Title 16. Reimbursements and Collections — Subtitle 2. General Provisions
Statutes in effect as of October 1, 2026.
Md. Code Ann., Health-Gen. § 16-201 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–201LinkCopy Citation
(a)
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:
(1)
Clinics;
(2)
Day care, day treatment, and day hospital care;
(3)
Group homes and small residential homes;
(4)
Inpatient care in regional and State hospitals and centers; and
(5)
Inpatient and outpatient care of any other kind.
(b)
(1)
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.
(2)
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.
(c)
Charges for services shall be set at least annually.
(d)
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.
Md. Code Ann., Health-Gen. § 16-201.1 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–201.1LinkCopy Citation
(a)
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.
(b)
The assessment shall include the following:
(1)
The availability of efficient health care services and providers;
(2)
The identification of health care services that are not available;
(3)
Access to health care;
(4)
The need for specific health care;
(5)
An evaluation of alternative means of providing health care services; and
(6)
Financial and manpower resources required and available.
(c)
An applicant for services under this section shall receive:
(1)
A personal financial consultation without charge to assess the applicant’s ability to pay for health care offered through local health agencies; and
(2)
Notification of the right to obtain services offered through local health agencies regardless of ability to pay.
(d)
(1)
The Secretary shall adopt regulations necessary to carry out the provisions of this section.
(2)
Local health agencies shall implement uniform procedures to notify and consult potential prenatal and infant care services recipients.
(3)
Reduced rates for recipients of services shall be applied fairly and uniformly, and according to the sliding fee scale developed by the Department.
Md. Code Ann., Health-Gen. § 16-201.2 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–201.2LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“Community developmental disabilities services provider” means a community–based developmental disabilities program licensed by the Department.
(3)
“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.
(4)
“Core service agency” has the meaning stated in § 7.5–101 of this article.
(5)
“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.
(6)
“Local behavioral health authority” has the meaning stated in § 7.5–101 of this article.
(b)
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.
(c)
(1)
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.
(2)
Annual adjustments shall be funded with due regard to the expenditures necessary to meet the needs of individuals receiving services.
(3)
The annual rate of change for the fees may not exceed a maximum rate of 5%.
Md. Code Ann., Health-Gen. § 16-201.3 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–201.3LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“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.
(3)
“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.
(b)
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.
(c)
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:
(1)
Compensate direct care staff and licensed clinicians employed by community providers; and
(2)
Improve the quality of programming provided by community providers.
(d)
(1)
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:
(i)
Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;
(ii)
Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and
(iii)
Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.
(2)
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:
(i)
Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;
(ii)
Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and
(iii)
Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.
(3)
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:
(i)
Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;
(ii)
Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and
(iii)
Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.
(4)
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:
(i)
Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;
(ii)
Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and
(iii)
Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.
(5)
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:
(i)
Object 08 Contractual Services in Program M00Q01.10 Medicaid Behavioral Health Provider Reimbursement – Medical Care Programs Administration;
(ii)
Object 08 Contractual Services in Program M00L01.02 Community Services – Behavioral Health Administration; and
(iii)
Object 08 Contractual Services in Program M00L01.03 Community Services for Medicaid State Fund Recipients – Behavioral Health Administration.
(6)
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.
(e)
(1)
In this subsection, “Commission” means the Maryland Health Care Commission.
(2)
On or before June 30, 2028, the Department shall:
(i)
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;
(ii)
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
(iii)
Administer cost–reporting tools and oversee cost–report submissions required to support the study required under item (i) of this paragraph.
(3)
The Commission shall assist the Department with the facilitation of the rate–setting study required under paragraph (2)(i) of this subsection, including by:
(i)
Consulting with stakeholders, including community providers and individuals receiving services; and
(ii)
Providing analytical support and technical assistance.
(4)
The Behavioral Health Administration and the Medical Care Programs Administration jointly shall:
(i)
Develop and implement a payment system incorporating the findings of the rate–setting study conducted under paragraph (2)(i) of this subsection; and
(ii)
Consult with stakeholders, including community providers and individuals receiving services, in developing the payment system required under item (i) of this paragraph.
(5)
The Administration shall adopt regulations to implement the payment system required by paragraph (4)(i) of this subsection.
(6)
(i)
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.
(ii)
The technical liaison shall:
(1)
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;
(2)
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
(3)
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.
(f)
If services of community providers are provided through managed care organizations, the managed care organizations shall:
(1)
Pay the rate in effect during the immediately preceding fiscal year for the first fiscal year the managed care organizations provide the services; and
(2)
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.
(g)
Increased funding provided under subsection (d) of this section may be used only to increase the rates paid to:
(1)
Community providers accredited by a State–approved accrediting body and licensed by the State; and
(2)
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.
(h)
(1)
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:
(i)
The delivery system through which community–based behavioral health services should be provided;
(ii)
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
(iii)
Any preliminary recommendations regarding the payment system required under this section.
(2)
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:
(i)
The wages and salaries paid and the benefits provided to direct care staff and licensed clinicians employed by community providers;
(ii)
The tenure and turnover of direct care staff and licensed clinicians employed by community providers; and
(iii)
The ability of community providers to recruit qualified direct care staff and licensed clinicians.
(3)
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.
Md. Code Ann., Health-Gen. § 16-201.4 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–201.4LinkCopy Citation
(a)
(1)
In this section the following words have the meanings indicated.
(2)
“Provider” means a provider of:
(i)
Nursing home services;
(ii)
Medical day care services;
(iii)
Private duty nursing services;
(iv)
Personal care services;
(v)
Home– and community–based services; and
(vi)
Services provided through the Community First Choice program.
(3)
“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.
(b)
(1)
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.
(2)
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.
(3)
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.
(4)
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.
(5)
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.
Md. Code Ann., Health-Gen. § 16-202 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–202LinkCopy Citation
(a)
To determine the ability to pay for the cost of care of a recipient of services, the Department shall investigate the financial condition of:
(1)
The recipient of services; and
(2)
Each chargeable person to the extent that the recipient of services is unable to pay this cost of care.
(b)
In determining the financial condition of persons under this section, public assistance payments shall be taken into consideration as financial resources.
(c)
(1)
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.
(2)
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.
(d)
(1)
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.
(2)
(i)
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.
(ii)
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.
(e)
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.
Md. Code Ann., Health-Gen. § 16-203 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–203LinkCopy Citation
(a)
(1)
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.
(2)
Except as otherwise provided in this title:
(i)
Payment for this cost of care shall be made by the recipient of services or a chargeable person;
(ii)
Their liability for this payment is joint and several; and
(iii)
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.
(3)
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.
(4)
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.
(b)
(1)
The Department:
(i)
Shall set the time and amount of payments; and
(ii)
May change its orders as to payments, as circumstances may warrant.
(2)
In setting the amount of payments, the Department:
(i)
Shall consider the financial means and abilities of the recipient of services and any chargeable person; and
(ii)
May agree to accept less than the charges set for the services provided.
(c)
(1)
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.
(2)
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.
(3)
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.
(d)
The Department may set the amount of payments retroactively:
(1)
For a period of not more than 6 months from the date when the Department sets the amount of payments; and
(2)
After inquiry by the Department, for a greater period, if:
(i)
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
(ii)
Any charges assessed third party insurers have been denied wholly or partly.
Md. Code Ann., Health-Gen. § 16-204 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–204LinkCopy Citation
(a)
(1)
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:
(i)
Made to and collected by the Department; and
(ii)
Accounted for and paid into the General Fund of this State by the Department.
(2)
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.
(b)
(1)
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.
(2)
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.
(c)
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.
(d)
(1)
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.
(2)
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.
(3)
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.
(4)
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.
(e)
(1)
The Department may institute any proceedings that the Department considers necessary to require collection of the established but uncollected payments.
(2)
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.
Md. Code Ann., Health-Gen. § 16-205 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–205LinkCopy Citation
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.
Md. Code Ann., Health-Gen. § 16-206 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–206LinkCopy Citation
(a)
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.
(b)
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.
Md. Code Ann., Health-Gen. § 16-207 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–207LinkCopy Citation
The Department shall bill and collect the fee for a service of a public health and clinical laboratory as provided in this subtitle.
Md. Code Ann., Health-Gen. § 16-208 (2026)
Title 16. Reimbursements and Collections
Subtitle 2. General Provisions
§ 16–208LinkCopy Citation
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.