N.M. Admin. Code § 7.25.10.15

Current through Register Vol. 36, No. 1, January 14, 2025

Section 7.25.10.15 - CARE AND MAINTENANCE CHARGES

A. Purpose: To establish policy and procedures relating to the scope and care offered and the maintenance charges for service.

B. Background: Although the state of New Mexico and the veterans administration pay for the majority of costs of care, it is necessary for the center to charge residents for services in order to provide the full range of services offered. These charges shall be based upon total income of the residents and based on their ability to pay.

C. Policy: It shall be the policy of the New Mexico veterans center, in accordance with the New Mexico Statutes Annotated, 1978 Compilation, Section 23-4-4, that:

(1) Patients of the New Mexico veterans center shall be assessed a monthly care and maintenance charge based upon the level of care provided to them and their individual ability to pay. The claim of the state for such care and treatment shall constitute a valid indebtedness against any such patient and his estate shall not be barred by any statute of limitations. At the death of the patient, this claim shall be allowed and paid as other lawful claims against the estate.

(2) Nursing care charge and scope of services provided:

(a) The charge for nursing care of patients shall be set by the veterans service commission.

(b) Nursing care shall include room and board in the nursing care section of the veterans center and the full range of medical and nursing services offered in-house at the center. Medical and nursing services shall minimally include: staff physician services, intermediate nursing care, all required medications and their administration, all necessary x-ray and laboratory services which are performed by the center, and all required therapy performed by the center. Nursing care does not include those medical or other services which a patient requires or receives beyond those provided within or by the center, personal discretionary use items, such as tobacco or the purchase or laundry of street clothes.

(3) Domiciliary care charge and scope of services provided:

(a) The charge for domiciliary care to patients shall be set by the veterans service commission.

(b) Domiciliary care shall include room and board in the domiciliary section of the veterans center and limited medical care services offered by the center. Medical services shall minimally include staff physician services, all required medications, all necessary x-ray and laboratory services which are performed by the center, and all required therapy performed by the center. Domiciliary care does not include intermediate nursing care, administration of medications, required medical or other services not performed by the center, personal discretionary use items, such as tobacco or the purchase or laundry of street clothes.

(4) Care and maintenance charge adjustments and exclusions:

(a) Care and maintenance charges shall be computed in a manner to maximize the veterans administration pension and compensation benefits to which the veteran is entitled.

(b) Care and maintenance charges shall be computed in a manner to assure that the veteran retains an equitable amount to be set by the veterans service commission.

(c) The care and maintenance charge shall not exceed three times the per diem paid by the veterans administration for the type of care provided.

(d) The ability or inability of a resident to pay the established rates shall not reflect adversely upon his admission to the center.

(e) Any patient of the New Mexico veterans center or his/her guardian may seek a reduction or waiver of care and maintenance charges for reasons of financial hardship by requesting a review of his/her case by the New Mexico veterans service commission. Requests for review of care and maintenance charges shall be submitted in writing to the center administrator or to the chairman of the veterans service commission and shall describe as fully as possible the reasons the patient is seeking relief and the extent of the relief from care and maintenance charges requested. Upon receiving a request for relief of care and maintenance charges from a patient, the veterans center administrator shall assist the veteran in preparing the formal request and shall conduct a thorough investigation of the circumstances. The request for relief, all pertinent information, and the recommendation of the center administrator shall then be forwarded to the chairman of the veterans service commission for submission to the veterans service commission for review and action.

(5) Other factors governing assessment and payment of care and maintenance charges:

(a) Care and maintenance charges begin on the first day of admission.

(b) Care and maintenance charges are to be paid on the first of each month or as soon thereafter as possible for the care and maintenance to be received in the following month.

(c) Any patient, his/her guardian, or legal spouse, who knowingly withholds or falsifies income or resource date or who withholds payment of assessed care and maintenance charges may subject the patient to discharge and forfeiture of benefits and may subject the patient, or other parties responsible, to legal action related to the recovery of valid indebtedness to the state of New Mexico.

(d) When a patient's veterans administration compensation and pension benefits have been reduced or stopped due to excessive resources or estate, a care and maintenance charge shall continue to be assessed at the level which would otherwise be indicated if the-patient was still entitled to receive full veterans administration compensation and benefits.

(e) Income will be rounded to the nearest whole dollar when computing care and maintenance charges, and the care and maintenance charges will be rounded to the nearest whole dollar when assessments are made.

(f) Patients on leave from the center for outside hospitalization or medical care shall not be charged for care and maintenance after their fourth day of absence. Patients on leave from the center for personal reasons of their own volition shall continue to be charged for care and maintenance for such period of their leave that their bed is being held open for them.

N.M. Admin. Code § 7.25.10.15

Recompiled 10/31/01