Maryland hospitals must meet the federal machine-readable file (MRF) requirement under 45 CFR 180.50 — and Maryland layers its own rules on top: Maryland operates under an all-payer hospital rate-setting model, with the Health Services Cost Review Commission (HSCRC) regulating hospital pricing directly. With ~48 hospitals in the state, CMS's 2026 AI-enabled audit ramp means non-compliant files in Maryland are more likely than ever to convert a warning letter into a $5,500/day fine.
Maryland's HSCRC rate-setting means every hospital charge is state-regulated — but the federal MRF requirement still applies, and non-compliance carries the same $5,500/day CMS exposure.
Federal baseline: 45 CFR Part 180 still applies to every Maryland hospital regardless of state rules. Missing either track is an exposure.
| Hospitals in Maryland | ~48 |
| State law | MD HSCRC — All-Payer Hospital Rate Setting |
| Federal exposure | $5,500/day per violation under 45 CFR 180.50 |
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