Current through Register Vol. 35, No. 18, September 24, 2024
A health care facility shall screen all patients and offer to
assist uninsured patients in obtaining or accessing Medicaid, public insurance,
public programs that assist with health care costs, and other financial
assistance offered by the health care facility, before seeking payment for
emergency or medically necessary care. A health care facility shall include a
written notification regarding screening with any forms presented to patients
for completion prior to service. No collection action shall occur during the
screening process or while the patient's financial status or application for
insurance or financial assistance is under review or in process. During a
screening or provision of application assistance under this section, a health
care facility shall not request or require information or documentation that is
not necessary to determine eligibility for public insurance, public programs
that may assist with health care costs, or financial assistance.
A.
Timing. Health care
facilities shall affirmatively offer to screen patients and, if the patient
accepts the offer, 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 48 hours of admission;
(c) a
patient who receives outpatient care shall be screened at the time that the
outpatient care is scheduled or prior to completion of treatment;
(d) upon request of a patient who is
scheduled to receive or has received health care services from the health care
facility; or
(e) an incapacitated
patient, including unconscious or otherwise unable to communicate, shall be
screened when the patient is able to effectively communicate, if such status is
achieved prior to discharge. The health care facility shall offer screening to
parents, spouses, persons with healthcare powers of attorney or guardians of
the patient, on the incapacitated patient's behalf.
(f) screening shall be provided upon request
and shall be offered at least once for every episode of care within a 12 month
period of time;
(g) completion of
the screening process may occur outside of the specified time frames if the
facility has made a documented good faith effort to complete the screening
timely but is unable to do so due to availability of its screening personnel,
inability of the patient to provide necessary documentation, or lack of
cooperation of the patient.
B.
Scope. Screeningfor public
health insurance and health cost assistance eligibility must be offered to
every patient and if requested by the patient, 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.
Assistance. Health care
facilities shall offer to provide assistance to uninsured patients with the
application process for programs identified in the screening and, if requested,
provide the assistance. Providing assistance means having adequate staff,
systems, and equipment available to enable the completion and submission of any
Medicaid, financial assistance or other health insurance application(s) within
15 days after receipt from the patient, or his or her representative, of the
information necessary to complete the application.
D.
Notification. The health care
facility must provide notification regarding the screening to patients who are
uninsured as follows.
(a) provide information
about the insurance for which the patient appears to be eligible and the
contact information for the program to which any application was
submitted;
(b) 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 15 days of the
completion of the screening.
(c) if
the patient declines 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 15 days of the patient's
discharge.
(d) if during the
screening the health care facility determines that the patient is indigent, the
patient must be notified in writing within 30 days of screening, that the
medical cost for the health care services may not be the subject of prohibited
collection action, although the health care facility may bill the patient for
the health services as permitted by law.
(e) if the patient is determined indigent
during the screening process the health care facility must take steps to ensure
that any subsequent medical debt collection efforts do not include prohibited
collection action. Such steps may include notifying the health care facility's
billing department and any debt collectors or attorneys acting on behalf of the
health care facility; and
(f) if
the patient is found presumptively eligible for Medicaid, or eligible for any
other public health insurance or financial assistance program, written
notification of eligibility must be provided to the patient within 30 days of
discharge;
(g) notwithstanding
sections (a) through (f) above, notification shall not be required if the
patient has not provided a valid telephone number or mailing address or if,
after three documented attempts, the facility has been unable to contact the
patient.
E.
Coordination. If the patient's treatment will include a
third-party health care provider 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.
(a) if the patient is uninsured,
the third-party health care provider will notify the health care facility that
results of the screening must be provided to it, and provide the secure method
of transmission for such notification.
(i) the
third-party healthcare provider will provide contact information to the health
care facility for receipt of screening information.
(ii) the health care facility will provide
contact information to all third-party providers with privileges at its health
care facility for the purpose of notification of patient screening.
(b) the information transmitted
shall include the patient's identifying information, whether the patient
participated in the screening, the outcome of the screening and any application
process, the status of the patient's application for assistance with health
care costs, and whether the screening identified the patient as
indigent.
(c) if the health care
facility has determined that the patient is indigent and provides that
information to the third-party health care provider, neither the health care
facility nor the third-party health care provider may engage in prohibited
collection action to collect unpaid medical debt.
(d) 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 to the third-party
healthcare provider. 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 in the process of screening for insurance eligibility it was
determined that the patient was found indigent, that it will not pursue any
prohibited collection action for the medical costs related to the health care
services.
F.
Confidentiality. A health care facility or third-party health care
provider shall not disclose or use information a patient provides during the
screening and application process 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 health care facility or third-party health care provider shall
disclose information obtained during a screening or application assistance
conducted pursuant to this rule or during an indigency determination pursuant
to Section 9 of this rule to the patient; or
(c) a health care facility or 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
health care facility's or third-party health care provider'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 any purpose other
than the investigation or determination of the health care facility's or third
party health care provider's compliance with the Act.
