Current through Register Vol. 35, No. 6, March 26, 2024
A health care facility shall screen and offer to assist
patients in obtaining Medicaid, public and other insurance, accessing public
programs that assist with health care costs other financial assistance offered
by the facility, before seeking payment for emergency or medically necessary
care. All screening shall utilize culturally linguistically appropriate
mechanisms for communication including ASL.
A. Health care facilities shall screen
patients when the patient is registered or within the following time periods:
(a) a patient who is admitted for emergency
care shall be screened when the patient's condition has been stabilized through
treatment and prior to discharge;
(b) a patient who is admitted for inpatient
care shall be screened at the time that the inpatient care is scheduled or
within 24 hours of admission;
(c) a
patient who receives outpatient care shall be screened at the time that the
outpatient care is scheduled and prior to discharge; or
(d) upon request of a patient who is
scheduled to receive or has received health care services from the health care
facility.
B. Screening
must be offered to every patient and if requested, the health care facility
shall:
(a) verify whether a patient is
uninsured;
(b) if the patient is
uninsured, offer information about, offer to screen for and screen the patient
for:
(i) all available public insurance
including Medicaid, Medicare, New Mexico's children's health insurance program
and Tricare;
(ii) public programs
that may assist with health care costs including but not limited to the New
Mexico health insurance exchange, the New Mexico medical insurance pool, county
indigent care programs, COVID-19 claims reimbursement programs, and the Indian
health service purchased/referred care program; and
(iii) financial assistance offered by the
health care facility.
C. Offer and if requested, provide assistance
with the application process for programs identified in the screening.
Providing assistance means having adequate staff, systems, and equipment
available to enable the completion of any Medicaid, financial assistance or
other health insurance application.
D. The health care facility must provide
notification regarding the screening to patients who are uninsured as follows.
(a) the results of the screening must be
delivered to the patient, or the patient's legal guardian or parent, if the
patient is a minor or disabled, in writing within five days of the completion
of the screening. If the patient is not found indigent, then the notice shall
inform the patient of their right to complain to the New Mexico attorney
general and shall include the website and telephone number of that
office.
(b) if the patient chooses
not to pursue screening, notification must be delivered to the patient with
information about how to apply for health insurance, including Medicaid and the
New Mexico health insurance exchange within five days of the patient's
discharge.
(c) if the patient is
deemed indigent, the patient must be notified in writing within 30 days of
discharge, that the medical cost for the health care services may not be the
subject of debt collection activity, although the facility may bill the patient
for the health services as permitted by law.
(d) if the patient is found presumptively
eligible for Medicaid, or any other health insurance or financial assistance
program, written notification must be provided to the patient within 30 days of
discharge.
E. If the
patient's treatment will include a third-party health care provider, as defined
by the Act, who will bill the patient, the information gathered in the
screening process will be provided by the health care facility to the
third-party health care provider within five business days through a secure
method of transmission protecting the confidentiality of the patient's
information The information transmitted shall include the patient's identifying
information, whether the patient participated in the screening, the outcome of
the screening and application process, the status of the patient's application
for assistance with health care costs, and whether the patient is
indigent.
F. The third-party health
care provider shall not seek payment for emergency or medically necessary care
until the health care facility has provided the screening information. When the
third-party health care provider has received the screening information, it
will notify the patient that it has received the results and, if the patient
was found indigent, that it will not pursue collection action for the medical
costs related to the health care services.
G. A health care facility or third-party
health care provider covered by the Act shall not disclose information a
patient provides during the screening and application process, to third
parties, except as permitted or required in the Act and its implementing
regulations and as further provided below:
(a)
as needed to facilitate the application process for health insurance or
financial assistance as described in Paragraph C of this section;
(b) upon request, a covered entity shall
disclose information obtained during a screening or application assistance
conducted pursuant to Section 7 of this rule or during an indigency
determination pursuant to Section 8 of this rule, to the patient; or
(c) a health care facility or covered
third-party health care provider is required to disclose information provided
during screening or application assistance, when required by the human services
department or the attorney general's office to investigate or determine the
covered entity's compliance with the Act; provided, that such information shall
not be used or disclosed by the human services department or attorney general's
office for the purpose other than the investigation or determination of the
facility or provider's compliance with the Act.
