N.M. Admin. Code § 13.10.29.8

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.29.8 - SCREENING FOR INSURANCE AND PROGRAM ELEGIBILITY

A health care facility shall screen and offer to assist patients in obtaining Medicaid, public and other insurance, accessing public programs that assist with health care costs other financial assistance offered by the facility, before seeking payment for emergency or medically necessary care. All screening shall utilize culturally linguistically appropriate mechanisms for communication including ASL.

A. Health care facilities shall 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 24 hours of admission;

(c) a patient who receives outpatient care shall be screened at the time that the outpatient care is scheduled and prior to discharge; or

(d) upon request of a patient who is scheduled to receive or has received health care services from the health care facility.

B. Screening must be offered to every patient and if requested, 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. Offer and if requested, provide assistance with the application process for programs identified in the screening. Providing assistance means having adequate staff, systems, and equipment available to enable the completion of any Medicaid, financial assistance or other health insurance application.

D. The health care facility must provide notification regarding the screening to patients who are uninsured as follows.

(a) 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 five days of the completion of the screening. If the patient is not found indigent, then the notice shall inform the patient of their right to complain to the New Mexico attorney general and shall include the website and telephone number of that office.

(b) if the patient chooses not to pursue 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 five days of the patient's discharge.

(c) if the patient is deemed indigent, the patient must be notified in writing within 30 days of discharge, that the medical cost for the health care services may not be the subject of debt collection activity, although the facility may bill the patient for the health services as permitted by law.

(d) if the patient is found presumptively eligible for Medicaid, or any other health insurance or financial assistance program, written notification must be provided to the patient within 30 days of discharge.

E. If the patient's treatment will include a third-party health care provider, as defined by the Act, 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 The information transmitted shall include the patient's identifying information, whether the patient participated in the screening, the outcome of the screening and application process, the status of the patient's application for assistance with health care costs, and whether the patient is indigent.

F. 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. 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 the patient was found indigent, that it will not pursue collection action for the medical costs related to the health care services.

G. A health care facility or third-party health care provider covered by the Act shall not disclose information a patient provides during the screening and application process, to third parties, 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 covered entity shall disclose information obtained during a screening or application assistance conducted pursuant to Section 7 of this rule or during an indigency determination pursuant to Section 8 of this rule, to the patient; or

(c) a health care facility or covered 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 covered entity'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 the purpose other than the investigation or determination of the facility or provider's compliance with the Act.

N.M. Admin. Code § 13.10.29.8

Adopted by New Mexico Register, Volume XXXII, Issue 12, June 22, 2021, eff. 7/1/2021