9.4.3.13 Maryland

Maryland’s medical debtor protection law requires hospitals to develop financial assistance policies for providing free and reduced-cost care to uninsured and underinsured patients.⁶⁰² These financial assistance policies must provide for free medically necessary care to patients with family incomes at or below 200% of the federal poverty level,⁶⁰³ and reduced-cost medically necessary care to low-income patients with family incomes above 150% of federal poverty.⁶⁰⁴ The Maryland Health Services Cost Review Commission (Commission) has the authority to establish higher income thresholds by regulation.⁶⁰⁵

The Maryland law requires hospitals to develop and distribute an information sheet that describes the hospital’s financial assistance policy. The information sheet must include contact information for the hospital department that assists patients with applying for charity care, contact information for the state Medicaid program, and an explanation that physician charges are billed separately.⁶⁰⁶ The hospital must post its financial assistance policy throughout the hospital and ensure the availability of staff who are trained to assist patients on billing issues and applying for charity care.⁶⁰⁷ The Maryland law also requires the Commission to develop a uniform financial assistance application to be used by hospitals.⁶⁰⁸

The Maryland law requires hospitals to develop a debt collection policy and submit to the policy to the Commission.⁶⁰⁹ Critically, the debt collection policy must prohibit the hospital from selling its debt.⁶¹⁰ The debt collection policy must prohibit the hospital from charging interest to “self-pay” patients before a court judgment is obtained.⁶¹¹ A hospital’s debt collection policy must describe the hospital’s collection procedures—including when the hospital will initiate a collection lawsuit—and must require active oversight by the hospital of debt collection contracts.⁶¹²

The Maryland law also requires hospitals to provide a review process for denials of free care,⁶¹³ requires refunds and correction of any adverse credit reporting for patients and guarantors if patients are found to be eligible for free care,⁶¹⁴ forbids foreclosure on a patient’s primary residence for a hospital debt (although a lien is permitted),⁶¹⁵ forbids adverse credit reports for 120 days after the issuance of a bill,⁶¹⁶ and sets standards for hospitals’ oversight of their collection agencies.⁶¹⁷