Hospital Payment Guidelines Under Review by Maryland Stakeholder Working Group

The group, including ACA member Leslie Bender, is tasked with finalizing hospital payment guidelines under a new Maryland medical debt law.

02/10/2022 9:00 A.M.

4.5 minute read

Maryland’s Health Services Cost Review Commission’s (HSCRC) Workgroup on Hospital Payment Plan Guidelines review of draft guidelines on payment plans is underway as part of requirements in the state’s new medical debt law, HB 565, that took effect Jan. 1.

The HSCRC Workgroup, which includes consumer advocates, health care providers, state regulators, consumer representatives and financial services industry members, met in January for the first of several meetings.

Leslie Bender, IFCCE, senior counsel at Clark Hill Law, is serving as a member of the HSCRC stakeholder group.

“I’m honored to be part of an active interdisciplinary work group of consumer advocates, regulators—including attorneys general—large Maryland-based hospitals, and patients who are working to formulate some regulations related to the payment arrangement portions of Maryland’s new medical debt protection act,” Bender said. “We look forward to a series of frequently asked questions or other guidance our financial services regulator, who is in the workgroup, will issue to help industry comply with Maryland’s new law.”

Under the Maryland law, a hospital must annually submit its policy on the collection of debts owed by patients as well as a specified report to the HSCRC. The HSCRC must compile these submissions into an annual medical debt collection report.

Modernizing Payment Plan Options

During its Jan. 24 meeting, the HSCRC discussed several of the draft payment plan guidelines required by the law.

The draft guidelines “apply to payment plans offered by hospitals to all patients to pay for hospital services after the services are provided. These guidelines do not apply to pre-payment plans.”

The draft payment plan guidelines stipulate that hospitals must make payment plans available to all patients irrespective of their insurance status, citizenship status or immigration status and eligibility for reduced cost care, including reduced cost care due to financial hardship.

Much of the Jan. 24 discussion focused on guidelines for notifying consumers about payment plan terms and making sure the payment plan information has details about financial assistance.

Members of the group also discussed how to incorporate technology into communications with consumers about the payment plans.

“It seems to me that we have an enormous opportunity to be modern here,” Bender said. “I would love to see a creative way to provide the information, electronically.”

According to the draft payment plan guidelines, the notice of availability of payment plans must be included in writing with an information sheet required by the Code of Maryland Regulations (COMAR).

As required in COMAR section 10.37.10.26, the information sheet is provided before the patient receives scheduled medical services; before discharge; with the hospital bill; on request; and in each written communication to the patient regarding collection of the hospital bill.

This timing matches the requirements in HB 565 for provision of information on payment plans.

For the notice of payment plan terms, hospitals shall provide a written copy of the payment plan to the patient before the due date of the patient’s first payment, according to the draft payment plan guidelines.

The payment plan must state:

  • The amount of medical debt owed to the hospital.
  • The amount of each periodic payment expected from the patient under the payment plan.
  • The number of periodic payments expected from the patient under the payment plan.
  • The expected due dates for each payment from the patient.
  • The expected date by which the account will be paid off in full.

Jedd Bellman, assistant commissioner at the Office of the Maryland Commissioner of Financial Regulation, said during the Jan. 24 meeting that the notice of payment terms could be modified for consumers who prefer digital communication methods, similar to the modernization of the Fair Debt Collection Practices Act by the Consumer Financial Protection Bureau through Reg F.

The group also discussed draft guidelines on payment amounts. Under a payment plan subject to these guidelines, a hospital shall not require a patient to make total payments in a month that exceed 5% of the lessor of the individual patient’s family federal or state adjusted gross monthly income for all medical debt with the hospital incurred by a family.

The group discussed suggested language related to a hospital consolidating multiple debts from a patient into a single payment plan and whether it is useful/necessary to provide for periodic adjustments to the amount of the monthly payments based on changes in the individual patient’s family federal or state adjusted gross monthly income.

Next Steps

ACA and the Mid-Atlantic Collectors Association continue to work closely with the Maryland Office of the Commissioner of Financial Regulations as it considers regulations and guidance to implement the new law.

The HSCRC will hold its next meeting, which is open to other stakeholders and the public, from 9-11 a.m. EDT, Feb. 11. It also added another meeting this month, Feb. 28, to allow for additional time to review the draft payment guidelines.

After the meetings, HSCRC staff will revise the guidelines based on input from stakeholders and present them at the March 9 HSCRC commission meeting.

There will be time for public comments on the proposed guidelines before they are presented to the commission again in April.

View a recording of the January meeting here, and register for the remaining February meetings here.

Read more about the Maryland law and other states implementing medical debt laws in the most recent issue of Collector magazine.

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