Division of Reimbursements
The Division conducts financial investigations to determine the legally responsible parties for the care provided to individuals by the MDH facilities. As part of this investigation, the Division determines the legally liable person’s ability to pay in accordance with Maryland laws and determines existing and potential third party insurers. Once the responsible party is determined, the Division then performs billings for the State hospital centers in an effort to recover the cost of care.
The Division consists of a Central billing office located in Baltimore, Maryland and nine field offices located in MDH hospital centers through out the State. These nine Field Offices also provide financial agent services to an additional four state health care facilities, including nursing facilities and residential treatment facilities located statewide. In addition to conducting financial investigations and ability to pay determinations, the Field Office staff performs Medicaid eligibility determinations and Medicaid certifications for the inpatients of the facilities.
The Central Office provides executive direction, fiscal accounts management, and management information systems to support the operations of the entire Division. The Central Office also provides legal support, and prepares claim filings against the estates of deceased recipients of services. The Central Office bills the cost of care to the recipient of service, the responsible relative, commercial insurances, Medicare and/or Medicaid depending upon the available coverage and eligibility. All funds recovered are returned to the State Treasury as an offset of the cost of providing care to those who are indigent.
The Division bills for the cost of care provided to inpatients receiving care at the MDH facilities which include two Chronic facilities, two nursing facilities, two Developmental Disability facilities, and the seven Mental Health facilities.
Laws and Regulations
The Division of Reimbursements operates under principals of law as set forth by the Health-General Title 16, §16 of the Annotated Code of Maryland, and by the Maryland Code of Regulations (COMAR), Maryland Code of Regulations (COMAR) under sections 10.02.01, 10.02,03, and 10.04.01. COMAR describes the responsibilities of the Division, the Department and the recipient of service and their legally liable sponsors. Further, COMAR describes the methodology used in the ability to pay determination, and special allowances and exemptions from the law.
COMAR 10.02.01.02 (B), defines a chargeable person as (1) “any responsible relative; and (2) Except for a recipient of services, any other person who is legally responsible in an individual or representative capacity for the care of the individual.”
A responsible relative is described in 10.02.01.02(H) as “(1) Spouse of a recipient of services; (2) Parents of a recipient of services who is a minor; and (3) Children of a recipient of services.”
COMAR 10.02.02 addresses “Abandonment or Abuse of Responsible Relatives by Recipients of Care”. This Chapter defines abandonment and/or abuse and also defines what proof is required to substantiate this exemption.
COMAR 10.02.03 addresses “Appeal Hearings to the Division of Reimbursements” and defines the opportunity for appeal, the notification process and the requests for a rate review and an appeal hearing.
COMAR 10.04.02 addresses the “Establishment and Payment of In-Patient Charges by Recipients of Services and Other Chargeable Persons for the Patient’s Care”. Issues addressed in this Chapter include the “Determination of the Ability of a Recipient of Services to Pay” and the “Determination of the Ability of a Responsible Relative to Pay.