An Act to Require Hospitals and Hospital-affiliated Providers to
Maine Legislature, Session 132, LD 1937
Committee: Health Coverage, Insurance and Financial Services
Sponsors: TALBOT ROSS, FECTEAU
Amends: 22 MRSA §1715, 22 MRSA §1716, 22 MRSA §1716-A, 22 MRSA §4313, 32 MRSA §11013

Legislative Document
No. 1937
S.P. 755
In Senate, May 6, 2025
An Act to Require Hospitals and Hospital-affiliated Providers to 
Provide Financial Assistance Programs for Medical Care
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator TALBOT ROSS of Cumberland.
Cosponsored by Speaker FECTEAU of Biddeford and
Senators: BAILEY of York, BALDACCI of Penobscot, INGWERSEN of York, ROTUNDO 
of Androscoggin, Representatives: GATTINE of Westbrook, MEYER of Eliot, SHAGOURY 
of Hallowell, STOVER of Boothbay.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §1715, as amended by PL 2017, c. 475, Pt. A, §29, is further 
amended to read:
§1715.  Access requirements applicable to certain health care providers
1.  Access requirements.  Any person, including, but not limited to, an affiliated 
interest as defined in former section 396‑L, that is subject to the requirements of this 
subsection, shall provide the services listed in paragraph C to individuals who are eligible 
for charity care in accordance with a charity care policy adopted by the affiliate or provider 
that is consistent with rules requirements applicable to hospitals under section 1716 1716-A 
and any rules adopted pursuant to section 1716-A.  A person is subject to this subsection if 
that person:
A.  Is either a direct provider of major ambulatory service, as defined in former section 
382, subsection 8‑A, or is or has been required to obtain a certificate of need under 
section 329 or former section 304 or 304-A;
B.  Provides outpatient services as defined in former section 382, subsection 9‑A; and
C.  Provides one or more of the following services:
(1)  Imaging services, including, but not limited to, magnetic resonance imaging, 
computerized tomography, mammography and radiology.  For purposes of this 
section, imaging services do not include:
(a)  Screening procedures that are not related to the diagnosis or treatment of a 
specific condition; or
(b)  Services when:
(i)  The services are owned by a community health center, a physician or 
group of physicians;
(ii)  The services are offered solely to the patients of that center, physician 
or group of physicians; and
(iii)  Referrals for the purpose of performing those services are not 
accepted from other physicians;
(2)  Laboratory services performed by a hospital or by a medical laboratory 
licensed in accordance with the Maine Medical Laboratory Commission, by the 
department or licensed by an equivalent out-of-state licensing authority, excluding 
those licensed laboratories owned by community health centers, by a physician or 
by a group of physicians where at which the laboratory services are offered solely 
to the patients of that center, physician or group of physicians;
(3)  Cardiac diagnostic services, including, but not limited to, cardiac 
catheterization and angiography but excluding electrocardiograms and 
electrocardiograph stress testing;
(4)  Lithotripsy services;
(5)  Services provided by free-standing ambulatory surgery facilities certified to 
participate in the Medicare program; or
(6)  Any other service performed in an out-patient setting requiring the purchase 
of medical equipment costing in the aggregate $500,000 or more and for which the 
charge per unit of service is $250 or more.
2.  Enforcement.  The requirements of subsection 1 are enforced through the following 
mechanisms.
A.  Any person who knowingly violates any provision of this section or any valid order 
or rule made or adopted pursuant to section 1716 1716-A, or who willfully fails, 
neglects or refuses to perform any of the duties imposed under this section, commits a 
civil violation for which a forfeiture of not less than $200 and not more than $500 per 
patient may be adjudged with respect to each patient denied access unless specific 
penalties are elsewhere provided.  Any forfeiture imposed under this section may not 
exceed $5,000 in the case of the first judgment under this section against the provider, 
$7,500 in the case of a 2nd judgment against the provider or $10,000 in the case of the 
3rd or subsequent judgment against the provider.  The Attorney General is authorized 
to prosecute the civil violations.
B.  Upon application of the Attorney General or any affected patient, the Superior Court 
or District Court has full jurisdiction to enforce the performance by providers of health 
care of all duties imposed upon them by this section and any valid rules adopted 
pursuant to section 1716 1716-A.
C.  In any civil action under this section, the court, in its discretion, may allow the 
prevailing party, other than the Attorney General, reasonable attorney's fees and costs 
and the Attorney General is liable for attorney's fees and costs in the same manner as a 
private person.
D.  It is an affirmative defense to any legal action brought under this section that the 
person subject to this section denied access to services on the grounds that the 
economic viability of the facility or practice would be jeopardized by compliance with 
this section.
Sec. 2.  22 MRSA §1716, as enacted by PL 1995, c. 653, Pt. B, §7 and affected by 
§8 and enacted by c. 696, Pt. A, §36, is repealed.
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 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 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 
paragraph, "family" means a group of 2 or more persons related by birth, marriage 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 program" means a program administered by a hospital to 
provide patients with free or reduced-cost health care 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).
F.  "State resident" means a person:
(1)  Living in the State with the intent to remain in the State indefinitely; or
(2)  Who enters the State with a permanent, temporary, seasonal or other job 
commitment or who is seeking employment.
"State resident" does not include a person who is in the State temporarily as a tourist 
or visitor.
2.  Hospital to provide charity care.  A hospital shall, in accordance with rules 
adopted by the department, 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 shall investigate the coverage 
of the patient by any insurance or state or federal programs of medical assistance. A hospital 
shall provide free, medically necessary services for patients whose family income is equal 
to or less than 200% of the federal poverty level.
3.  Applications and eligibility requirements for financial assistance 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 department:
A.  May use an application form developed by the department pursuant to subsection 
12;
B.  May not require notarization of any application materials or supporting 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 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 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;
E.  Shall, within 15 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 30 days from the date a completed application is 
submitted; and
F.  Shall provide interpretation services to patients with limited English proficiency 
and patients who are deaf or hard of hearing. This requirement applies to patients 
applying for or receiving assistance under a financial assistance program.
4.  Applications and eligibility requirements specific to charity 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);
B.  Shall provide versions of the charity care application and the summary described 
in subsection 5, paragraph A translated into any language spoken by 5% of the 
population of the State or 1,000 people in the State, whichever is less, as well as any 
additional languages 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 subparagraphs (1) and (2), is equal to or less than 200% of the 
federal poverty level. 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 for the 12 months preceding the 
determination of eligibility.
If one method of calculation is inapplicable, the other method must be applied prior to 
determining an applicant's eligibility for charity care;
D.  Shall provide each applicant who requests charity care and is denied it, in whole or 
in part, a written 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 part, 
information regarding the right to request a fair hearing from the department regarding 
the patient's eligibility for charity care.
5.  Notice and publication requirements.  In accordance with rules adopted by the 
department, a hospital shall widely publicize its financial assistance programs within the 
community served by the hospital, including by:
A. Publishing a summary of the financial assistance programs written in plain 
language, including a summary of services not covered by financial assistance 
programs;
B. Providing physical copies of the plain language summary under paragraph A, the 
financial assistance program application and any application instructions in 
conspicuous locations within the hospital, including admission, registration and 
waiting areas;
C. Posting a full, accessible 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 instructions, 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 
Consumer Assistance Program 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 program, 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 respect 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 information 
required pursuant to subsection 5, paragraph D, a telephone number to request a paper 
charity care application, the website address where a patient can submit an online 
application pursuant to subsection 10, 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 part of a medical service, treatment, 
procedure or test provided or administered to the patient in the hospital is not covered by 
the hospital's financial assistance programs. A hospital may not bill a patient for a medical 
service, treatment, procedure or test if the hospital failed to provide the patient with advance 
notice that a medical service, treatment, procedure or test is not covered under 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 accordance 
with rules adopted by the department, a hospital shall offer a patient with a documented 
family income that does not exceed 400% of the federal poverty level a payment plan that 
requires monthly out-of-pocket payments that do not exceed 3% of the patient's monthly 
family income that is not exempt from attachment or garnishment under state law.
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 for paying or otherwise settling a bill, the 
contact information for the individual or entity charged with handling disputed charges 
must be provided.
10. Online application for charity care. A hospital shall provide an online option 
through which an applicant may file an application for charity care. The online option must 
provide for an e-mail response to the applicant that the application has been received. The 
hospital shall provide an option for a patient to request that an application be mailed to the 
patient.
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) Require a corrective action of a hospital, if the department 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 department determines that a hospital knowingly or willfully violated this 
section or engaged in a pattern of noncompliance 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 department. The department shall develop an 
application for patients to apply for financial assistance programs, including charity 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 purposes of this 
section. Rules adopted pursuant to this section must be consistent with the requirements of 
the United States Internal Revenue Code of 1986, Section 501(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.
Sec. 4.  22 MRSA §4313, sub-§1, as amended by PL 1995, c. 696, Pt. A, §40, is 
further amended to read:
1.  Emergency care.  In the event of an admission of an eligible person to the hospital, 
the hospital shall notify the overseer of the liable municipality within 5 business days of 
the person's admission.  In no event may hospital services to a person who If the person 
meets the financial eligibility guidelines adopted pursuant to section 1716 requirements for 
charity care under section 1716-A, hospital services may not be billed to the patient person 
or to a municipality.
Sec. 5.  32 MRSA §11013, sub-§11, as enacted by PL 2021, c. 245, Pt. E, §1, is 
amended to read:
11.  Collection action prohibited on debt from medical expenses if eligible for free 
or charity care.  If a debt collector has been notified, orally or in writing, by a creditor or 
the consumer of the consumer’s actual or potential qualification for free or charity care 
under guidelines adopted pursuant to Title 22, section 1716 1716-A, a debt collector may 
not collect or attempt to collect a debt for medical expenses against a consumer who has 
been determined to be qualified for free or charity care under guidelines adopted pursuant 
to Title 22, section 1716 1716-A or against a consumer who would have been determined 
to be qualified for free or charity care under guidelines adopted pursuant to Title 22, section 
1716 1716-A but did not apply for good cause. If the notification is provided to a debt 
collector, the debt collector shall suspend collection efforts until the creditor has notified 
the debt collector and the consumer that the consumer is not qualified for free or charity 
care and, in that case, the debt collector may renew debt collection efforts.
Sec. 6. Department of Health and Human Services to adopt rules.  By June 
30, 2026, the Department of Health and Human Services shall adopt rules pursuant to the 
Maine Revised Statutes, Title 22, section 1716-A, subsection 13 to implement the 
requirements of this Act.  The rules must include a provision limiting a patient's right to 
request an administrative hearing to within 60 days after the date of the written notification 
of the action under section 1716-A that the patient wishes to appeal.
Sec. 7.  Effective date. This Act takes effect January 1, 2026.
SUMMARY
The bill eliminates the existing law that requires the Department of Health and Human 
Services to adopt guidelines governing charity care and replaces it with a more 
comprehensive law governing charity care and other financial assistance programs 
provided by hospitals to patients to cover charges for services provided by that hospital. 
The bill does the following.
1. It requires that hospitals provide charity care or free health care services to patients 
who are state residents and whose family income is equal to or less than 200% of the federal 
poverty level.
2. It establishes requirements with respect to hospital-provided financial assistance 
programs and specific requirements applying only to charity care that hospitals must follow 
in accordance with rules adopted by the department concerning the application process, 
language interpretation, eligibility determinations, notification of eligibility determinations 
and, in the case of charity care, rights to a hearing following a denial. 
3. It requires that hospitals widely publicize their financial assistance programs within 
the community served by the hospital, including by publishing a summary of the programs 
written in plain language; by providing physical copies of the summary, application and 
application instructions in conspicuous locations within the hospital; and by posting a full, 
accessible and downloadable version of the application on the hospital's publicly accessible 
website.
4. It requires that a hospital provide individual written notice of the availability of 
charity care to each patient. For inpatient services, the notice must be provided upon 
admission, or in the case of emergency admission before discharge. For outpatient services, 
individual notice must be included with the patient's bill or at the time service is provided.
5. It requires that a hospital notify a patient who is determined to be eligible for 
financial assistance if any part of the services provided are not covered by the hospital's 
financial assistance program. A hospital that fails to provide this notice is prohibited from 
charging the patient for those services, but is permitted to charge the patient's health 
insurance carrier for those services. 
6. It provides that a hospital must offer, for patients with family incomes that do not 
exceed 400% of the federal poverty level, a payment plan that requires monthly out-of-
pocket payments that do not exceed 3% of the patient's monthly family income that is not 
exempt from attachment or garnishment under Maine law.
7. It requires hospitals to include on a patient's bill information concerning the process 
for disputing charges. 
8. It requires that hospitals provide an online option for applying for charity care. 
9. It requires the department to enforce the provisions of this bill. The department must 
establish a process to receive patient complaints for hospital noncompliance, conduct 
reviews of those complaints and require a corrective action when a hospital is found to be 
noncompliant.
10. It establishes a civil penalty not to exceed $1,000 for hospitals that knowingly or 
willfully violate the provisions of this bill or engage in a pattern of noncompliance with 
these provisions. 
11. It requires the department to adopt rules by June 30, 2026 to carry out the purposes 
of this bill.