New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 39 - PATIENTS' DEBT COLLECTION PROTECTIONS
Section 13.10.39.7 - DEFINITIONS

Universal Citation: 13 NM Admin Code 13.10.39.7

Current through Register Vol. 35, No. 18, September 24, 2024

For definitions of terms contained in this rule, refer to the Patients' Debt Collection Protection Act Sections 57-32-1 to 57-32-10 NMSA 1978 and in Chapter 59A NMSA 1978, unless otherwise noted below.

A. "Culturally and linguistically appropriate" means communication that meets the following requirements:

(1) the provision of oral and hearing-impaired language services (such as the telephone customer assistance hotline) that includes answering questions in any applicable non-English language, including American sign language (ASL), and providing assistance with filing claims and reviews in any applicable non-English language;

(2) the provisions of, upon request, verbal interpretation or translation of a notice into any applicable non-English language;

(3) the inclusion of, in the English version of all notices, a statement prominently displayed in any applicable non-English language clearly indicating how to access the language services provided by the health care facility;

(4) applicable non-English language is as defined by the centers for Medicare and Medicaid Services; and

(5) any written notice required by this rule must include the required information in English and Spanish.

B. "Day" or "days" means, unless otherwise specified:

(1) one - five days excludes weekends and state holidays; and

(2) six days or more includes weekends and holidays.

C. "Deliver" or "delivery" means email and retain an email delivery confirmation; written documentation of a verbal communication; electronic transmission through a dedicated two-way communication portal and retain delivery confirmation; fax and retain a fax delivery confirmation; regular mail; or personal delivery. Written documentation may be maintained in a patient's electronic health record.

D. "Disclose" or "disclosure" means the release, transfer, provision of access to, or divulging in any manner of information outside the entity holding the information.

E. "Episode of care" means all emergency or medically necessary health care services related to the treatment of a condition or a service category for such treatment and for acute conditions, includes health care service and treatment provided from the onset of the condition to its resolution or a service category for such treatment and, for chronic conditions, includes health care services and treatment provided over a given period of time.

F. "Federal poverty guidelines" means the poverty guidelines issued annually by the U.S department of health and human services at aspe.hhs.gov/poverty-guidelines/.

G. "Household" means the countable members of the patient's household as defined by modified adjusted gross income.

H. "Medicaid" means the federal health program administered by the New Mexico human services department and established by the federal department of health and human services under Title XIX of the Social Security Act and by state statute, Section 27-1-12 NMSA 1978 et. seq., and regulations, including 8.391.430 NMAC.

I. "Modified adjusted gross income" or "MAGI" means household size and income calculated to determine eligibility for a Medicaid program as set forth by the New Mexico human services department.

J. "Patients' Debt Collection Protection Act" ("the Act") means Sections 1 through 10 of Chapter 57-32 NMSA 1978 and Section 61-18A-2 NMSA 1978.

K. "Public insurance" or "public health insurance" means Medicare, Medicaid, or any other government-supported health insurance and includes insurance offered on the New Mexico insurance exchange or by the New Mexico medical insurance pool.

L. "Screen" or "Screening" means a culturally and linguistically appropriate verbal or written inquiry to the patient about the patient's insured status for purposes of determining presumptive eligibility for Medicaid, eligibility for Medicaid or other public insurance programs, and eligibility for public financial assistance programs, including but not limited to the health care facility's own programs, or county or state indigency assistance.

M. "Uninsured" means that a patient who does not have major medical insurance compliant with the provisions of the Affordable Care Act.

Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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