Md. Code, Health Occupations § 19-202 — MD Code / Article gho / Title 19 / Subtitle 2 / Section 19-202
§19–202.
Status: in_force

(a) (1) The Board consists of 12 members.

(2) Of the 12 Board members:

(i) 10 shall be licensed social workers of whom:

1. Subject to paragraph (3) of this subsection, 1 is a licensed bachelor social worker;

2. Subject to paragraph (3) of this subsection, 1 is a licensed master social worker at the time of appointment;

3. Subject to paragraph (3) of this subsection, at least 1 is:

A. A licensed certified social worker; or

B. A licensed master social worker who is approved for independent practice;

4. Subject to paragraph (3) of this subsection, at least 4 are licensed certified social workers–clinical;

5. 1 is a licensed social worker employed by the Department of Human Services; and

6. Subject to paragraph (3) of this subsection, 1 is a licensed social worker who is:

A. Primarily engaged in social worker education at a social work program accredited by the Council on Social Work Education; and

B. Nominated from a list of names submitted by the deans and directors of the Maryland Social Work Education Programs; and

(ii) 2 shall be consumer members.

(3) If a licensee of the specified license category is not appointed to the Board under paragraph (2)(i) of this subsection within 3 months of a vacancy, a licensee of any license category shall be appointed immediately if that licensee is qualified to be a member of the Board under subsections (b) and (d) of this section.

(4) The Governor shall appoint all members of the Board with the advice of the Secretary and the advice and consent of the Senate.

(5) The Governor shall appoint all social work members of the Board from a list of nominees containing names submitted by:

(i) Professional social work associations in the State;

(ii) Any person who provides a statement of nomination signed by at least 15 social workers licensed in the State;

(iii) The secretaries of public agencies of the State where social workers are employed; or

(iv) The corporate executive officers or executive directors of private organizations where social workers are employed.

(b) Each member of the Board shall be a resident of this State.

(c) Each consumer member of the Board:

(1) Shall be a member of the general public;

(2) May not be or ever have been a social worker or in training to become a social worker;

(3) May not have a household member who is a social worker or in training to become a social worker;

(4) May not participate or ever have participated in a commercial or professional field related to social work;

(5) May not have a household member who participates in a commercial or professional field related to social work; and

(6) May not have had within 2 years before appointment a substantial financial interest in a person regulated by the Board or a person that employs a person regulated by the Board.

(d) Except for a licensed bachelor social worker member or a licensed master social worker member, each social worker member of the Board shall have been licensed in the State for 5 years immediately preceding the appointment and actively employed in the field of social work for at least 3 of the 5 years immediately preceding the appointment.

(e) While a member of the Board, a consumer member may not have a substantial financial interest in a person regulated by the Board or a person that employs a person regulated by the Board.

(f) Before taking office, each appointee to the Board shall take the oath required by Article I, § 9 of the Maryland Constitution.

(g) (1) The term of a member is 4 years.

(2) The terms of members are staggered.

(3) At the end of a term, a member continues to serve until a successor is appointed and qualifies.

(4) A member who is appointed after a term has begun serves only for the rest of the term and until a successor is appointed and qualifies.

(5) (i) Except as provided in subparagraph (ii) of this paragraph, a member may not serve more than 2 consecutive full terms.

(ii) A licensed social worker member who is nominated in accordance with subsection (a)(2)(i)6B of this section may not serve more than 1 full term.

(6) To the extent practicable, the Governor shall fill any vacancy on the Board within 60 days of the date of the vacancy.

(h) (1) The Governor may remove a member for incompetence, misconduct, or neglect of duty.

(2) Upon the recommendation of the Secretary, the Governor may remove a member whom the Secretary finds to have been absent from 2 successive Board meetings without adequate reason.
Md. Code, Health - General § 19-120 — MD Code / Article ghg / Title 19 / Subtitle 1 / Section 19-120
§19–120.
Status: reserved

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

(2) “Consolidation” and “merger” include increases and decreases in bed capacity or services among the components of an organization that:

(i) Operates more than one health care facility; or

(ii) Operates one or more health care facilities and holds an outstanding certificate of need to construct a health care facility.

(3) (i) “Health care service” means any clinically related patient service.

(ii) “Health care service” includes a medical service.

(4) “Hospital capital threshold” means the lesser of:

(i) 25% of the hospital’s gross regulated charges for the immediately preceding year; or

(ii) $50,000,000.

(5) “Limited service hospital” means a health care facility that:

(i) Is licensed as a hospital on or after January 1, 1999;

(ii) Changes the type or scope of health care services offered by eliminating the facility’s capability to admit or retain patients for overnight hospitalization;

(iii) Retains an emergency or urgent care center; and

(iv) Complies with the regulations adopted by the Secretary under § 19–307.1 of this title.

(6) “Medical service” means:

(i) Any of the following categories of health care services:

1. Medicine, surgery, gynecology, addictions;

2. Obstetrics;

3. Pediatrics;

4. Psychiatry;

5. Rehabilitation;

6. Chronic care;

7. Comprehensive care;

8. Extended care;

9. Intermediate care; or

10. Residential treatment; or

(ii) Any subcategory of the rehabilitation, psychiatry, comprehensive care, or intermediate care categories of health care services for which need is projected in the State health plan.

(b) The Commission may set an application fee for a certificate of need for health care facilities not assessed a user fee under this subtitle.

(c) The Commission shall adopt rules and regulations for applying for and issuing certificates of need.

(d) The Commission may adopt, after October 1, 1983, new thresholds or methods for determining the circumstances or minimum cost requirements under which a certificate of need application must be filed.

(e) (1) A person shall have a certificate of need issued by the Commission before the person develops, operates, or participates in any of the health care projects for which a certificate of need is required under this section.

(2) A certificate of need issued before January 13, 1987, may not be rendered wholly or partially invalid solely because certain conditions have been imposed, if an appeal concerning the certificate of need, challenging the power of the Commission to impose certain conditions on a certificate of need, has not been noted by an aggrieved party before January 13, 1987.

(f) Except as provided in subsection (g)(2)(iii) of this section, a certificate of need is required before a new health care facility is built, developed, or established.

(g) (1) A certificate of need is required before an existing or previously approved, but unbuilt, health care facility is moved to another site.

(2) This subsection does not apply if:

(i) The Commission adopts limits for relocations and the proposed relocation does not exceed those limits;

(ii) The relocation is the result of a partial or complete replacement of an existing hospital or related institution, as defined in § 19–301 of this title, and the relocation is to another part of the site or immediately adjacent to the site of the existing hospital or related institution;

(iii) Subject to the provisions of subsections (i) and (j) of this section, the relocation is of an existing health care facility owned or controlled by a merged asset system and is to:

1. A site within the primary service area of the health care facility to be relocated if:

A. The proposed relocation is not across county boundaries; and

B. At least 45 days prior to the proposed relocation, notice is filed with the Commission;

2. A site outside the primary service area of the health care facility to be relocated but within the primary service area of the merged asset system if:

A. At least 45 days prior to the proposed relocation, notice is filed with the Commission; and

B. The Commission in its sole discretion, and in accordance with the criteria adopted by regulation, finds that the relocation is in the public interest, is not inconsistent with the State health plan, and will result in the more efficient and effective delivery of health care services; or

3. For a limited service hospital, a site within the immediate area as defined in regulation by the Commission; or

(iv) The relocation involves moving a portion of a complement of comprehensive care beds previously approved by the Commission after January 1, 1995, for use in a proposed new related institution, as defined in § 19–301 of this title, but unbuilt on October 1, 1998, if:

1. The comprehensive care beds that were originally approved by the Commission in a prior certificate of need review were approved for use in a proposed new related institution to be located in a municipal corporation within Carroll County in which a related institution is not located;

2. The comprehensive care beds being relocated will be used to establish an additional new related institution that is located in another municipal corporation within Carroll County in which a related institution is not located;

3. The comprehensive care beds not being relocated are intended to be used to establish a related institution on the original site; and

4. Both the previously approved comprehensive care beds for use on the original site and the relocated comprehensive care beds for use on the new site will be used as components of single buildings on each site that also offer independent or assisted living residential units.

(3) Notwithstanding any other provision of this subtitle, a certificate of need is not required for a relocation described under paragraph (2)(iv) of this subsection.

(h) (1) A certificate of need is required before the bed capacity of a health care facility is changed.

(2) This subsection does not apply to any increase or decrease in bed capacity if:

(i) For a health care facility that is not a hospital, during a 2–year period the increase or decrease would not exceed the lesser of 10 percent of the total bed capacity or 10 beds;

(ii) 1. The increase or decrease would change the bed capacity for an existing medical service; and

2. A. The change would not increase total bed capacity;

B. The change is maintained for at least a 1–year period; and

C. At least 45 days prior to the change, the hospital provides written notice to the Commission describing the change and providing an updated inventory of the hospital’s licensed bed complement;

(iii) 1. At least 45 days before increasing or decreasing bed capacity, written notice of intent to change bed capacity is filed with the Commission;

2. The Commission in its sole discretion finds that the proposed change:

A. Is pursuant to the consolidation or merger of two or more health care facilities, or conversion of a health care facility or part of a facility to a nonhealth–related use;

B. Is not inconsistent with the State health plan or the institution–specific plan developed by the Commission;

C. Will result in the delivery of more efficient and effective health care services; and

D. Is in the public interest; and

3. Within 45 days of receiving notice, the Commission notifies the health care facility of its finding;

(iv) The increase or decrease in bed capacity is the result of the annual licensed bed recalculation provided under § 19–307.2 of this title; or

(v) 1. The increase or decrease in bed capacity will occur in:

A. An intermediate care facility that offers residential or intensive substance–related disorder treatment services and has a current license issued by the Secretary; or

B. An existing general hospice program that has a current license issued by the Secretary; and

2. At least 45 days before increasing or decreasing bed capacity, written notice of the intent to change bed capacity is filed with the Commission.

(i) (1) Except as provided in paragraph (2) of this subsection, for a hospital located in a county with three or more hospitals, a certificate of need is not required before the bed capacity is increased or decreased if the change:

(i) Occurs on or after July 1, 2000;

(ii) Is between hospitals in a merged asset system located within the same health service area;

(iii) Does not involve comprehensive or extended care beds; and

(iv) Does not occur earlier than 45 days after a notice of intent to reallocate bed capacity is filed with the Commission.

(2) A hospital may not create a new health care service through the relocation of beds from one county to another county pursuant to this subsection.

(j) (1) A certificate of need is required before the type or scope of any health care service is changed if the health care service:

(i) Is offered:

1. By a health care facility;

2. In space that is leased from a health care facility; or

3. In space that is on land leased from a health care facility; or

(ii) Results in a change in operating room capacity in a hospital, a freestanding medical facility, or an ambulatory surgical facility.

(2) This subsection does not apply if:

(i) The Commission adopts limits for changes in health care services and the proposed change would not exceed those limits;

(ii) The proposed change and the annual operating revenue that would result from the addition is entirely associated with the use of medical equipment;

(iii) The proposed change would establish, increase, or decrease a health care service and the change would not result in the:

1. Establishment of a new medical service or elimination of an existing medical service;

2. Establishment of a cardiac surgery, organ transplant surgery, or burn or neonatal intensive health care service;

3. Except as provided in § 19–120.1 of this subtitle, establishment of percutaneous coronary intervention services;

4. Establishment of a home health program, hospice program, or freestanding ambulatory surgical center or facility; or

5. Expansion of a comprehensive care, extended care, intermediate care, residential treatment, psychiatry, or rehabilitation medical service, except for an expansion related to an increase in total bed capacity in accordance with subsection (h)(2)(i) of this section; or

(iv) 1. At least 45 days before increasing or decreasing the volume of one or more health care services, written notice of intent to change the volume of health care services is filed with the Commission;

2. The Commission in its sole discretion finds that the proposed change:

A. Is pursuant to:

I. The consolidation or merger of two or more health care facilities;

II. The conversion of a health care facility or part of a facility to a nonhealth–related use;

III. The conversion of a hospital to a limited service hospital; or

IV. The conversion of a licensed general hospital to a freestanding medical facility in accordance with subsection (o)(3) of this section;

B. Is not inconsistent with the State health plan or the institution–specific plan developed and adopted by the Commission;

C. Will result in the delivery of more efficient and effective health care services; and

D. Is in the public interest; and

3. Within 45 days of receiving notice under item 1 of this item, the Commission notifies the health care facility of its finding.

(3) Notwithstanding the provisions of paragraph (2) of this subsection, a certificate of need is required:

(i) Before an additional home health agency, branch office, or home health care service is established by an existing health care agency or facility;

(ii) Before an existing home health agency or health care facility establishes a home health agency or home health care service at a location in the service area not included under a previous certificate of need or license;

(iii) Before a transfer of ownership of any branch office of a home health agency or home health care service of an existing health care facility that separates the ownership of the branch office from the home health agency or home health care service of an existing health care facility which established the branch office; or

(iv) Before the expansion of a home health service or program by a health care facility that:

1. Established the home health service or program without a certificate of need between January 1, 1984, and July 1, 1984; and

2. During a 1–year period, the annual operating revenue of the home health service or program would be greater than $333,000 after an annual adjustment for inflation, based on an appropriate index specified by the Commission.

(k) (1) A certificate of need is required before any of the following capital expenditures are made by or on behalf of a hospital:

(i) Any expenditure that, under generally accepted accounting principles, is not properly chargeable as an operating or maintenance expense, if:

1. The expenditure is made as part of an acquisition, improvement, or expansion, and, after adjustment for inflation as provided in the regulations of the Commission, the total expenditure, including the cost of each study, survey, design, plan, working drawing, specification, and other essential activity, is more than the hospital capital threshold;

2. The expenditure is made as part of a replacement of any plant and equipment of the hospital and is more than the hospital capital threshold after adjustment for inflation as provided in the regulations of the Commission;

3. The expenditure results in a substantial change in the bed capacity of the hospital; or

4. The expenditure results in the establishment of a new medical service in a hospital that would require a certificate of need under subsection (i) of this section; or

(ii) Any expenditure that is made to lease or, by comparable arrangement, obtain any plant or equipment for the hospital, if:

1. The expenditure is made as part of an acquisition, improvement, or expansion, and the total expenditure, including the cost of each study, survey, design, plan, working drawing, specification, and other essential activity, is more than the hospital capital threshold;

2. The expenditure is made as part of a replacement of any plant and equipment and is more than the hospital capital threshold after adjustment for inflation as provided in the regulations of the Commission;

3. The expenditure results in a substantial change in the bed capacity of the hospital; or

4. The expenditure results in the establishment of a new medical service in a hospital that would require a certificate of need under subsection (i) of this section.

(2) A certificate of need is required before any of the following capital expenditures are made by or on behalf of a health care facility other than a hospital:

(i) Any expenditure that, under generally accepted accounting principles, is not properly chargeable as an operating or maintenance expense, if:

1. The expenditure results in a substantial change in the bed capacity of the health care facility other than a hospital; or

2. The expenditure results in the establishment of a new medical service in a health care facility other than a hospital that would require a certificate of need under subsection (i) of this section; or

(ii) Any expenditure that is made to lease or, by comparable arrangement, obtain any plant or equipment for the health care facility other than a hospital, if:

1. The expenditure results in a substantial change in the bed capacity of the health care facility other than a hospital; or

2. The expenditure results in the establishment of a new medical service in a health care facility other than a hospital that would require a certificate of need under subsection (i) of this section.

(3) A certificate of need is required before any equipment or plant is donated to a health care facility, if a certificate of need would be required under paragraph (1) or (2) of this subsection for an expenditure by the health care facility to acquire the equipment or plant directly.

(4) A certificate of need is required before any equipment or plant is transferred to a health care facility at less than fair market value if a certificate of need would be required under paragraph (1) or (2) of this subsection for the transfer at fair market value.

(5) A certificate of need is required before a person acquires a health care facility if a certificate of need would be required under paragraph (1) or (2) of this subsection for the acquisition by or on behalf of the health care facility.

(6) This subsection does not apply to:

(i) Site acquisition;

(ii) An acquisition of a health care facility if:

1. At least 30 days before making the contractual arrangement to acquire the facility, written notice of the intent to make the arrangement is filed with the Commission and the Commission does not find, within 30 days after the Commission receives notice, that the health services or bed capacity of the facility will be changed, provided that, for a merger with or acquisition of an existing general hospice, the purchaser of the general hospice may only acquire the authority to provide home–based hospice services in jurisdictions in which the seller of the general hospice is licensed to provide home–based hospice services; and

2. For an acquisition of a nursing home, the acquisition has been approved in accordance with § 19–120.2 of this subtitle;

(iii) Acquisition of business or office equipment that is not directly related to patient care;

(iv) Capital expenditures to the extent that they are directly related to the acquisition and installation of major medical equipment;

(v) A capital expenditure made as part of a consolidation or merger of two or more health care facilities, or conversion of a health care facility or part of a facility to a nonhealth–related use if:

1. At least 45 days before an expenditure is made, written notice of intent is filed with the Commission;

2. Within 45 days of receiving notice, the Commission in its sole discretion finds that the proposed consolidation, merger, or conversion:

A. Is not inconsistent with the State health plan or the institution–specific plan developed by the Commission as appropriate;

B. Will result in the delivery of more efficient and effective health care services; and

C. Is in the public interest; and

3. Within 45 days of receiving notice, the Commission notifies the health care facility of its finding;

(vi) A capital expenditure by a nursing home for equipment, construction, or renovation that:

1. Is not directly related to patient care; and

2. Is not directly related to any change in patient charges or other rates;

(vii) A capital expenditure by a hospital, as defined in § 19–301 of this title, for equipment, construction, or renovation that:

1. Is not directly related to patient care; and

2. Does not increase patient charges or hospital rates;

(viii) A capital expenditure by a hospital, as defined in § 19–301 of this title, for a project in excess of the hospital capital threshold and is for construction or renovation that:

1. May be related to patient care;

2. Does not require, over the entire period or schedule of debt service associated with the project, a total cumulative increase in patient charges or hospital rates of more than $1,500,000 for the capital costs associated with the project as determined by the Commission, after consultation with the Health Services Cost Review Commission;

3. At least 45 days before the proposed expenditure is made, the hospital notifies the Commission;

4. A. Within 45 days of receipt of the relevant financial information, the Commission makes the financial determination required under item 2 of this item; or

B. The Commission has not made the financial determination required under item 2 of this item within 60 days of the receipt of the relevant financial information; and

5. The relevant financial information to be submitted by the hospital is defined in regulations adopted by the Commission, after consultation with the Health Services Cost Review Commission;

(ix) A plant donated to a hospital, as defined in § 19–301 of this title, that does not require a cumulative increase in patient charges or hospital rates of more than $1,500,000 for capital costs associated with the donated plant as determined by the Commission, after consultation with the Health Services Cost Review Commission, if:

1. At least 45 days before the proposed donation is made, the hospital notifies the Commission;

2. A. Within 45 days of receipt of the relevant financial information, the Commission makes the financial determination required under this item (ix) of this paragraph; or

B. The Commission has not made the financial determination required under this item (ix) of this paragraph within 60 days of the receipt of the relevant financial information; and

3. The relevant financial information to be submitted by the hospital is defined in regulations adopted by the Commission after consultation with the Health Services Cost Review Commission; or

(x) A capital expenditure made as part of a conversion of a licensed general hospital to a freestanding medical facility in accordance with subsection (o)(3) of this section.

(7) Paragraph (6)(vi), (vii), (viii), (ix), and (x) of this subsection may not be construed to permit a facility to offer a new health care service for which a certificate of need is otherwise required.

(l) (1) A certificate of need is not required to close any health care facility or part of a health care facility if at least 90 days before the closing or if at least 45 days before the partial closing of the health care facility, including a State hospital, a person proposing to close all or part of the health care facility files notice of the proposed closing or partial closing with the Commission.

(2) A hospital shall hold a public informational hearing in the county where the hospital is located if the hospital:

(i) Files a notice of the proposed closing of the hospital with the Commission;

(ii) Requests an exemption from the Commission under subsection (o)(3) of this section to convert to a freestanding medical facility; or

(iii) Is located in a county with fewer than three hospitals and files a notice of the partial closing of the hospital with the Commission.

(3) The Commission may require a health care facility other than a hospital described in paragraph (2) of this subsection that files notice of its proposed closing or partial closing to hold a public informational hearing in the county where the health care facility is located.

(4) A public informational hearing required under paragraph (2) or (3) of this subsection shall be held by the health care facility, in consultation with the Commission, within 30 days after:

(i) The health care facility files with the Commission a notice of its proposed closing or partial closing; or

(ii) The hospital files with the Commission a notice of intent to convert to a freestanding medical facility.

(5) (i) The Commission shall establish by regulation requirements for a public informational hearing required under paragraph (2) or (3) of this subsection.

(ii) For a hospital proposing to close, partially close, or convert to a freestanding medical facility, the regulations shall require the hospital to address:

1. The reasons for the closure, partial closure, or conversion;

2. The plan for transitioning acute care services previously provided by the hospital to residents of the hospital service area;

3. The plan for addressing the health care needs of the residents of the hospital service area;

4. The plan for retraining and placing displaced employees;

5. The plan for the hospital’s physical plant and site; and

6. The proposed timeline for the closure, partial closure, or conversion to a freestanding medical facility.

(6) Within 10 working days after a public informational hearing held by a hospital under this subsection, the hospital shall provide a written summary of the hearing to:

(i) The Governor;

(ii) The Secretary;

(iii) The governing body of the county in which the hospital is located;

(iv) The local health department and the local board of health or similar body for the county in which the hospital is located;

(v) The Commission; and

(vi) Subject to § 2–1257 of the State Government Article, the Senate Finance Committee, the House Health and Government Operations Committee, and the members of the General Assembly who represent the district in which the hospital is located.

(m) (1) Notwithstanding any other provision of this section, the Commission shall consider the special needs and circumstances of a county where a medical service, as defined in this section, does not exist; and

(2) The Commission shall consider and may approve under this subsection a certificate of need application to establish, build, operate, or participate in a health care project to provide a new medical service in a county if the Commission, in its sole discretion, finds that:

(i) The proposed medical service does not exist in the county that the project would be located;

(ii) The proposed medical service is necessary to meet the health care needs of the residents of that county;

(iii) The proposed medical service would have a positive impact on the existing health care system;

(iv) The proposed medical service would result in the delivery of more efficient and effective health care services to the residents of that county; and

(v) The application meets any other standards or regulations established by the Commission to approve applications under this subsection.

(n) The Commission may not issue a certificate of need or a determination with respect to an acquisition that authorizes a general hospice to provide home–based hospice services on a statewide basis.

(o) (1) Except as provided in paragraphs (2) and (3) of this subsection, a person shall have a certificate of need issued by the Commission before a person establishes or operates a freestanding medical facility.

(2) A certificate of need is not required for the establishment or operation of a freestanding medical facility pilot project established under § 19–3A–07 of this title.

(3) (i) A certificate of need is not required to establish or operate a freestanding medical facility if:

1. The freestanding medical facility is established as the result of the conversion of a licensed general hospital;

2. Through the conversion, the licensed general hospital will eliminate the capability of the hospital to admit or retain patients for overnight hospitalization, except for observation stays;

3. Except as provided in subparagraph (ii) of this paragraph, the freestanding medical facility will remain on the site of, or on a site adjacent to, the licensed general hospital;

4. At least 60 days before the conversion, written notice of intent to convert the licensed general hospital to a freestanding medical facility is filed with the Commission;

5. The Commission in its sole discretion finds that the conversion:

A. Is consistent with the State health plan;

B. Will result in the delivery of more efficient and effective health care services;

C. Will maintain adequate and appropriate delivery of emergency care within the statewide emergency medical services system as determined by the State Emergency Medical Services Board; and

D. Is in the public interest; and

6. Within 60 days after receiving notice under item 4 of this subparagraph, the Commission notifies the licensed general hospital of the Commission’s findings.

(ii) The Commission may approve a site for a freestanding medical facility that is not on the site of, or on a site adjacent to, the licensed general hospital if:

1. The licensed general hospital is:

A. The only hospital in the county; or

B. One of two hospitals in the county that are part of the same merged asset system, and are the only two hospitals in the county; and

2. The site is within a 5–mile radius and in the primary service area of the licensed general hospital.

(iii) Notwithstanding subparagraph (i) of this paragraph, a licensed general hospital located in Kent County may not convert to a freestanding medical facility in accordance with subparagraph (i) of this paragraph before July 1, 2020.
Md. Code, Health - General § 19-308.4 — MD Code / Article ghg / Title 19 / Subtitle 3 / Section 19-308.4
§19–308.
Status: in_force

§19–308.4.

(a) Each hospital or nursing facility in the State shall ensure that its employees and any other individuals who provide a health care service within or on the premises of the hospital or nursing facility wear a personal identification tag, except where inappropriate for medical reasons, that indicates in readable text:

(1) The first name, nickname, last name, or full name of the individual that is commonly used in the hospital or nursing facility; and

(2) The professional or other title of the individual.

(b) The Secretary may impose a fine not to exceed $25 per violation of this section.
Md. Code, Health - General § 19-2201 — MD Code / Article ghg / Title 19 / Subtitle 22 / Section 19-2201
§19–2201.
Status: in_force

§19–2201. IN EFFECT

(a) In this section, “Fund” means the Community Health Resources Commission Fund.

(b) There is a Community Health Resources Commission Fund.

(c) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.

(2) The Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.

(d) The Fund consists of:

(1) Money collected from a nonprofit health service plan in accordance with § 14–106.1 of the Insurance Article;

(2) Money from the Cigarette Restitution Fund, appropriated in accordance with § 7–317 of the State Finance and Procurement Article;

(3) Interest earned on investments;

(4) Money donated to the Fund;

(5) Money awarded to the Fund through grants; and

(6) Any other money from any other source accepted for the benefit of the Fund.

(e) (1) Subject to paragraph (2) of this subsection, the Fund may be used only to:

(i) Cover the administrative costs of the Commission;

(ii) Cover the actual documented direct costs of fulfilling the statutory and regulatory duties of the Commission in accordance with the provisions of this subtitle;

(iii) Provide operating grants to qualifying community health resources; and

(iv) Provide funding for the development, support, and monitoring of a unified data information system among primary and specialty care providers, hospitals, and other providers of services to community health resource members.

(2) (i) For fiscal years 2014, 2015, and 2016, the Fund may be used for any project or initiative authorized under Title 20, Subtitle 14 of this article and approved by the Commission if no less than $4,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.

(ii) For fiscal year 2017, the Fund may be used for any project or initiative authorized under Title 20, Subtitle 14 of this article and approved by the Commission if no less than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.

(iii) For fiscal year 2018, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if no less than $4,750,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in that fiscal year for the purposes under paragraph (1) of this subsection.

(iv) For fiscal years 2019 through 2021, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if no less than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.

(v) For fiscal year 2022, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if not more than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in that fiscal year for the purposes under paragraph (1) of this subsection.

(3) The funding for a unified data information system under paragraph (1)(iv) of this subsection shall be limited to:

(i) $500,000 in fiscal year 2006; and

(ii) $1,700,000 in fiscal year 2007 and annually thereafter.

(f) The Commission shall adopt regulations that:

(1) Establish the criteria for a community health resource to qualify for a grant;

(2) Establish the procedures for disbursing grants to qualifying community health resources;

(3) Develop a formula for disbursing grants to qualifying community health resources;

(4) Establish criteria and mechanisms for funding a unified data information system; and

(5) In consultation with the Secretary, implement a program to provide subsidies to community health resources for office–based specialty care visits, diagnostic testing, and laboratory tests.

(g) In developing regulations under subsection (f)(1) of this section, the Commission shall:

(1) Consider geographic balance; and

(2) Give priority to community health resources that:

(i) In addition to normal business hours, have evening and weekend hours of operation;

(ii) Have partnered with a hospital to establish a reverse referral program at the hospital;

(iii) Reduce the use of the hospital emergency department for nonemergency services;

(iv) Assist patients in establishing a medical home with a community health resource;

(v) Coordinate and integrate the delivery of primary and specialty care services;

(vi) Promote the integration of mental and somatic health with federally qualified health centers or other somatic care providers;

(vii) Fund medication management or therapy services for uninsured individuals up to 200% of the federal poverty level who meet medical necessity criteria but who are ineligible for the public mental health system;

(viii) Provide a clinical home for individuals who access hospital emergency departments for mental health services, substance abuse services, or both; and

(ix) Support the implementation of evidence–based clinical practices.

(h) Grants awarded to a community health resource under this section may be used:

(1) To provide operational assistance to a community health resource; and

(2) For any other purpose the Commission determines is appropriate to assist a community health resource.

(i) (1) The Treasurer shall invest the money in the Fund in the same manner as other State money may be invested.

(2) Any investment earnings of the Fund shall be retained to the credit of the Fund.

(j) The Fund shall be subject to an audit by the Office of Legislative Audits as provided for in § 2–1220 of the State Government Article.

§19–2201. // EFFECTIVE JUNE 30, 2029 PER CHAPTER 644 OF 2023 //

(a) In this section, “Fund” means the Community Health Resources Commission Fund.

(b) There is a Community Health Resources Commission Fund.

(c) (1) The Fund is a special, nonlapsing fund that is not subject to § 7–302 of the State Finance and Procurement Article.

(2) The Treasurer shall hold the Fund separately, and the Comptroller shall account for the Fund.

(d) The Fund consists of:

(1) Money collected from a nonprofit health service plan in accordance with § 14–106.1 of the Insurance Article;

(2) Interest earned on investments;

(3) Money donated to the Fund;

(4) Money awarded to the Fund through grants; and

(5) Any other money from any other source accepted for the benefit of the Fund.

(e) (1) Subject to paragraph (2) of this subsection, the Fund may be used only to:

(i) Cover the administrative costs of the Commission;

(ii) Cover the actual documented direct costs of fulfilling the statutory and regulatory duties of the Commission in accordance with the provisions of this subtitle;

(iii) Provide operating grants to qualifying community health resources; and

(iv) Provide funding for the development, support, and monitoring of a unified data information system among primary and specialty care providers, hospitals, and other providers of services to community health resource members.

(2) (i) For fiscal years 2014, 2015, and 2016, the Fund may be used for any project or initiative authorized under Title 20, Subtitle 14 of this article and approved by the Commission if no less than $4,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.

(ii) For fiscal year 2017, the Fund may be used for any project or initiative authorized under Title 20, Subtitle 14 of this article and approved by the Commission if no less than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.

(iii) For fiscal year 2018, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if no less than $4,750,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in that fiscal year for the purposes under paragraph (1) of this subsection.

(iv) For fiscal years 2019 through 2021, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if no less than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in each fiscal year for the purposes under paragraph (1) of this subsection.

(v) For fiscal year 2022, the Fund may be used for any project or initiative authorized under Title 10, Subtitle 2 and Title 13, Subtitle 3 of this article and approved by the Commission if not more than $8,000,000 of the subsidy required under § 14–106(d)(2)(ii)2 of the Insurance Article is used in that fiscal year for the purposes under paragraph (1) of this subsection.

(3) The funding for a unified data information system under paragraph (1)(iv) of this subsection shall be limited to:

(i) $500,000 in fiscal year 2006; and

(ii) $1,700,000 in fiscal year 2007 and annually thereafter.

(f) The Commission shall adopt regulations that:

(1) Establish the criteria for a community health resource to qualify for a grant;

(2) Establish the procedures for disbursing grants to qualifying community health resources;

(3) Develop a formula for disbursing grants to qualifying community health resources;

(4) Establish criteria and mechanisms for funding a unified data information system; and

(5) In consultation with the Secretary, implement a program to provide subsidies to community health resources for office–based specialty care visits, diagnostic testing, and laboratory tests.

(g) In developing regulations under subsection (f)(1) of this section, the Commission shall:

(1) Consider geographic balance; and

(2) Give priority to community health resources that:

(i) In addition to normal business hours, have evening and weekend hours of operation;

(ii) Have partnered with a hospital to establish a reverse referral program at the hospital;

(iii) Reduce the use of the hospital emergency department for nonemergency services;

(iv) Assist patients in establishing a medical home with a community health resource;

(v) Coordinate and integrate the delivery of primary and specialty care services;

(vi) Promote the integration of mental and somatic health with federally qualified health centers or other somatic care providers;

(vii) Fund medication management or therapy services for uninsured individuals up to 200% of the federal poverty level who meet medical necessity criteria but who are ineligible for the public mental health system;

(viii) Provide a clinical home for individuals who access hospital emergency departments for mental health services, substance abuse services, or both; and

(ix) Support the implementation of evidence–based clinical practices.

(h) Grants awarded to a community health resource under this section may be used:

(1) To provide operational assistance to a community health resource; and

(2) For any other purpose the Commission determines is appropriate to assist a community health resource.

(i) (1) The Treasurer shall invest the money in the Fund in the same manner as other State money may be invested.

(2) Any investment earnings of the Fund shall be retained to the credit of the Fund.

(j) The Fund shall be subject to an audit by the Office of Legislative Audits as provided for in § 2–1220 of the State Government Article.
Md. Code, Health - General § 19-145 — MD Code / Article ghg / Title 19 / Subtitle 1 / Section 19-145
§19–145.
Status: in_force

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

(2) “Dispenser” means a person authorized by law to dispense, as defined in § 12–101 of the Health Occupations Article, a prescription drug to a patient or the patient’s agent in the State.

(3) “Noncontrolled prescription drug” means a prescription drug, as defined in § 21–201 of this article, that is not a controlled dangerous substance designated under Title 5, Subtitle 4 of the Criminal Law Article.

(4) “State–designated health information exchange” has the meaning stated in § 4–301 of this article.

(b) The State–designated health information exchange shall operate as a health data utility for the State.

(c) The purposes of the health data utility include:

(1) The collection, aggregation, and analysis of clinical information, public health data, and health administrative and operations data to assist the Department, local health departments, the Commission, and the Health Services Cost Review Commission in the evaluation of public health interventions and health equity;

(2) The communication of data between public health officials and health care providers to advance disease control and health equity; and

(3) The enhancement and acceleration of the interoperability of health information throughout the State.

(d) Dispensers shall provide data to the State–designated health information exchange.

(e) (1) The purpose of this subsection is to:

(i) Authorize individuals and organizations involved in the treatment and care coordination of patients to access, as legally authorized, a patient’s medication history, including medications prescribed for the patient; and

(ii) Assist health care providers, care managers, the Department, and local health departments to understand and promote matters of health equity and treatment efficacy.

(2) After dispensing a noncontrolled prescription drug, a dispenser shall submit prescription information to the State–designated health information exchange.

(3) The prescription information shall be submitted:

(i) By electronic means;

(ii) Without unduly increasing the workload and expense on a dispenser;

(iii) In a manner that minimizes burden and duplication by being as compatible as possible with existing federal standards for data submission practices, including technology software of dispensers; and

(iv) As otherwise required by regulations adopted by the Commission.

(4) The State–designated health information exchange may not impose any fees or other assessments on dispensers to support the operation of the exchange.

(5) The State–designated health information exchange shall make prescription information submitted under this subsection available for purposes of treatment and care coordination of a patient.

(f) The State–designated health information exchange may provide data, as allowed by law, for public health purposes that may include:

(1) Improving health equity through access to prescription medications, including for the treatment of infectious disease;

(2) Assisting programs led by health care providers and the Department, local health departments, the Commission, and the Health Services Cost Review Commission to identify opportunities for quality improvement, including for stewardship of antibiotic medications; and

(3) Conducting case investigations and related activities.

(g) Information submitted to the State–designated health information exchange or provided by the State–designated health information exchange under this section shall be submitted or provided, to the extent practicable, in as near to real time as possible.

(h) (1) The Commission, in consultation with appropriate stakeholders, shall adopt regulations to carry out this section.

(2) The regulations shall take into account consumer perspective and include:

(i) The specific data required to be provided under subsection (d) of this section;

(ii) The specific prescription information required to be submitted under subsection (e) of this section;

(iii) The time frame for submitting prescription information under subsection (e) of this section;

(iv) The electronic means and manner by which prescription information is to be submitted under subsection (e) of this section;

(v) Prescription information submission requirements that align with the data submission requirements on dispensers of monitored prescription drugs under Title 21, Subtitle 2A of this article; and

(vi) Identification and necessary suppression of information related to providers or medications that are determined to have significant potential to cause harm.

(i) (1) The State–designated health information exchange shall establish a consumer advisory council to bring the perspectives of individuals and organizations with an interest in protecting consumers into the delivery of services provided by the State–designated health information exchange.

(2) In selecting members, the State–designated health information exchange shall consider diversity of experience.

(3) The consumer advisory council established under paragraph (1) of this subsection shall:

(i) Consist of a minimum of six members, including at least four consumer representatives and two staff representatives, and maintain a ratio of consumer representatives to nonconsumer representatives of at least two to one;

(ii) Identify and report consumer privacy concerns to senior leadership of the State–designated health information exchange;

(iii) Advise on efforts to educate consumers on data exchange policies, including options for consumers to opt out of disclosure of protected health information;

(iv) Meet at least 3 times each year; and

(v) Adopt and maintain a charter to be posted online that includes the purpose, members, and meeting schedule of the consumer advisory council.
Md. Code, Health - General § 19-713.6 — MD Code / Article ghg / Title 19 / Subtitle 7 / Section 19-713.6
§19–713.
Status: in_force

§19–713.6.

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

(2) “Documented informed consent” means:

(i) A written consent form signed by a patient; or

(ii) Verbal or otherwise communicated consent signified by a notation in a patient’s electronic medical record maintained by a group model health maintenance organization.

(3) “Drug therapy management” means treatment of a patient using drug therapy, laboratory tests, or medical devices under conditions or limitations set forth in a protocol specified in a physician–pharmacist agreement for the purpose of improving patient outcome.

(4) “Group model health maintenance organization” means a health maintenance organization that:

(i) Contracts with one multispecialty group of physicians who are employed by and shareholders of the multispecialty group; and

(ii) Provides and arranges for the provision of physician services to patients at medical facilities operated by the health maintenance organization.

(5) “Licensed pharmacist” means an individual who is licensed to practice pharmacy under Title 12 of the Health Occupations Article.

(6) “Licensed physician” means an individual who is licensed to practice medicine under Title 14 of the Health Occupations Article.

(7) “Patient” means:

(i) A patient who is a member of a group model health maintenance organization; or

(ii) An individual to whom the group model health maintenance organization is contractually or legally obligated to provide, or arrange to provide, health care services.

(8) “Physician–pharmacist agreement” means an agreement between a licensed physician and a licensed pharmacist that is disease–state specific and specifies the protocols that may be used.

(9) “Protocol” means a course of treatment predetermined by the licensed physician and licensed pharmacist according to generally accepted medical practice for the proper completion of a particular therapeutic or diagnostic intervention.

(b) (1) In a group model health maintenance organization, a licensed physician and a licensed pharmacist who wish to provide drug therapy management to patients shall have a physician–pharmacist agreement.

(2) Drug therapy management shall be provided under this section only:

(i) In accordance with a physician–pharmacist agreement; and

(ii) Through the internal pharmacy operations of the group model health maintenance organization.

(3) A licensed physician who has entered into a physician–pharmacist agreement shall submit to the State Board of Physicians a copy of the physician–pharmacist agreement and any subsequent modifications made to the physician–pharmacist agreement or the protocols specified in the physician–pharmacist agreement.

(4) A licensed pharmacist who has entered into a physician–pharmacist agreement shall submit to the State Board of Pharmacy a copy of the physician–pharmacist agreement and any subsequent modifications made to the physician–pharmacist agreement or the protocols specified in the physician–pharmacist agreement.

(c) A licensed pharmacist is authorized to enter into a physician–pharmacist agreement if the licensed pharmacist:

(1) Has a Doctor of Pharmacy degree or equivalent training as established in regulations adopted by the State Board of Pharmacy;

(2) Is approved by the State Board of Pharmacy to enter into a physician–pharmacist agreement with a licensed physician; and

(3) Meets any other requirements established by regulation by the State Board of Pharmacy.

(d) A physician–pharmacist agreement shall prohibit the substitution of a chemically dissimilar drug product by the pharmacist for the product prescribed by the physician, unless permitted in the protocol specified in the physician–pharmacist agreement.

(e) A patient may decline to participate or withdraw from participating in drug therapy management in a group model health maintenance organization at any time.

(f) A licensed physician or licensed pharmacist or both shall inform a patient:

(1) Regarding the procedures that will be utilized for drug therapy management under the associated protocols;

(2) That the patient may decline to participate or withdraw from participating in the drug therapy management at any time; and

(3) That neither the physician nor the pharmacist has been coerced, given economic incentives, excluding normal reimbursement for services rendered, or involuntarily required to participate.

(g) A licensed physician or a licensed pharmacist or both shall obtain documented informed consent from a patient after disclosing the information required to be disclosed under subsection (f) of this section.
Md. Code, Health - General § 19-1808 — MD Code / Article ghg / Title 19 / Subtitle 18 / Section 19-1808
§19–1808.
Status: in_force

(a) The Department, in consultation with the Maryland Health Care Commission and stakeholders, including advocates, consumers, and providers of assisted living services, shall develop a standard assisted living program services disclosure statement.

(b) The purpose of the assisted living program services disclosure statement is to inform potential consumers about the services provided by an assisted living program in order to assist a consumer in choosing the most appropriate assisted living program.

(c) (1) An assisted living program, as part of the application for licensure, shall file with the Office of Health Care Quality the assisted living program services disclosure statement developed by the Department.

(2) If an assisted living program changes the services reported on the assisted living program services disclosure statement, the assisted living program shall file with the Office of Health Care Quality an amended assisted living program services disclosure statement within 30 days of the change in services.

(d) (1) If an individual requests a copy of an assisted living program’s services disclosure statement, the assisted living program shall provide a copy of the services disclosure statement to the individual making the request.

(2) An assisted living program shall provide a copy of the services disclosure statement to individuals as part of the program’s marketing materials.
Md. Code, Health - General § 19-219 — MD Code / Article ghg / Title 19 / Subtitle 2 / Section 19-219
§19–219.
Status: in_force

§19–219. ** CONTINGENCY – IN EFFECT – CHAPTERS 244 AND 245 OF 2008 **

(a) The Commission may review the costs, and rates, quality, and efficiency of facility services, and make any investigation that the Commission considers necessary to assure each purchaser of health care facility services that:

(1) The total costs of all hospital services offered by or through a facility are reasonable;

(2) The aggregate rates of the facility are related reasonably to the aggregate costs of the facility; and

(3) Except as provided in § 19–214.2(m) of this subtitle, the rates are set equitably among all purchasers or classes of purchasers without undue discrimination or preference.

(b) (1) To carry out its powers under subsection (a) of this section, the Commission may review and approve or disapprove the reasonableness of any rate or amount of revenue that a facility sets or requests.

(2) A facility shall:

(i) Charge for services only at a rate set in accordance with this subtitle; and

(ii) Comply with the applicable terms and conditions of the all–payer model contract.

(3) Consistent with the all–payer model contract, in determining the reasonableness of rates, the Commission may take into account objective standards of efficiency and effectiveness.

(c) Consistent with the all–payer model contract, and notwithstanding any other provision of this subtitle, the Commission may:

(1) Establish hospital rate levels and rate increases in the aggregate or on a hospital–specific basis;

(2) Promote and approve alternative methods of rate determination and payment of an experimental nature for the duration of the all–payer model contract; and

(3) On request of the Secretary, assist in the implementation of federally approved model programs.

§19–219. ** CONTINGENCY – NOT IN EFFECT – CHAPTERS 244 AND 245 OF 2008 **

(a) The Commission may review the costs, and rates, quality, and efficiency of facility services, and make any investigation that the Commission considers necessary to assure each purchaser of health care facility services that:

(1) The total costs of all hospital services offered by or through a facility are reasonable;

(2) The aggregate rates of the facility are related reasonably to the aggregate costs of the facility; and

(3) Except as provided in § 19–214.2(m) of this subtitle, the rates are set equitably among all purchasers or classes of purchasers without undue discrimination or preference.

(b) (1) To carry out its powers under subsection (a) of this section, the Commission may review and approve or disapprove the reasonableness of any rate or amount of revenue that a facility sets or requests.

(2) A facility shall:

(i) Charge for services only at a rate set in accordance with this subtitle; and

(ii) Comply with the applicable terms and conditions of the all–payer model contract.

(3) Consistent with the all–payer model contract, in determining the reasonableness of rates, the Commission may take into account objective standards of efficiency and effectiveness.

(c) Consistent with the all–payer model contract, and notwithstanding any other provision of this subtitle, the Commission may:

(1) Establish hospital rate levels and rate increases in the aggregate or on a hospital–specific basis;

(2) Promote and approve alternative methods of rate determination and payment of an experimental nature for the duration of the all–payer model contract; and

(3) On request of the Secretary, assist in the implementation of federally approved model programs.

(d) (1) In this subsection, “base hospital rate” means the aggregate value to participating commercial health insurance carriers of the substantial, available, and affordable coverage purchaser differential as determined by the Commission for the calendar year 2002.

(2) The Commission, in accordance with this subsection, shall calculate the amount of funds necessary to operate and administer the Maryland Health Insurance Plan established under Title 14, Subtitle 5 of the Insurance Article.

(3) (i) The Commission shall determine the percentage of total net patient revenue received in calendar year 2002 by all hospitals for which the Commission approved hospital rates that is represented by the base hospital rate.

(ii) The percentage under subparagraph (i) of this paragraph shall be determined by dividing the base hospital rate by the total net patient revenue received in calendar year 2002 by all hospitals for which the Commission approved hospital rates.

(4) On or before May 1 of each year, the Commission shall:

(i) Determine the amount of funding to allocate to the Maryland Health Insurance Plan by multiplying the percentage determined under paragraph (3) of this subsection by the value of the total net patient revenues received in the immediately preceding State fiscal year by all hospitals for which rates were approved by the Commission; and

(ii) Determine the share of total funding owed by each hospital for which rates have been approved by the Commission proportionate to the percentage of the base hospital rate attributable to each hospital.

(5) Each hospital shall remit monthly one–twelfth of the amount determined under paragraph (4)(ii) of this subsection to the Maryland Health Insurance Plan Fund.

(e) (1) The Commission shall adjust hospital rates to ensure that the assessment collected under subsection (d) of this section is revenue neutral to each hospital.

(2) The Commission may not consider the assessment required under subsection (d) of this section in determining:

(i) The reasonableness of rates under this section; or

(ii) Hospital financial performance.

§19–219. ** CONTINGENCY – IN EFFECT – CHAPTERS 244 AND 245 OF 2008 **

// EFFECTIVE UNTIL JUNE 30, 2028 PER CHAPTER 750 OF 2028 //

(a) The Commission may review the costs, and rates, quality, and efficiency of facility services, and make any investigation that the Commission considers necessary to assure each purchaser of health care facility services that:

(1) The total costs of all hospital services offered by or through a facility are reasonable;

(2) The aggregate rates of the facility are related reasonably to the aggregate costs of the facility; and

(3) The rates are set equitably among all purchasers or classes of purchasers without undue discrimination or preference.

(b) (1) To carry out its powers under subsection (a) of this section, the Commission may review and approve or disapprove the reasonableness of any rate or amount of revenue that a facility sets or requests.

(2) A facility shall:

(i) Charge for services only at a rate set in accordance with this subtitle; and

(ii) Comply with the applicable terms and conditions of the all–payer model contract.

(3) Consistent with the all–payer model contract, in determining the reasonableness of rates, the Commission may take into account objective standards of efficiency and effectiveness.

(c) Consistent with the all–payer model contract, and notwithstanding any other provision of this subtitle, the Commission may:

(1) Establish hospital rate levels and rate increases in the aggregate or on a hospital–specific basis;

(2) Promote and approve alternative methods of rate determination and payment of an experimental nature for the duration of the all–payer model contract; and

(3) On request of the Secretary, assist in the implementation of federally approved model programs.

§19–219. // EFFECTIVE JULY 1, 2028 PER CHAPTER 750 OF 2025 //

** CONTINGENCY – NOT IN EFFECT – CHAPTERS 244 AND 245 OF 2008 **

(a) The Commission may review the costs, and rates, quality, and efficiency of facility services, and make any investigation that the Commission considers necessary to assure each purchaser of health care facility services that:

(1) The total costs of all hospital services offered by or through a facility are reasonable;

(2) The aggregate rates of the facility are related reasonably to the aggregate costs of the facility; and

(3) The rates are set equitably among all purchasers or classes of purchasers without undue discrimination or preference.

(b) (1) To carry out its powers under subsection (a) of this section, the Commission may review and approve or disapprove the reasonableness of any rate or amount of revenue that a facility sets or requests.

(2) A facility shall:

(i) Charge for services only at a rate set in accordance with this subtitle; and

(ii) Comply with the applicable terms and conditions of the all–payer model contract.

(3) Consistent with the all–payer model contract, in determining the reasonableness of rates, the Commission may take into account objective standards of efficiency and effectiveness.

(c) Consistent with the all–payer model contract, and notwithstanding any other provision of this subtitle, the Commission may:

(1) Establish hospital rate levels and rate increases in the aggregate or on a hospital–specific basis;

(2) Promote and approve alternative methods of rate determination and payment of an experimental nature for the duration of the all–payer model contract; and

(3) On request of the Secretary, assist in the implementation of federally approved model programs.

(d) (1) In this subsection, “base hospital rate” means the aggregate value to participating commercial health insurance carriers of the substantial, available, and affordable coverage purchaser differential as determined by the Commission for the calendar year 2002.

(2) The Commission, in accordance with this subsection, shall calculate the amount of funds necessary to operate and administer the Maryland Health Insurance Plan established under Title 14, Subtitle 5 of the Insurance Article.

(3) (i) The Commission shall determine the percentage of total net patient revenue received in calendar year 2002 by all hospitals for which the Commission approved hospital rates that is represented by the base hospital rate.

(ii) The percentage under subparagraph (i) of this paragraph shall be determined by dividing the base hospital rate by the total net patient revenue received in calendar year 2002 by all hospitals for which the Commission approved hospital rates.

(4) On or before May 1 of each year, the Commission shall:

(i) Determine the amount of funding to allocate to the Maryland Health Insurance Plan by multiplying the percentage determined under paragraph (3) of this subsection by the value of the total net patient revenues received in the immediately preceding State fiscal year by all hospitals for which rates were approved by the Commission; and

(ii) Determine the share of total funding owed by each hospital for which rates have been approved by the Commission proportionate to the percentage of the base hospital rate attributable to each hospital.

(5) Each hospital shall remit monthly one–twelfth of the amount determined under paragraph (4)(ii) of this subsection to the Maryland Health Insurance Plan Fund.

(e) (1) The Commission shall adjust hospital rates to ensure that the assessment collected under subsection (d) of this section is revenue neutral to each hospital.

(2) The Commission may not consider the assessment required under subsection (d) of this section in determining:

(i) The reasonableness of rates under this section; or

(ii) Hospital financial performance.
Md. Code, Insurance § 19-1104 — MD Code / Article gin / Title 19 / Subtitle 11 / Section 19-1104
§19–1104.
Status: reserved

(a) A pet insurer transacting pet insurance shall disclose the following to consumers:

(1) all policy exclusions, including exclusions of coverage due to:

(i) a preexisting condition;

(ii) a hereditary disorder;

(iii) a congenital anomaly or disorder; or

(iv) a chronic condition;

(2) any policy provision that limits coverage through a waiting period, a deductible, coinsurance, or an annual or lifetime policy limit;

(3) whether the pet insurer reduces coverage or increases premiums based on the insured’s claim history, the age of the covered pet, or a change in the geographic location of the insured; and

(4) the identity of the underwriting company if the company differs from the brand name used to market and sell the pet insurance policy.

(b) (1) A notice shall be prominently printed on or attached to the face of the pet insurance policy that states that:

(i) the policy may be surrendered to the insurer for cancellation within 10 days after the date the policy is delivered to the insured; and

(ii) if a policy is canceled during the 10–day period, a pro rata premium for the unexpired term of the policy shall be returned to the insured.

(2) An insured is not entitled to a pro rata premium in accordance with paragraph (1)(ii) of this subsection if the insured has made a claim under the pet insurance policy.

(c) A pet insurer shall clearly disclose a summary description of the basis or formula on which the pet insurer determines claim payments under a pet insurance policy:

(1) within the policy;

(2) before issuing the policy; and

(3) through a clear and conspicuous link on the main page of the website of the pet insurer or pet insurer’s program administrator.

(d) If a pet insurer uses a benefit schedule to determine claim payment under a pet insurance policy, the pet insurer shall:

(1) clearly disclose the applicable benefit schedule in the policy; and

(2) disclose all benefit schedules used by the pet insurer under its pet insurance policies through a clear and conspicuous link on the main page of the website of the pet insurer or pet insurer’s program administrator.

(e) If a pet insurer determines claim payments under a pet insurance policy that are based on usual and customary fees, or any other reimbursement limitation based on prevailing veterinary practitioner charges, the pet insurer shall:

(1) include a usual and customary fee limitation provision in the policy that clearly describes:

(i) the pet insurer’s basis for determining usual and customary fees; and

(ii) how the basis is applied in calculating claim payments; and

(2) disclose the pet insurer’s basis for determining usual and customary fees through a clear and conspicuous link on the main page of the website of the pet insurer or pet insurer’s program administrator.

(f) If a medical examination by a veterinary practitioner is required to begin coverage, the pet insurer shall:

(1) clearly and conspicuously disclose the required aspects of the examination before purchase of the pet insurance policy; and

(2) disclose that examination documentation may result in a preexisting condition exclusion.

(g) A pet insurer shall clearly and prominently disclose any waiting periods and the requirements applicable to the waiting periods before purchase of the pet insurance policy.

(h) (1) A pet insurer shall:

(i) include with a copy of the pet insurance policy a summary of all policy provisions required in accordance with subsections (a) through (g) of this section in a separate document in at least 12 point type titled: “Insurer Disclosure of Important Policy Provisions”; and

(ii) include the document required under item (i) of this paragraph on the website of the pet insurer or pet insurer’s program administrator through a clear and conspicuous link on the main page of the website.

(2) The document required under paragraph (1)(i) of this subsection shall include all relevant definitions established under § 19–1101 of this subtitle.

(i) At the time a pet insurance policy is issued or delivered to a policyholder, the pet insurer shall include the following information, printed in 12 point boldface type:

(1) the Administration’s mailing address, toll–free telephone number, and website address;

(2) the address and customer service telephone number of the pet insurer or the insurance producer of record for the pet insurer; and

(3) if the policy was issued or delivered by an insurance producer, a statement advising the policyholder to contact the insurance producer for assistance.

(j) The disclosure requirements required in accordance with this section shall be in addition to any other applicable disclosure requirements under this article or regulations adopted under this article.
Md. Code, Insurance § 19-502 — MD Code / Article gin / Title 19 / Subtitle 5 / Section 19-502
§19–502.
Status: in_force

(a) This subtitle does not affect Title 17 of the Transportation Article.

(b) Neither this subtitle nor Title 17 of the Transportation Article prevents an insurer from issuing, selling, or delivering motor vehicle liability insurance policies that provide liability coverage in excess of the requirements of the Maryland Vehicle Law.

(c) (1) This subtitle does not prohibit an insurer from providing benefits for Christian Science care and treatment.

(2) Expenses for Christian Science care and treatment constitute economic loss for purposes of this subtitle.

(d) This subtitle does not affect the right of a person to claim and sue for damages or losses that the person sustains as the result of a motor vehicle accident.
Md. Code, Health - General § 19-305 — MD Code / Article ghg / Title 19 / Subtitle 3 / Section 19-305
§19–305.
Status: in_force

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

(2) “Adverse event” means an unexpected occurrence that:

(i) Is related to a resident’s medical or behavioral treatment; and

(ii) Is not related to the natural course of the resident’s illness or underlying disease condition.

(3) “Change in condition” means a significant change in a resident’s physical, mental, or psychological status including:

(i) Life-threatening conditions;

(ii) Clinical complications including significant somatic symptoms that require the assessment of or treatment by qualified medical personnel;

(iii) The need to discontinue a medication or treatment because of:

1. Adverse consequences; or

2. The need to begin a new form of treatment;

(iv) Evaluation at or admission to a hospital;

(v) Injuries that require the assessment of or treatment by qualified medical personnel;

(vi) The use of restraint or seclusion; and

(vii) Suicide attempts.

(b) (1) Within 24 hours, in accordance with State and federal confidentiality laws, a residential treatment center shall attempt to notify a resident and a resident’s representative, family member, legal guardian, or custodian of:

(i) A change in condition;

(ii) An adverse event; and

(iii) Corrective action, if appropriate.

(2) If a residential treatment center sends a notice to an individual under paragraph (1) of this subsection, the individual may send a written response to the residential treatment center instructing the residential treatment center that:

(i) The individual waives the notification required under paragraph (1) of this subsection; or

(ii) The individual requires notification only in the circumstances specified in writing by the individual.

(c) A residential treatment center shall document the notification required under subsection (b)(1) of this section and the response of the resident and the resident’s representative, family member, legal guardian, or custodian in the resident’s medical record.

(d) If the Department determines that a residential treatment center failed to notify a resident and a resident’s representative, family member, legal guardian, or custodian under subsection (b)(1) of this section, the Department shall require the residential treatment center, as part of a plan of correction, to notify the resident and the resident’s representative, family member, legal guardian, or custodian as soon as possible.
Md. Code, Business Regulation § 19-108 — MD Code / Article gbr / Title 19 / Subtitle 1 / Section 19-108
§19–108.
Status: in_force

A cellular phone carrier shall allow:

(1) the customer of record who is responsible for payment on an account to designate other individuals as authorized users on the account; and

(2) an individual designated as an authorized user on an account to purchase services or devices or to take additional action under any service contract connected to the account to the extent that the authorization extends to the action.
Md. Code, Insurance § 19-516 — MD Code / Article gin / Title 19 / Subtitle 5 / Section 19-516
§19–516.
Status: in_force

(a) This section applies to a motor vehicle insurance policy issued, sold, or delivered in the State that covers a motor vehicle that is specially equipped for the transportation of or operation by an individual with a disability.

(b) If a motor vehicle insurance policy described in subsection (a) of this section provides for reimbursement of the costs of a rental motor vehicle, the insurer shall, upon request of the applicant or insured, make available for the appropriate premium at the time of the issuance or renewal of the policy a daily reimbursement rate of up to $100, for a maximum of $1,500 per policy period, to allow the insured to rent a motor vehicle that is equipped similarly to the covered motor vehicle.
Md. Code, Local Government § 19-302 — MD Code / Article glg / Title 19 / Subtitle 3 / Section 19-302
§19–302.
Status: in_force

(a) A municipality may:

(1) borrow money for any public purpose; and

(2) issue and sell general obligation bonds to evidence the borrowing.

(b) In its charter, a municipality may provide for the issuance of revenue bonds payable as to principal and interest solely from the revenues of one or more revenue–producing projects of the municipality.

(c) (1) Unless the charter of the municipality provides otherwise, in anticipation of the receipt of current taxes, a municipality may:

(i) borrow money for any public purpose; and

(ii) issue and sell tax anticipation notes to evidence the borrowing.

(2) The municipality shall pay the principal of and interest on tax anticipation notes when current taxes are received.

(3) Tax anticipation notes:

(i) shall be issued in accordance with § 19–303 of this subtitle; but

(ii) may be sold by private negotiations.
Md. Code, Local Government § 19-204 — MD Code / Article glg / Title 19 / Subtitle 2 / Section 19-204
§19–204.
Status: in_force

(a) This section applies only to the following governmental entities:

(1) a county;

(2) a municipality;

(3) a public corporation of the State;

(4) a sanitary commission or district; and

(5) a unit, public corporation, or other instrumentality of a county or a municipality.

(b) Notwithstanding any other law, a governmental entity authorized to issue bonds may issue bonds in a form that qualifies as a registered form under §§ 103 and 149 of the Internal Revenue Code or a regulation adopted under those sections.

(c) Whenever a governmental entity provides for the sale of bonds in registered form, the governmental entity may:

(1) establish procedures for the registration and transfer of the bonds;

(2) appoint any agent, including an authenticating trustee, corporate trustee, paying agent, registrar, or transfer agent;

(3) in connection with the establishment and maintenance of a central depository system for the transfer or pledge of the bonds, make agreements with:

(i) custodian banks and their nominees; or

(ii) financial intermediaries and their nominees; and

(4) exercise any other power that relates to issuance of bonds in registered form.
Md. Code, Health - General § 19-2002 — MD Code / Article ghg / Title 19 / Subtitle 20 / Section 19-2002
§19–2002.
Status: in_force

(a) In this section, “Office” means the Office of Health Care Quality in the Department.

(b) The Office may inspect a health care staff agency to verify compliance with this subtitle.

(c) When the Office conducts an inspection, the Office shall verify that the health care practitioners referred by the health care staff agency are licensed or certified by the appropriate health occupation board.

(d) When the Office conducts an inspection, the Office shall verify that the health care staff agency has developed, documented, and implemented procedures for:

(1) Selecting and verifying the credentials of health care practitioners referred by the health care staff agency;

(2) Validating experience of health care practitioners prior to referral by the health care staff agency;

(3) Tracking and acting on serious or life–threatening complaints received by a client facility or the client facility’s agent;

(4) Reporting of an action or condition under § 19–2001(f) of this subtitle;

(5) Verifying that health care practitioners referred by the health care staff agency are of satisfactory health status and have received the necessary testing and immunization as required or requested by the client facility;

(6) Verifying I–9 status;

(7) Verifying, prior to initial referral of health care practitioners to a client facility by the health care staff agency, drug screening of health care practitioners referred by the health care staff agency if the client facility requires drug screening for facility employees;

(8) Verifying, when there is probable cause to perform a drug test or when a client facility requests a drug test, drug testing of health care practitioners referred by the health care staff agency;

(9) Verifying, prior to initial referral of health care practitioners to a client facility by the health care staff agency, criminal background checks of health care practitioners referred by the health care staff agency if the client facility requires criminal background checks for facility employees; and

(10) Verifying the references of health care practitioners referred by the health care staff agency.

(e) A health care staff agency shall attest that the health care staff agency is in compliance with the:

(1) Civil Rights Act of 1964;

(2) Rehabilitation Act of 1973;

(3) Americans with Disabilities Act of 1990; and

(4) Drug Free Workplace Act of 1988, if applicable.

(f) The Office may inspect a health care staff agency upon receiving a complaint, and may give notice of the inspection to the health care staff agency.
Md. Code, Health - General § 19-2106 — MD Code / Article ghg / Title 19 / Subtitle 21 / Section 19-2106
§19–2106.
Status: in_force

§19–2106. IN EFFECT

// EFFECTIVE UNTIL JUNE 30, 2035 PER CHAPTER 386 OF 2024 //

(a) (1) A majority of the full authorized membership of the Commission is a quorum.

(2) The decision of the Commission shall be by a majority of the quorum present and voting.

(b) The Commission shall meet at least six times a year, at the times and places that it determines.

(c) A member of the Commission is entitled to:

(1) Compensation in accordance with the State budget; and

(2) Reimbursement for expenses under the Standard State Travel Regulations, as provided in the State budget.

(d) (1) The Commission may employ a staff in accordance with the State budget.

(2) The Commission, in consultation with the Secretary, shall determine the appropriate job classifications and grades for all staff.

(3) The Commission, in consultation with the Secretary, may set the compensation of a Commission employee in a position that:

(i) Is unique to the Commission;

(ii) Requires specific skills or experience to perform the duties of the position; and

(iii) Does not require the employee to perform functions that are comparable to functions performed in other units of the Executive Branch of State government.

(4) The Secretary of Budget and Management, in consultation with the Commission, shall determine the positions for which the Commission may set compensation under paragraph (3) of this subsection.
Md. Code, Health - General § 19-712.2 — MD Code / Article ghg / Title 19 / Subtitle 7 / Section 19-712.2
§19–712.
Status: in_force

§19–712.2.

(a) A health maintenance organization that provides pharmaceutical benefits shall notify all pharmacies under contract with the health maintenance organization in writing of changes in the pharmaceutical benefit program rules or requirements at least 30 days before the change is effective.

(b) Changes that require 30 days’ advance written notice under subsection (a) of this section are:

(1) Exclusion of coverage for classes of drugs as specified by contract;

(2) Changes in prior or preauthorization procedures; and

(3) Selection of new prescription claims processors.

(c) A health maintenance organization that fails to provide advance notice as required under subsection (a) of this section shall honor and pay in full any claim under the program rules or requirements that existed before the change for 30 days after the postmarked date of the notice.
Md. Code, Health Occupations § 19-314 — MD Code / Article gho / Title 19 / Subtitle 3 / Section 19-314
§19–314.
Status: in_force

If a license has been suspended or revoked under § 19–311 of this subtitle, the Board may reinstate that license only in accordance with:

(1) The terms and conditions of the order of suspension or revocation; or

(2) An order of reinstatement issued by the Board.
Md. Code, Health - General § 19-223 — MD Code / Article ghg / Title 19 / Subtitle 2 / Section 19-223
§19–223.
Status: in_force

The Commission shall assess a fee on all hospitals whose rates have been approved by the Commission to pay for:

(1) To the extent provided for in Title 10, Subtitle 3, Part IV of the Economic Development Article, the amounts required by § 10–350 of the Economic Development Article with respect to public obligations or closure costs of a closed or delicensed hospital; and

(2) Funding the Hospital Employees Retraining Fund.
Md. Code, Health - General § 19-201 — MD Code / Article ghg / Title 19 / Subtitle 2 / Section 19-201
§19–201.
Status: in_force

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

(b) “All–payer model contract” means the payment model demonstration agreement authorized under § 1115A of the Social Security Act, including any amendments to the agreement, between the State and the federal Center for Medicare and Medicaid Innovation.

(c) “Commission” means the State Health Services Cost Review Commission.

(d) “Facility” means, whether operated for a profit or not:

(1) Any hospital; or

(2) Any related institution.

(e) (1) “Hospital services” means:

(i) Inpatient hospital services as enumerated in Medicare Regulation 42 C.F.R. § 409.10, as amended;

(ii) Emergency services, including services provided at a freestanding medical facility licensed under Subtitle 3A of this title;

(iii) Outpatient services provided at a hospital;

(iv) Outpatient services, as specified by the Commission in regulation, provided at a freestanding medical facility licensed under Subtitle 3A of this title that has received:

1. A certificate of need under § 19–120(o)(1) of this title; or

2. An exemption from obtaining a certificate of need under § 19–120(o)(3) of this title; and

(v) Identified physician services for which a facility has Commission–approved rates on June 30, 1985.

(2) “Hospital services” includes a hospital outpatient service:

(i) Of a hospital that, on or before June 1, 2015, is under a merged asset hospital system;

(ii) That is designated as a part of another hospital under the same merged asset hospital system to make it possible for the hospital outpatient service to participate in the 340B Program under the federal Public Health Service Act; and

(iii) That complies with all federal requirements for the 340B Program and applicable provisions of 42 C.F.R. § 413.65.

(3) “Hospital services” does not include:

(i) Outpatient renal dialysis services; or

(ii) Outpatient services provided at a limited service hospital as defined in § 19–301 of this title, except for emergency services.

(f) (1) “Related institution” means an institution that is licensed by the Department as:

(i) A comprehensive care facility that is currently regulated by the Commission; or

(ii) An intermediate care facility–intellectual disability.

(2) “Related institution” includes any institution in paragraph (1) of this subsection, as reclassified from time to time by law.
Md. Code, Local Government § 19-603 — MD Code / Article glg / Title 19 / Subtitle 6 / Section 19-603
§19–603.
Status: in_force

A county may expend the net proceeds of the sale of an issue of notes only to:

(1) pay the costs of public school construction or capital improvements approved at any time by the Board of Public Works in anticipation of State money for any of the construction or improvements; or

(2) refund one or more issues of notes.
Md. Code, Health - General § 19-214.4 — MD Code / Article ghg / Title 19 / Subtitle 2 / Section 19-214.4
§19–214.
Status: in_force

§19–214.4. IN EFFECT

// EFFECTIVE UNTIL JUNE 30, 2025 PER CHAPTER 683 OF 2022 //

(a) The Commission, in coordination with the Department, the Department of Human Services, 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 on the date the hospital service was provided 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

(4) Determines how the Commission, the Department, the Department of Human Services, 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 obtaining reimbursement under this section.

(c) (1) The process developed under subsection (a) of this section:

(i) Shall require each hospital to consider:

1. Tax data from the Office of the Comptroller as de facto evidence 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 patient’s presumptive eligibility for free care;

(ii) Shall require each hospital to provide refunds to patients who qualify under subsection (g)(2) of this section; and

(iii) May not require a hospital to provide a patient with a refund if the patient previously was denied free care because of a failed asset test for the identified date of service.

(2) Each hospital shall create a webpage that includes:

(i) Information about the reimbursement provided in accordance with this section, including the process to be followed by a patient and relevant timelines; and

(ii) A telephone number and e–mail address that a patient may use to submit questions about the reimbursement process developed under this section.

(3) If a patient is entitled to a single refund per year under subsection (a) of this section in an amount of $25 or less, the hospital may but is not required to provide the reimbursement.

(d) (1) The Commission may modify the process developed under subsection (a) of this section as necessary.

(2) If reimbursements are provided incrementally and less than 5% of the estimated reimbursements are made each year during the first increment, the Commission is not required to implement additional increments 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 on the process developed under this section to the Commission, in the time and manner determined by the Commission.

(f) (1) Notwithstanding any other 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:

(i) Each other, to the minimum extent necessary, relevant information, including tax information, necessary for implementation of the process developed under subsection (a) of this section; and

(ii) The Health Education and Advocacy Unit relevant information necessary for the Health Education and Advocacy Unit to assist patients in obtaining reimbursement under subsection (a) of this section, on receipt of the patient’s executed authorization for release of medical information form provided by the Health Education and Advocacy Unit or other authorization 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 assist a patient in obtaining 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 information to the Health Education and Advocacy Unit within 10 business days after the date of the receipt of the request.

(3) This section may not be construed to make a hospital responsible for the confidentiality of the information in possession of each State entity listed in paragraph (1) of this subsection.

(g) (1) (i) On or before January 1, 2023, and 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.

(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 subparagraph (i) of this paragraph.

(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 subparagraph (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 implement Option 3 from the “Free Hospital Care Refund Process” report submitted by the Commission in December 2022 as required under paragraph (1)(i) of this subsection and in accordance with this section and § 13–203(c) of the Tax – General Article.

(ii) Under the process required under subparagraph (i) of this paragraph, a patient shall qualify for refunds who paid an out–of–pocket expense for services based on the following:

1. The Office of the Comptroller determining 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 service date or dates, the patient:

A. Received benefits through the federal Supplemental Nutrition Assistance Program;

B. Received benefits through the State’s Energy Assistance Program;

C. Received benefits through the federal Special Supplemental Food Program for Women, Infants, and Children; or

D. Lived in a household with children enrolled in the free and reduced–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 may not implement the alternative approach included with Option 3 in the report identified under paragraph (2)(i) of this subsection.

(h) (1) Each hospital shall reimburse 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 each State entity in complying with this section.

(2) (i) Reimbursement required under paragraph (1) of this subsection shall be based on the hospital’s proportion of the total number of patients who were identified by the State entity as potentially eligible for reimbursement in a designated year, as determined by the Commission.

(ii) For the purpose of determining the reimbursement due under subparagraph (i) of this paragraph, the State entities identified under paragraph (1) of this subsection shall provide quarterly cost information to the Commission.

(3) The Commission shall provide each hospital with the reimbursement amount due to the appropriate State entity based on the costs incurred by the entity in complying with this section.

(i) (1) (i) If a hospital fails to provide refunds to patients who qualify under subsection (g)(2) of this section as required, the Commission may impose a fine not exceeding $50,000 per violation.

(ii) In determining the amount of a fine to be imposed under subparagraph (i) of this paragraph, the Commission shall consider the appropriateness of the fine in relation to the severity of the violation.

(2) A violation of this section by a hospital is:

(i) An unfair, abusive, or deceptive trade practice, as defined under Title 13 of the Commercial Law Article; and

(ii) Subject to enforcement and penalty provisions of Title 13 of the Commercial Law Article.
Md. Code, Health - General § 19-1205 — MD Code / Article ghg / Title 19 / Subtitle 12 / Section 19-1205
§19–1205.
Status: in_force

The Secretary may inspect a comprehensive rehabilitation facility to assure that the facility meets the requirements of this subtitle.
Md. Code, Commercial Law § 19-101 — MD Code / Article gcl / Title 19 / Subtitle 1 / Section 19-101
§19–101.
Status: in_force

(a) In this title, unless the context requires otherwise, the following words have the meanings indicated.

(b) “Contract” means a written or oral contract or agreement between a dealer and a wholesaler, manufacturer, or distributor by which:

(1) The dealer is granted the right to sell or distribute goods or services; or

(2) The dealer is granted the right to use a trade name, trademark, service mark, logo type, or advertising or other commercial symbol.

(c) “Current model” means a model listed in a wholesaler’s, manufacturer’s, or distributor’s current sales manual or a supplement to the current sales manual.

(d) “Current net price” means the price listed in the supplier’s price list or catalog in effect at the time the contract agreement is terminated, less any applicable discount allowed.

(e) (1) “Dealer” means a person engaged in the business of selling at retail construction, farm, utility, or industrial equipment, implements, machinery, attachments, outdoor power equipment, outdoor power sports equipment, or repair parts.

(2) “Dealer” includes a person engaged in the business of selling, on commission or at retail, commercial heating, ventilation, and air–conditioning equipment or repair parts.

(f) “Family member” means a spouse, sibling, parent, grandparent, child, grandchild, mother–in–law, father–in–law, daughter–in–law, son–in–law, stepparent, or stepchild, or a lineal descendant of the dealer or principal owner of the dealership.

(g) “Good cause” means failure by a dealer to comply with requirements imposed on the dealer by a contract if the requirements are not different from requirements imposed on other dealers similarly situated in the State.

(h) (1) “Inventory” means farm implements or machinery, construction, utility, and industrial equipment, consumer products, outdoor power equipment, outdoor power sports equipment, attachments, or repair parts.

(2) “Inventory” includes commercial heating, ventilation, and air–conditioning equipment or repair parts.

(i) “Net cost” means the price the dealer paid the supplier for the inventory, less all applicable discounts allowed, plus the amount the dealer paid for freight costs from the supplier’s location to the dealer’s location, plus the reasonable cost of assembly or disassembly performed by the dealer.

(j) “Outdoor power sports equipment” means the following vehicles and any attachments or repair parts for the following vehicles:

(1) A motor–assisted or motor–driven vehicle that:

(i) Is designed to carry only the operator of the vehicle on a seat or saddle designed to be straddled by the operator or is designed to carry only the operator of the vehicle and one passenger; and

(ii) Is commonly known as an all–terrain vehicle;

(2) A motorcycle that:

(i) Is designed for off–highway operation and is not eligible for registration as a Class D (motorcycle) vehicle under the Transportation Article; and

(ii) Is commonly known as a dirt bike; or

(3) A snowmobile.

(k) “Superseded part” means a part that will provide the same function as a currently available part as of the date of cancellation of a contract.

(l) “Supplier” means:

(1) A wholesaler, manufacturer, or distributor who enters into a contract with a dealer; or

(2) A purchaser of assets or stock of a surviving corporation resulting from a merger or liquidation, a receiver or assignee, or a trustee of the original manufacturer, wholesaler, or distributor who enters into a contract with a dealer.

(m) “Termination” means the termination, cancellation, nonrenewal, or noncontinuation of a contract.

(n) “Utility” and “industrial”, when used to refer to equipment, implements, machinery, attachments, or repair parts, have the meanings commonly used and understood among dealers and suppliers of farm equipment as a usage of trade.
Md. Code, Health Occupations § 19-310 — MD Code / Article gho / Title 19 / Subtitle 3 / Section 19-310
§19–310.
Status: in_force

(a) Unless the Board agrees to accept the surrender of a license, a licensed social worker or the holder of a conditional license may not surrender the license nor may the license lapse by operation of law while the licensee is under investigation or while charges are pending against the social worker.

(b) The Board may set conditions on its agreement with the social worker under investigation or against whom charges are pending to accept surrender of the social worker’s license.
Md. Code, Health - General § 19-307.1 — MD Code / Article ghg / Title 19 / Subtitle 3 / Section 19-307.1
§19–307.
Status: in_force

§19–307.1.

The Department shall adopt regulations for a limited service hospital that include the following standards:

(1) The limited service hospital shall be open 24 hours a day, 7 days a week;

(2) There shall be at least one physician credentialed in emergency medicine at the limited service hospital at all times;

(3) A sufficient number of registered nurses and other health professionals shall be available at the limited service hospital to provide advanced life support;

(4) Basic X–ray and laboratory facilities shall be available at the limited service hospital and operable at all times by one radiology technician and one laboratory technician;

(5) Resuscitation equipment, including monitor, defibrillator, cardiac medications, intubation equipment, and intravenous line equipment shall be available at the limited service hospital and operable at all times;

(6) Standard procedures in accordance with the State Emergency Medical Services Plan shall exist for the immediate transport of individuals in need of hospitalization or other more definitive care;

(7) A specific defined role in the Emergency Medical Services System with appropriate telephone communication shall exist;

(8) Emergency services shall be available to all persons regardless of ability to pay;

(9) Adoption, implementation, and enforcement of a policy shall exist that requires, except in an emergency life–threatening situation where it is not feasible or practicable, compliance by all employees and medical staff involved in patient care services with the Centers for Disease Control and Prevention’s guidelines on universal precautions; and

(10) Any other standard that the Secretary deems necessary to ensure the quality of the services provided by a limited service hospital.
Md. Code, Health - General § 19-207 — MD Code / Article ghg / Title 19 / Subtitle 2 / Section 19-207
§19–207.
Status: in_force

(a) In addition to the powers set forth elsewhere in this subtitle, the Commission may:

(1) Adopt rules and regulations to carry out the provisions of this subtitle;

(2) Create committees from among its members;

(3) Appoint advisory committees, which may include individuals and representatives of interested public or private organizations;

(4) Apply for and accept any funds, property, or services from any person or government agency;

(5) Make agreements with a grantor or payor of funds, property, or services, including an agreement to make any study, plan, demonstration, or project;

(6) Publish and give out any information that relates to the financial aspects of health care and is considered desirable in the public interest; and

(7) Subject to the limitations of this subtitle, exercise any other power that is reasonably necessary to carry out the purposes of this subtitle.

(b) In addition to the duties set forth elsewhere in this subtitle, the Commission shall:

(1) Adopt rules and regulations that relate to its meetings, minutes, and transactions;

(2) Keep minutes of each meeting;

(3) Prepare annually a budget proposal that includes the estimated income of the Commission and proposed expenses for its administration and operation;

(4) Within a reasonable time after the end of each facility’s fiscal year or more often as the Commission determines, prepare from the information filed with the Commission any summary, compilation, or other supplementary report that will advance the purposes of this subtitle;

(5) Periodically participate in or do analyses and studies that relate to:

(i) Health care costs;

(ii) The financial status of any facility; or

(iii) Any other appropriate matter;

(6) On or before May 1 of each year, submit to the Governor, to the Secretary, and, subject to § 2–1257 of the State Government Article, to the General Assembly an annual report on the operations and activities of the Commission during the preceding fiscal year, including:

(i) A copy of each summary, compilation, and supplementary report required by this subtitle;

(ii) Budget information regarding the Health Services Cost Review Commission Fund, including:

1. Any balance remaining in the Fund at the end of the previous fiscal year; and

2. The percentage of the total annual costs of the Commission that is represented by the balance remaining in the Fund at the end of the previous fiscal year;

(iii) A summary of the Commission’s role in hospital quality of care activities, including information about the status of any pay for performance initiatives;

(iv) An update on the status of the State’s compliance with the provisions of the all–payer model contract that includes:

1. Performance in limiting inpatient and outpatient hospital per capita cost growth for all payers;

2. Annual progress toward achieving the State’s financial targets established by the all–payer model contract;

3. A summary of the work conducted, recommendations made, including recommendations made by workgroups created to provide technical input and advice, and Commission action on activities related to the all–payer model contract;

4. Actions approved by the Commission to promote alternative methods of rate determination and payment of an experimental nature, as authorized under § 19–219(c)(2) of this subtitle;

5. Reports submitted to the federal Center for Medicare and Medicaid Innovation relating to the all–payer model contract;

6. Any known adverse consequences in implementing the all–payer model contract, as reported to the federal Center for Medicare and Medicaid Innovation, that may negatively impact quality of or access to care, and the actions taken by the Commission to mitigate the consequences; and

7. Annual progress made in the development of public and private partnerships between hospitals and other entities, including community–based physicians, community–based organizations, and other post–acute care providers, to achieve the population health goals established with the federal Center for Medicare and Medicaid Innovation; and

(v) Any other fact, suggestion, or policy recommendation that the Commission considers necessary;

(7) Oversee and administer the Maryland Trauma Physician Services Fund in conjunction with the Maryland Health Care Commission; and

(8) If the Centers for Medicare and Medicaid Services issues a warning notice related to a “triggering event” as described in the all–payer model contract, provide written notification to the Governor, the Secretary, and, subject to § 2–1257 of the State Government Article, the General Assembly within 15 days after the issuance of the notice.

(c) (1) The Commission shall set deadlines for the filing of reports required under this subtitle.

(2) The Commission may adopt rules or regulations that impose penalties for failure to file a report as required.

(3) The amount of any penalty under paragraph (2) of this subsection may not be included in the costs of a facility in regulating its rates.

(d) Except for privileged medical information, the Commission shall make:

(1) Each report filed and each summary, compilation, and report required under this subtitle available for public inspection at the office of the Commission during regular business hours; and

(2) Each summary, compilation, and report available to any agency on request.

(e) (1) The Commission may contract with a qualified, independent third party for any service necessary to carry out the powers and duties of the Commission.

(2) Unless permission is granted specifically by the Commission, a third party hired by the Commission may not release, publish, or otherwise use any information to which the third party has access under its contract.
Md. Code, Business Occupations and Professions § 19-402 — MD Code / Article gbo / Title 19 / Subtitle 4 / Section 19-402
§19–402.
Status: in_force

(a) To qualify for certification as a security guard, an individual shall:

(1) meet the standards set by the Secretary;

(2) be an employee of or an applicant for employment with a licensed security guard agency or a security guard employer;

(3) be of good moral character and reputation;

(4) submit to the licensed security guard agency or the security guard employer, for forwarding to the Secretary:

(i) a sworn application in the manner and format designated by the Secretary;

(ii) the fingerprints required under § 19–304(c) of this title;

(iii) a nonrefundable application fee of $15;

(iv) a declaration under the penalties of perjury stating whether:

1. the individual has been convicted of:

A. a disqualifying crime, under § 5–101 of the Public Safety Article; or

B. a crime of violence, under § 14–101 of the Criminal Law Article;

2. if currently or formerly employed as a police officer, the individual has had any formal findings by a court, hearing board, or other governmental entity of unlawful or excessive use of force or of making a false statement during the individual’s employment with the law enforcement agency; and

3. the individual plans to carry a handgun in the course of providing security guard services; and

(v) documentation that the individual has either:

1. satisfactorily completed 12 hours of initial security training that is approved by the Maryland Police Training and Standards Commission under § 19–412 of this subtitle; or

2. been employed as a police officer in the 3 years immediately preceding the application;

(5) pay to the licensed security guard agency or the security guard employer, for forwarding to the Secretary, the fees authorized under § 19–304(c) of this title; and

(6) be at least 18 years old.

(b) On receipt from an applicant for certification as a security guard, a licensed security guard agency or security guard employer shall forward to the Secretary the applicant’s application, fingerprint cards, and criminal history records check fees.

(c) (1) Subject to paragraph (2) of this subsection, an applicant for certification as a security guard shall complete 12 hours of initial security training that is approved by the Maryland Police Training and Standards Commission under § 19–412 of this subtitle.

(2) An applicant for certification may not be required to complete the training specified in paragraph (1) of this subsection if the applicant:

(i) has been employed as a police officer in the 3 years immediately preceding the application; and

(ii) provides supporting documentation with the application for certification as a security guard in accordance with subsection (a)(4)(v)2 of this section.
Md. Code, Health - General § 19-1414 — MD Code / Article ghg / Title 19 / Subtitle 14 / Section 19-1414
§19–1414.
Status: in_force

The Department may review financial and performance records of an applicant for a license or management firm under contract with an applicant for a license to determine ability of the applicant or management firm to comply with appropriate laws and regulations.
Md. Code, Business Regulation § 19-901 — MD Code / Article gbr / Title 19 / Subtitle 9 / Section 19-901
§19–901.
Status: in_force

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

(2) (i) “Security system” means any burglary alarm system or robbery alarm system.

(ii) “Security system” includes the service of monitoring the property to which a security system is attached in case of an alarm sounding.

(3) (i) “Wireless security system” means a security system that is designed to carry a voltage of 50 volts or less and not hardwired.

(ii) “Wireless security system” includes ancillary low–voltage components that are either wireless or battery–operated and supplementary smoke detectors as defined in the National Fire Protection Association 72: National Fire Alarm and Signaling Code.

(b) If a wireless security system does not require the submission of a fire protection plan review to a local government for compliance with the State or a local building code, a local government may not require an electrical license or an electrical permit to install, maintain, inspect, replace, or service the wireless security system.

(c) (1) A local government may:

(i) require a person who provides wireless security systems to comply with a local alarm ordinance or obtain an alarm business registration or permit; and

(ii) require a person who operates wireless security systems or causes wireless security systems to be operated to comply with a local alarm ordinance or obtain an alarm system registration or permit.

(2) A local government may not require a person described in paragraph (1) of this subsection to obtain an electrical permit.

(d) Wireless security systems are not exempt from Title 18 of the Business Occupations and Professions Article.

(e) Wireless security systems must comply with any State or local building codes.
Md. Code, Health - General § 19-214.2 — MD Code / Article ghg / Title 19 / Subtitle 2 / Section 19-214.2
§19–214.
Status: in_force

§19–214.2. IN EFFECT

(a) (1) Each hospital annually shall submit to the Commission:

(i) At times prescribed by the Commission, the hospital’s policy on the collection of debts owed by patients; and

(ii) A report including:

1. The total number of patients by race or ethnicity, gender, and zip code of residence against whom the hospital, or a debt collector used by the hospital, filed an action to collect a debt owed on a hospital bill;

2. The total number of patients by race or ethnicity, gender, and zip code of residence with respect to whom the hospital has and has not reported or classified a bad debt;

3. The total dollar amount of the charges for hospital services provided to patients but not collected by the hospital for patients covered by insurance, including the out–of–pocket costs for patients covered by insurance, and patients without insurance; and

4. For hospital debts owed by patients of the hospital that the hospital sold to a governmental unit, contractor, or nonprofit organization under subsection (l) of this section:

A. The total dollar amount of the debt sold by the hospital for the reporting year;

B. The total dollar amount paid to the hospital by the unit, contractor, or nonprofit organization who purchased the debt; and

C. The total number of patients whose debt was sold, in full or in part, to the unit, contractor, or nonprofit organization who purchased the debt.

(2) The Commission shall post the information submitted under paragraph (1) of this subsection on its website.

(b) The policy submitted under subsection (a)(1) of this section shall:

(1) Provide for active oversight by the hospital of any contract for collection of debts on behalf of the hospital;

(2) Except as provided in subsection (l) of this section, prohibit the hospital from selling any debt;

(3) Describe in detail the consideration by the hospital of patient income, assets, and other criteria;

(4) Prohibit the hospital from reporting adverse information to a consumer reporting agency;

(5) Prohibit the hospital from filing a civil action to collect a debt within 240 days after the initial bill is provided;

(6) Prohibit the hospital from filing a civil action to collect a debt against a patient whose outstanding debt is at or below $500;

(7) Describe the hospital’s procedures for collecting a debt;

(8) Describe the circumstances in which the hospital will seek a judgment against a patient;

(9) In accordance with subsection (c) of this section, provide for a refund of amounts collected from a patient or the guarantor of a patient who was later found to be eligible for free care within 240 days after the initial bill was provided;

(10) If the hospital has obtained a judgment against or reported adverse information to a consumer reporting agency about a patient who later was found to be eligible for free care within 240 days after the initial bill was provided for which the judgment was awarded or the adverse information was reported, require the hospital to seek to vacate the judgment or strike the adverse information;

(11) Provide a mechanism for a patient to:

(i) Request the hospital to reconsider the denial of free or reduced–cost care;

(ii) File with the hospital a complaint against the hospital or a debt collector used by the hospital regarding the handling of the patient’s bill; and

(iii) Allow the patient and the hospital to mutually agree to modify the terms of a payment plan offered under subsection (d) of this section or entered into with the patient;

(12) For a patient who is eligible for free or reduced–cost care under the hospital’s financial assistance policy, prohibit the hospital from:

(i) Charging interest on the debt owed on a bill for the patient before a court judgment is obtained; or

(ii) Collecting fees or any other amount that exceeds the approved charge for the hospital service as established by the Commission;

(13) Require the hospital to dismiss actions pending against a patient for collection of debt that was sold under subsection (l) of this section;

(14) Prohibit the hospital from:

(i) Engaging in collection activities on 100% of the outstanding amount of the Commission–set charge for debt sold under subsection (l) of this section; and

(ii) Collecting on judgments entered into on patient debt that was sold under subsection (l) of this section; and

(15) Comply with § 24–2502 of this article.

(c) (1) (i) A hospital shall provide for a refund of amounts exceeding $25 collected from a patient or the guarantor of a patient who was found to be eligible for free care within 240 days after the initial bill is provided to the patient.

(ii) The hospital shall provide the refund to the patient not later than 30 days after determining that the patient was eligible for free care.

(2) If a patient is enrolled in a means–tested government health care plan that requires the patient to pay out–of–pocket for hospital services, a hospital’s refund policy shall provide for a refund that complies with the terms of the patient’s plan.

(d) (1) Subject to paragraph (2) of this subsection, a hospital shall provide in writing to each patient who incurs medical debt information about the availability of an installment payment plan for the debt.

(2) A hospital shall provide the information under paragraph (1) of this subsection to the patient, the patient’s family, the patient’s authorized representative, or the patient’s legal guardian:

(i) Before the patient is discharged;

(ii) With the hospital bill;

(iii) On request; and

(iv) In each written communication to the patient regarding collection of hospital debt.

(3) (i) The Commission shall develop guidelines, with input from stakeholders, for an income–based payment plan offered under this subsection that includes:

1. The amount of medical debt owed to the hospital;

2. The duration of the payment plan based on a patient’s annual gross income;

3. Guidelines for requiring appropriate documentation of income level;

4. Guidelines for the payment amount that:

A. May not exceed 5% of the patient’s federal or State adjusted gross monthly household income that takes into consideration all individuals on the same federal or State tax return; and

B. Shall consider financial hardship, as defined in § 19–214.1(a) of this subtitle;

5. Guidelines for:

A. The determination of possible interest payments for patients who do not qualify for free or reduced–cost care, which may not begin before 240 days after the initial bill is provided; and

B. A prohibition on interest payments for patients who qualify for free or reduced–cost care as required under subsection (b)(12) of this section;

6. Guidelines for modification of a payment plan that does not create a greater financial burden on the patient; and

7. A prohibition on penalties or fees for prepayment or early payment.

(ii) A hospital may not seek legal action against a patient on a debt owed until the hospital has established and implemented a payment plan policy that complies with the guidelines developed under subparagraph (i) of this paragraph.

(4) (i) A patient shall be deemed to be compliant with a payment plan if the patient makes at least 11 scheduled monthly payments within a 12–month period.

(ii) If a patient misses a scheduled monthly payment, the patient shall contact the health care facility and identify a plan to make up the missed payment within 1 year after the date of the missed payment.

(iii) The health care facility may, but may not be required to, waive any additional missed payments that occur within a 12–month period and allow the patient to continue to participate in the income–based payment plan and not refer the outstanding balance owed to a collection agency or for legal action.

(5) (i) A hospital shall demonstrate that it attempted in good faith to meet the requirements of this subsection and the guidelines developed by the Commission under paragraph (3) of this subsection before the hospital:

1. Files an action to collect a debt owed on a hospital bill by a patient; or

2. Delegates collection activity to a debt collector for a debt owed on a hospital bill by a patient.

(ii) Subparagraph (i) of this paragraph does not prohibit a hospital from using an eligibility vendor to provide outreach to a patient for purposes of assisting the patient in qualifying for financial assistance.

(e) (1) A hospital shall comply with § 24–2502 of this article.

(2) For at least 240 days after the initial patient bill was provided, a hospital may not report adverse information about a patient to a consumer reporting agency or commence civil action against a patient for nonpayment.

(3) A hospital shall report the fulfillment of a patient’s payment obligation within 60 days after the obligation is fulfilled to any consumer reporting agency to which the hospital had reported adverse information about the patient, including if the debt was sold under subsection (l) of this section.

(4) A hospital may not commence a civil action against a patient for nonpayment, or delegate collection activity to a debt collector:

(i) If the hospital was notified in accordance with federal law by the patient or the insurance carrier that an appeal or a review of a health insurance decision is pending within the immediately preceding 60 days;

(ii) If the hospital is processing a requested reconsideration of the denial of free or reduced–cost care that was appropriately completed by the patient or has completed the reconsideration within the immediately preceding 60 days; or

(iii) If the hospital sold the debt under subsection (l) of this section.

(5) By November 1, 2025, a hospital that had reported adverse information about a patient to a consumer reporting agency shall instruct the consumer reporting agency to delete the adverse information about the patient.

(f) (1) A hospital may not force the sale or foreclosure of a patient’s primary residence to collect a debt owed on a hospital bill.

(2) A hospital may not request a lien against a patient’s primary residence in an action to collect debt owed on a hospital bill.

(3) (i) A hospital may not give notice to a patient under subsection (h) of this section until after 240 days after the initial bill was provided.

(ii) If a hospital files an action to collect the debt owed on a hospital bill, the hospital may not request the issuance of or otherwise knowingly take action that would cause a court to issue:

1. A body attachment against a patient; or

2. An arrest warrant against a patient.

(4) A hospital may not request a writ of garnishment of wages or file an action that would result in an attachment of wages against a patient to collect debt owed on a hospital bill if the patient is eligible for free or reduced–cost care under § 19–214.1 of this subtitle.

(5) (i) A hospital may not make a claim against the estate of a deceased patient to collect a debt owed on a hospital bill if the deceased patient was known by the hospital to be eligible for free care under § 19–214.1 of this subtitle or if the value of the estate after tax obligations are fulfilled is less than half of the debt owed.

(ii) A hospital may offer the family of the deceased patient the ability to apply for financial assistance.

(6) A hospital may not file an action to collect a debt owed on a hospital bill by a patient until the hospital determines whether the patient is eligible for free or reduced–cost care under § 19–214.1 of this subtitle.

(g) (1) Except as provided in paragraph (2) of this subsection, a spouse or another individual may not be held liable for the debt owed on a hospital bill of an individual who is at least 18 years old.

(2) An individual may voluntarily consent to assume liability for the debt owed on a hospital bill of any other individual if the consent is:

(i) Made on a separate document signed by the individual;

(ii) Not solicited in an emergency room or during an emergency situation; and

(iii) Not required as a condition of providing any emergency or nonemergency health care services.

(h) (1) Subject to paragraph (2) of this subsection, at least 45 days before filing an action against a patient to collect on the debt owed on a hospital bill, a hospital shall send written notice of the intent to file an action to the patient.

(2) The notice required under paragraph (1) of this subsection shall:

(i) Be sent to the patient by certified mail and first–class mail;

(ii) Be in simplified language and in at least 10 point type;

(iii) Include:

1. The name and telephone number of:

A. The hospital;

B. If applicable, the debt collector; and

C. An agent of the hospital authorized to modify the terms of the payment plan, if any;

2. The amount required to cure the nonpayment of debt, including past due payments, interest, penalties, and fees;

3. A statement recommending that the patient seek debt counseling services;

4. Telephone numbers and Internet addresses of the Health Education Advocacy Unit in the Office of the Attorney General, available to assist patients experiencing medical debt;

5. An explanation of the hospital’s financial assistance policy; and

6. Any other relevant information prescribed by the Commission; and

(iv) Be provided in the patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes at least 5% of the population within the jurisdiction in which the hospital is located as measured by the most recent federal census.

(3) The notice required under this subsection shall be accompanied by:

(i) An application for financial assistance under the hospital’s financial assistance policy, along with instructions for completing the application for financial assistance, and the telephone number to call to confirm receipt of the application;

(ii) The availability of an income–based payment plan to satisfy the medical debt that is the subject of the hospital debt collection action; and

(iii) The information sheet required under § 19–214.1(f) of this subtitle.

(i) A complaint by a hospital in an action to collect a debt owed on a hospital bill by a patient shall:

(1) Include an affidavit stating:

(i) The date on which the 240–day period required under subsection (f)(3) of this section elapsed and the nature of the nonpayment;

(ii) That a notice of intent to file an action under subsection (h) of this section:

1. Was sent to the patient and the date on which the notice was sent; and

2. Accurately reflected the contents required to be included in the notice;

(iii) That the hospital provided:

1. The patient with a copy of the information sheet on the financial assistance policy in accordance with subsection (h)(3)(ii) of this section; and

2. Notice of the financial assistance policy as documented under § 19–214.1(f) of this subtitle;

(iv) That the hospital made a determination regarding whether the patient is eligible for the hospital’s financial assistance policy in accordance with § 19–214.1 of this subtitle; and

(v) That the hospital made a good–faith effort to meet the requirements of subsection (d) of this section; and

(2) Be accompanied by:

(i) The original or a certified copy of the hospital bill;

(ii) A statement of the remaining due and payable debt supported by an affidavit of the plaintiff, the hospital, or the agent or attorney of the plaintiff or hospital;

(iii) A copy of the most recent hospital bill sent to the patient;

(iv) If the defendant is eligible for federal Service Members Civil Relief Act benefits, an affidavit that the hospital is in compliance with the Act;

(v) A copy of the notice of intent to file an action on a hospital bill; and

(vi) A copy of the patient’s signed certified mail acknowledgment of receipt of the written notice of intent to file an action, if received by the hospital.

(j) If a hospital delegates collection activity to a debt collector, the hospital shall:

(1) Specify the collection activity to be performed by the debt collector through an explicit authorization or contract;

(2) Require the debt collector to abide by the hospital’s credit and collection policy;

(3) Specify procedures the debt collector must follow if a patient appears to qualify for financial assistance; and

(4) Require the debt collector to:

(i) In accordance with the hospital’s policy, provide a mechanism for a patient to file with the hospital a complaint against the hospital or the debt collector regarding the handling of the patient’s bill;

(ii) Forward the complaint to the hospital if a patient files a complaint with the debt collector; and

(iii) Along with the hospital, be jointly and severally responsible for meeting the requirements of this section.

(k) (1) The board of directors of each hospital shall review and approve the hospital’s financial assistance policy required under § 19–214.1 of this subtitle and debt collection policy required under this section at least every 2 years.

(2) A hospital may not alter its financial assistance or debt collection policies without approval by the board of directors.

(l) (1) (i) Subject to paragraph (2) of this subsection, a hospital may sell debt owed to the hospital by a patient for hospital services to a governmental unit or an entity that is under contract with the unit or to a nonprofit organization that is exempt from taxation under § 501(c)(3) of the Internal Revenue Code for the sole purpose of canceling the debt.

(ii) The contract between the hospital and the governmental unit, contractor, or nonprofit organization purchasing the debt under this subsection shall state that the sole purpose of the sale of the debt is to cancel the debt.

(iii) The patient is not responsible to the hospital, the governmental unit, the contractor, or the nonprofit organization for any amount of the debt that is sold under this subsection or any interest, fees, or costs associated with the debt or the sale.

(2) Debt sold under this subsection:

(i) Must be for hospital services provided at least 2 years before the date of the sale;

(ii) May not be expected to yield additional reimbursements from a third–party payor;

(iii) May not be subject to an open appeal with an insurance company; and

(iv) Must be for an individual whose family income is at or below 500% of the federal poverty level or who has medical debt exceeding 5% of the individual’s family income, as determined by the governmental unit, contractor, or nonprofit organization purchasing the debt.

(3) Debt sold under this subsection may be sold with a reduction of Commission charges.

(4) The Commission shall treat the amount of payments to hospitals under this subsection as an offset to uncompensated care amounts reported by hospitals.

(5) The purchaser of the debt shall:

(i) Notify the patient that the debt has been canceled; and

(ii) If the hospital obtained a judgment against the patient or reported adverse information to a consumer reporting agency about the patient, seek to vacate the judgment or strike the adverse information.

(m) The Commission shall review each hospital’s implementation of and compliance with the hospital’s policies and the requirements of this section.

(n) (1) On or before February 1 each year, beginning in 2023, the Commission shall compile the information required under subsection (a) of this section and prepare a medical debt collection report based on the compiled information.

(2) The report required under paragraph (1) of this subsection shall be:

(i) Made available to the public free of charge; and

(ii) Submitted to the Senate Finance Committee and the House Health and Government Operations Committee in accordance with § 2–1257 of the State Government Article.

§19–214.2. // EFFECTIVE JUNE 30, 2028 PER CHAPTER 750 OF 2025 //

(a) (1) Each hospital annually shall submit to the Commission:

(i) At times prescribed by the Commission, the hospital’s policy on the collection of debts owed by patients; and

(ii) A report including:

1. The total number of patients by race or ethnicity, gender, and zip code of residence against whom the hospital, or a debt collector used by the hospital, filed an action to collect a debt owed on a hospital bill;

2. The total number of patients by race or ethnicity, gender, and zip code of residence with respect to whom the hospital has and has not reported or classified a bad debt; and

3. The total dollar amount of the charges for hospital services provided to patients but not collected by the hospital for patients covered by insurance, including the out–of–pocket costs for patients covered by insurance, and patients without insurance.

(2) The Commission shall post the information submitted under paragraph (1) of this subsection on its website.

(b) The policy submitted under subsection (a)(1) of this section shall:

(1) Provide for active oversight by the hospital of any contract for collection of debts on behalf of the hospital;

(2) Prohibit the hospital from selling any debt;

(3) Describe in detail the consideration by the hospital of patient income, assets, and other criteria;

(4) Prohibit the hospital from reporting adverse information to a consumer reporting agency;

(5) Prohibit the hospital from filing a civil action to collect a debt within 240 days after the initial bill is provided;

(6) Prohibit the hospital from filing a civil action to collect a debt against a patient whose outstanding debt is at or below $500;

(7) Describe the hospital’s procedures for collecting a debt;

(8) Describe the circumstances in which the hospital will seek a judgment against a patient;

(9) In accordance with subsection (c) of this section, provide for a refund of amounts collected from a patient or the guarantor of a patient who was later found to be eligible for free care within 240 days after the initial bill was provided;

(10) If the hospital has obtained a judgment against or reported adverse information to a consumer reporting agency about a patient who later was found to be eligible for free care within 240 days after the initial bill was provided for which the judgment was awarded or the adverse information was reported, require the hospital to seek to vacate the judgment or strike the adverse information;

(11) Provide a mechanism for a patient to:

(i) Request the hospital to reconsider the denial of free or reduced–cost care;

(ii) File with the hospital a complaint against the hospital or a debt collector used by the hospital regarding the handling of the patient’s bill; and

(iii) Allow the patient and the hospital to mutually agree to modify the terms of a payment plan offered under subsection (d) of this section or entered into with the patient;

(12) For a patient who is eligible for free or reduced–cost care under the hospital’s financial assistance policy, prohibit the hospital from:

(i) Charging interest on the debt owed on a bill for the patient before a court judgment is obtained; or

(ii) Collecting fees or any other amount that exceeds the approved charge for the hospital service as established by the Commission; and

(13) Comply with § 24–2502 of this article.

(c) (1) (i) A hospital shall provide for a refund of amounts exceeding $25 collected from a patient or the guarantor of a patient who was found to be eligible for free care within 240 days after the initial bill is provided to the patient.

(ii) The hospital shall provide the refund to the patient not later than 30 days after determining that the patient was eligible for free care.

(2) If a patient is enrolled in a means–tested government health care plan that requires the patient to pay out–of–pocket for hospital services, a hospital’s refund policy shall provide for a refund that complies with the terms of the patient’s plan.

(d) (1) Subject to paragraph (2) of this subsection, a hospital shall provide in writing to each patient who incurs medical debt information about the availability of an installment payment plan for the debt.

(2) A hospital shall provide the information under paragraph (1) of this subsection to the patient, the patient’s family, the patient’s authorized representative, or the patient’s legal guardian:

(i) Before the patient is discharged;

(ii) With the hospital bill;

(iii) On request; and

(iv) In each written communication to the patient regarding collection of hospital debt.

(3) (i) The Commission shall develop guidelines, with input from stakeholders, for an income–based payment plan offered under this subsection that includes:

1. The amount of medical debt owed to the hospital;

2. The duration of the payment plan based on a patient’s annual gross income;

3. Guidelines for requiring appropriate documentation of income level;

4. Guidelines for the payment amount that:

A. May not exceed 5% of the patient’s federal or State adjusted gross monthly household income that takes into consideration all individuals on the same federal or State tax return; and

B. Shall consider financial hardship, as defined in § 19–214.1(a) of this subtitle;

5. Guidelines for:

A. The determination of possible interest payments for patients who do not qualify for free or reduced–cost care, which may not begin before 240 days after the initial bill is provided; and

B. A prohibition on interest payments for patients who qualify for free or reduced–cost care as required under subsection (b)(12) of this section;

6. Guidelines for modification of a payment plan that does not create a greater financial burden on the patient; and

7. A prohibition on penalties or fees for prepayment or early payment.

(ii) A hospital may not seek legal action against a patient on a debt owed until the hospital has established and implemented a payment plan policy that complies with the guidelines developed under subparagraph (i) of this paragraph.

(4) (i) A patient shall be deemed to be compliant with a payment plan if the patient makes at least 11 scheduled monthly payments within a 12–month period.

(ii) If a patient misses a scheduled monthly payment, the patient shall contact the health care facility and identify a plan to make up the missed payment within 1 year after the date of the missed payment.

(iii) The health care facility may, but may not be required to, waive any additional missed payments that occur within a 12–month period and allow the patient to continue to participate in the income–based payment plan and not refer the outstanding balance owed to a collection agency or for legal action.

(5) (i) A hospital shall demonstrate that it attempted in good faith to meet the requirements of this subsection and the guidelines developed by the Commission under paragraph (3) of this subsection before the hospital:

1. Files an action to collect a debt owed on a hospital bill by a patient; or

2. Delegates collection activity to a debt collector for a debt owed on a hospital bill by a patient.

(ii) Subparagraph (i) of this paragraph does not prohibit a hospital from using an eligibility vendor to provide outreach to a patient for purposes of assisting the patient in qualifying for financial assistance.

(e) (1) A hospital shall comply with § 24–2502 of this article.

(2) For at least 240 days after issuing an initial patient bill, a hospital may not commence civil action against a patient for nonpayment.

(3) A hospital shall report the fulfillment of a patient’s payment obligation within 60 days after the obligation is fulfilled to any consumer reporting agency to which the hospital had reported adverse information about the patient.

(4) A hospital may not commence a civil action against a patient for nonpayment, or delegate collection activity to a debt collector:

(i) If the hospital was notified in accordance with federal law by the patient or the insurance carrier that an appeal or a review of a health insurance decision is pending within the immediately preceding 60 days; or

(ii) If the hospital has completed a requested reconsideration of the denial of free or reduced–cost care that was appropriately completed by the patient within the immediately preceding 60 days.

(5) By November 1, 2025, a hospital that had reported adverse information about a patient to a consumer reporting agency shall instruct the consumer reporting agency to delete the adverse information about the patient.

(f) (1) A hospital may not force the sale or foreclosure of a patient’s primary residence to collect a debt owed on a hospital bill.

(2) A hospital may not request a lien against a patient’s primary residence in an action to collect debt owed on a hospital bill.

(3) (i) A hospital may not give notice to a patient under subsection (h) of this section until after 240 days after the initial bill was provided.

(ii) If a hospital files an action to collect the debt owed on a hospital bill, the hospital may not request the issuance of or otherwise knowingly take action that would cause a court to issue:

1. A body attachment against a patient; or

2. An arrest warrant against a patient.

(4) A hospital may not request a writ of garnishment of wages or file an action that would result in an attachment of wages against a patient to collect debt owed on a hospital bill if the patient is eligible for free or reduced–cost care under § 19–214.1 of this subtitle.

(5) (i) A hospital may not make a claim against the estate of a deceased patient to collect a debt owed on a hospital bill if the deceased patient was known by the hospital to be eligible for free care under § 19–214.1 of this subtitle or if the value of the estate after tax obligations are fulfilled is less than half of the debt owed.

(ii) A hospital may offer the family of the deceased patient the ability to apply for financial assistance.

(6) A hospital may not file an action to collect a debt owed on a hospital bill by a patient until the hospital determines whether the patient is eligible for free or reduced–cost care under § 19–214.1 of this subtitle.

(g) (1) Except as provided in paragraph (2) of this subsection, a spouse or another individual may not be held liable for the debt owed on a hospital bill of an individual who is at least 18 years old.

(2) An individual may voluntarily consent to assume liability for the debt owed on a hospital bill of any other individual if the consent is:

(i) Made on a separate document signed by the individual;

(ii) Not solicited in an emergency room or during an emergency situation; and

(iii) Not required as a condition of providing any emergency or nonemergency health care services.

(h) (1) Subject to paragraph (2) of this subsection, at least 45 days before filing an action against a patient to collect on the debt owed on a hospital bill, a hospital shall send written notice of the intent to file an action to the patient.

(2) The notice required under paragraph (1) of this subsection shall:

(i) Be sent to the patient by certified mail and first–class mail;

(ii) Be in simplified language and in at least 10 point type;

(iii) Include:

1. The name and telephone number of:

A. The hospital;

B. If applicable, the debt collector; and

C. An agent of the hospital authorized to modify the terms of the payment plan, if any;

2. The amount required to cure the nonpayment of debt, including past due payments, interest, penalties, and fees;

3. A statement recommending that the patient seek debt counseling services;

4. Telephone numbers and Internet addresses of the Health Education Advocacy Unit in the Office of the Attorney General, available to assist patients experiencing medical debt;

5. An explanation of the hospital’s financial assistance policy; and

6. Any other relevant information prescribed by the Commission; and

(iv) Be provided in the patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes at least 5% of the population within the jurisdiction in which the hospital is located as measured by the most recent federal census.

(3) The notice required under this subsection shall be accompanied by:

(i) An application for financial assistance under the hospital’s financial assistance policy, along with instructions for completing the application for financial assistance, and the telephone number to call to confirm receipt of the application;

(ii) The availability of an income–based payment plan to satisfy the medical debt that is the subject of the hospital debt collection action; and

(iii) The information sheet required under § 19–214.1(f) of this subtitle.

(i) A complaint by a hospital in an action to collect a debt owed on a hospital bill by a patient shall:

(1) Include an affidavit stating:

(i) The date on which the 240–day period required under subsection (f)(3) of this section elapsed and the nature of the nonpayment;

(ii) That a notice of intent to file an action under subsection (h) of this section:

1. Was sent to the patient and the date on which the notice was sent; and

2. Accurately reflected the contents required to be included in the notice;

(iii) That the hospital provided:

1. The patient with a copy of the information sheet on the financial assistance policy in accordance with subsection (h)(3)(ii) of this section; and

2. Notice of the financial assistance policy as documented under § 19–214.1(f) of this subtitle;

(iv) That the hospital made a determination regarding whether the patient is eligible for the hospital’s financial assistance policy in accordance with § 19–214.1 of this subtitle; and

(v) That the hospital made a good–faith effort to meet the requirements of subsection (d) of this section; and

(2) Be accompanied by:

(i) The original or a certified copy of the hospital bill;

(ii) A statement of the remaining due and payable debt supported by an affidavit of the plaintiff, the hospital, or the agent or attorney of the plaintiff or hospital;

(iii) A copy of the most recent hospital bill sent to the patient;

(iv) If the defendant is eligible for federal Service Members Civil Relief Act benefits, an affidavit that the hospital is in compliance with the Act;

(v) A copy of the notice of intent to file an action on a hospital bill; and

(vi) A copy of the patient’s signed certified mail acknowledgment of receipt of the written notice of intent to file an action, if received by the hospital.

(j) If a hospital delegates collection activity to a debt collector, the hospital shall:

(1) Specify the collection activity to be performed by the debt collector through an explicit authorization or contract;

(2) Require the debt collector to abide by the hospital’s credit and collection policy;

(3) Specify procedures the debt collector must follow if a patient appears to qualify for financial assistance; and

(4) Require the debt collector to:

(i) In accordance with the hospital’s policy, provide a mechanism for a patient to file with the hospital a complaint against the hospital or the debt collector regarding the handling of the patient’s bill;

(ii) Forward the complaint to the hospital if a patient files a complaint with the debt collector; and

(iii) Along with the hospital, be jointly and severally responsible for meeting the requirements of this section.

(k) (1) The board of directors of each hospital shall review and approve the hospital’s financial assistance policy required under § 19–214.1 of this subtitle and debt collection policy required under this section at least every 2 years.

(2) A hospital may not alter its financial assistance or debt collection policies without approval by the board of directors.

(l) The Commission shall review each hospital’s implementation of and compliance with the hospital’s policies and the requirements of this section.

(m) (1) On or before February 1 each year, beginning in 2023, the Commission shall compile the information required under subsection (a) of this section and prepare a medical debt collection report based on the compiled information.

(2) The report required under paragraph (1) of this subsection shall be:

(i) Made available to the public free of charge; and

(ii) Submitted to the Senate Finance Committee and the House Health and Government Operations Committee in accordance with § 2–1257 of the State Government Article.
Md. Code, Insurance § 19-102 — MD Code / Article gin / Title 19 / Subtitle 1 / Section 19-102
§19–102.
Status: in_force

(a) A liability insurance policy issued in the State may not require the insured to pay for liability or loss under the policy.

(b) Each liability insurance policy issued in the State shall provide that:

(1) the bankruptcy or insolvency of the insured does not release the insurer from liability; and

(2) if an injured person or another person claiming by, through, or under the injured person is unable, after execution on a final judgment entered in an action against an insured, to recover the full amount of the final judgment, the person may bring an action against the insured’s insurer in accordance with the terms of the policy for the lesser of the amount of the judgment recovered in the action against the insured or the amount of the policy.

(c) Notwithstanding anything to the contrary in the policy, each liability insurance policy issued in the State shall be construed to contain the provisions required by subsection (b) of this section.