N.M. Admin. Code § 13.10.29.9

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

Section 13.10.29.9 - INDIGENT PATIENT DETERMINATION

Collection actions based on charges for health care services and medical debt may not be pursued against an indigent patient.

A. Medical creditors, medical debt buyers, and medical debt collectors shall include a notice with each bill sent to a patient, informing the patient that a determination of indigency may be conducted, if requested, and that if the patient is indigent, no collection actions will be pursued. The notice shall be culturally and linguistically appropriate, will be on a separate piece of paper, in bold font no smaller than 12 points, and will provide both a telephone number, email contact and website link for the patient to utilize in requesting an indigency determination.

B. Medical creditors, medical debt buyers, and medical debt collectors shall make a determination as to whether a 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 shall determine whether the patient's income is less than or equal to two hundred percent of the federal poverty guidelines; and

(c) in determining household income, the medical creditor will consider both permanent and temporary income as defined by MAGI.

C. If the medical creditor is a health care facility or third-party provider, it may use the information gathered during the screening process described in the Act and in Section 8 of this rule to determine whether the patient is indigent.

D. All medical creditors, medical debt buyers and medical debt collectors 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 of the purpose of the communication, i.e., to determine indigency for purpose of whether collection actions may be pursued;

(b) if the patient is a minor or incapacitated, the communication should be with the parent(s) or legal guardian(s) of the patient;

(c) the verbal or written communication with the patient will be documented, including date, time, identity of persons engaged in the communication, and complete content 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 i.e., pay stubs, at the election of the patient.

E. The patient will be provided with notification of the determination of indigency in writing within 10 days.

(a) if the patient is determined to be indigent, the notice shall inform the patient that collection actions 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, for public insurance, and for insurance through the New Mexico health insurance exchange.

(c) the notice shall inform the patient the right to complain to the New Mexico attorney general and shall include the website and telephone number of that office.

N.M. Admin. Code § 13.10.29.9

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