(a)    (1)    In this section the following words have the meanings indicated.

(2)    “Financial hardship” means medical debt, incurred by a family over a 12–month period, that exceeds 25% of family income.

(3)    “Medical debt” means out–of–pocket expenses, excluding co–payments, coinsurance, and deductibles, for medical costs billed by a hospital.

(b)    (1)    The Commission shall require each acute care hospital and each chronic care hospital in the State under the jurisdiction of the Commission to develop a financial assistance policy for providing free and reduced–cost care to patients who lack health care coverage or whose health care coverage does not pay the full cost of the hospital bill.

(2)    The financial assistance policy shall provide, at a minimum:

(i)    Free medically necessary care to patients with family income at or below 150% of the federal poverty level; and

(ii)    Reduced–cost medically necessary care to low–income patients with family income above 150% of the federal poverty level, in accordance with the mission and service area of the hospital.

(3)    (i)    The Commission by regulation may establish income thresholds higher than those under paragraph (2) of this subsection.

(ii)    In establishing income thresholds that are higher than those under paragraph (2) of this subsection for a hospital, the Commission shall take into account:

1.    The patient mix of the hospital;

2.    The financial condition of the hospital;

3.    The level of bad debt experienced by the hospital; and

4.    The amount of charity care provided by the hospital.

(4)    (i)    Subject to subparagraphs (ii) and (iii) of this paragraph, the financial assistance policy required under this subsection shall provide reduced–cost medically necessary care to patients with family income below 500% of the federal poverty level who have a financial hardship.

(ii)    A hospital may seek and the Commission may approve a family income threshold that is different than the family income threshold under subparagraph (i) of this paragraph.

(iii)    In establishing a family income threshold that is different than the family income threshold under subparagraph (i) of this paragraph, the Commission shall take into account:

1.    The median family income in the hospital’s service area;

2.    The patient mix of the hospital;

3.    The financial condition of the hospital;

4.    The level of bad debt experienced by the hospital;

5.    The amount of charity care provided by the hospital; and

6.    Other relevant factors.

(5)    If a patient is eligible for reduced–cost medically necessary care under paragraphs (2)(ii) and (4) of this subsection, the hospital shall apply the reduction that is most favorable to the patient.

(6)    If a patient has received reduced–cost medically necessary care due to a financial hardship, the patient or any immediate family member of the patient living in the same household:

(i)    Shall remain eligible for reduced–cost medically necessary care when seeking subsequent care at the same hospital during the 12–month period beginning on the date on which the reduced–cost medically necessary care was initially received; and

(ii)    To avoid an unnecessary duplication of the hospital’s determination of eligibility for free and reduced–cost care, shall inform the hospital of the patient’s or family member’s eligibility for the reduced–cost medically necessary care.

(c)    A hospital shall post a notice in conspicuous places throughout the hospital, including the billing office, informing patients of their right to apply for financial assistance and who to contact at the hospital for additional information.

(d)    The Commission shall:

(1)    Develop a uniform financial assistance application; and

(2)    Require each hospital to use the uniform financial assistance application to determine eligibility for free and reduced–cost care under the hospital’s financial assistance policy.

(e)    The uniform financial assistance application:

(1)    Shall be written in simplified language; and

(2)    May not require documentation that presents an undue barrier to a patient’s receipt of financial assistance.

(f)    (1)    Each hospital shall develop an information sheet that:

(i)    Describes the hospital’s financial assistance policy;

(ii)    Describes a patient’s rights and obligations with regard to hospital billing and collection under the law;

(iii)    Provides contact information for the individual or office at the hospital that is available to assist the patient, the patient’s family, or the patient’s authorized representative in order to understand:

1.    The patient’s hospital bill;

2.    The patient’s rights and obligations with regard to the hospital bill;

3.    How to apply for free and reduced–cost care; and

4.    How to apply for the Maryland Medical Assistance Program and any other programs that may help pay the bill;

(iv)    Provides contact information for the Maryland Medical Assistance Program; and

(v)    Includes a statement that physician charges are not included in the hospital bill and are billed separately.

(2)    The information sheet shall be provided to the patient, the patient’s family, or the patient’s authorized representative:

(i)    Before discharge;

(ii)    With the hospital bill; and

(iii)    On request.

(3)    The hospital bill shall include a reference to the information sheet.

(4)    The Commission shall:

(i)    Establish uniform requirements for the information sheet; and

(ii)    Review each hospital’s implementation of and compliance with the requirements of this subsection.

(g)    Each hospital shall ensure the availability of staff who are trained to work with the patient, the patient’s family, and the patient’s authorized representative in order to understand:

(1)    The patient’s hospital bill;

(2)    The patient’s rights and obligations with regard to the hospital bill, including the patient’s rights and obligations with regard to reduced–cost medically necessary care due to a financial hardship;

(3)    How to apply for the Maryland Medical Assistance Program and any other programs that may help pay the hospital bill; and

(4)    How to contact the hospital for additional assistance.