New Mexico

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Glossary of Terms

OVERVIEW:  New Mexico’s Indigent Hospital and County Health Care Act created county hospital claims funds, whereby hospitals and other health care providers might apply to be reimbursed for hospital care rendered to indigents. While New Mexico does not mandate the provision of free care at hospitals, non-federal health care facilities are required to report detailed information and data regarding charity care policies and utilization.

CITATION:
Indigent Hospital and County Health Care
New Mexico Statutes §§ 27-5-1 – 27-5-18

Health Information Systems Act (statutory authority for charity care reporting regulations)
New Mexico Statutes §§ 24-14A-3(D) and 24-14A-5

Charity Care Data Reporting Requirements
New Mexico Administrative Code §§ 7.1.24.1 to 7.1.24.17

TERMINOLOGY:
Indigent health care
Charity care

REGULATORY OVERSIGHT:
The members of a county’s Board of County Commissioners (hereinafter “the Board”) oversee its Indigent Hospital and County Health Care programs and administers the county hospital indigent claims fund. N.M. Stat. Ann, § 27-5-5(A). The New Mexico Health Policy Commission oversees the charity care data reporting requirements.  N.M. Admin. Code § 7.1.24.1.

DEFINITIONS AND DISTINCTIONS:
For purposes of reporting, the following terms apply:

“Bad debt” means “an account receivable based on services furnished to a patient which is:  (1) regarded as uncollectible, following reasonable collection efforts, pursuant to the facility’s credit and collection policies and procedures; (2) charged as a credit loss pursuant to the facility’s credit and collection policies and procedures; and (3) not otherwise classified as charity care.” N.M. Admin. Code § 7.1.24.7(B).

“Charity care” means “the provision of medically necessary health care without any expectation of cash inflow and without classification as revenue or receivables in a financial statement, as determined by the criteria established in a formal policy by the facility providing the care.”  N.M. Admin. Code § 7.1.24.7(C).  Charity care expressly excludes contractual allowances.

“Charity care encounters” means the total number of patient visits at which charity care was provided in whole or in part.  N.M. Admin. Code § 7.1.24.7(E).

“Charity care policy” means “a facility’s formal policy that establishes criteria for classifying the provision of medically necessary health care as charity care and includes as a criterion the level of qualifying income as a percentage of the applicable federal poverty level.”  N.M. Admin. Code § 7.1.24.7(F).

An “indigent person,” for purposes of reimbursement under the Indigent Hospital and County Health Care Act, is defined as a person “who can normally support himself and his dependents on present income and liquid assets available to him but, taking into consideration this income and those assets and his requirement for other necessities of life for himself and his dependents, is unable to pay the cost of the ambulance transportation or medical care administered or both.”  N.M. Stat. Ann. § 27-5-4(C).  By statute, the statewide indigency standard, which takes into account the individual’s income and spousal income, is limited to 150 percent of the per capita personal income for New Mexico.  Id.

FREE CARE AS A COMMUNITY BENEFIT: N/A

ELIGIBILITY REQUIREMENTS:
County Hospital Indigent Claims Fund.  The statewide eligibility standard for reimbursing medical providers for indigent hospital or health care is limited to 150 percent of the per capita personal income for New Mexico (including individual and spousal income).  N.M. Stat. Ann. § 27-5-4(C).  A county board may pass a resolution to increase the indigency standard only if there is a balance remaining in the county’s hospital indigent claims fund at the end of the fiscal year.  Id.       

New Mexico does not require hospitals to have charity care policies.  Its charity care reporting regulations do, however, require all non-federal licensed health care facility’s charity care policy to submit their formal charity care policies (see Reporting Requirements), with the stipulation that these policies use the federal poverty guidelines as a criterion of income eligibility.  N.M. Admin. Code 7.1.24.8(C).

FINANCING SOURCE:
The Indigent Hospital and County Health Care Program is funded by the County Indigent
Hospital Claims Fund. N.M. Stat. Ann. § 27-5-7.  A portion of the county property tax, determined by the Board of County Commissioners, is used to fund the County Indigent Hospital Claims Fund.  N.M. Stat. Ann. § 27-5-9(A).  If there is not enough money in the Fund to cover all claims for a particular year, the claims shall be carried over to the next year.  N.M. Stat. Ann. § 27-5-13. 

SERVICES COVERED: N/A

NOTIFICATION REQUIREMENTS: N/A

APPLICATION PROCESS:
Rather than the patient applying to participate in the Indigent Hospital and County Health
Care Program, the hospital or provider applies to the County Indigent Hospital and County Health Care Board for reimbursement of care.  When filing a claim for reimbursement, the hospital or provider must:

• File the claim with the board of the county in which the patient is domiciled;
• File a separate claim for each patient; and
• File a verified statement signed by the patient stating that he or she qualifies as an indigent patient and is unable to pay for the care received. This statement should contain a list of all assets the patient owns.  N.M. Stat. Ann. § 27-5-12(A).

The County Indigent Hospital and County Health Care Board then determines whether a particular patient is indigent and determines the allowable costs for the care provided. 
N.M. Stat. Ann. § 27-5-6(I).

GRIEVANCE/APPEAL PROCESS:
When the County Indigent Hospital and County Health Care Board denies a provider’s claim, it must notify the hospital or health care provider within 60 days of making its decision.  N.M. Stat. Ann. § 27-6-6(J).  Any hospital or provider that is aggrieved by a decision of the County Indigent Hospital and County Health Care Board may appeal the decision to the district court.  N.M. Stat. Ann. § 27-5-12.1.

REPORTING REQUIREMENTS:
Hospitals, ambulance services, and/or health care providers must keep on file with the
County Indigent Hospital and County Health Care Board current data, statistics, schedules, and other information necessary to determine the cost for all patients being served; proof of licensure; and any other information deemed necessary by the Board.  N.M. Stat. Ann. § 27-5-11(A). 

All non-federal licensed health care facilities must annually submit their formal charity care policies to the New Mexico Health Policy Commission.  N.M. Stat. Ann. § 24-14A-N.M. Admin. Code 7.1.24.8(C).  The policy must specify the level of qualifying income as a percentage of the applicable federal poverty level.  Id.  They must also report data for each fiscal year on bad debt, charity care charges, cost-to-charge ratio, and county indigent fund revenues.  N.M. Admin. Code 7.1.24.12.  If these reporting requirements require unreasonable cost, a health care facility can apply for a temporary modification or exemption.  N.M. Admin. Code 7.1.24.15(A).

PENALTIES FOR NONCOMPLIANCE: N/A

OTHER:
After a claim has been paid from the County Hospital Indigent Claims Fund, the Fund has a claim against the estate of the indigent patient and a lien against all real property vested in or later acquired by the patient.  N.M. Stat. Ann, § 27-5-14.  However, if the county has a sales tax for the support of indigent hospital patients, this provision will not apply.  N.M. Stat. Ann. § 27-5-15. 

The Hospital and County Health Care Act does not apply to any county that had a county sales tax when the Act became effective, unless that tax resolution provided for possible expanded use of the county indigent hospital claims fund.  N.M. Stat. Ann. § 27-5-4.1.