An Act to Require Hospitals and Hospital~affiliated Providers to Provide
Maine Legislature, Session 132, LD 1937
Committee Amendment CA_A_SA_A_S393 (Senate)
Amends: 22 MRSA §1716-A

SENATE AMENDMENT «A ,, to COMMITTEE AMENDMENT "N
to S.P. 755, 
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 read: 
§1716-A, Charity care and financial assistance programs provided by hospitals 
This section applies to financial assistance programs provided by hospitals to 
qualifying patients. including program requirements specific to chal'ity 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 care 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 birth, maniage, 
civil union. domestic pa1tnership or adoption who reside together and among whom 
there are legal responsibilities for support. All such related persons are considered one 
family. 
C. "Federal poverty level" has the same meaning as in section 3762. subsection 1. 
paragraph C. 
D. "Financial assistance progrnm
means a program administered by a hospital to 
pl'ovide patients with free or reduced-cost health cal'e services and includes, but is not 
limited to, charity care. 
E. "Income" means modified adjusted gross income as determined using the 
methodology described in 42 Code of Federal Regulations. Section 435.603(e). 
Page I • 132LR0979(04) 
SENATE AMENDMENT 
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SENATE AMENDMENT 'A "to COMMITI'EE AMENDMENT "A" lo S.P. 755, L.D. 193? { S· ,3'1~ 
F. "State resident" has the same meaning as in 42 Code of Federal Regulations, Section 
435.403(d). 
2. Hospital to pt·ovide charity care, A hospital shall, in accordance with rules 
adopted by the depa1tment. provide free health care services to eligible patients who are 
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 shal I investigate the coverage 
of the patient by any insurnnce 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 150% of the federal pove1ty level or 200% of the federal poverty 
level if the patient is uninsured. 
• 
The income of a secondary or postsecondaty student in the State must be determined by 
including the student's parents' or caregivers' income. 
3. Applications ancl eligibility requirements for financial assistance programs 
generallx, The following requirements apply to financial assistance programs provided by 
a hospital, including charity care except as otherwise pt'ovided in subsection 4. A hospital, 
in accordance with rnles adopted by the depa1tment: 
A. May use an application form developed by the department pursuant to subsection 
Tu 
B. May not require notarization of any application materials or suppo1ting documents 
requit'ed for an application, However, a hospital may include on an application for a 
financial assistance progrnm: 
(1) A requirement for an applicant to attest to the accmacy 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 for 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 depa1tment 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 contraty. a person who is 
determined to be eligible for assistance under a hospital's financial assistance program must 
notify the hospital if any change has occurred that may impact the person's eligibility for 
SENATE AMENDMENT 
SBNATB AMENDMENT" A-" to COMMl'ITBB AMENDMENT "A" to S.P, 755, L.D, 1937 ( $ ·.?'f ~ 
assistance at the time a service is scheduled or delivered, Failul'e to notify the hospital if 
any change has occurred that may impact the person's eligibility for assistance will cause 
the person to be ineligible for free ca1·e pursuant to this section. 
4. Applications and eligibility requirements specific to chal'ity care. In addition to 
the requirements of subsection 3, and notwithstanding any provision of subsection 3 to the 
contrary, the following requirements apply to charity care. A hospital, in accordance with 
rules adopted by the department: 
A. May not solicit from an applicant for charity care 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 Federal 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 versions of the charity care application and the summaty described in 
subsection 5, paragraph 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 cat·e when the family income of the patient. as calculated by either of the 
methods described in subparngrnphs (1) and (2). is equal to 01· less than 150% of the 
federal 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 pl'eceding the 
detet·mination of eligibility: or 
(2) Using the patient's actual family income for the 12 months preceding the 
determination of eligibility. 
If one method of calculation is inapplicable, the other method must be applied pri01· to 
determining an applicant's eligibility for charity care. 
The income of a secondaty or postsecondaty student in the State must be determined 
by including the student's parents' or cal'egivers' income: 
D. Shall provide each applicant who requests chat;ity care and is denied it, in whole or 
in part, a wdtten and dated statement of the reasons for the denial when the denial is 
made: and 
E. Shall provide to an applicant who is denied charity care. in whole or in pa1t. 
information 1·egarding the right to request a fair hearing from the depa1tment regarding 
the patient's eligibility fo1· charity care. 
5. Notice and publication requh-ements. In accordance with rules adopted by the 
department, a hospital shall widely publicize its financial assistance progrnms within the 
community se1·ved by the hospital. including by: 
A. Publishing a summary of the financial assistance programs written ht plain 
language. including a summary of services not covered by financial assistance 
programs; 
SENATE AMENDMENT 
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SENATE AMBNDMEN'f "/4-" to COMMIITEE AMENDMBNT "A" to S.P. 155, L.D. 1937 ( S· 31S) 
B. Providing, in conspicuous locations within the hospital. including admission, 
registration and waiting areas. information regarding how patients can access physical 
copies of the plain language summary under paragraph 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 program 
application instrnctions. excluding billing statements except as otherwise provided in 
paragraph E and subsection 6. information regarding the hospital's financial assistance 
program and information regarding the availability of no-cost assistance with applying 
for financial assistance and health coverage programs through the Health Insurance 
Consume1· Assistance Progrnm established in Title 24-A. section 4326: and 
E. Providing on all billing statements sent to a patient information on the availability 
of financial assistance. including how to apply for the financial assistance progrnm. the 
address of a publicly accessible website from which a patient may download a copy of 
the application and a telephone number that a patient may call to request a paper copy 
of the application. 
6, Individual written notice of charity 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 before discharge. 
B. With 1·espect to outpatient services, the hospital shall either include with the patient's 
bill a copy of an individual notice of the availability of charity care or provide a copy 
of the individual notice at the time service is provided. 
The individual notice provided pursuant to this subsection must include the infol'lnation 
required pursuant to subsection 5, paragraph D. a telephone number to request 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 noncove1·ed services; consequences for failing to notify, In 
accordance with rules adopted by the depa11ment. a hospital shall inform a patient who is 
determined to be eligible for financial assistance if any part of a medical service. treatment. 
procedure 01· test provided or administered to the patient in the hospital is not covered by 
the hospital's financial assistance programs. A hospital may bill a patient's health insurance 
carrier for a medical service. treatment. procedure or test for which the hospital is 
prohibited from billing the patient under this subsection. 
8, Reasonable payment plans; maximum out-of-pocket payments, In acco1·dance 
with mies adopted by the depaitment. 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 patient's monthly 
family income that is not exempt from attachment or garnishment under state law. 
A hospital is not 1·equil'ed to offer a patient a payment plan for a debt less than $1.000. 
SENATE AMENDMENT 
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SHNATE AMENDMENT" /r to COMMITIEB AMENDMENT "A" to S.P, 755, L.D, 1937 (s ·-3 ~ 
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 charged with handling disputed charges 
must be provided. 
10. Employer failure to provide insurance or workers' compensation. If a person 
is employed and the person's employer fails to provide health insurance or workers' 
compensation insmance as required 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 fo1• the cost of the treatment received by that person. 
11. Enforcement. This subsection governs enforcement of this section. 
A. The department shall: 
(1) Establish a process for 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) Requil'e a corrective action of a hospital. if the department dete1·mines 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 department determines that a hospital knowingly or willfully violated this 
section or engaged in a pattern ofnoncompliance with this section. the department 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 developed by depal'tment, The department shall develop an 
application for patients to apply for financial assistance progt·ams. 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 or 1.000 people in the State, whichever is less. 
13, Rulemaking, The department shall adopt rules to carry out the pUl'poses of this 
section. Rules adopted pursuant to this subsection must be consistent with the requit·ements 
of the United States lntemal Revenue Code of 1986, Section 50l(r) and any federal 
regulations implementing those requirements. Rules adopted pursuant to this subsection 
are routine technical rules as defined in Title 5. chapter 375. subchapter 2~A,' 
Amend the amendment by relettel'ing 01· renumbering any nonconsecutive Part letter or 
section number to read consecutively, 
SUMMARY 
This amendment does the following, 
l. It amends the definition of "family income" to include income from persons related 
by civil union or domestic partnership and clarifies that a secondary or postsecondary 
student's income includes the student's parents' income. 
SENATE AMENDMENT 
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SENATE AMENDMENT "A "to COMMl'JTEE AMENDMENT "A" to S.P. 755, L.D. 1937 ( S·:J13~ 
2. It amends the definition of "state resident0 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 employe1· fails to provide 
health insurance 01· workers' compensation insUl'ance as required 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 treatment received by that 
person. 
4. It clarifies that the expansion of the mandatory charity earn threshold from 1 SO% of 
the federal 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 recipient's eligibility to receive chal'ity 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 hard of hearing. 
8. It exempts hospitals from providing payment plans for debts less than $1,000. 
SPONSORED BY: ~~ 
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(Senator MOORE, M.) 
COUNTY: Washington 
SENATE AMENDMENT