0001| HOUSE BILL 355
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0002| 43rd legislature - STATE OF NEW MEXICO - first session, 1997
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0003| INTRODUCED BY
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0004| MICHAEL M. OLGUIN
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0005|
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0006|
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0007|
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0008| FOR THE HEALTH CARE REFORM COMMITTEE
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0009|
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0010| AN ACT
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0011| RELATING TO HEALTH; AMENDING THE INDIGENT HOSPITAL AND COUNTY
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0012| HEALTH CARE ACT TO AUTHORIZE FUNDING OF COUNTYWIDE OR
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0013| MULTICOUNTY HEALTH PLANNING, BROADEN CRITERIA FOR ELIGIBLE
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0014| PAYMENTS AND ESTABLISH TIME LIMITS FOR APPROVAL AND PAYMENT OF
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0015| CLAIMS.
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0016|
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0017| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:
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0018| Section 1. Section 27-5-2 NMSA 1978 (being Laws 1965,
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0019| Chapter 234, Section 2, as amended) is amended to read:
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0020| "27-5-2. PURPOSE OF INDIGENT HOSPITAL AND COUNTY HEALTH
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0021| CARE ACT.--The purpose of the Indigent Hospital and County
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0022| Health Care Act is:
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0023| A. to recognize that the individual county of this
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0024| state is the responsible agency for ambulance transportation or
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0025| the hospital care or the provision of [the] health care to
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0001| indigent patients domiciled in that county for at least three
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0002| months or for such period of time, not in excess of three
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0003| months, as determined by resolution of the board of county
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0004| commissioners, and to provide a means whereby each county can
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0005| discharge this responsibility through a system of [financial
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reimbursement] payments to ambulance providers, hospitals or
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0007| health care providers for [actual cost incurred for] the care
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0008| and treatment of, [the] or the provision of health care
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0009| services to, indigent [patient in the hospitals of this
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state, or both] patients; [and]
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0011| B. to recognize that the counties of the state are
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0012| also responsible for supporting indigent patients by providing
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0013| local revenues to match federal funds for the state medicaid
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0014| program, including the provision of matching funds for payments
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0015| to sole community provider hospitals and the transfer of funds
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0016| to the county-supported medicaid fund pursuant to the Statewide
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0017| Health Care Act; and
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0018| C. to recognize that the counties of the state can
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0019| improve the provision of health care to indigent patients by
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0020| providing local revenues for countywide or multicounty health
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0021| planning."
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0022| Section 2. Section 27-5-4 NMSA 1978 (being Laws 1965,
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0023| Chapter 234, Section 4, as amended) is amended to read:
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0024| "27-5-4. DEFINITIONS.--As used in the Indigent Hospital
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0025| and County Health Care Act:
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0001| A. "ambulance provider" or "ambulance service"
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0002| means a specialized carrier based within the state authorized
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0003| under provisions and subject to limitations as provided in
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0004| individual carrier certificates issued by the state corporation
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0005| commission to transport persons alive, dead or dying en route
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0006| by means of ambulance service. The rates and charges
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0007| established by state corporation commission tariff shall govern
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0008| as to allowable cost. Also included are air ambulance services
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0009| approved by the board. The air ambulance service charges shall
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0010| be filed and approved pursuant to Subsection D of Section 27-5-
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0011| 6 NMSA 1978 and Section 27-5-11 NMSA 1978;
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0012| B. "board" means [the] a county indigent
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0013| hospital and county health care board;
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0014| C. "indigent patient" means a person to whom an
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0015| ambulance service, a hospital or a health care provider has
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0016| provided medical care, [or] ambulance transportation or
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0017| health care services and who can normally support himself and
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0018| his dependents on present income and liquid assets available to
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0019| him but, taking into consideration this income and those assets
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0020| and his requirement for other necessities of life for himself
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0021| and his dependents, is unable to pay the cost of the ambulance
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0022| transportation or medical care administered or both. If
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0023| provided by resolution of [the] a board, it shall not
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0024| include any person whose annual income together with his
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0025| spouse's annual income totals an amount that is fifty percent
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0001| greater than the per capita personal income for New Mexico as
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0002| shown for the most recent year available in the survey of
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0003| current business published by the United States department of
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0004| commerce. Every board that has a balance remaining in the fund
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0005| at the end of a given fiscal year shall consider and may adopt
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0006| at the first meeting of the succeeding fiscal year a resolution
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0007| increasing the standard for indigency. The term "indigent
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0008| patient" includes a minor who has received ambulance
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0009| transportation or medical care or both and whose parent or the
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0010| person having custody of that minor would qualify as an
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0011| indigent patient if transported by ambulance or admitted to a
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0012| hospital for care or treated by a health care provider or all
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0013| three;
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0014| D. "hospital" means any general or limited hospital
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0015| licensed by the department of health, whether nonprofit or
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0016| owned by a political subdivision, and may include by resolution
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0017| of [the] a board the following health facilities if
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0018| licensed or, in the case of out-of-state hospitals, approved,
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0019| by the department of health:
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0020| (l) for-profit hospitals;
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0021| (2) state-owned hospitals; or
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0022| (3) licensed out-of-state hospitals where
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0023| treatment provided is necessary for the proper care of an
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0024| indigent patient when that care is not available in an in-state
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0025| hospital;
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0001| E. "cost" means all allowable ambulance
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0002| transportation [or] costs, medical care costs [including
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the costs of prenatal care] or costs of providing health care
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0004| services, to the extent determined by resolution of [the]
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0005| a board, for an indigent patient. Allowable costs shall be
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0006| determined in accordance with a uniform system of accounting
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0007| and cost analysis as determined by regulation of [the] a
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0008| board, which includes cost of ancillary services but shall not
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0009| include the cost of servicing long-term indebtedness of a
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0010| hospital, health care provider or ambulance service;
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0011| F. "fund" means [the] a county indigent
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0012| hospital claims fund;
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0013| G. "medicaid eligible" means a person who is
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0014| eligible for medical assistance from the department;
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0015| H. "county" means any county except a class A
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0016| county with a county hospital operated and maintained pursuant
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0017| to a lease with a state educational institution named in
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0018| Article 12, Section 11 of the constitution of New Mexico;
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0019| I. "department" means the human services
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0020| department;
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0021| J. "sole community provider hospital" means a
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0022| hospital that is a sole community provider hospital under the
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0023| provisions of the federal medicare guidelines established in 42
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0024| C.F.R. 412.92 pursuant to Title 18 of the federal Social
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0025| Security Act;
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0001| K. "drug rehabilitation center" means an agency of
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0002| local government, a state agency, a private nonprofit entity or
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0003| combination thereof that operates drug abuse rehabilitation
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0004| programs that meet the standards and requirements pursuant to
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0005| the Drug Abuse Act;
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0006| L. "alcohol rehabilitation center" means an agency
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0007| of local government, a state agency, a private nonprofit entity
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0008| or combination thereof that operates alcohol abuse
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0009| rehabilitation programs that meet the standards set by the
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0010| department of health pursuant to the Alcoholism and Alcohol
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0011| Abuse Prevention, Screening and Treatment Act;
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0012| M. "mental health center" means a not-for-profit
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0013| center that provides outpatient mental health services that
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0014| meet the standards set by the department of health pursuant to
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0015| the Community Mental Health Services Act; [and]
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0016| N. "health care provider" means:
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0017| (1) a nursing home;
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0018| (2) an in-state home health [agencies]
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0019| agency;
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0020| (3) an in-state licensed hospice;
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0021| (4) a community-based health program operated
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0022| by a political subdivision of the state or other nonprofit
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0023| health organization that provides prenatal care delivered by
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0024| New Mexico licensed, certified or registered health care
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0025| practitioners;
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0001| (5) a community-based health program operated
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0002| by a political subdivision of the state or other nonprofit
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0003| health care organization that provides primary care delivered
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0004| by New Mexico licensed, certified or registered health care
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0005| practitioners;
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0006| (6) a drug rehabilitation center;
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0007| (7) an alcohol rehabilitation center; or
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0008| (8) a mental health center; and
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0009| O. "health care services" means all treatment and
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0010| services designed to promote improved health in the county
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0011| indigent population, including primary care, prenatal care,
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0012| dental care, provision of prescription drugs, preventive care
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0013| or health outreach services, to the extent determined by
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0014| resolution of the board."
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0015| Section 3. Section 27-5-6 NMSA 1978 (being Laws 1965,
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0016| Chapter 234, Section 6, as amended) is amended to read:
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0017| "27-5-6. POWERS AND DUTIES OF THE BOARD.--The board:
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0018| A. shall administer claims pursuant to the
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0019| provisions of the Indigent Hospital and County Health Care Act;
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0020| B. shall prepare and submit a budget to the board
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0021| of county commissioners for the amount needed to defray claims
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0022| made upon the fund and to pay costs of administration of the
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0023| Indigent Hospital and County Health Care Act [which] and
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0024| costs of development of a countywide or multicounty health
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0025| plan. The total costs of administration and planning shall
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0001| in no event exceed the following percentages of revenues based
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0002| on the previous fiscal year revenues for a fund that has
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0003| existed for at least one fiscal year or based on projected
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0004| revenues for the year being budgeted for a fund that has
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0005| existed for less than one fiscal year. The percentage of the
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0006| revenues in the fund that may be used for such total
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0007| administrative and planning costs is equal to the sum of the
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0008| following:
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0009| (1) ten percent of the amount of the
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0010| revenues in the fund not over five hundred thousand dollars
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0011| ($500,000);
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0012| (2) eight percent of the amount of the
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0013| revenues in the fund over five hundred thousand dollars
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0014| ($500,000) but not over one million dollars ($1,000,000); and
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0015| (3) four and one-half percent of the amount
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0016| of the revenues in the fund over one million dollars
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0017| ($1,000,000);
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0018| C. shall make rules and regulations necessary to
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0019| carry out the provisions of the Indigent Hospital and County
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0020| Health Care Act; provided that the standards for eligibility
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0021| and allowable costs for county indigent patients shall be no
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0022| more restrictive than the standards for eligibility and
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0023| allowable costs prior to December 31, 1992;
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0024| D. shall set criteria and cost limitations for
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0025| medical care in licensed out-of-state hospitals, ambulance
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0001| services or health care providers;
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0002| E. shall cooperate with appropriate state agencies
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0003| to use available funds efficiently and to make health care more
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0004| available;
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0005| F. shall cooperate with the department in making
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0006| any investigation to determine the validity of claims made upon
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0007| the fund for any indigent patient;
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0008| G. may accept contributions or other county
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0009| revenues, which shall be deposited in the fund;
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0010| H. may hire personnel to carry out the provisions
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0011| of the Indigent Hospital and County Health Care Act;
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0012| I. shall review all claims presented by a hospital,
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0013| ambulance service or health care provider to determine
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0014| compliance with the rules and regulations adopted by the board
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0015| or with the provisions of the Indigent Hospital and County
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0016| Health Care Act, determine whether the patient for whom the
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0017| claim is made is an indigent patient and determine the
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0018| allowable medical, [or] ambulance service or health care
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0019| services costs; provided that the burden of proof of any claim
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0020| shall be upon the hospital, ambulance service or health care
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0021| provider;
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0022| J. shall state in writing the reason for rejecting
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0023| or disapproving any claim and shall notify the submitting
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0024| hospital, ambulance service or health care provider of the
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0025| decision within sixty days after submission of the claim;
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0001| K. shall pay all claims that are not matched with
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0002| federal funds under the state medicaid program and that have
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0003| been approved by the board from the fund and shall make
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0004| payment within sixty days after approval of a claim by the
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0005| board;
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0006| L. shall determine by county ordinance the types of
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0007| health care providers that will be eligible to submit claims
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0008| under the Indigent Hospital and County Health Care Act;
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0009| M. shall review, verify and approve all medicaid
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0010| sole community provider hospital payment requests in accordance
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0011| with rules and regulations adopted by the board prior to their
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0012| submittal by the hospital to the department for payment but no
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0013| later than January 1 of each year;
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0014| N. shall transfer to the state treasurer by the
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0015| last day of March, June, September and December of each year an
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0016| amount equal to one-fourth of the county's payment for support
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0017| of sole community provider payments as calculated by the
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0018| department for that county for the current fiscal year. This
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0019| money shall be deposited in the sole community provider fund;
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0020| [and]
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0021| O. may provide for the transfer of money from the
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0022| county indigent hospital claims fund to the county-supported
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0023| medicaid fund to meet the requirements of the Statewide Health
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0024| Care Act; and
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0025| P. may contract with ambulance providers,
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0001| hospitals or health care providers for the provision of health
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0002| care services."
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0003| Section 4. Section 27-5-12 NMSA 1978 (being Laws 1965,
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0004| Chapter 234, Section 13, as amended) is amended to read:
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0005| "27-5-12. PAYMENT OF CLAIMS.--
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0006| A. A hospital, ambulance service or health care
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0007| provider filing a claim with the board shall:
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0008| [A.] (1) file claim with the board of the
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0009| county in which the indigent patient is domiciled;
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0010| [B.] (2) file claim for each patient
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0011| separately, with an itemized detail of the total cost; and
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0012| [C.] (3) file with the claim a verified
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0013| statement of qualification for ambulance service, indigent
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0014| hospital care or care from a health care provider signed by the
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0015| patient or by the parent or person having his custody to the
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0016| effect that he qualifies under the provisions of the Indigent
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0017| Hospital and County Health Care Act as an indigent patient and
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0018| is unable to pay the cost for the care administered and listing
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0019| all assets owned by the patient or any person legally
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0020| responsible for his care. The statement shall constitute an
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0021| oath of the person signing it, and any false statements in the
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0022| statement made knowingly constitute a felony.
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0023| B. A hospital, ambulance service or health care
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0024| provider that has contracted with a board for provision of
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0025| health care services shall file claims for payment for services
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0001| in accordance with the procedures specified in the contract."
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0002| - 11 -
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0003|
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0004|
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0005|
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0006|
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0007|
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0008| State of New Mexico
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0009| House of Representatives
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0010|
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0011| FORTY-THIRD LEGISLATURE
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0012| FIRST SESSION, 1997
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0013|
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0014|
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0015| February 13, 1997
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0016|
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0017|
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0018| Mr. Speaker:
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0019|
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0020| Your GOVERNMENT AND URBAN AFFAIRS COMMITTEE, to
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0021| whom has been referred
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0022|
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0023| HOUSE BILL 355
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0024|
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0025| has had it under consideration and reports same with
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0001| recommendation that it DO PASS, and thence referred to the
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0002| APPROPRIATIONS AND FINANCE COMMITTEE.
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0003|
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0004| Respectfully submitted,
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0005|
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0006|
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0007|
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0008|
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0009|
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0010| Lynda M. Lovejoy, Chairwoman
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0011|
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0012|
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0013| Adopted Not Adopted
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0014|
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0015| (Chief Clerk) (Chief Clerk)
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0016|
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0017| Date
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0018|
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0019| The roll call vote was 5 For 1 Against
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0020| Yes: 5
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0021| No: Pearce
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0022| Excused: Beam, Pederson
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0023| Absent: None
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0024|
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0025|
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0001| G:\BILLTEXT\BILLW_97\H0355 State of New Mexico
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0002| House of Representatives
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0003|
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0004| FORTY-THIRD LEGISLATURE
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0005| FIRST SESSION, 1997
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0006|
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0007|
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0008| February 25, 1997
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0009|
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0010|
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0011| Mr. Speaker:
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0012|
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0013| Your APPROPRIATIONS AND FINANCE COMMITTEE, to
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0014| whom has been referred
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0015|
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0016| HOUSE BILL 355
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0017|
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0018| has had it under consideration and reports same with
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0019| recommendation that it DO PASS, amended as follows:
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0020|
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0021| 1. On page 7, line 5, strike "; and".
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0022|
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0023| 2. On page 7, line 11, strike the period and quotation mark
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0024| and insert in lieu thereof "; and".
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0025|
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0001| 3. On page 7, between lines 11 and 12 insert the following
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0002| new subsection:
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0003|
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0004| "P. "planning" means the development of a countywide
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0005| or multicounty health plan to improve and fund health services in
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0006| the county based on the county's needs assessment and inventory
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0007| of existing services and resources and which demonstrates
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0008| coordination between the county and state and local health
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0009| planning efforts."".
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0010|
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0011| 4. On page 7, line 22, strike "total" and insert
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0012| "combined".
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0013|
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0014| 5. On page 8, line 3, strike "total" and insert "combined".
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0015|
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0016| 6. On page 9, line 18, strike "submission of the claim" and
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0017| insert "eligibility for claim payment has been determined".
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0018|
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0019| 7. On page 11, line 17, strike "file claims" and insert
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0020| "provide evidence of health care services rendered".
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0021|
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0022| Respectfully submitted,
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0023|
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0024|
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0025|
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0001|
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0002|
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0003| Max Coll, Chairman
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0004|
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0005|
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0006| Adopted Not Adopted
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0007|
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0008| (Chief Clerk) (Chief Clerk)
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0009|
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0010| Date
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0011|
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0012| The roll call vote was 11 For 2 Against
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0013| Yes: 11
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0014| No: Bird, Pearce
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0015| Excused: Heaton, Saavedra, Townsend, Watchman
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0016| Absent: None
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0017|
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0018|
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0019| .117706.1
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0020| G:\BILLTEXT\BILLW_97\H0355
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0021|
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0022| FORTY-THIRD LEGISLATURE
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0023| FIRST SESSION, 1997
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0024|
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0025|
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0001| March 8, 1997
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0002|
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0003| Mr. President:
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0004|
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0005| Your CORPORATIONS & TRANSPORTATION COMMITTEE, to
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0006| whom has been referred
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0007|
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0008| HOUSE BILL 355, as amended
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0009|
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0010| has had it under consideration and reports same with
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0011| recommendation that it DO PASS, and thence referred to the
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0012| FINANCE COMMITTEE.
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0013|
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0014| Respectfully submitted,
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0015|
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0016|
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0017|
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0018|
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0019| __________________________________
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0020| Roman M. Maes, III, Chairman
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0021|
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0022|
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0023|
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0024| Adopted_______________________ Not
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0025| Adopted_______________________
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0001| (Chief Clerk) (Chief Clerk)
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0002|
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0003|
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0004| Date ________________________
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0005|
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0006|
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0007| The roll call vote was 7 For 0 Against
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0008| Yes: 7
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0009| No: 0
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0010| Excused: Fidel, Kidd, McKibben
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0011| Absent: None
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0012|
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0013|
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0014| H0355CT1
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0015|
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0016|
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0017|
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0018| FORTY-THIRD LEGISLATURE
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0019| FIRST SESSION, 1997
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0020|
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0021|
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0022| March 12, 1997
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0023|
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0024| Mr. President:
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0025|
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0001| Your FINANCE COMMITTEE, to whom has been referred
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0002|
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0003| HOUSE BILL 355, as amended
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0004|
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0005| has had it under consideration and reports same with
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0006| recommendation that it DO PASS.
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0007|
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0008| Respectfully submitted,
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0009|
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0010|
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0011|
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0012|
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0013| __________________________________
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0014| Ben D. Altamirano, Chairman
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0015|
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0016|
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0017|
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0018| Adopted_______________________ Not
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0019| Adopted_______________________
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0020| (Chief Clerk) (Chief Clerk)
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0021|
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0022|
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0023|
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0024| Date ________________________
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0025|
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0001|
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0002| The roll call vote was 5 For 2 Against
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0003| Yes: 5
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0004| No: Aragon, Eisenstadt
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0005| Excused: Carraro, Ingle, McKibben, Fidel
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0006| Absent: None
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0007|
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0008|
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0009| H0355FC1
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