1. A. Each hospital shall develop an information sheet that:

   1. (1) Describes clearly:

      1. (a) The hospital's financial assistance policy as required in Regulation .06 of this chapter and Health-General Article, §19-214.1, Annotated Code of Maryland; and
      2. (b) A patient's legal rights and obligations with regard to hospital billing and collection;

   2. (2) Informs the patient, the patient’s family, the patient’s authorized representative, or the patient’s legal guardian:

      1. (a) That the hospital is permitted to bill outpatients a fee, commonly referred to as a facility fee, for their use of hospital facilities, clinics, supplies, and equipment, and nonphysician services, including but not limited to the services of nonphysician clinicians, in addition to physician fees billed for professional services provided in the hospital;
      2. (b) Of the patient’s right to request and receive a written estimate of the total charges for the hospital non-emergency services, procedures, and supplies that reasonably are expected to be provided and billed for by the hospital, in addition to the good faith estimate requirements in 42 U.S.C §2799B-6, the No Surprises Act;
      3. (c) Of the patient’s right to file a complaint with the Commission or jointly with the Health Education and Advocacy Unit of the Maryland Attorney General’s Office against a hospital for an alleged violation of Health-General Article, §§19-214.1 and 19-214.2, Annotated Code of Maryland;
      4. (d) Of the availability of an income-based payment plan; and
      5. (e) That physician charges, to both hospital inpatients and outpatients, are generally not included in the hospital bill and are billed separately;

   3. (3) Provides contact information for:

      1. (a) The individual or office at the hospital that is available to assist the patient, the patient's family, or the patient's authorized representative in order to understand:

         1. (i) The patient's hospital bill;
         2. (ii) The patient’s rights and obligations with regard to the hospital bill, including the patient’s rights and obligations with regard to reduced-cost medically necessary care due to a financial hardship;
         3. (iii) How to apply for financial assistance;
         4. (iv) How to apply for the Maryland Medical Assistance Program and any other programs that may help pay the bill; and
         5. (v) How to apply for a payment plan;
      2. (b) The Maryland Medical Assistance Program;
      3. (c) Filing a complaint with the Commission or jointly with the Health Education and Advocacy Unit of the Maryland Attorney General’s Office against a hospital for an alleged violation of Health-General Article, §§19-214.1 and 19-214.2, Annotated Code of Maryland; and
   4. (4) Includes a section that allows the patient to initial that the patient has been made aware of the financial assistance policy.

2. B. The information sheet shall be written in:

   1. (1) Simplified language;
   2. (2) At least 12-point type; and
   3. (3) The patient’s preferred language or, if no preferred language is specified, each language spoken by a limited English proficient population that constitutes at least 5 percent of the overall population within the city or county in which the hospital is located as measured by the most recent census.
3. C. The information sheet shall conform with Health-General Article, §19–342(d)(7) and (10), Annotated Code of Maryland.

4. D. The information sheet shall be provided in writing to the patient, the patient’s family, the patient’s authorized representative, or the patient’s legal guardian:

   1. (1) Before the patient receives scheduled medical services;
   2. (2) Before discharge;
   3. (3) With the hospital bill;
   4. (4) On request; and
   5. (5) In each written communication to the patient regarding collection of the hospital bill.
5. E. The hospital bill shall include a reference to the information sheet.

6. F. The Commission shall:

   1. (1) Establish uniform requirements for the information sheet; and
   2. (2) Review each hospital's implementation of and compliance with the requirements of this regulation.

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)