<section article="ghg" article_name="Health - General" number="16-101" title_number="16" title_name="Reimbursements and Collections" subtitle_number="1" subtitle_name="Definitions; Legislative Policy"> <level label="a"> <text>In this title the following words have the meanings indicated.</text> </level> <level label="b"> <level label="1"> <text>As to a recipient of services under the Maryland Developmental Disabilities Law, a word used in this title has the same meaning as is indicated by a definition of the word in § 7–101 of this article.</text> </level> <level label="2"> <text>As to a recipient of services under the Maryland Mental Health Law, a word used in this title has the same meaning as is indicated by a definition of the word in § 7.5–101 or § 10–101 of this article.</text> </level> </level> <level label="c"> <text>“Chargeable person” means:</text> <level label="1"> <text>Any responsible relative;</text> </level> <level label="2"> <text>Except for a recipient of services, any other person who is legally responsible for the care of the individual; and</text> </level> <level label="3"> <text>Any person who maintains a policy of health insurance under which a recipient of services is insured.</text> </level> </level> <level label="d"> <level label="1"> <text>“Cost of care” means the cost of care, maintenance, treatment, and support of a recipient of services.</text> </level> <level label="2"> <text>“Cost of care” includes the cost of:</text> <level label="i"> <text>An evaluation of an individual required under the Maryland Developmental Disabilities Law; and</text> </level> <level label="ii"> <text>Any juvenile screening or treatment service provided to an individual under § 9–227(b)(1)(ii) of the Human Services Article.</text> </level> </level> </level> <level label="e"> <level label="1"> <text>“Recipient of services” means an individual who receives care, maintenance, treatment, or support in a facility or program that is operated or funded wholly or partly by the Department.</text> </level> <level label="2"> <text>“Recipient of services” includes:</text> <level label="i"> <text>An individual in a public facility under the Maryland Mental Health Law;</text> </level> <level label="ii"> <text>An individual in a facility for an evaluation required under the Maryland Developmental Disabilities Law;</text> </level> <level label="iii"> <text>An individual in a residential, public facility or a facility from which this State obtains residential care under the Maryland Developmental Disabilities Law;</text> </level> <level label="iv"> <text>An individual to whom juvenile screening or treatment services are provided under § 9–227(b)(1)(ii) of the Human Services Article; and</text> </level> <level label="v"> <text>An individual in a private therapeutic group home from which this State obtains residential care under the Maryland Mental Health Law.</text> </level> </level> </level> <level label="f"> <text>“Responsible relative” means:</text> <level label="1"> <text>The spouse of a recipient of services; and</text> </level> <level label="2"> <text>The parents of a recipient of services who is a minor.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-102" title_number="16" title_name="Reimbursements and Collections" subtitle_number="1" subtitle_name="Definitions; Legislative Policy"> <level label="a"> <text>It is the policy of this State to obligate each recipient of services and, to the extent provided in this title, those legally responsible for the recipient to pay, if financially able, for the cost of care that is received by the recipient of services. Unless otherwise provided by statute, the recipient of services and the chargeable person shall be responsible for payment regardless of whether the recipient of services was admitted voluntarily, involuntarily, or by court order. If the recipient of services is involuntarily admitted to a public facility and released after evaluation, for failure to meet the standards for involuntary commitment, the recipient of services or chargeable person shall not be responsible for the cost of care.</text> </level> <level label="b"> <text>The total cost of care of each recipient of services is, in the first instance, the responsibility of the recipient of services and, as provided in this title, the chargeable person. Any uncollectible costs for services provided to the recipient shall become the responsibility of this State.</text> </level> </section> <section article="ghg" article_name="Health - General" number="16-201" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <text>The Secretary shall adopt rules and regulations that set charges for services that the Department provides for the physically ill, aged, mentally disordered, intellectually disabled, and developmentally disabled and other recipients of services in or through State–operated:</text> <level label="1"> <text>Clinics;</text> </level> <level label="2"> <text>Day care, day treatment, and day hospital care;</text> </level> <level label="3"> <text>Group homes and small residential homes;</text> </level> <level label="4"> <text>Inpatient care in regional and State hospitals and centers; and</text> </level> <level label="5"> <text>Inpatient and outpatient care of any other kind.</text> </level> </level> <level label="b"> <level label="1"> <text>The Secretary shall require political subdivisions and grantees to set, subject to approval and modifications of the Secretary, charges for services that are provided by the political subdivisions or grantees and that are supported wholly or partly by State or federal funds administered by the Department.</text> </level> <level label="2"> <text>If a health officer for a political subdivision considers it to be in the best interest of public health, the health officer may waive a charge set under this subsection.</text> </level> </level> <level label="c"> <text>Charges for services shall be set at least annually.</text> </level> <level label="d"> <text>If the Secretary considers it to be in the best interest of the public health, the Secretary may designate specific services for which a charge may not be made.</text> </level> </section> <section article="ghg" article_name="Health - General" number="16-201.1" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <text>The Secretary shall make an assessment of the Department’s health care services and ability-to-pay schedule for prenatal and infant care services offered through local health agencies.</text> </level> <level label="b"> <text>The assessment shall include the following:</text> <level label="1"> <text>The availability of efficient health care services and providers;</text> </level> <level label="2"> <text>The identification of health care services that are not available;</text> </level> <level label="3"> <text>Access to health care;</text> </level> <level label="4"> <text>The need for specific health care;</text> </level> <level label="5"> <text>An evaluation of alternative means of providing health care services; and</text> </level> <level label="6"> <text>Financial and manpower resources required and available.</text> </level> </level> <level label="c"> <text>An applicant for services under this section shall receive:</text> <level label="1"> <text>A personal financial consultation without charge to assess the applicant’s ability to pay for health care offered through local health agencies; and</text> </level> <level label="2"> <text>Notification of the right to obtain services offered through local health agencies regardless of ability to pay.</text> </level> </level> <level label="d"> <level label="1"> <text>The Secretary shall adopt regulations necessary to carry out the provisions of this section.</text> </level> <level label="2"> <text>Local health agencies shall implement uniform procedures to notify and consult potential prenatal and infant care services recipients.</text> </level> <level label="3"> <text>Reduced rates for recipients of services shall be applied fairly and uniformly, and according to the sliding fee scale developed by the Department.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-201.2" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Community developmental disabilities services provider” means a community–based developmental disabilities program licensed by the Department.</text> </level> <level label="3"> <text>“Community mental health services provider” means a community–based mental health program approved by the Department or an individual practitioner who contracts with the Department or the appropriate core service agency or local behavioral health authority.</text> </level> <level label="4"> <text>“Core service agency” has the meaning stated in § 7.5–101 of this article.</text> </level> <level label="5"> <text>“Eligible individual” means a Medicaid recipient or an individual who receives developmental disabilities services or mental health services subsidized in whole or in part by the State.</text> </level> <level label="6"> <text>“Local behavioral health authority” has the meaning stated in § 7.5–101 of this article.</text> </level> </level> <level label="b"> <text>Notwithstanding the provisions of this subtitle, the Department shall reimburse a community developmental disabilities services provider or a community mental health services provider for approved services rendered to an eligible individual as provided in this section.</text> </level> <level label="c"> <level label="1"> <text>Subject to the limitations of the State budget, beginning in fiscal year 2008 and in each fiscal year thereafter, the Department shall adjust for inflation the fees paid to a community developmental disabilities services provider and a community mental health services provider for approved services rendered to an eligible individual using the update factor recommended by the Community Services Reimbursement Rate Commission.</text> </level> <level label="2"> <text>Annual adjustments shall be funded with due regard to the expenditures necessary to meet the needs of individuals receiving services.</text> </level> <level label="3"> <text>The annual rate of change for the fees may not exceed a maximum rate of 5%.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-201.3" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Community provider” means a community–based agency or program funded by the Behavioral Health Administration or the Medical Care Programs Administration to serve individuals with mental disorders, substance–related disorders, or a combination of these disorders.</text> </level> <level label="3"> <text>“Rate” means the reimbursement rate paid by the Department to a community provider from the State General Fund, Maryland Medical Assistance Program funds, other State or federal funds, or a combination of these funds.</text> </level> </level> <level label="b"> <text>This section does not apply to reimbursement for any service provided by a community provider whose rates are regulated by the Health Services Cost Review Commission.</text> </level> <level label="c"> <text>It is the intent of the General Assembly that a substantial portion of the rate adjustment provided under subsection (d) of this section be used to:</text> <level label="1"> <text>Compensate direct care staff and licensed clinicians employed by community providers; and</text> </level> <level label="2"> <text>Improve the quality of programming provided by community providers.</text> </level> </level> <level label="d"> <level label="1"> <text>The Governor’s proposed budget for fiscal year 2019 and fiscal year 2020 shall include a 3.5% rate increase for community providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year for each of the following:</text> <level label="i"> <text>Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;</text> </level> <level label="ii"> <text>Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and</text> </level> <level label="iii"> <text>Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.</text> </level> </level> <level label="2"> <text>The Governor’s proposed budget for fiscal year 2021 shall include a 4% rate increase for community providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year for each of the following:</text> <level label="i"> <text>Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;</text> </level> <level label="ii"> <text>Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and</text> </level> <level label="iii"> <text>Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.</text> </level> </level> <level label="3"> <text>The Governor’s proposed budget for fiscal year 2022 shall include a 3.5% rate increase for community providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year for each of the following:</text> <level label="i"> <text>Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;</text> </level> <level label="ii"> <text>Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and</text> </level> <level label="iii"> <text>Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.</text> </level> </level> <level label="4"> <text>The Governor’s proposed budget for fiscal year 2023 shall include a 3.25% rate increase for community providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year for each of the following:</text> <level label="i"> <text>Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;</text> </level> <level label="ii"> <text>Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and</text> </level> <level label="iii"> <text>Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.</text> </level> </level> <level label="5"> <text>The Governor’s proposed budget for fiscal year 2024 shall include a 3% rate increase for community providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year for each of the following:</text> <level label="i"> <text>Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;</text> </level> <level label="ii"> <text>Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and</text> </level> <level label="iii"> <text>Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.</text> </level> </level> <level label="6"> <text>The Governor’s proposed budget for fiscal year 2019 and each fiscal year thereafter for community providers shall be presented in the same manner, including object and program information, as in the fiscal year 2018 budget.</text> </level> </level> <level label="e"> <level label="1"> <text>In this subsection, “Commission” means the Maryland Health Care Commission.</text> </level> <level label="2"> <text>On or before June 30, 2028, the Department shall:</text> <level label="i"> <text>Conduct an independent cost–driven, rate–setting study to set community provider rates for community–based behavioral health services that includes a rate analysis and an impact study that considers the actual cost of providing community–based behavioral health services;</text> </level> <level label="ii"> <text>Review and implement the recommendations of the Workgroup on Behavioral Health Rate Methodology Modernization established by Chapters 218 and 219 of the Acts of the General Assembly of 2026; and</text> </level> <level label="iii"> <text>Administer cost–reporting tools and oversee cost–report submissions required to support the study required under item (i) of this paragraph.</text> </level> </level> <level label="3"> <text>The Commission shall assist the Department with the facilitation of the rate–setting study required under paragraph (2)(i) of this subsection, including by:</text> <level label="i"> <text>Consulting with stakeholders, including community providers and individuals receiving services; and</text> </level> <level label="ii"> <text>Providing analytical support and technical assistance.</text> </level> </level> <level label="4"> <text>The Behavioral Health Administration and the Medical Care Programs Administration jointly shall:</text> <level label="i"> <text>Develop and implement a payment system incorporating the findings of the rate–setting study conducted under paragraph (2)(i) of this subsection; and</text> </level> <level label="ii"> <text>Consult with stakeholders, including community providers and individuals receiving services, in developing the payment system required under item (i) of this paragraph.</text> </level> </level> <level label="5"> <text>The Administration shall adopt regulations to implement the payment system required by paragraph (4)(i) of this subsection.</text> </level> <level label="6"> <level label="i"> <text>The Secretary, or the Secretary’s designee, shall designate a representative of the Administration to serve as a technical liaison between the Department and the Commission.</text> </level> <level label="ii"> <text>The technical liaison shall:</text> <level label="1"> <text>Provide technical input for the completion of the study required under paragraph (2)(i) of this subsection regarding Medicaid policy, behavioral health reimbursement structures, and existing data sources;</text> </level> <level label="2"> <text>Ensure continuity between the Department’s work regarding the completion of the study required under paragraph (2)(i) of this subsection and the Commission’s facilitation of the Workgroup on Behavioral Health Rate Methodology Modernization established under Chapters 218 and 219 of the Acts of the General Assembly of 2026; and</text> </level> <level label="3"> <text>Coordinate the Commission’s access to existing analytical work or study preparation that has been completed by the Department in complying with paragraph (2) of this subsection.</text> </level> </level> </level> </level> <level label="f"> <text>If services of community providers are provided through managed care organizations, the managed care organizations shall:</text> <level label="1"> <text>Pay the rate in effect during the immediately preceding fiscal year for the first fiscal year the managed care organizations provide the services; and</text> </level> <level label="2"> <text>Adjust the rate for community providers each fiscal year by at least the same amount that otherwise would have been required under subsection (d) of this section.</text> </level> </level> <level label="g"> <text>Increased funding provided under subsection (d) of this section may be used only to increase the rates paid to:</text> <level label="1"> <text>Community providers accredited by a State–approved accrediting body and licensed by the State; and</text> </level> <level label="2"> <text>Health care providers who are acting within the scopes of practice of the health care providers’ licenses or certificates as specified under the Health Occupations Article.</text> </level> </level> <level label="h"> <level label="1"> <text>On or before January 1, 2028, the Commission shall submit an interim report to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly on:</text> <level label="i"> <text>The delivery system through which community–based behavioral health services should be provided;</text> </level> <level label="ii"> <text>The status of the implementation of the recommendations of the Workgroup on Behavioral Health Rate Methodology Modernization established under Chapters 218 and 219 of the Acts of the General Assembly of 2026; and</text> </level> <level label="iii"> <text>Any preliminary recommendations regarding the payment system required under this section.</text> </level> </level> <level label="2"> <text>On or before December 1, 2028, and on or before December 1 each year thereafter, the Commission shall submit a report to the Governor and, in accordance with § 2–1257 of the State Government Article, the General Assembly on the impact of the rate adjustments and the payment system required under this section on community providers, including the impact on:</text> <level label="i"> <text>The wages and salaries paid and the benefits provided to direct care staff and licensed clinicians employed by community providers;</text> </level> <level label="ii"> <text>The tenure and turnover of direct care staff and licensed clinicians employed by community providers; and</text> </level> <level label="iii"> <text>The ability of community providers to recruit qualified direct care staff and licensed clinicians.</text> </level> </level> <level label="3"> <text>The Commission may require a community provider to submit, in the form and manner required by the Commission, information that the Commission considers necessary for completion of the report required under paragraph (2) of this subsection.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-201.4" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <level label="1"> <text>In this section the following words have the meanings indicated.</text> </level> <level label="2"> <text>“Provider” means a provider of:</text> <level label="i"> <text>Nursing home services;</text> </level> <level label="ii"> <text>Medical day care services;</text> </level> <level label="iii"> <text>Private duty nursing services;</text> </level> <level label="iv"> <text>Personal care services;</text> </level> <level label="v"> <text>Home– and community–based services; and</text> </level> <level label="vi"> <text>Services provided through the Community First Choice program.</text> </level> </level> <level label="3"> <text>“Rate” means the reimbursement rate paid by the Department to providers of nursing home, medical day care, private duty nursing, personal care, and home– and community–based services and services provided through the Community First Choice program from the State General Fund, Maryland Medical Assistance Program funds, other State or federal funds, or a combination of these funds.</text> </level> </level> <level label="b"> <level label="1"> <text>The Governor’s proposed budget for fiscal year 2021 shall include a 4% rate increase for providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year in Program M00Q01.03 Medical Care Provider Reimbursements – Medical Care Programs Administration and Program M00Q01.07 Maryland Children’s Health Program – Medical Care Programs Administration.</text> </level> <level label="2"> <text>The Governor’s proposed budget for fiscal year 2022 shall include a 4% rate increase for providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year in Program M00Q01.03 Medical Care Provider Reimbursements – Medical Care Programs Administration and Program M00Q01.07 Maryland Children’s Health Program – Medical Care Programs Administration.</text> </level> <level label="3"> <text>The Governor’s proposed budget for fiscal year 2023 shall include a 4% rate increase for providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year in Program M00Q01.03 Medical Care Provider Reimbursements – Medical Care Programs Administration and Program M00Q01.07 Maryland Children’s Health Program – Medical Care Programs Administration.</text> </level> <level label="4"> <text>The Governor’s proposed budget for fiscal year 2024 shall include a 4% rate increase for providers over the funding provided in the legislative appropriation for the immediately preceding fiscal year in Program M00Q01.03 Medical Care Provider Reimbursements – Medical Care Programs Administration and Program M00Q01.07 Maryland Children’s Health Program – Medical Care Programs Administration.</text> </level> <level label="5"> <text>The Governor’s proposed budget for fiscal year 2021 and each fiscal year thereafter shall be presented in the same manner, including object and program information, as in the fiscal year 2020 budget.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-202" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <text>To determine the ability to pay for the cost of care of a recipient of services, the Department shall investigate the financial condition of:</text> <level label="1"> <text>The recipient of services; and</text> </level> <level label="2"> <text>Each chargeable person to the extent that the recipient of services is unable to pay this cost of care.</text> </level> </level> <level label="b"> <text>In determining the financial condition of persons under this section, public assistance payments shall be taken into consideration as financial resources.</text> </level> <level label="c"> <level label="1"> <text>In its investigations, the Department may require the recipient of services, any chargeable person, and any other person to submit reports to the Department on the forms that the Department provides.</text> </level> <level label="2"> <text>If any person refuses or otherwise fails to file a required report, on petition of the Department, the circuit court for the county where the person resides or does business may compel the filing of the report.</text> </level> </level> <level label="d"> <level label="1"> <text>Notwithstanding any other provision of law to the contrary, the Department or its designated financial agent may obtain and use financial information and, if and when necessary, a summary of medical and psychological diagnoses regarding a recipient of services if the obtaining and use of this information is connected to the Department’s billing and collection functions under this subtitle. The Department shall obtain a release from the recipient of services or a chargeable person to secure information from a financial institution.</text> </level> <level label="2"> <level label="i"> <text>Except as provided in subparagraph (ii) of this paragraph, all information obtained by the Department or its designated agent under paragraph (1) of this subsection shall be treated as confidential.</text> </level> <level label="ii"> <text>If the financial information is connected to the treatment or care of a recipient of services under this subtitle, the Department or its designated financial agent may disclose the financial information obtained under paragraph (1) of this subsection to a designated clinical representative of a facility.</text> </level> </level> </level> <level label="e"> <text>As to services that are provided by a political subdivision or grantee, the Department may delegate to the political subdivision or grantee the investigation of financial condition and the determination and collection of the amount payable. However, the political subdivision or grantee shall follow each law and each rule and regulation of the Department that relates to the investigation and determination.</text> </level> </section> <section article="ghg" article_name="Health - General" number="16-203" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <level label="1"> <text>The cost of care of a recipient of services shall be determined in accordance with the charges for services set under § 16–201 of this subtitle.</text> </level> <level label="2"> <text>Except as otherwise provided in this title:</text> <level label="i"> <text>Payment for this cost of care shall be made by the recipient of services or a chargeable person;</text> </level> <level label="ii"> <text>Their liability for this payment is joint and several; and</text> </level> <level label="iii"> <text>The insured or policyholder may not withhold the payment and shall assign to the Department any benefits available under the policy for services rendered by the Department to any insured covered by the policy.</text> </level> </level> <level label="3"> <text>Liability may not be imposed under this title on any spouse of a recipient of services, if the spouse has been abandoned by the recipient of services. The Department shall adopt rules and regulations that define abandonment for the purposes of this subsection.</text> </level> <level label="4"> <text>Liability may not be imposed under this title on a responsible relative if any responsible relative has been the victim of sexual abuse, physical abuse, or a crime of violence as defined in § 14–101 of the Criminal Law Article perpetrated by the recipient of services. The Department shall adopt regulations that define “sexual abuse, physical abuse, or a crime of violence” as defined in § 14–101 of the Criminal Law Article for the purposes of this paragraph.</text> </level> </level> <level label="b"> <level label="1"> <text>The Department:</text> <level label="i"> <text>Shall set the time and amount of payments; and</text> </level> <level label="ii"> <text>May change its orders as to payments, as circumstances may warrant.</text> </level> </level> <level label="2"> <text>In setting the amount of payments, the Department:</text> <level label="i"> <text>Shall consider the financial means and abilities of the recipient of services and any chargeable person; and</text> </level> <level label="ii"> <text>May agree to accept less than the charges set for the services provided.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>In this subsection, “total lifetime hospitalization” means the sum total of all periods of inpatient hospitalization for a recipient of services in any State hospital or facility whether these periods are intermittent or continuous.</text> </level> <level label="2"> <text>If a chargeable person has paid for the first 24 months of total lifetime hospitalization of a recipient of services, the liability of that chargeable person for care of the recipient of services after that period may not exceed 15 percent of the charges for services set under § 16-201 of this subtitle.</text> </level> <level label="3"> <text>The sum of any proceeds of applicable insurance, group health plan, or prepaid medical care that the insurer or plan pays because of liability for the payment of or repayment for the cost of care provided to the recipient of services does not count as payments paid by a chargeable person for the purpose of determining the total lifetime hospitalization of a recipient of services.</text> </level> </level> <level label="d"> <text>The Department may set the amount of payments retroactively:</text> <level label="1"> <text>For a period of not more than 6 months from the date when the Department sets the amount of payments; and</text> </level> <level label="2"> <text>After inquiry by the Department, for a greater period, if:</text> <level label="i"> <text>The recipient of services, the responsible relatives of the recipient, or any other person, agency, or organization that has a summary of financial, medical, or psychological diagnoses about the recipient of services has failed or refused to give that information to the Department when the obtaining and use of this information is connected to the Department’s billing and collection functions under this subtitle; or</text> </level> <level label="ii"> <text>Any charges assessed third party insurers have been denied wholly or partly.</text> </level> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-204" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <level label="1"> <text>Except as provided in subsections (b) and (c) of this section, all payments made under this subtitle for services provided through a facility or program of the Department shall be:</text> <level label="i"> <text>Made to and collected by the Department; and</text> </level> <level label="ii"> <text>Accounted for and paid into the General Fund of this State by the Department.</text> </level> </level> <level label="2"> <text>If the Secretary has delegated to a political subdivision or grantee the collection of payments for services, the political subdivision or grantee shall collect and account for these payments in accordance with the rules and regulations of the Department.</text> </level> </level> <level label="b"> <level label="1"> <text>The Department may collect fees from persons certified for Kidney Disease Program benefits prior to providing these benefits in accordance with Title 13, Subtitle 3 of this article. Any fee collected by the Department for kidney disease services may be kept by the Department only to maintain and operate the State Kidney Disease Program.</text> </level> <level label="2"> <text>Subject only to the limitations provided in Title 13, Subtitle 3 of this article and in the provisions of the State budget for the State Kidney Disease Program, the Department may require providers of services in State or privately operated kidney disease centers and providers of prescription drugs and other pharmaceutical products to seek all available third party reimbursement prior to billing the program.</text> </level> </level> <level label="c"> <text>The Department may collect fees from a core service agency or local behavioral health authority for the cost of treatment of individuals whom the core service agency authorizes as eligible for admission into a State facility as described in Title 10, Subtitle 4 of this article. Any such fees collected by the Department for the admission and treatment of individuals authorized by the core service agency or local behavioral health authority shall be kept by the Department to be used to maintain and operate the respective State facility.</text> </level> <level label="d"> <level label="1"> <text>If a recipient of services dies, the Department may make a claim against the estate of the recipient for any unpaid fees established for that recipient.</text> </level> <level label="2"> <text>Except as provided in paragraph (4) of this subsection, a claim under this subsection may not include any fee for services provided more than 3 years before the recipient of services died.</text> </level> <level label="3"> <text>A claim made under this subsection is a preferred claim against the estate of a deceased recipient of services. The claim may be waived by the Department if, in its judgment, enforcement of the claim will cause substantial hardship to dependents of the deceased.</text> </level> <level label="4"> <text>If a responsible relative who is liable for the cost of care of the recipient of services has misrepresented assets or submitted fraudulent information and, by doing so, has avoided any part of the claim for the cost of care, there is no limitation on the time in which the claim may be brought against the estate.</text> </level> </level> <level label="e"> <level label="1"> <text>The Department may institute any proceedings that the Department considers necessary to require collection of the established but uncollected payments.</text> </level> <level label="2"> <text>The Central Collection Unit in the Department of Budget and Management shall handle those delinquent accounts and debts that the Maryland Department of Health refers under § 3–202 of the State Finance and Procurement Article.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-205" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <text>Instead of the requirements of this subtitle, the Department may accept those requirements that are set out in the Maryland Medical Assistance Plan or the federal laws and regulations under Title XIX of the Social Security Act and that govern the investigation of financial condition, standards of eligibility, and legal responsibility of recipients of services, their responsible relatives, legal representatives and estates, or other chargeable persons.</text> </section> <section article="ghg" article_name="Health - General" number="16-206" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <level label="a"> <text>For juvenile screening and treatment services that a unit of the Department provides under § 9–227(b)(1)(ii) of the Human Services Article, the Department shall bill and collect the cost of care as provided in this subtitle and as if the recipient of services were not a ward of this State.</text> </level> <level label="b"> <text>The Department of Juvenile Services shall pay for juvenile screening and treatment services that any person other than the Department provides under § 9–227(b)(1)(ii) of the Human Services Article. However, the Department later shall bill and collect this cost of care as provided in this subtitle.</text> </level> </section> <section article="ghg" article_name="Health - General" number="16-207" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <text>The Department shall bill and collect the fee for a service of a public health and clinical laboratory as provided in this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="16-208" title_number="16" title_name="Reimbursements and Collections" subtitle_number="2" subtitle_name="General Provisions"> <text>As far as practical, the rules and regulations enforcing this subtitle shall be applied uniformly to all individuals who receive services under programs that either are operated by the Department or supported wholly or partly by State or federal funds administered by the Department.</text> </section> <section article="ghg" article_name="Health - General" number="16-301" title_number="16" title_name="Reimbursements and Collections" subtitle_number="3" subtitle_name="Special Provisions as to Mental Health"> <text>Except as otherwise provided in this subtitle, Subtitle 2 of this title applies to a recipient of services under the Maryland Mental Health Law.</text> </section> <section article="ghg" article_name="Health - General" number="16-302" title_number="16" title_name="Reimbursements and Collections" subtitle_number="3" subtitle_name="Special Provisions as to Mental Health"> <level label="a"> <level label="1"> <text>Except as otherwise provided in this section, if any individual is examined under a court order by a representative of the Behavioral Health Administration, a reasonable cost of the examination shall be assumed by this State.</text> </level> <level label="2"> <text>The Administration is subrogated to any right or right of action that the individual examined has under the terms of any insurance policy to recover the costs of these services.</text> </level> </level> <level label="b"> <text>If the examination is requested by the individual being examined:</text> <level label="1"> <text>The individual is responsible for payment of the appropriate fee; and</text> </level> <level label="2"> <text>The Administration may ask and the court may require the individual to post a bond for payment of that fee.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-303" title_number="16" title_name="Reimbursements and Collections" subtitle_number="3" subtitle_name="Special Provisions as to Mental Health"> <level label="a"> <text>This section does not apply to funds that are derived from benefits payable under laws administered by the U.S. Department of Veterans Affairs.</text> </level> <level label="b"> <level label="1"> <text>If any property of an individual admitted under the Maryland Mental Health Law remains in the custody of a public facility for 1 year after the death or escape of the individual, the administrative head of the facility shall investigate to determine if any other person legally is entitled to that property.</text> </level> <level label="2"> <text>If such a person is not found:</text> <level label="i"> <text>As much as possible of the account of the individual at the facility shall be paid from the property; and</text> </level> <level label="ii"> <text>Any balance becomes the property of this State and shall be paid into the General Fund of this State.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>An action may not be brought more than 3 years after the death or escape of an individual to recover property of the individual left at or in the custody of the facility.</text> </level> <level label="2"> <text>This subsection does not waive any defense, including the defense of governmental immunity, available to any facility or other State agency in an action brought against it, even if the action is brought within 3 years after the death or escape of the individual.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-304" title_number="16" title_name="Reimbursements and Collections" subtitle_number="3" subtitle_name="Special Provisions as to Mental Health"> <text>State funding shall be as provided in the budget.</text> </section> <section article="ghg" article_name="Health - General" number="16-401" title_number="16" title_name="Reimbursements and Collections" subtitle_number="4" subtitle_name="Special Provisions as to Intellectual Disability"> <text>Except as otherwise provided in this subtitle, Subtitle 2 of this title applies to a recipient of services under the Maryland Developmental Disabilities Law.</text> </section> <section article="ghg" article_name="Health - General" number="16-402" title_number="16" title_name="Reimbursements and Collections" subtitle_number="4" subtitle_name="Special Provisions as to Intellectual Disability"> <text>When an individual enters a facility for comprehensive evaluation and when an individual with an intellectual disability is admitted to a public facility, each proponent of the admission shall be advised in writing, in clear and simple terms, of those provisions of this title that apply to that individual.</text> </section> <section article="ghg" article_name="Health - General" number="16-403" title_number="16" title_name="Reimbursements and Collections" subtitle_number="4" subtitle_name="Special Provisions as to Intellectual Disability"> <text>Notwithstanding any other provision of this title, the amount to be charged to chargeable persons for services received by a recipient of services under the Maryland Developmental Disabilities Law shall be as provided in this subtitle.</text> </section> <section article="ghg" article_name="Health - General" number="16-404" title_number="16" title_name="Reimbursements and Collections" subtitle_number="4" subtitle_name="Special Provisions as to Intellectual Disability"> <level label="a"> <text>If there is any insurance, group health plan, or prepaid medical care coverage for part or all of the cost of the care provided, the Department shall seek to collect the proceeds of the insurance, plan, or coverage to the full extent required to pay for the charges for services set under § 16–201 of this title. The insured or policyholder may not withhold the payment and shall assign to the Department any benefits available under the policy for services rendered by the Department to any insured covered by the policy.</text> </level> <level label="b"> <text>The liability of a chargeable person for services provided to an individual with an intellectual disability may not exceed the greater of:</text> <level label="1"> <text>The sum of any proceeds of insurance, group health plan, or prepaid medical care that the insurer or plan pays because of liability for the payment of or repayment for the cost of care provided to the individual; or</text> </level> <level label="2"> <text>The lesser of:</text> <level label="i"> <text>The amount determined under § 16–405 of this subtitle; or</text> </level> <level label="ii"> <text>The amount set by the Department under § 16–203(b) of this title.</text> </level> </level> </level> <level label="c"> <text>The liability of responsible relatives for the cost of care of an individual with an intellectual disability in a residential, State facility ceases when the cost of care of the individual with an intellectual disability has been charged for a period or periods that total 16 years.</text> </level> </section> <section article="ghg" article_name="Health - General" number="16-405" title_number="16" title_name="Reimbursements and Collections" subtitle_number="4" subtitle_name="Special Provisions as to Intellectual Disability"> <level label="a"> <text>In this section, “taxable income” has the meaning that federal law gives to it for purposes of the Internal Revenue Code.</text> </level> <level label="b"> <text>For purposes of § 16–404(b)(2) of this subtitle, the liability of a chargeable person for the cost of care of an individual with an intellectual disability shall be determined in accordance with either of the following schedules, at the option of the chargeable person.</text> <text>Schedule A</text> <text>Schedule Based on Gross Monthly Income</text> <text>Gross Monthly</text> <text>Income of Person Monthly Rate of Contribution</text> <text>Liable for Support</text> <text>At Less 2 3 4 5 6 7 8</text> <text>Least Than Dep. Dep. Dep. Dep. Dep. Dep. Dep.</text> <text>$ 500 –– 575 $16.00 $ ........ $ ........ $ ........ $ ........ $ ........ $ ........</text> <text>��575 –– 650 22.40 16.00 ........ ........ ........ ........ ........</text> <text>��650 –– 725 25.60 22.40 19.20 16.00 ........ ........ ........</text> <text>��725 –– 800 32.00 28.80 22.40 19.20 16.00 ........ ........</text> <text>��800 –– 875 35.20 32.00 28.80 25.60 22.40 16.00 ........</text> <text>��875 –– 950 43.20 39.20 35.20 32.00 25.60 22.40 19.20</text> <text>��950 –– 1025 56.00 49.60 43.20 35.20 32.00 28.80 25.60</text> <text>��1025 –– 1100 72.00 64.00 49.60 43.20 39.20 35.20 32.00</text> <text>��1100 –– 1175 88.00 72.00 64.00 56.00 49.60 43.20 35.20</text> <text>��1175 –– 1250 91.00 88.00 80.00 72.00 64.00 49.60 43.20</text> <text>��1250 –– 1325 94.00 94.00 91.00 88.00 72.00 64.00 56.00</text> <text>��1325 –– 1400 94.00 94.00 94.00 91.00 88.00 80.00 72.00</text> <text>��1400 –– 1475 94.00 94.00 94.00 94.00 94.00 91.00 88.00</text> <text>��1475 –– 1550 94.00 94.00 94.00 94.00 94.00 94.00 91.00</text> <text>��1550 and up 94.00 94.00 94.00 94.00 94.00 94.00 94.00</text> <text>Schedule B</text> <text>Schedule Based on Taxable Income Under</text> <text>Federal Internal Revenue Code</text> <text>Annual Taxable Income of</text> <text>Person Liable for Support Monthly Rate of Contribution</text> <text>At least $4,000 but less than $5,000 $16.00</text> <text>At least $5,000 but less than $6,000 ��22.40</text> <text>At least $6,000 but less than $7,000 ��28.80</text> <text>At least $7,000 but less than $8,000 ��35.20</text> <text>At least $8,000 but less than $9,000 ��43.20</text> <text>At least $9,000 but less than $10,000 ��56.00</text> <text>At least $10,000 but less than $11,000 ��72.00</text> <text>At least $11,000 but less than $12,000 ��88.00</text> <text>At least $12,000 ��94.00</text> </level> <level label="c"> <text>To establish the taxable income, the chargeable person shall provide either a copy of a federal income tax return or an affidavit as to the taxable income reported on that federal income tax return.</text> </level> <level label="d"> <text>Any modification of liability for charges based on a federal income tax return shall become effective as of July 1 in each calendar year.</text> </level> <level label="e"> <level label="1"> <text>Within the time that the Secretary sets and on the forms that the Secretary provides, each chargeable person shall elect the schedule under which the chargeable person is to be billed.</text> </level> <level label="2"> <text>The election is effective as of the day that the individual with an intellectual disability first is admitted for service and remains in force until changed by the chargeable person.</text> </level> <level label="3"> <text>A change in the election is effective on July 1 after the date on which the Department is notified of the change.</text> </level> <level label="4"> <text>If a person fails to elect within the time that the Secretary sets, the Secretary shall determine which schedule is to apply.</text> </level> </level> <level label="f"> <text>A person whose taxable income is less than $4,000 a year may not be charged any amount under this section.</text> </level> <level label="g"> <text>For purposes of this section, both parents of an individual with an intellectual disability shall be considered a single responsible relative.</text> </level> </section> <section article="ghg" article_name="Health - General" number="16-406" title_number="16" title_name="Reimbursements and Collections" subtitle_number="4" subtitle_name="Special Provisions as to Intellectual Disability"> <level label="a"> <level label="1"> <text>Except as otherwise provided in this section, if any individual is examined under a court order by a representative of the Developmental Disabilities Administration, the cost of the examination shall be assumed by this State.</text> </level> <level label="2"> <text>The Administration is subrogated to any right or right of action that the individual examined has under the terms of any insurance policy to recover the costs of this service.</text> </level> </level> <level label="b"> <text>If the examination is requested by the individual being examined:</text> <level label="1"> <text>The individual is responsible for payment of the appropriate fee; and</text> </level> <level label="2"> <text>The Developmental Disabilities Administration may ask and the court may require the individual to post a bond for payment of that fee.</text> </level> </level> </section> <section article="ghg" article_name="Health - General" number="16-407" title_number="16" title_name="Reimbursements and Collections" subtitle_number="4" subtitle_name="Special Provisions as to Intellectual Disability"> <level label="a"> <text>This section does not apply to funds that are derived from benefits payable under laws administered by the Veterans’ Administration.</text> </level> <level label="b"> <level label="1"> <text>If any property of an individual with an intellectual disability remains in the custody of a public facility for 1 year after the death or release of the individual with an intellectual disability, the Department shall investigate to locate the individual or to determine if any other person legally is entitled to that property.</text> </level> <level label="2"> <text>If such a person is not found:</text> <level label="i"> <text>As much as possible of the account of the individual with an intellectual disability at the facility shall be paid from the property; and</text> </level> <level label="ii"> <text>Any balance becomes the property of this State and shall be paid into the General Fund of this State.</text> </level> </level> </level> <level label="c"> <level label="1"> <text>An action may not be brought more than 3 years after the death or release of an individual with an intellectual disability to recover any of this property left at or in the custody of the facility.</text> </level> <level label="2"> <text>This subsection does not waive any defense, including the defense of governmental immunity, available to any facility or other State agency in an action brought against it, even if the action is brought within 3 years after the death or release of the individual with an intellectual disability.</text> </level> </level> </section>