SENATE TAX, BUSINESS AND TRANSPORTATION COMMITTEE SUBSTITUTE
FOR SENATE BILL 146
56th legislature - STATE OF NEW MEXICO - second session, 2024
RELATING TO HOSPITALS; ENACTING A NEW SECTION OF THE HOSPITAL FUNDING ACT TO REQUIRE COUNTY HOSPITALS AND CONTRACTING HOSPITALS TO ACCEPT CERTAIN QUALIFIED HEALTH PLANS AVAILABLE THROUGH THE NEW MEXICO HEALTH INSURANCE EXCHANGE AND PROVIDE AFFORDABLE PAYMENT PLANS TO UNINSURED PATIENTS UNDER CERTAIN CIRCUMSTANCES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
SECTION 1. A new section of the Hospital Funding Act is enacted to read:
"[NEW MATERIAL] COUNTY HOSPITALS AND CONTRACTING HOSPITALS--ACCEPTANCE OF CERTAIN QUALIFIED HEALTH PLANS-- PAYMENT PLANS FOR UNINSURED PATIENTS.--
A. A county hospital or contracting hospital that accepts coverage for medicaid patients from a managed care organization shall either:
(1) contract with a health insurance carrier contracting with the health care authority department as a managed care organization and offering a qualified health plan that is offered on the New Mexico health insurance exchange; or
(2) accept patients enrolled in a non- contracted qualified health plan at a reimbursement rate at the sixtieth percentile of the allowed commercial reimbursement rate for a health care service performed by a provider in the same or similar specialty, in the same geographic area, as reported in a benchmarking database maintained by a nonprofit organization specified by the superintendent of insurance after consultation with health care sector stakeholders; provided that no reimbursement rate shall be paid at less than one hundred fifty percent of the medicare reimbursement rate for the health care service provided.
B. A county hospital or contracting hospital shall provide a patient with an affordable payment plan under the following circumstances:
(1) the county hospital or contracting hospital is the only provider of care in the county where the patient resides for a condition, including cancer, that places the patient's health in serious jeopardy, causes serious impairment to bodily function or causes serious dysfunction of any bodily organ;
(2) the patient's health insurance plan is not accepted by the county hospital or contracting hospital; or
(3) the patient is uninsured.
C. If the patient is uninsured, the hospital shall adhere to the medicaid or medicare fee schedule, whichever is higher, when assessing charges.
D. As used in this section, "qualified health plan" means a health plan that has in effect a certification from the superintendent of insurance that it meets the standards set forth in applicable federal and state law and rules, as well as any additional requirements established by the board of directors of the New Mexico health insurance exchange."
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