A hospital shall provide both an oral and written notice to a patient of: The patient’s outpatient on observation status; The billing implications of the outpatient on observation status; and The impact of the outpatient on observation status on the patient’s eligibility for Medicare rehabilitation services if: The patient received on-site services from the hospital for more than 23 consecutive hours; The on-site services received by the patient include a hospital bed and meals that have been provided in an area of the hospital other than the Emergency Department; and The patient is classified as an outpatient at the hospital for observation rather than as an admitted inpatient. The written notice shall include: That the patient is considered to be on observation as an outpatient and is not admitted as an inpatient; The reason or rationale that the patient has not been admitted for inpatient services; That the patient, if needed upon discharge, may not qualify for Medicare Part A reimbursement for rehabilitation services, including such services provided under Medicare Part A in a skilled nursing facility; That there may be billing implications based on their outpatient status that may increase the patient’s out-of-pocket costs for their stay; The name and title of the staff who provided the oral notice stating the date and time of the oral notice; and The signature of the patient to verify an understanding and receipt of the written notice. Once the patient has received onsite services for more than 23 hours, the hospital shall provide written and oral notice to the patient that the physician has ordered services be provided as outpatient on observation status. The oral and written notice shall be provided in a manner that is understood by the patient. If the patient lacks capacity to understand the medical or financial implications of his or her outpatient on observation status, the oral and written notice shall be provided to a person authorized to make medical or financial decisions for the patient, including: A guardian of the person under Estates and Trusts Article, §13-705, Annotated Code of Maryland; A guardian of the property under Estates and Trusts Article, §13-201, Annotated Code of Maryland; An agent appointed under an advance directive that meets the requirements of Health-General Article, §5-602, Annotated Code of Maryland; A surrogate decision maker with authority under Health-General Article, §5-605, Annotated Code of Maryland; An agent appointed under a power of attorney that meets the requirements of Estates and Trusts Article, Title 17, Annotated Code of Maryland; A representative payee or other similar fiduciary; or Any other person, if that person was designated by the patient who was competent at the time of designation, and the patient or representative has provided the hospital with documentation of the designation. For Medicare patients only, a hospital has the option to provide only the notice required by Medicare under 42 CFR §489.20(y). Hospitals that elect to use that option shall be considered compliant with this regulation if the notice is provided to patients that receive on-site services for more than 23 hours.