Maryland law should be changed so that hospitals are required to provide charity care to more people and give financial-assistance information to all patients, according to the state agency that sets hospital rates.
In a report to Gov. Martin O'Malley that will be released today, the Health Services Cost Review Commission recommends several changes to the state's unique rate-setting system, which was designed in part to guarantee all Marylanders hospital care whether they could afford it or not.
The commission also recommended that hospitals be required to provide written notice about the availability of financial assistance to all patients before or as they are discharged, and that hospitals and their collection agencies be barred from adding interest and penalties on bills to uninsured patients for periods before court judgments are entered against them.
O'Malley ordered the commission to do an "immediate and thorough review" of hospital debt collection practices in response to a Baltimore Sun investigative series in December. The articles documented how hospitals were aggressively pursuing collection of unpaid bills from patients of limited means even though those debts are supposed to be recovered in the rates they charge.
"When we identify there is a problem, it is important that we study it and come up with practical solutions to solve it," said John M. Colmers, secretary of the Department of Health and Mental Hygiene.
The 90-page report says hospitals should be required to provide free care to all Maryland residents whose incomes are less than 200 percent of the federal poverty guideline - or $36,620 for a family of three or $44,100 for a family of four.
The Maryland Hospital Association has said all of its members, at a minimum, offer free care to patients who have incomes below 150 percent of federal poverty guidelines - $27,465 for a family of three and $33,075 for a family of four - and less than $10,000 in net assets.
"The State lacks any standards for Credit and Collection activities and hospitals' articulated policies are ambiguous and vary even more widely," according to the report by Robert B. Murray, executive director of the cost review commission.
State officials said yesterday that they could not pinpoint the number of additional Marylanders who could be eligible for charity care if the General Assembly follows the report's recommendations, partly because they are still studying the issue of using assets to determine eligibility. But based on 2007 figures, an estimated 90,000 uninsured, nonelderly citizens could become eligible.
