1. A. In this chapter, the following terms have the meanings indicated.

2. B. Terms Defined.

   1. (1) “Credit and collection policy” means a hospital’s policy on the collection of medical debt.

   2. (2) Debt Collector.

      1. (a) “Debt collector” means a person who engages directly or indirectly in the business of:

         1. (i) Collecting for, or soliciting from another, medical debt;
         2. (ii) Giving, selling, attempting to give or sell to another, or using, for collection of medical debt, a series or system of forms or letters that indicates directly or indirectly that a person other than the hospital is asserting the medical debt; or
         3. (iii) Employing the services of an individual or business to solicit or sell a collection system to be used for collection of medical debt.
      2. (b) “Debt collector” includes a “collection agency” as defined in Business Regulation Article, §7-101, Annotated Code of Maryland.
   3. (3) “Financial hardship” means medical debt, incurred by a family over a 12-month period, that exceeds 25 percent of family income.
   4. (4) “Hospital” has the meaning stated in Health-General Article, §19- 301(f), Annotated Code of Maryland.

   5. (5) Hospital Services.

      1. (a) “Hospital services” means:

         1. (i) Inpatient hospital services as enumerated in 42 C.F.R. §409.10, as amended;
         2. (ii) Emergency services, including services provided at a freestanding medical facility licensed under Health Occupations Article, Title 19, Subtitle 3A, Annotated Code of Maryland
         3. (iii) Outpatient services provided at a hospital as defined in COMAR 10.37.10.07-2;
         4. (iv) Outpatient services, as specified by the Commission in COMAR 10.37.10.07-2, provided at a freestanding medical facility licensed under Health-General Article, Title 19, Subtitle 3A, Health-General Article, Annotated Code of Maryland that has received a certificate of need under Health-General Article, §19–120(o)(1), Annotated Code of Maryland, or an exemption from obtaining a certificate of need under Health-General Article, §19–120(o)(3), Annotated Code of Maryland; and
         5. (v) Identified physician services for which a facility has Commission–approved rates on June 30, 1985.

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

         1. (i) Of a hospital that, on or before June 1, 2015, is under a merged asset hospital system;
         2. (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
         3. (iii) That complies with all federal requirements for the 340B Program and applicable provisions of 42 C.F.R. §413.65.

      3. (c) “Hospital services” does not include:

         1. (i) Outpatient renal dialysis services;
         2. (ii) Outpatient services provided at a limited service hospital as defined in Health-General Article, §19–301, Annotated Code of Maryland except for emergency services; or
         3. (iii) Physician services that are billed separately.

   6. (6) Household.

      1. (a) “Household” means, at a minimum, for an adult patient, the patient and the following individuals that live in the same dwelling:

         1. (i) A spouse, regardless of whether the patient and spouse expect to file a joint federal or State tax return;
         2. (ii) Biological children, adopted children, or stepchildren; and
         3. (iii) All individuals on the same federal or State tax return, including anyone for whom the patient claims a personal exemption in a federal or State tax return.

      2. (b) “Household” means, at a minimum, for a patient who is a child, the patient and the following individuals that live in the same dwelling:

         1. (i) Biological parents, adoptive parents, stepparents, or guardians;
         2. (ii) Biological siblings, adopted siblings, or step siblings; and
         3. (iii) All individuals on the same federal or State tax return, including anyone for whom the patient’s parents or guardians claim a personal exemption in a federal or State tax return.
      3. (c) The terms "household” and “family” are synonymous for the purposes of this chapter.

   7. (7) Income.

      1. (a) “Income” means total taxable income, before taxes.

      2. (b) “Income” includes:

         1. (i) If a hospital uses state or federal tax returns to verify income, the adjustments listed on Schedule 1 of Form 1040; and
         2. (ii) If a hospital utilizes an asset test, the value of household monetary assets, consistent with Regulation 06J of this chapter.
   8. (8) “Initial bill” means the first billing statement provided to an individual by a hospital after the care, whether inpatient or outpatient, is provided and the individual has left the hospital.
   9. (9) “Medical debt” means out-of-pocket expenses, including co-payments, coinsurance, and deductibles, for hospital services that are regulated by the Commission that are billed to a patient or a co-signer for the patient, excluding amounts contractually paid by another payer such as insurers, including Medicare, Medicaid, or CHIP.

   10. (10) “Medically necessary care” including care provided in accordance with the Emergency Medical Treatment and Labor Act of 1986), means care that is:

       1. (a) Directly related to diagnostic, preventative, curative, palliative, rehabilitative, or ameliorative treatment of an illness, injury, disability or health condition;
       2. (b) Consistent with current accepted standards of good medical practice; and
       3. (c) Not primarily for the convenience of the patient, the patient’s family, or the provider.

   11. (11) Monetary Assets.

       1. (a) “Monetary assets” means assets in excess of $100,000 that can readily be converted into a fixed or precisely determinable amount of money, including cash and cash equivalents.
       2. (b) “Monetary assets” include cash on hand, bank deposits, investment accounts, accounts receivable, and notes receivable.
       3. (c) “Monetary assets” do not include retirement assets to which the Internal Revenue Service has granted preferential tax treatment, including deferred–compensation plans qualified under the Internal Revenue Code or nonqualified deferred–compensation plans.

   12. (12) Payment Plan.

       1. (a) “Payment plan” means an agreement between a patient, or a guarantor, to pay for a hospital service over a period of time.

       2. (b) “Payment plan” includes:

          1. (i) An “income-based payment plan” set forth in Regulation .05 of this chapter; and
          2. (ii) A “non-income-based payment plan” set forth in Regulation .05W of this chapter.
   13. (13) “Qualified Maryland resident” means someone who lives in Maryland for more than 6 months of the year or whose primary residence is in Maryland, including those in Maryland for school or work.

   14. (14) Written.

       1. (a) “Written” means communications in paper form and communications delivered electronically, including through electronic mail, a secure web, or mobile based application such as a patient portal.
       2. (b) “Written” does not include oral communications, including communications delivered by phone.

Authority: Health-General Article, §§19-214.2, 19-214.3, 19-207, and 19-219, Annotated Code of Maryland

Effective date: December 11, 2025 (52:24 Md. R. 1198)