WES MOORE, Governor Ch. 311
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Chapter 311
(Senate Bill 404)
AN ACT concerning
Hospitals – Financial Assistance – Medical Bill Reimbursement Process
FOR the purpose of establishing requirements related to the reimbursement of
out–of–pocket costs paid by certain hospital patients who were eligible for free care,
including requirements related to the consideration of data and the reporting and
disclosure of certain information; modifying the process the Health Services Cost
Review Commission is required to develop for identifying and reimbursing certain
patients of hospitals; providing that a hospital is not required to provide certain
reimbursements under certain circumstances; requiring the implementation of a
certain option from a certain report under certain circumstances; requiring a
hospital to reimburse certain State government entities for certain costs; making a
violation of this Act an unfair, abusive, or deceptive trade practice that is subject to
enforcement and penalties under the Maryland Consumer Protection Act;
authorizing the State Department of Assessments and Taxation and the Office of the
Comptroller to disclose tax information to hospitals and certain units for a certain
purpose; and generally relating to hospitals, financial assistance policies, and
reimbursement for paid bills.
BY repealing and reenacting, with amendments,
Article – Commercial Law
Section 13–301(14)(xxxv)
Annotated Code of Maryland
(2013 Replacement Volume and 2022 Supplement)
BY repealing and reenacting, without amendments,
Article – Commercial Law
Section 13–301(14)(xxxvi)
Annotated Code of Maryland
(2013 Replacement Volume and 2022 Supplement)
BY adding to
Article – Commercial Law
Section 13–301(14)(xxxvii)
Annotated Code of Maryland
(2013 Replacement Volume and 2022 Supplement)
BY repealing and reenacting, with amendments,
Article – Health – General
Section 19–214.4
Annotated Code of Maryland
(2019 Replacement Volume and 2022 Supplement) Ch. 311 2023 LAWS OF MARYLAND
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BY repealing and reenacting, with amendments,
Article – Tax – General
Section 13–203(c)
Annotated Code of Maryland
(2022 Replacement Volume)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Commercial Law
13–301.
Unfair, abusive, or deceptive trade practices include any:
(14) Violation of a provision of:
(xxxv) Section 11–210 of the Education Article; [or]
(xxxvi) Title 14, Subtitle 44 of this article; or
(XXXVII) SECTION 19–214.4 OF THE HEALTH – GENERAL
ARTICLE BY A HOSPITAL ; OR
Article – Health – General
19–214.4.
(a) The Commission, in coordination with the DEPARTMENT , THE Department
of Human Services, [the State designated exchange,] the Office of the Comptroller, THE
STATE DEPARTMENT OF EDUCATION, THE HEALTH EDUCATION AND ADVOCACY
UNIT, and the Maryland Hospital Association, shall develop a process that:
(1) Identifies the patients who paid MORE THAN $25 for hospital services
who may have qualified for free care under § 19–214.1 of this subtitle [at the time of care]
ON THE DATE THE HOSP ITAL SERVICE WAS PRO VIDED during calendar years 2017
through 2021;
(2) Provides reimbursement to the patients identified under item (1) of this
subsection, which may be applied incrementally;
(3) Ensures that a patient’s alternate address is used if the patient
requested an alternate address for safety reasons; and
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(4) Determines how the Commission, THE DEPARTMENT, the
Department of Human Services, [and] the Office of the Comptroller ,
AND THE STATE DEPARTMENT OF EDUCATION should share with or disclose relevant
information, including tax information, 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 developed under this subsection.
(B) THE HEALTH EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE
ATTORNEY GENERAL SHALL ASSIST PATIENTS IDENTIFIED UNDER SUBSECTION (A)
OF THIS SECTION IN O BTAINING REIMBURSEME NT UNDER THIS SECTIO N.
(C) (1) THE PROCESS DEVELOPED UNDER SUBSECTION (A) OF THIS
SECTION:
(I) SHALL REQUIRE EACH HO SPITAL TO CONSIDER :
1. TAX DATA FROM THE OFFICE OF THE COMPTROLLER
AS DE FACTO EVIDENC E OF A PATIENT’S INCOME; AND
2. DATA FROM THE DEPARTMENT , THE DEPARTMENT
OF HUMAN SERVICES, AND THE STATE DEPARTMENT OF EDUCATION AS DE FACTO
EVIDENCE OF A PATIEN T’S PRESUMPTIVE ELIGIB ILITY FOR FREE CARE ;
(II) SHALL REQUIRE EACH HO SPITAL TO PROVIDE REFUNDS TO
PATIENTS WHO QUALIFY UNDER SUBSECTION (G)(2) OF THIS SECTION; AND
(III) MAY NOT REQUIRE A HOS PITAL TO PROVIDE A P ATIENT
WITH A REFUND IF THE PATIENT PREVIOUSLY W AS DENIED FREE CARE BECAUSE OF
A FAILED ASSET TEST FOR THE IDENTIFIED D ATE OF SERVICE.
(2) EACH HOSPITAL SHALL C REATE A WEBPAGE THAT INCLUDES:
(I) INFORMATION ABOUT THE REIMBURSEMENT PROVID ED IN
ACCORDANCE WITH THIS SECTION, INCLUDING THE PROCES S TO BE FOLLOWED BY
A PATIENT AND RELEVA NT TIMELINES; AND
(II) A TELEPHONE NUMBER AND E–MAIL ADDRESS THAT A
PATIENT MAY USE TO S UBMIT QUESTIONS ABOU T THE REIMBURSEMENT PROCESS
DEVELOPED UNDER THIS SECTION.
(3) IF A PATIENT IS ENTITLED TO A SINGLE REFU ND PER YEAR UNDER
SUBSECTION (A) OF THIS SECTION IN A N AMOUNT OF $25 OR LESS, THE HOSPITAL
MAY BUT IS NOT REQUI RED TO PROVIDE THE R EIMBURSEMENT .
Ch. 311 2023 LAWS OF MARYLAND
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[(b)] (D) (1) The Commission may modify the process developed under
subsection (a) of this section as necessary.
(2) IF REIMBURSEMENTS ARE PROVIDED INCREMENTAL LY AND LESS
THAN 10% 5% OF THE ESTIMATED REI MBURSEMENTS ARE MADE EACH YEAR DURING
THE FIRST INCREMENT , THE COMMISSION IS NOT REQ UIRED TO IMPLEMENT
ADDITIONAL INCREMENT S OF THE PROCESS .
(E) THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE
OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND
EACH HOSPITAL SHALL REPORT INFORMATION O N THE PROCESS DEVELO PED
UNDER THIS SECTION T O THE COMMISSION, IN THE TIME AND MANN ER
DETERMINED BY THE COMMISSION.
(F) (1) NOTWITHSTANDING ANY O THER PROVISION OF LAW, THE
COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE
OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, AND
EACH HOSPITAL SHALL DISCLOSE TO EACH:
(I) EACH OTHER, TO THE MINIMUM EXTEN T NECESSARY ,
RELEVANT INFORMATION , INCLUDING TAX INFORMAT ION, NECESSARY FOR
IMPLEMENTATION OF TH E PROCESS DEVELOPED UNDER SUBSECTION (A) OF THIS
SECTION; AND
(II) THE HEALTH EDUCATION AND ADVOCACY UNIT RELEVANT
INFORMATION NECESSAR Y FOR THE HEALTH EDUCATION AND ADVOCACY UNIT TO
ASSIST PATIENTS IN OBTAINING R EIMBURSEMENT UNDER S UBSECTION (A) OF THIS
SECTION, ON RECEIPT OF THE PA TIENT’S EXECUTED AUTHORIZA TION FOR RELEASE
OF MEDICAL INFORMATI ON FORM PROVIDED BY THE HEALTH EDUCATION AND
ADVOCACY UNIT OR OTHER AUTHORI ZATION FORM REQUIRED BY THE
DEPARTMENT OF HUMAN SERVICES, THE OFFICE OF THE COMPTROLLER , OR THE
STATE DEPARTMENT OF EDUCATION.
(2) IF THE HEALTH EDUCATION AND ADVOCACY UNIT REQUESTS
INFORMATION FROM THE COMMISSION, THE DEPARTMENT , THE DEPARTMENT OF
HUMAN SERVICES, THE OFFICE OF THE COMPTROLLER , THE STATE DEPARTMENT
OF EDUCATION, OR A HOSPITAL TO ASS IST A PATIENT IN OBT AINING
REIMBURSEMENT UNDER SUBSECTION (A) OF THIS SECTION, THE COMMISSION, THE
DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, THE OFFICE OF THE
COMPTROLLER , THE STATE DEPARTMENT OF EDUCATION, OR THE HOSPITAL
SHALL PROVIDE THE IN FORMATION TO THE HEALTH EDUCATION AND ADVOCACY
UNIT WITHIN 10 BUSINESS DAYS AFTER THE DATE OF THE RECE IPT OF THE
REQUEST. WES MOORE, Governor Ch. 311
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(2) (3) THIS SECTION MAY NOT BE CONSTRUED TO MAKE A
HOSPITAL RESPONSIBLE FOR THE CONFIDENTIALITY OF T HE INFORMATION IN
POSSESSION OF EACH STATE ENTITY LISTED I N PARAGRAPH (1) OF THIS
SUBSECTION.
[(c)] (G) (1) (I) On or before January 1, 2023, and [January 1] OCTOBER
1, 2024, the Commission shall report 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 and implementation by hospitals of the process
required under subsection (a) of this section.
[(2)] (II) If the process developed under subsection (a) of this section
requires legislation for implementation, the Commission shall include the legislative
recommendations in the report required on or before January 1, 2023, under [paragraph
(1)] SUBPARAGRAPH (I) of this [subsection] PARAGRAPH .
[(3)] (III) If the process established under subsection (a) of this section does
not require legislation, each hospital shall implement the process developed under
subsection (a) of this section on or before January 1, 2023.
(2) (I) SUBJECT TO SUBPARAGRA PH (II) OF THIS PARAGRAPH ,
EACH HOSPITAL THE COMMISSION, THE OFFICE OF THE COMPTROLLER , THE
DEPARTMENT , THE DEPARTMENT OF HUMAN SERVICES, AND THE STATE
DEPARTMENT OF EDUCATION SHALL IMPLE MENT OPTION 3 FROM THE “FREE
HOSPITAL CARE REFUND PROCESS” REPORT SUBMITTED BY THE COMMISSION IN
DECEMBER 2022 AS REQUIRED UNDER PA RAGRAPH (1)(I) OF THIS SUBSECTION A ND
IN ACCORDANCE WITH T HIS SECTION AND § 12–203(C) § 13–203(C) OF THE TAX –
GENERAL ARTICLE.
(II) UNDER THE PROCESS REQ UIRED UNDER SUBPARAGRAPH
(I) OF THIS PARAGRAPH , A PATIENT SHALL QUAL IFY FOR REFUNDS WHO PAID AN
OUT–OF–POCKET EXPENSE FOR S ERVICES BASED ON THE FOLLOWING:
1. THE OFFICE OF THE COMPTROLLER DETERMINI NG
THAT THE PATIENT ’S FAMILY INCOME WAS AT OR BELOW 200% OF THE FEDERAL
POVERTY LEVEL DURING THE YEAR OF SERVICE DATE OR DATES ; OR
2. THE DEPARTMENT OF HUMAN SERVICES, THE
DEPARTMENT , OR THE STATE DEPARTMENT OF EDUCATION DETERMINING THAT
DURING THE YEAR OF S ERVICE DATE OR DATES , THE PATIENT:
A. RECEIVED BENEFI TS THROUGH THE FEDER AL
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM; Ch. 311 2023 LAWS OF MARYLAND
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B. RECEIVED BENEFITS THR OUGH THE STATE’S
ENERGY ASSISTANCE PROGRAM;
C. RECEIVED BENEFITS THR OUGH THE FEDERAL
SPECIAL SUPPLEMENTAL FOOD PROGRAM FOR WOMEN, INFANTS, AND CHILDREN;
OR
D. LIVED IN A HOUSEHOLD WITH CHILDREN ENROLL ED
IN THE FREE AND REDU CED–COST MEAL PROGRAM .
(3) THE OFFICE OF THE COMPTROLLER , THE DEPARTMENT OF
HUMAN SERVICES, THE DEPARTMENT , THE STATE DEPARTMENT OF EDUCATION,
THE COMMISSION, AND EACH HOSPITAL MA Y NOT IMPLEMENT THE ALTERNATIVE
APPROACH INCLUDED WI TH OPTION 3 IN THE REPORT IDENTI FIED UNDER
PARAGRAPH (2)(I) OF THIS SUBSECTION .
(H) (1) EACH HOSPITAL SHALL R EIMBURSE THE COMMISSION, THE
OFFICE OF THE COMPTROLLER , THE DEPARTMENT , THE DEPARTMENT OF HUMAN
SERVICES, THE STATE DEPARTMENT OF EDUCATION, AND THE HEALTH
EDUCATION ADVOCACY UNIT IN THE OFFICE OF THE ATTORNEY GENERAL FOR THE
COSTS INCURRED BY EA CH STATE ENTITY IN COMPL YING WITH THIS SECTI ON.
(2) (I) REIMBURSEMENT REQUIRE D UNDER PARAGRAPH (1) OF
THIS SUBSECTION SHAL L BE BASED ON THE HO SPITAL’S PROPORTION OF THE TOTAL
NUMBER OF PATIENTS W HO WERE IDENTIFIED B Y THE STATE ENTITY AS
POTENTIALLY ELIGIBLE FOR REIMBURSEMENT IN A DESIGNATED YEAR , AS
DETERMINED BY THE COMMISSION.
(II) FOR THE PURPOSE OF DETERMINING THE R EIMBURSEMENT
DUE UNDER SUBPARAGRA PH (I) OF THIS PARAGRAPH , THE STATE ENTITIES
IDENTIFIED UNDER PAR AGRAPH (1) OF THIS SUBSECTION S HALL PROVIDE
QUARTERLY COST INFOR MATION TO THE COMMISSION.
(3) THE COMMISSION SHALL PROV IDE EACH HOSPITA L WITH THE
REIMBURSEMENT AMOUNT DUE TO THE APPROPRIA TE STATE ENTITY BASED ON THE
COSTS INCURRED BY TH E ENTITY IN COMPLYIN G WITH THIS SECTION .
(I) (1) (I) IF A HOSPITAL FAILS T O PROVIDE REFUNDS TO PATIENTS
WHO QUALIFY UNDER SU BSECTION (G)(2) OF THIS SECTION AS REQUIRED , THE
COMMISSION MAY IMPOSE A FINE NOT EXCEEDING $50,000 PER VIOLATION.
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(II) IN DETERMINING THE AM OUNT OF A FINE TO BE IMPOSED
UNDER SUBPARAGRAPH (I) OF THIS PARAGRAPH , THE COMMISSION SHALL
CONSIDER THE APPROPR IATENESS OF THE FINE IN RELATION TO THE SEVE RITY OF
THE VIOLATION.
(2) A VIOLATION OF THIS SE CTION BY A HOSPITAL IS:
(I) AN UNFAIR, ABUSIVE, OR DECEPTIVE TRADE P RACTICE, AS
DEFINED UNDER TITLE 13 OF THE COMMERCIAL LAW ARTICLE; AND
(II) SUBJECT TO ENFORCEMEN T AND PENAL TY PROVISIONS OF
TITLE 13 OF THE COMMERCIAL LAW ARTICLE.
Article – Tax – General
13–203.
(c) Tax information may be disclosed to:
(1) an employee or officer of the State who, by reason of that employment
or office, has the right to the tax information;
(2) another tax collector;
(3) the Maryland Tax Court;
(4) a legal representative of the State, to review the tax information about
a taxpayer:
(i) who applies for review under this title;
(ii) who appeals from a determination under this title; or
(iii) against whom an action to recover tax or a penalty is pending or
will be initiated under this title;
(5) any license issuing authority of the State required by State law to verify
through the Comptroller that an applicant has paid all undisputed taxes and
unemployment insurance contributions payable to the Comptroller or the Secretary of
Labor or that the applicant has provided for payment in a manner satisfactory to the unit
responsible for collection;
(6) a local official as defined in § 13–925 of this title to the extent necessary
to administer Subtitle 9, Part V of this title;
Ch. 311 2023 LAWS OF MARYLAND
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(7) a federal official as defined in § 13–930 of this title to the extent
necessary to administer Subtitle 9, Part VI of this title;
(8) the Maryland Department of Health in accordance with the federal
Children’s Health Insurance Program Reauthorization Act of 2009;
(9) the State Board of Individual Tax Preparers;
(10) the Alcohol and Tobacco Commission;
(11) the Maryland 9–1–1 Board; [and]
(12) a person or governmental entity authorized by the Comptroller in
writing to receive tax information for the purpose of identifying, preventing, or responding
to fraud, provided that the tax information is:
(i) anonymized to the extent pos sible consistent with the
information’s intended use; and
(ii) in addition to any other protections and safeguards under law,
subject to any protections and safeguards set forth by the Comptroller in the written
authorization; [and]
(13) the Maryland Higher Education Commission; AND
(14) A HOSPITAL, THE HEALTH SERVICES COST REVIEW COMMISSION,
THE DEPARTMENT OF HUMAN SERVICES, THE MARYLAND DEPARTMENT OF
HEALTH, AND THE STATE DEPARTMENT OF EDUCATION, TO THE EXTENT
NECESSARY TO ADMINIS TER § 19–214.4 OF THE HEALTH – GENERAL ARTICLE.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect July
1, 2023. It shall remain effective until the taking effect of the termination provision
specified in Section 2 of Chapter 683 of the Acts of the General Assembly of 2022. If that
termination provision takes effect, this Act shall be abrogated and of no further force and
effect. This Act may not be interpreted to have any effect on that termination provision.
Approved by the Governor, May 3, 2023.