Current through Register Vol. 35, No. 18, September 24, 2024
Collection action based on charges for health care services
and medical debt may not be pursued against an indigent patient. A
determination whether a patient is an indigent patient shall be made before
collection action is pursued against the patient.
A.
Prohibited activity. Medical
creditors and medical debt collectors shall not pursue collection action
against indigent patients.
(a) A medical
creditor may engage in a determination of indigency at the time of service or
at any time during or after the provision of services. If the patient is
determined to be indigent the medical creditor may not engage in prohibited
collection action.
(b) A failure to
make a determination of indigency does not waive the prohibition on collection
action against indigent patients unless the failure to make the determination
is due to noncooperation by the patient. Noncooperation must be documented and
the medical creditor or debt collector must be able to demonstrate a minimum of
three efforts to contact the patient.
(c) Any bill or statement to a patient must
be accompanied by a notice, in English and Spanish, in at least 14-point font
in the form prescribed by the superintendent. The superintendent will publish
the required notice on its website.
(d) If the patient contacts the medical
creditor or medical debt collector to request a determination of indigency, the
medical creditor or medical debt collector must make a determination using the
methodology set forth below.
B.
Methodology. The medical
creditor or medical debt collector shall make a determination as to whether the
patient is indigent using the following methodology:
(a) household income will be calculated using
the methods used to determine Medicaid eligibility by the New Mexico human
services department, Title 8 Chapter 200 NMAC, and by the federal Medicaid
program utilizing the MAGI protocols promulgated by the New Mexico human
services department;
(b) utilizing
the most recent federal poverty guidelines, the patient household income and
household size, the medical creditor or medical debt collector shall determine
whether the patient's income is less than or equal to two hundred percent of
the federal poverty guidelines;
(c)
in determining household income, the medical creditor or medical debt collector
will consider both permanent and temporary income as defined by MAGI;
(d) the inquiry as to indigency is restricted
to the categories of income subject to inclusion in the MAGI
guidelines;
(e) information
obtained from the patient or the patient's household during the determination
of indigency shall be considered confidential and may not be used or disclosed
for any other purpose; and
(f) the
determination of a patient's indigency is valid for 24 months.
C.
Indigency tool.
The superintendent on an annual basis will provide an optional on-line
tool for calculation of indigency for purposes of this section. The
superintendent will publish a self-attestation form on its website for use by
medical creditors, medical debt collectors and patients in establishing
indigency.
D.
Use of
screening information. If the medical creditor is a health care facility
or third-party provider, it may use the information gathered during the
screening process to determine whether the patient is indigent. If the patient
is indigent based on information gathered during the screening process, then
the health care facility or third-party provider shall ensure that its efforts
to collect unpaid medical debt do not include prohibited collection action. The
health care facility and third-party provider will also inform any medical debt
buyer or medical debt collector that collection action is prohibited against
that patient
E.
Medical
creditors. Medical creditors will make the determination of indigency
based on verbal or written communication with the patient, in which the patient
will be asked to prove household income and household size consistent with the
MAGI protocols.
(a) the verbal or written
communication will inform the patient that the purpose of the communication is
to determine indigency for the purpose of whether collection action may be
pursued.
(b) if the patient is a
minor or incapacitated, the communication should be with the parent(s), spouse,
or legal guardian(s) of the patient;
(c) the verbal or written communication with
the patient will be documented, including date, time, identity of person
engaged in the communication, and complete contents of the information obtained
from the communication; and
(d) the
patient may respond to the communication by providing a signed attestation as
to household income and size, or through provision of documentation such as pay
stubs, at the election of the patient.
F.
Notification. The patient
will be provided with notification of the results of the determination of
indigency in writing within 30 days of the date the medical creditor made the
determination but in no event more than 60 days after the determination was
initiated.
(a) if the patient is determined to
be indigent, the notice shall inform the patient that certain collection action
for the health care services and medical debt are prohibited by the
Act.
(b) the notice will provide
information to the patient about how to apply for Medicaid, public insurance,
and insurance through the New Mexico health insurance exchange.
(c) the notice shall inform the patient of
the right to complain to the New Mexico attorney general and shall include the
website and telephone number of that office.
G.
Medical debt collectors. A
medical debt collector shall inquire of the medical creditor on behalf of whom
it is pursuing collection against a patient, whether that patient had been
determined indigent. If the patient has been determined indigent, then certain
collection action as defined herein is prohibited.
(a) the action of selling medical debt of an
indigent patient to a medical debt buyer or medical debt collector constitutes
prohibited collection action.
(b)
medical creditors, including but not limited to health care facilities and
third-party health providers, shall not hire or otherwise engage third parties
to use prohibited collection action or otherwise recover debts from indigent
patients. These third parties, including debt collectors and debt buyers, are
prohibited from recovering debts from indigent persons, to include activity
intended to collect an unpaid medical debt.
