,
347		-	subject to any protections and safeguards set forth by the Comptroller in the written
348		-	authorization; [and]
349	328
350		-	(13) the Maryland Higher Education Commission; AND
351	329
352		-	(14) A HOSPITAL, THE HEALTH SERVICES COST REVIEW COMMISSION,
353		-	THE DEPARTMENT OF HUMAN SERVICES, THE MARYLAND DEPARTMENT OF
354		-	HEALTH, AND THE STATE DEPARTMENT OF EDUCATION, TO THE EXTENT
355		-	NECESSARY TO ADMINIS TER § 19–214.4 OF THE HEALTH – GENERAL ARTICLE.
	330	+	(iii) against whom an action to recover tax or a penalty is pending or 1
	331	+	will be initiated under this title; 2
356	332
357		-	~~SECTION 2.~~ ~~AND BE IT FURTHER ENACTED,~~ ~~That this Act shall take effect July~~
358		-	~~1, 2023. It shall remain effective until~~ the ~~taking effect of the termination provision~~
359		-	~~specified in Section 2~~ of ~~Chapter 683 of the Acts of the General Assembly of 2022. If that~~
360		-	~~termination provision takes effect,~~ ~~this Act shall be abrogated and of no further force and~~
361		-	~~effect. This Act may not be interpreted to have any effect on that termination provision.~~
	333	+	(5) any license issuing authority of the State required by State law to verify 3
	334	+	through the Comptroller that an applicant has paid all undisputed taxes and 4
	335	+	unemployment insurance contributions payable to the Comptroller or the Secretary of 5
	336	+	Labor or that the applicant has provided for payment in a manner satisfactory to the unit 6
	337	+	responsible for collection; 7
362	338
363		-	Approved by the Governor, May 3, 2023.
	339	+	(6) a local official as defined in § 13–925 of this title to the extent necessary 8
	340	+	to administer Subtitle 9, Part V of this title; 9
	341	+
	342	+	(7) a federal official as defined in § 13–930 of this title to the extent 10
	343	+	necessary to administer Subtitle 9, Part VI of this title; 11
	344	+
	345	+	(8) the Maryland Department of Health in accordance with the federal 12
	346	+	Children’s Health Insurance Program Reauthorization Act of 2009; 13
	347	+
	348	+	(9) the State Board of Individual Tax Preparers; 14
	349	+
	350	+	(10) the Alcohol and Tobacco Commission; 15
	351	+
	352	+	(11) the Maryland 9–1–1 Board; [and] 16
	353	+
	354	+	(12) a person or governmental entity authorized by the Comptroller in 17
	355	+	writing to receive tax information for the purpose of identifying, preventing, or responding 18
	356	+	to fraud, provided that the tax information is: 19
	357	+
	358	+	(i) anonymized to the extent possible consistent with the 20
	359	+	information’s intended use; and 21
	360	+
	361	+	(ii) in addition to any other protections and safeguards under law, 22
	362	+	subject to any protections and safeguards set forth by the Comptroller in the written 23
	363	+	authorization; [and] 24
	364	+
	365	+	(13) the Maryland Higher Education Commission; AND 25
	366	+
	367	+	(14) A HOSPITAL, THE HEALTH SERVICES COST REVIEW COMMISSION, 26
	368	+	THE DEPARTMENT OF HUMAN SERVICES, THE MARYLAND DEPARTMENT OF 27
	369	+	HEALTH, AND THE STATE DEPARTMENT OF EDUCATION, TO THE EXTENT 28
	370	+	NECESSARY TO ADMINIS TER § 19–214.4 OF THE HEALTH – GENERAL ARTICLE. 29
	371	+
	372	+	SECTION 2. AND BE IT FURTHER ENA CTED, That this Act shall take effect July 30
	373	+	1, 2023. It shall remain effective until the taking effect of the termination provision 31
	374	+	specified in Section 2 of Chapter 683 of the Acts of the General Assembly of 2022. If that 32 SENATE BILL 404 9
	375	+
	376	+
	377	+	termination provision takes effect, this Act shall be abrogated and of no further force and 1
	378	+	effect. This Act may not be interpreted to have any effect on that termination provision. 2
	379	+
	380	+
	381	+
	382	+
	383	+	Approved:
	384	+	________________________________________________________________________________
	385	+	Governor.
	386	+	________________________________________________________________________________
	387	+	President of the Senate.
	388	+	________________________________________________________________________________
	389	+	Speaker of the House of Delegates.