An Act to Require Hospitals and Hospital-affiliated Providers to Provide
Maine Legislature, Session 132, LD 1937
Committee Amendment CA_A_HA_A_H707 (House)
Amends: 22 MRSA §1716-A

HOUSE AMENDMENT " A ,, to COMMITTEE AMENDMENT "A" to S.P. 75S, 
L.D. 1937, "An Act to Require Hospitals and Hospital-affiliated Providers to Provide 
Financial Assistance Programs for Medical Care» 
Amend the amendment on page 1 by striking out all of lines 12 to 23 and inse1ting the 
following: 
'Amend the bill by striking out all of section 3 and inserting the following: 
'Sec, 3. 22 MRSA §1716-A is enacted to 1·ead: 
§1716-A. Ch,uity care and financial assistance programs provided by hospitals 
This section applies to financial assistance progrnms provided by hospitals to 
qualifying patients. including program reguil'ements specific to charity care. 
1. Definitions. As used in this section. unless the context otherwise indicates. the 
following terms have the following meanings. 
A. "Charity care" means free health ca,·e services provided by hospitals to patients in 
accordance with the requirements under subsection 2. 
B. "Family income" means the cumulative income of a patient and the patient's family. 
"Family income" does not include the income of any individual residing in a patient's 
household who is not a member of the patient's family. For the purposes of this 
parngrnph. "family" means a group of 2 or more persons related by bil'th. marriage. 
civil union. domestic partnership or adoption who reside together and among whom 
there are legal responsibilities fot· suppo11. All such related persons are conside1·ed one 
family. 
C. "Federal poverty level" has the same meaning as in section 3762. subsection 1. 
parag1·aph C, 
D. "Financial assistance progl'am" means a program administered by a hospital to 
provide patients with free or reduced-cost health cal'e services and includes, but is not 
limited to, chal'ity care. 
E. "Income" means modified adiusted gross income as determined using the 
methodology described in 42 Code of Federal Regulations. Section 435.603(e). 
Page I • 132LR0979(05) 
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HOUSE AMENDMENT "A "to COMMITTEE AMENDMENT "A" to S.P. 755, L.D. 1937 
F. "State resident" has the same meaning as in 42 Code of Federal Regulations, Section 
435.403{d). 
2, Hospital to provide charity care, A hospital shall, in accordance with rules 
adopted by the department. provide free health ca1·e services to eligible patients who al'e 
state residents in accordance with this section. Upon admission of a patient, or in cases of 
emergency admission before discharge of a patient, a hospital shall investigate the coverage 
of the patient by any insurance or state or federal programs of medical assistance, A 
hospital shall provide free, medically necessa1y services for patients whose family income 
is equal to or less than l 50% of the federal poverty level or 200% of the federal poverty 
level if the patient is uninsured. 
The income of a secondary or postsecondaiy student in the State must be determined by 
including the student's pat·ents' or caregivers' income. 
3. Applications and eligibility requirements for financial assistonce programs 
generally. The following requirements apply to financial assistance programs provided by 
a hospital. including charity care except as otherwise provided in subsection 4. A hospital. 
in accordance with rules adopted by the depa1tment: 
A. May use an application fonn developed by the department put·suant to subsection 
12.t 
B. May not require notal'ization of any application materials or supportit1g documents 
required for an application. However, a hospital may include on an application for a 
financial assistance program: 
(1) A requirement for an applicant to attest to the accuracy of the information 
submitted: 
(2) A statement that any information submitted that is determined to be false will 
result in a denial of financial assistance and that the applicant will bear financial 
responsibility fo1• charges for services provided by the hospital; and 
(3) A statement informing the applicant that knowingly submitting false 
information is unlawful; 
C. Shall accept documentation specified by the department by rule that may be used as 
proof that the applicant is a state resident: 
D. Shall determine eligibility based upon the applicant's family income at the time the 
application is submitted; and 
E. Shall. within 30 days of receiving an application. notify the applicant to clearly 
explain what additional information or documentation, if any. is necessary to complete 
the application. The hospital shall provide the patient with a reasonable amount of time 
that is no less than 30 days following notification to the patient of any information 
needed to complete the application before denying the application based on incomplete 
information. The hospital shall determine eligibility and inform the patient of the 
eligibility determination within 45 days from the date a completed application is 
submitted. 
Notwithstanding any provision of this subsection to the contrary. a person who is 
determined to be eligible for assistance under a hospital's financial assistance progrnm must 
notify the hospital if any change has occurred that may impact the person's eligibility for 
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HOUSE AMENDMENT" A "to COMMITTEE AMENDMENT "A" to S.P. 755, L.D. 1937 
assistance at the time a service is scheduled or delivered. Failure to notify the hospital if 
any change has occurred that may impact the person's eligibility fot• assistance will cause 
the person to be ineligible for free ca1·e pursuant to this section, 
4. Applications and eligibility requirements specific to charity ca1•e, In addition to 
the requirements of subsection 3, and notwithstanding any pl'Ovision of subsection 3 to the 
contraty. the following requirements apply to charity care, A hospital. in accordance with 
rules adopted by the depattment: 
A. May not solicit from an applicant for charity cal'e provided in accordance with this 
section information regarding any assets or income that are not used to calculate 
modified adjusted gross income as described in 42 Code of Federnl Regulations, 
Section 435.603(e). except that a hospital may solicit from an applicant information 
regarding assets or income not included under 42 Code of Federal Regulations, Section 
435.603(e) that is subject to Maine individual income taxation: 
B. Shall provide ve1·sions of the charity cm·e application and the summaty described in 
subsection 5, pal'Rgraph A translated into any language spoken by 5% of the community 
served by the hospital or 1,000 people in the community served by the hospital, 
whichever is less; 
C. Shall determine that an applicant is unable to pay for hospital services and is eligible 
for charity care when the family income of the patient, as calculated by either of the 
methods described in subparagrnphs (1) and (2), is equal to or less than 150% of the 
federnl poverty level if the applicant is insured or 200% of the federal poverty level if 
the applicant is uninsured. Eligibility may be calculated by: 
(1) Multiplying by 4 the patient's family income for the 3 months preceding the 
determination of eligibility: or 
(2) Using the patient's actual family income fot· the 12 months preceding the 
determination of eligibility. 
If one method of calculation is inapplicable. the other method must be applied p1fo1· to 
determining an applicant's eligibility for charity care. 
The income of a secondary 01· postsecondaty student in the State must be dete1·mined 
by including the student's parents' or caregive1·s
income; 
D. Shall provide each applicant who requests chal'ity care and is denied it, in whole or 
in part. a written and dated statement of the reasons fot· the denial when the denial is 
made: and 
E. Shall pl'Ovide to an applicant who is denied charity care, in whole or in patt. 
information regarding the right to request a fail' hearing from the depa1tment regarding 
the patient's eligibility fot· charity care. 
5, Notice and publication requfrements. In accordance with mies adopted by the 
department. a hospital shall widely publicize its financial assistance prog1·ams within the 
community served by the hospital, including by: 
A. Publishing a summa1y of the financial assistance progrnms written in plain 
language, including a summary of services not covered by financial assistance 
programs: 
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B. Providing, in conspicuous locations within the hospital, including admission, 
l'egistrntion and waiting areas. information regarding how patients can access physical 
copies of the plain language summaiy under paragt·aph A. the financial assistance 
program application and any application instructions; 
C. Posting a full and downloadable version of the financial assistance program 
application on the hospital's publicly accessible website; 
D. Including on all plain language summaries and financial assistance prngram 
application instructions. excluding billing statements except as otherwise provided in 
parngraph E and subsection 6, information regarding the hospital's financial assistance 
prngram and information regal'ding the availability of no-cost assistance with applying 
for financial assistance and health covernge programs through the Health Insurance 
Consumer Assistance Prngram established in Title 24-A. section 4326: and 
E. Prnviding on all billing statements sent to a patient information on the availability 
of financial assistance. including how to apply for the financial assistance program. the 
address of a publicly accessible website from which a patient may download a copy of 
the application and a telephone numbel' that a patient may call to 1·equest a papet· copy 
of the application. 
6, Individual w1·itten notice of chal'ity care availability. A hospital shall provide a 
patient with individual written notice of the availability of charity care according to the 
following, 
A. With respect to inpatient services, the hospital shall provide individual written 
notice of the availability of charity care to each patient upon admission. or in the case 
of emergency admission befot•e discharge. 
B. With 1·espect to outpatient se1·vices, the hospital shall either include with the patient's 
bill a copy of an individual notice of the availability of charity care or prnvide a copy 
of the individual notice at the time service is provided. 
The individual notice provided pursuant to this subsection must include the information 
required pursuant to subsection S, paragraph D, a telephone number to reqi1est a paper 
charity care application. the income guidelines to qualify for charity care and any other 
information specified by the department by rule. 
7. Patient notified of noncovered services; consequences for failing to notify. In 
accordance with rules adopted by the department, a hospital shall inform a patient who is 
determined to be eligible for financial assistance if any pait of a medical service, treatment, 
procedure or test provided ot· administered to the patient in the hospital is not covered by 
the hospital's financial assistance progrnms. A hospital may bill a patient's health insurance 
carder fol' a medical service, treatment. procedure 01· test for which the hospital is 
prohibited from billing the patient under this subsection. 
8, Reasonable payment utans; maximum out~of~pocket payments, In accordance 
with rules adopted by the department. a hospital shall offer a patient with a documented 
family income that does not exceed 300% of the federal poverty level a payment plan that 
requires monthly out-of-pocket payments that do not exceed 4% of the patienes monthl}'. 
famil}'. income that is not exempt from attachment or garnishment under state law. 
A hospital is not required to offer a patient a payment plan for a debt less than $1,000. 
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9. Bill disputes. A hospital shall include on a billing statement sent to a patient 
information regarding how to dispute a charge. If the contact information for disputing a 
charge is distinct from the contact information fo1• paying or otherwise settling a bill. the 
contact information for the individual or entity chat·ged with handling disputed charges 
must be provided. 
10. Employer failu1•e to provide insm•ance or workers' compensation. If a person 
is employed and the person's employer fails to provide health insurance or workers' 
compensation insurance as required by state or federal law and the insurnnce or WOl'kers' 
compensation would have covered the treatment received by the person, the person's 
employer is responsible for the cost of the treatment received by that person. 
11. Enforcement. This subsection governs enforcement of this section. 
A. The depattment shall: 
(1) Establish a process fot· a patient to submit a complaint of hospital 
noncompliance with this section: 
(2) Conduct a review within 30 days of receiving a complaint from a patient 
regarding noncompliance with this section: and 
(3) Require a conective action of a hospital. if the depattment determines that the 
hospital is not in compliance with this section. which may include: 
(a) Measures to inform the patient about the noncompliance: and 
(b) Adjusting any amount billed to the patient in violation of this section. 
B. If the depa11ment determines that a hospital knowingly or willfully violated this 
section 01· engaged in a pattem of noncompliance with this section, the depa1tment may. 
through the Office of the Attorney General. bring a civil action against the hospital for 
a penalty not to exceed $1.000. 
12, Application developecl by department. The depa11ment shall develop an 
application for patients to apply for financial assistance prngrams, including chadty care. 
consistent with the requirements of subsections 3 and 4. as applicable. The department 
shall translate any application it develops into any language spoken by 5% of the population 
of the State 01· 1,000 people in the State. whichever is less. 
13. Rulemaldng, The depa11ment shall adopt rules to car1y out the purposes of this 
section. Rules adopted pursuant to this subsection must be consistent with the requirements 
of the United States Internal Revenue Code of 1986, Section 50l(r) and any federal 
1·egulations implementing those regufrements. Rules adopted pu1·suant to this subsection 
are routine technical rnles as defined in Title 5, chapter 375, subchapter 2MA.'' 
Amend the amendment by relettering ot· 1·enumbedng any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment does the following. 
1. It amends the definition of "family income" to include income from persons related 
by civil union or domestic partnership and clal'ifies that a secondary or postsecondary 
student's income includes the student's parents' income. 
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HOUSE AMENDMENT" A "to COMMITTEE AMENDMENT "A" to S,P, 755, L,D, 1937 
2. It amends the definition of "state resident" to match the one used in 42 Code of 
Federal Regulations, Section 435.403(d), 
3. It clarifies that if a person is employed and the person's employer fails to provide 
health insurance 01· workers' compensation insurance as requit·ed by state or federal law and 
the insurance or workers' compensation would have covered the treatment received by the 
person, the person's employer is responsible for the cost of the tt·eatment received by that 
person. 
4. It clarifies that the expansion of the mandatory charity care threshold from 150% of 
the federnl poverty level to 200% applies only to uninsured persons. 
5. It requires the recipient of charity care to notify the hospital of any change that might 
affect the 1·ecipient
1s eligibility to receive charity care. 
6. It changes the completeness review deadline from 15 days to 30 days. 
7, It removes the requirement that a hospital must provide interpretation services to 
patients with limited English proficiency and patients who are deaf or ha1·d of heal'ing. 
8. It exempts hospitals from providing payment plans for debts less than $1,000. 
SPONSORED BY: ~h 
,, = 
(Representative~ ~;,) v • .,, 
TOWN: Chester 
HOUSE AMENDMENT