HOUSE BILL 438

49th legislature - STATE OF NEW MEXICO - first session, 2009

INTRODUCED BY

Keith J. Gardner

AN ACT

RELATING TO PUBLIC ASSISTANCE; REQUIRING COST-SHARING PAYMENTS FOR MEDICAID RECIPIENTS WHO CHOOSE EMERGENCY MEDICAL SERVICES WHEN NON-EMERGENCY SERVICES ARE INDICATED.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     Section 1. A new section of the Public Assistance Act is enacted to read:

     "[NEW MATERIAL] MEDICAID RECIPIENTS--COST-SHARING PAYMENTS FOR EMERGENCY MEDICAL SERVICES WHEN NON-EMERGENCY SERVICES ARE INDICATED.--

          A. Consistent with the federal act and subject to the appropriation and availability of federal and state funds, the department shall promulgate rules that require a recipient who chooses a high-cost medical service provided through a hospital emergency room to pay a co-payment, premium payment or other cost-sharing payment for the high-cost medical service if:

                (1) the hospital from which the recipient seeks service:

                     (a) performs an appropriate medical screening and determines that the recipient does not have a condition requiring emergency medical services;

                     (b) informs the recipient that the recipient does not have a condition requiring emergency medical services;

                     (c) informs the recipient that if the hospital provides the non-emergency service, the hospital may require the recipient to pay a co-payment, premium payment or other cost-sharing payment in advance of providing the service;

                     (d) informs the recipient of the name and address of a non-emergency medicaid provider that can provide the appropriate medical service without imposing a cost-sharing payment; and

                     (e) offers to provide the recipient with a referral to the non-emergency provider to facilitate scheduling of the service; and

                (2) after receiving the information and assistance from the hospital described in Paragraph (1) of Subsection A of this section, the recipient chooses to obtain emergency medical services despite having access to medically acceptable, lower-cost non-emergency medical services.

          B. The department shall not seek a federal waiver or other authorization to carry out the provisions of Subsection A of this section that would prevent a medicaid recipient who has a condition requiring emergency medical services from receiving care through a hospital emergency room or waive any provision under Section 1867 of the federal act.

          C. The department shall not reduce hospital payments to reflect the potential receipt of a co-payment or other payment from a recipient receiving medical services provided through a hospital emergency room."

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