N.M. Code R. § 13.10.29.7

Current through Register Vol. 35, No. 11, June 11, 2024

Section 13.10.29.7 - DEFINITIONS

For definitions of terms contained in this rule, refer the Patients' Debt Collection Protection Act or in Chapter 59A NMSA 1978, unless otherwise noted below.

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

(1) the provisions 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 ASL, and providing assistance with filing claims and reviews in any applicable non-English language;

(2) the provisions of, upon request, a notice in 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 insurer; and

(4) for purposes of this definition, with respect to an address in any New Mexico county to which a notice is sent, a non-English language is an applicable non-English language if ten percent or more of the population residing in the county is literate only in the same non-English language, as determined by the department of health and human services ("HHS") The counties that meet this ten percent standard, as determined by HHS, are found at http://cciio.cms.gov/resources/factsheets/clas-data.html and any necessary changes to this list are posted by HHS annually.

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."Debt collection activity" means collection action as defined in the Act, including sale of the debt to a third-party debt collector or any type of legal action, including liens, property seizure, wage garnishment and law suits against the patient in pursuit of collection of the debt. Debt collection activity does not include the health care facility or third-party health care provider sending a bill or inquiring about payment.

D."Deliver or delivery means email and retain an email delivery confirmation; electronic transmission through a dedicated two way communication portal and retain deliver confirmation; fax and retain a fax delivery confirmation; regular mail; or personal delivery.

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

F."Health care service or service" means services for the diagnosis, prevention, treatment, care, or relief of a physical, dental, behavior or mental health condition, substance use disorder, illness, injury or disease, which services include procedures, products, devices or medications.

E."Household" means the countable members of the patient's household as defined by MAGI.

G."Household income" means the sum of the current MAGI-based income of the patient's household and includes permanent and temporary income calculated in a MAGI-based income calculation.

H."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/.

I."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 8.291.430 NMAC.

J."Medicaid 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.

K."Patient" means the person who receives health care services, or the parent or legal guardian of a minor or an adult under guardianship who receives health care services.

L."Patients' Debt Collection Protection Act" ("the Act") means New Mexico Senate Bill 71 from the 2021 regular session to be codified at NMSA Chapter 57 and 61.

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

N.M. Code R. § 13.10.29.7

Adopted by New Mexico Register, Volume XXIX, Issue 18, September 25, 2018, eff. 10/1/2018, Amended by New Mexico Register, Volume XXX, Issue 03, February 12, 2019, eff. 2/12/2019, Adopted by New Mexico Register, Volume XXXII, Issue 12, June 22, 2021, eff. 7/1/2021