APPROVED CHAPTER
JULY 1, 2025 488
BY GOVERNOR PUBLIC LAW
STATE OF MAINE
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IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-FIVE
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S.P. 755 - L.D. 1937
An Act to Require Hospitals and Hospital-affiliated Providers to Provide
Financial Assistance Programs for Medical Care
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 22 MRSA §1715, as amended by PL 2017, c. 475, Pt. A, §29, is further
amended to read:
§1715. Access requirements applicable to certain health care providers
1. Access requirements. Any person, including, but not limited to, an affiliated
interest as defined in former section 396‑L, that is subject to the requirements of this
subsection, shall provide the services listed in paragraph C to individuals who are eligible
for charity care in accordance with a charity care policy adopted by the affiliate or provider
that is consistent with rules requirements applicable to hospitals under section 1716 1716-A
and any rules adopted pursuant to section 1716-A. A person is subject to this subsection if
that person:
A. Is either a direct provider of major ambulatory service, as defined in former section
382, subsection 8‑A, or is or has been required to obtain a certificate of need under
section 329 or former section 304 or 304-A;
B. Provides outpatient services as defined in former section 382, subsection 9‑A; and
C. Provides one or more of the following services:
(1) Imaging services, including, but not limited to, magnetic resonance imaging,
computerized tomography, mammography and radiology. For purposes of this
section, imaging services do not include:
(a) Screening procedures that are not related to the diagnosis or treatment of a
specific condition; or
(b) Services when:
(i) The services are owned by a community health center, a physician or
group of physicians;
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 (ii) The services are offered solely to the patients of that center, physician
or group of physicians; and
(iii) Referrals for the purpose of performing those services are not
accepted from other physicians;
(2) Laboratory services performed by a hospital or by a medical laboratory
licensed in accordance with the Maine Medical Laboratory Commission, by the
department or licensed by an equivalent out-of-state licensing authority, excluding
those licensed laboratories owned by community health centers, by a physician or
by a group of physicians where at which the laboratory services are offered solely
to the patients of that center, physician or group of physicians;
(3) Cardiac diagnostic services, including, but not limited to, cardiac
catheterization and angiography but excluding electrocardiograms and
electrocardiograph stress testing;
(4) Lithotripsy services;
(5) Services provided by free-standing ambulatory surgery facilities certified to
participate in the Medicare program; or
(6) Any other service performed in an out-patient setting requiring the purchase
of medical equipment costing in the aggregate $500,000 or more and for which the
charge per unit of service is $250 or more.
2. Enforcement. The requirements of subsection 1 are enforced through the following
mechanisms.
A. Any person who knowingly violates any provision of this section or any valid order
or rule made or adopted pursuant to section 1716 1716-A, or who willfully fails,
neglects or refuses to perform any of the duties imposed under this section, commits a
civil violation for which a forfeiture of not less than $200 and not more than $500 per
patient may be adjudged with respect to each patient denied access unless specific
penalties are elsewhere provided. Any forfeiture imposed under this section may not
exceed $5,000 in the case of the first judgment under this section against the provider,
$7,500 in the case of a 2nd judgment against the provider or $10,000 in the case of the
3rd or subsequent judgment against the provider. The Attorney General is authorized
to prosecute the civil violations.
B. Upon application of the Attorney General or any affected patient, the Superior Court
or District Court has full jurisdiction to enforce the performance by providers of health
care of all duties imposed upon them by this section and any valid rules adopted
pursuant to section 1716 1716-A.
C. In any civil action under this section, the court, in its discretion, may allow the
prevailing party, other than the Attorney General, reasonable attorney's fees and costs
and the Attorney General is liable for attorney's fees and costs in the same manner as a
private person.
D. It is an affirmative defense to any legal action brought under this section that the
person subject to this section denied access to services on the grounds that the
economic viability of the facility or practice would be jeopardized by compliance with
this section.
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 Sec. 2. 22 MRSA §1716, as enacted by PL 1995, c. 653, Pt. B, §7 and affected by
§8 and enacted by c. 696, Pt. A, §36, is repealed.
Sec. 3. 22 MRSA §1716-A is enacted to read:
§1716-A. Charity care and financial assistance programs provided by hospitals
This section applies to financial assistance programs provided by hospitals to
qualifying patients, including program requirements specific to charity care.
1. Definitions. As used in this section, unless the context otherwise indicates, the
following terms have the following meanings.
A. "Charity care" means free health care services provided by hospitals to patients in
accordance with the requirements under subsection 2.
B. "Family income" means the cumulative income of a patient and the patient's family.
"Family income" does not include the income of any individual residing in a patient's
household who is not a member of the patient's family. For the purposes of this
paragraph, "family" means a group of 2 or more persons related by birth, marriage or
adoption who reside together and among whom there are legal responsibilities for
support. All such related persons are considered one family.
C. "Federal poverty level" has the same meaning as in section 3762, subsection 1,
paragraph C.
D. "Financial assistance program" means a program administered by a hospital to
provide patients with free or reduced-cost health care services and includes, but is not
limited to, charity care.
E. "Income" means modified adjusted gross income as determined using the
methodology described in 42 Code of Federal Regulations, Section 435.603(e).
F. "State resident" means a person:
(1) Living in the State with the intent to remain in the State indefinitely; or
(2) Who enters the State with a permanent, temporary, seasonal or other job
commitment or who is seeking employment.
"State resident" does not include a person who is in the State temporarily as a tourist
or visitor.
2. Hospital to provide charity care. A hospital shall, in accordance with rules
adopted by the department, provide free health care services to eligible patients who are
state residents in accordance with this section. Upon admission of a patient, or in cases of
emergency admission before discharge of a patient, a hospital shall investigate the coverage
of the patient by any insurance or state or federal programs of medical assistance. A hospital
shall provide free, medically necessary services for patients whose family income is equal
to or less than 200% of the federal poverty level.
3. Applications and eligibility requirements for financial assistance programs
generally. The following requirements apply to financial assistance programs provided by
a hospital, including charity care except as otherwise provided in subsection 4. A hospital,
in accordance with rules adopted by the department:
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 A. May use an application form developed by the department pursuant to subsection
12;
B. May not require notarization of any application materials or supporting documents
required for an application. However, a hospital may include on an application for a
financial assistance program:
(1) A requirement for an applicant to attest to the accuracy of the information
submitted;
(2) A statement that any information submitted that is determined to be false will
result in a denial of financial assistance and that the applicant will bear financial
responsibility for charges for services provided by the hospital; and
(3) A statement informing the applicant that knowingly submitting false
information is unlawful;
C. Shall accept documentation specified by the department by rule that may be used
as proof that the applicant is a state resident;
D. Shall determine eligibility based upon the applicant's family income at the time the
application is submitted;
E. Shall, within 15 days of receiving an application, notify the applicant to clearly
explain what additional information or documentation, if any, is necessary to complete
the application. The hospital shall provide the patient with a reasonable amount of time
that is no less than 30 days following notification to the patient of any information
needed to complete the application before denying the application based on incomplete
information. The hospital shall determine eligibility and inform the patient of the
eligibility determination within 45 days from the date a completed application is
submitted; and
F. Shall provide interpretation services to patients with limited English proficiency
and patients who are deaf or hard of hearing. This requirement applies to patients
applying for or receiving assistance under a financial assistance program.
4. Applications and eligibility requirements specific to charity care. In addition to
the requirements of subsection 3, and notwithstanding any provision of subsection 3 to the
contrary, the following requirements apply to charity care. A hospital, in accordance with
rules adopted by the department:
A. May not solicit from an applicant for charity care provided in accordance with this
section information regarding any assets or income that are not used to calculate
modified adjusted gross income as described in 42 Code of Federal Regulations,
Section 435.603(e);
B. Shall provide versions of the charity care application and the summary described
in subsection 5, paragraph A translated into any language spoken by 5% of the
population of the State or 1,000 people in the State, whichever is less, as well as any
additional languages spoken by 5% of the community served by the hospital or 1,000
people in the community served by the hospital, whichever is less;
C. Shall determine that an applicant is unable to pay for hospital services and is eligible
for charity care when the family income of the patient, as calculated by either of the
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 methods described in subparagraphs (1) and (2), is equal to or less than 200% of the
federal poverty level. Eligibility may be calculated by:
(1) Multiplying by 4 the patient's family income for the 3 months preceding the
determination of eligibility; or
(2) Using the patient's actual family income for the 12 months preceding the
determination of eligibility.
If one method of calculation is inapplicable, the other method must be applied prior to
determining an applicant's eligibility for charity care;
D. Shall provide each applicant who requests charity care and is denied it, in whole or
in part, a written and dated statement of the reasons for the denial when the denial is
made; and
E. Shall provide to an applicant who is denied charity care, in whole or in part,
information regarding the right to request a fair hearing from the department regarding
the patient's eligibility for charity care.
5. Notice and publication requirements. In accordance with rules adopted by the
department, a hospital shall widely publicize its financial assistance programs within the
community served by the hospital, including by:
A. Publishing a summary of the financial assistance programs written in plain
language, including a summary of services not covered by financial assistance
programs;
B. Providing, in conspicuous locations within the hospital, including admission,
registration and waiting areas, information regarding how patients can access physical
copies of the plain language summary under paragraph A, the financial assistance
program application and any application instructions;
C. Posting a full, accessible and downloadable version of the financial assistance
program application on the hospital's publicly accessible website;
D. Including on all plain language summaries and financial assistance program
application instructions, excluding billing statements except as otherwise provided in
paragraph E and subsection 6, information regarding the hospital's financial assistance
program and information regarding the availability of no-cost assistance with applying
for financial assistance and health coverage programs through the Health Insurance
Consumer Assistance Program established in Title 24-A, section 4326; and
E. Providing on all billing statements sent to a patient information on the availability
of financial assistance, including how to apply for the financial assistance program, the
address of a publicly accessible website from which a patient may download a copy of
the application and a telephone number that a patient may call to request a paper copy
of the application.
6. Individual written notice of charity care availability. A hospital shall provide a
patient with individual written notice of the availability of charity care according to the
following.
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 A. With respect to inpatient services, the hospital shall provide individual written
notice of the availability of charity care to each patient upon admission, or in the case
of emergency admission before discharge.
B. With respect to outpatient services, the hospital shall either include with the patient's
bill a copy of an individual notice of the availability of charity care or provide a copy
of the individual notice at the time service is provided.
The individual notice provided pursuant to this subsection must include the information
required pursuant to subsection 5, paragraph D, a telephone number to request a paper
charity care application, the website address where a patient can submit an online
application pursuant to subsection 10, the income guidelines to qualify for charity care and
any other information specified by the department by rule.
7. Patient notified of noncovered services; consequences for failing to notify. In
accordance with rules adopted by the department, a hospital shall inform a patient who is
determined to be eligible for financial assistance if any part of a medical service, treatment,
procedure or test provided or administered to the patient in the hospital is not covered by
the hospital's financial assistance programs. A hospital may not bill a patient for a medical
service, treatment, procedure or test if the hospital failed to provide the patient with advance
notice that a medical service, treatment, procedure or test is not covered under the hospital's
financial assistance programs. A hospital may bill a patient's health insurance carrier for a
medical service, treatment, procedure or test for which the hospital is prohibited from
billing the patient under this subsection.
8. Reasonable payment plans; maximum out-of-pocket payments. In accordance
with rules adopted by the department, a hospital shall offer a patient with a documented
family income that does not exceed 400% of the federal poverty level a payment plan that
requires monthly out-of-pocket payments that do not exceed 4% of the patient's monthly
family income that is not exempt from attachment or garnishment under state law.
9. Bill disputes. A hospital shall include on a billing statement sent to a patient
information regarding how to dispute a charge. If the contact information for disputing a
charge is distinct from the contact information for paying or otherwise settling a bill, the
contact information for the individual or entity charged with handling disputed charges
must be provided.
10. Online application for charity care. A hospital shall, by July 1, 2028, provide an
online option through which an applicant may file an application for charity care. The
online option must provide for an e-mail response to the applicant that the application has
been received. The hospital shall provide an option for a patient to request that an
application be mailed to the patient.
11. Enforcement. This subsection governs enforcement of this section.
A. The department shall:
(1) Establish a process for a patient to submit a complaint of hospital
noncompliance with this section;
(2) Conduct a review within 30 days of receiving a complaint from a patient
regarding noncompliance with this section; and
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 (3) Require a corrective action of a hospital, if the department determines that the
hospital is not in compliance with this section, whi