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Indigent Hospital and County Health Care Act

27-5-1. Short title.

Chapter 27, Article 5 NMSA 1978 may be cited as the "Indigent Hospital and County Health
Care Act".

27-5-2. Purpose of Indigent Hospital and County Health Care Act.

The purpose of the Indigent Hospital and County Health Care Act [27-5-1 NMSA 1978] is:

A. to recognize that the individual county of this state is the responsible agency for ambulance
transportation or the hospital care or the provision of health care to indigent patients domiciled in
that county for at least three months or for such period of time, not in excess of three months, as
determined by resolution of the board of county commissioners, and to provide a means whereby
each county can discharge this responsibility through a system of payments to ambulance
providers, hospitals or health care providers for the care and treatment of, or the provision of
health care services to, indigent patients;

B. to recognize that the counties of the state are also responsible for supporting indigent
patients by providing local revenues to match federal funds for the state medicaid program,
including the provision of matching funds for payments to sole community provider hospitals
and the transfer of funds to the county-supported medicaid fund pursuant to the Statewide Health
Care Act [27-10-1 NMSA 1978]; and

C. to recognize that the counties of the state can improve the provision of health care to
indigent patients by providing local revenues for countywide or multicounty health planning

27-5-3. Public assistance provisions.

A. A hospital shall not be paid from the fund under the Indigent Hospital and County Health
Care Act [27-5-1 NMSA 1978] for costs of an indigent patient for services that have been
determined by the department to be eligible for medicaid reimbursement. However, nothing in
the Indigent Hospital and County Health Care Act shall be construed to prevent the board from
transferring money from the fund to the sole community provider fund or the county-supported
medicaid fund for support of the state medicaid program.

B. No action for collection of claims under the Indigent Hospital and County Health Care Act
[27-5-1 NMSA 1978] shall be allowed against an indigent patient who is medicaid eligible for
medicaid covered services, nor shall action be allowed against the person who is legally
responsible for the care of the indigent patient during the time that person is medicaid eligible.

27-5-4. Definitions.

As used in the Indigent Hospital and County Health Care Act [27-5-1 NMSA 1978]:
"ambulance provider" or "ambulance service" means a specialized carrier based within the state
authorized under provisions and subject to limitations as provided in individual carrier
certificates issued by the public regulation commission to transport persons alive, dead or dying
en route by means of ambulance service. The rates and charges established by public regulation
commission tariff shall govern as to allowable cost. Also included are air ambulance services
approved by the board. The air ambulance service charges shall be filed and approved pursuant
to Subsection D of Section 27-5-6 NMSA 1978 and Section 27-5-11 NMSA 1978;

B. "board" means a county indigent hospital and county health care board

C. "indigent patient" means a person to whom an ambulance service, a hospital or a health
care provider has provided medical care, ambulance transportation or health care services and
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. If provided by resolution of a
board, it shall not include any person whose annual income together with his spouse's annual
income totals an amount that is fifty percent greater than the per capita personal income for New
Mexico as shown for the most recent year available in the survey of current business published
by the United States department of commerce. Every board that has a balance remaining in the
fund at the end of a given fiscal year shall consider and may adopt at the first meeting of the
succeeding fiscal year a resolution increasing the standard for indigency. The term "indigent
patient" includes a minor who has received ambulance transportation or medical care or both and
whose parent or the person having custody of that minor would qualify as an indigent patient if
transported by ambulance, admitted to a hospital for care or treated by a health care provider;

D. "hospital" means a general or limited hospital licensed by the department of health, whether
nonprofit or owned by a political subdivision, and may include by resolution of a board the
following health facilities if licensed or, in the case of out-of-state hospitals, approved by the
department of health:

(1) for-profit hospitals;

(2) state-owned hospitals; or

(3) licensed out-of-state hospitals where treatment provided is necessary for the proper care of
an indigent patient when that care is not available in an in-state hospital;

E. "cost" means all allowable costs of providing health care services, to the extent determined
by resolution of a board, for an indigent patient. Allowable costs shall be based on medicaid feefor-
service reimbursement rates for hospitals, licensed medical doctors and osteopathic
physicians;

F. "fund" means a county indigent hospital claims fund;

G. "medicaid eligible" means a person who is eligible for medical assistance from the
department;

H. "county" means a county except a class A county with a county hospital operated and
maintained pursuant to a lease with a state educational institution named in Article 12, Section
11 of the constitution of New Mexico;

I. "department" means the human services department

J. "sole community provider hospital" means:

(1) a hospital that is a sole community provider hospital under the provisions of the federal
medicare guidelines; or

(2) an acute care general hospital licensed by the department of health that is qualified,
pursuant to rules adopted by the state agency primarily responsible for the medicaid program, to
receive distributions from the sole community provider fund;

K. "drug rehabilitation center" means an agency of local government, a state agency, a private
nonprofit entity or combination thereof that operates drug abuse rehabilitation programs that
meet the standards and requirements set by the department of health;

L. "alcohol rehabilitation center" means an agency of local government, a state agency, a
private nonprofit entity or combination thereof that operates alcohol abuse rehabilitation
programs that meet the standards set by the department of health;

M. "mental health center" means a not-for-profit center that provides outpatient mental health
services that meet the standards set by the department of health;

N. "health care provider" means:

(1) a nursing home;

(2) an in-state home health agency;

(3) an in-state licensed hospice;

(4) a community-based health program operated by a political subdivision of the state or other
nonprofit health organization that provides prenatal care delivered by New Mexico licensed,
certified or registered health care practitioners;

(5) a community-based health program operated by a political subdivision of the state or other
nonprofit health care organization that provides primary care delivered by New Mexico licensed,
certified or registered health care practitioners;

(6) a drug rehabilitation center;

(7) an alcohol rehabilitation center;

(8) a mental health center;

(9) a licensed medical doctor, osteopathic physician, dentist, optometrist or expanded practice
nurse when providing emergency services, as determined by the board, in a hospital to an
indigent patient; or

(10) a licensed medical doctor or osteopathic physician, dentist, optometrist or expanded
practice nurse when providing services in an outpatient setting, as determined by the board, to an
indigent patient with a life-threatening illness or disability;

O. "health care services" means treatment and services designed to promote improved health
in the county indigent population, including primary care, prenatal care, dental care, provision of
prescription drugs, preventive care or health outreach services, to the extent determined by
resolution of the board;

P. "planning" means the development of a countywide or multicounty health plan to improve
and fund health services in the county based on the county's needs assessment and inventory of
existing services and resources and that demonstrates coordination between the county and state
and local health planning efforts; and

Q. "commission" means the New Mexico health policy commission.

27-5-4.1. Applicability.

Nothing in this act shall apply to any county which has in effect, upon the effective date of this
act, a county sales tax, unless the most recent county sales tax resolution provides for possible
expanded use of the county indigent hospital claims fund.

27-5-5. County indigent hospital and county health care board.

A. There is created within each county a "county indigent hospital and county health care
board" which shall be composed of the members of the board of county commissioners of that
county, and the chairman of the board of county commissioners shall be the chairman of the
board.

B. Members of the board shall receive no compensation but shall be reimbursed for their
actual per diem and mileage in an amount not to exceed the per diem and mileage paid to county
commissioners.

C. Each member of the board shall furnish a surety bond, premium for which shall be paid
from the fund, executed by a surety company licensed to do business in New Mexico,
conditioned that he will faithfully perform his duties and account for the funds. The bond shall
be in the penal sum of five thousand dollars ($5,000) running to the benefit of the board for
payments into the fund.

27-5-5.1. Indigent health care report; required.

Every county in New Mexico shall file an annual report on all indigent health care funding by
the county with the commission. The report shall contain the county's eligibility criteria for
indigent patients, services provided to indigent patients, restrictions on services provided to
indigent patients, conditions for reimbursement to providers of health care, revenue sources used
to pay for indigent health care and other related information as determined by the commission.
The report shall be submitted by October 1 of each year on a form provided by the commission.
The commission shall make the report available to interested parties.

27-5-6. Powers and duties of the board.

The board:

A. shall administer claims pursuant to the provisions of the Indigent Hospital and County
Health Care Act [27-5-1 NMSA 1978];

B. shall prepare and submit a budget to the board of county commissioners for the amount
needed to defray claims made upon the fund and to pay costs of administration of the Indigent
Hospital and County Health Care Act and costs of development of a countywide or multicounty
health plan. The combined costs of administration and planning shall not exceed the following
percentages of revenues based on the previous fiscal year revenues for a fund that has existed for
at least one fiscal year or based on projected revenues for the year being budgeted for a fund that
has existed for less than one fiscal year. The percentage of the revenues in the fund that may be
used for such combined administrative and planning costs is equal to the sum of the following:

(1) ten percent of the amount of the revenues in the fund not over five hundred thousand
dollars ($500,000);

(2) eight percent of the amount of the revenues in the fund over five hundred thousand dollars
($500,000) but not over one million dollars ($1,000,000); and four and one-half percent of the
amount of the revenues in the fund over one million dollars ($1,000,000);

C. shall make rules necessary to carry out the provisions of the Indigent Hospital and County
Health Care Act; provided that the standards for eligibility and allowable costs for county
indigent patients shall be no more restrictive than the standards for eligibility and allowable costs
prior to December 31, 1992;

D. shall set criteria and cost limitations for medical care furnished by licensed out-of-state
hospitals, ambulance services or health care providers;

E. shall cooperate with appropriate state agencies to use available funds efficiently and to make
health care more available;

F. shall cooperate with the department in making an investigation to determine the validity of
claims made upon the fund for an indigent patient;

G. may accept contributions or other county revenues, which shall be deposited in the fund;

H. may hire personnel to carry out the provisions of the Indigent Hospital and County Health
Care Act;

I. shall review all claims presented by a hospital, ambulance service or health care provider to
determine compliance with the rules adopted by the board or with the provisions of the Indigent
Hospital and County Health Care Act; determine whether the patient for whom the claim is made
is an indigent patient; and determine the allowable medical, ambulance service or health care
services costs; provided that the burden of proof of any claim shall be upon the hospital,
ambulance service or health care provider;

J. shall state in writing the reason for rejecting or disapproving any claim and shall notify the
submitting hospital, ambulance service or health care provider of the decision within sixty days
after eligibility for claim payment has been determined;

K. shall pay all claims that are not matched with federal funds under the state medicaid
program and that have been approved by the board from the fund and shall make payment within
thirty days after approval of a claim by the board;

L. shall determine by county ordinance the types of health care providers that will be eligible to
submit claims under the Indigent Hospital and County Health Care Act;

M. shall review, verify and approve all medicaid sole community provider hospital payment
requests in accordance with rules adopted by the board prior to their submittal by the hospital to
the department for payment but no later than January 1 of each year;

N. shall transfer to the state by the last day of March, June, September and December of each
year an amount equal to one-fourth of the county's payment for support of sole community
provider payments as calculated by the department for that county for the current fiscal year.
This money shall be deposited in the sole community provider fund;

O. shall, in carrying out the provisions of the Indigent Hospital and County Health Care Act,
comply with the standards of the federal Health Insurance Portability and Accountability Act of
1996;

P. may provide for the transfer of money from the fund to the county-supported medicaid
fund to meet the requirements of the Statewide Health Care Act [27-10-1 NMSA 1978]; and

Q. may contract with ambulance providers, hospitals or health care providers for the provision
of health care services.

27-5-6.1. Sole community provider fund created.

A. The "sole community provider fund" is created in the state treasury. The fund, which shall
be administered by the human services department, shall consist of funds provided by counties to
match federal funds for medicaid sole community provider hospital payments. Money in the
fund shall be invested by the state treasurer as other state funds are invested. Any unexpended or
unencumbered balance remaining in the fund at the end of any fiscal year shall not revert.

B. Money in the sole community provider fund is appropriated to the human services
department to make sole community provider hospital payments pursuant to the state medicaid
program. No sole community provider hospital payments or money in the sole community
provider fund shall be used to supplant any general fund support for the state medicaid program.

C. Money in the sole community provider fund shall be remitted back to the individual
counties from which it came if federal medicaid matching funds are not received for medicaid
sole community provider hospital payments.

27-5-7. County indigent hospital claims fund.

A. There is created in the county treasury of each county a "county indigent hospital claims
fund".

B. Collections under the levy made pursuant to the Indigent Hospital and County Health Care
Act [27-5-1 NMSA 1978] and all payments shall be placed into the fund, and the amount placed
in the fund shall be budgeted and expended only for the purposes specified in the Indigent
Hospital and County Health Care Act, by warrant upon vouchers approved by a majority of the
board and signed by the chairman of the board. Payments for indigent hospitalizations shall not
be made from any other county fund.

C. The fund shall be audited in the manner that other state and county funds are audited, and
all records of payments and verified statements of qualification upon which payments were made
from the fund shall be open to the public.

D. Any balance remaining in the fund at the end of the fiscal year shall carry over into the
ensuing year, and that balance shall be taken into consideration in the determination of the
ensuing year's budget and certification of need for purposes of making a tax levy.

E. Money may be transferred to the fund from other sources, but no transfers may be made
from the fund for any purpose other than those specified in the Indigent Hospital and County
Health Care Act.

27-5-7.1. County indigent hospital claims fund; authorized uses of the fund.

A. The fund shall be used:

(1) to meet the county's contribution for support of sole community provider payments as
calculated by the department for that county;

(2) to pay for expenses of burial or cremation of an indigent person; and

(3) to pay all claims that have been approved by the board that are not matched with federal
funds under the state medicaid program.

B. The fund may be used to meet the county's obligation under Section 27-10-4 NMSA 1978.

27-5-8. Board certification to county commissioners.

For the purpose of providing funds for the administration of the Indigent Hospital and County
Health Care Act [27-5-1 NMSA 1978], the board shall each year certify the amount needed to
the board of county commissioners. For the first year of operation the board shall estimate the
amount necessary, and in succeeding years the board may use the previous year's experience to
determine the amount necessary.

27-5-9. Tax levies authorized.

A. Subject to the provisions of Subsection B of this section, the board of county
commissioners, upon the certification of the board as to the amount needed in the fund, shall
impose a levy against the net taxable value, as that term is defined in the Property Tax Code [7-
35-1 NMSA 1978], of the property in the county sufficient to raise the amount certified by the
board.

B. The question of imposing an indigent hospital levy for the purpose of the Indigent Hospital
and County Health Care Act [27-5-1 NMSA 1978] shall be submitted to the electors and voted
upon as a separate question at the next subsequent general election or any special election called
prior thereto for such purpose.

C. Upon finding by the board of county commissioners that an election will be necessary, the
board of county commissioners shall meet and order an election to be held at a designated time
in the county upon the question of imposing an indigent hospital levy for the purpose of the
Indigent Hospital and County Health Care Act in the county. If the question is to be voted upon
at a special election, the election shall be held not less than thirty nor more than fifty days after
the finding, but in no event shall the election be held within five days preceding or succeeding
any general election held in the county. The order for the election shall be made a part of the
official minutes of the board of county commissioners. A copy of the order shall be published in
a newspaper of general circulation in the county at least fifteen days before the date set for the
election, and an affidavit of publication shall be obtained. At least five days prior to the date for
holding the election, the board of county commissioners shall publish in a newspaper of general
circulation in the county and post in five conspicuous places in the county a notice of election,
which shall be in substantially the following form:

"NOTICE OF ELECTION ON SPECIAL INDIGENT HOSPITAL LEVY

Notice is given on the __________ day of _____________, 19______, there will be held in
_____________ county of New Mexico an election on the question of imposing an indigent
hospital levy for the purposes of the Indigent Hospital and County Health Care Act, such levy to
be made annually against the taxable value of the property in the county and limited to an
amount sufficient to provide funds necessary to pay claims pursuant to such act.

____________________________________________________________".

Official Title of the Authority

The election shall be held on the date specified in the notice and shall be, if a special election,
conducted and canvassed in substantially the same manner as general elections are conducted
and canvassed in the county; provided that the ballot used in any election shall be a special and
separate ballot and shall be in substantially the following form:

"BALLOT

On the question of imposing an indigent hospital levy for the purposes of the Indigent Hospital
and County Health Care Act, such levy to be made annually against the taxable value of the
property in __________ county of New Mexico, and limited to an amount sufficient to provide
funds budgeted and certified as necessary to pay claims pursuant to such act:

FOR THE LEVY ................................ __________

AGAINST THE LEVY ...................... __________".

D. If the electors vote in favor of an indigent hospital levy, the levy shall become effective in
the same manner prescribed by law for all levies upon property within that county, and a levy for
those purposes in such an amount as will provide sufficient money for the fund shall be made for
each year thereafter.

E. Any board of county commissioners that has, prior to the effective date of this section,
made a valid imposition of a property tax for the purpose of the Indigent Hospital and County
Health Care Act shall not be required to hold an election on the existing tax, and that tax may be
imposed and continue to be imposed in accordance with the provisions of law existing at the time
of its imposition. However, if any such tax is not imposed in a given property tax year or if the
authorization for its imposition terminates or expires, the election requirements of Subsections B
and C of this section shall apply to any subsequent proposed imposition of a property tax for the
purpose of the Indigent Hospital and County Health Care Act.

27-5-10. Subrogation of claim.

Payment to a hospital from the fund of any claim shall operate as an assignment to the board of
any cause of action to the extent of the payment from the fund to the hospital.

27-5-11. Hospitals and ambulance services; health care providers; required to file data;
sole community provider hospital duties.

A. An ambulance service, hospital or health care provider in New Mexico or licensed out-ofstate
hospital, prior to the filing of a claim with the board, shall have placed on file with the
board:

(1) current data, statistics, schedules and information deemed necessary by the board to
determine the cost for all patients in that hospital or cared for by that health care provider or
tariff rates or charges of an ambulance service;

2) proof that the hospital, ambulance service or health care provider is licensed under the laws
of this state or the state in which the hospital operates; and

(3) other information or data deemed necessary by the board.

B. A sole community provider hospital requesting or receiving medicaid sole community
provider hospital payments shall:

(1) accept indigent patients and request reimbursement for those patients through the
appropriate county indigent fund. The responsible county shall approve requests meeting its
eligibility standards and notify the hospital of such approval;

(2) confirm the amount of payment authorized by each county for indigent patients, to that
county for the previous fiscal year, by September 30 of each calendar year;

(3) negotiate with each county the amount of indigent hospital payments anticipated for the
following fiscal year by December 31 of each year; and

(4) provide to the department prior to January 15 of each year the amount of the authorized
indigent hospital payments anticipated for the following fiscal year after an agreement has been
reached on the amount with each responsible county and such other related information as the
department may request.

27-5-12. Payment of claims.

A. A hospital, ambulance service or health care provider filing a claim with the board shall:

(1) file claim with the board of the county in which the indigent patient is domiciled;

(2) file claim for each patient separately, with an itemized detail of the total cost; and

(3) file with the claim a verified statement of qualification for ambulance service, indigent
hospital care or care from a health care provider signed by the patient or by the parent or person
having his custody to the effect that he qualifies under the provisions of the Indigent Hospital
and County Health Care Act [27-5-1 NMSA 1978] as an indigent patient and is unable to pay
the cost for the care administered and listing all assets owned by the patient or any person legally
responsible for his care. The statement shall constitute an oath of the person signing it, and any
false statements in the statement made knowingly constitute a felony.

B. A hospital, ambulance service or health care provider that has contracted with a board for
provision of health care services shall provide evidence of health care services rendered for
payment for services in accordance with the procedures specified in the contract.

27-5-12.1. Appeal.

Any hospital or ambulance service aggrieved by any decision of the board may appeal to the
district court pursuant to the provisions of Section 39-3-1.1 NMSA 1978.

27-5-12.2. Duties of the county; sole community provider hospital payments.

A county that authorizes payment for services to a sole community provider hospital shall:

A. determine eligibility for benefits and determine an amount payable on each claim for
services to indigent patients from sole community provider hospitals;

B. notify the sole community provider hospital of its decision on each request for payment
while not actually reimbursing the hospital for the services that are reimbursed with federal funds
under the state medicaid program;

C. confirm the amount of the sole community provider hospital payments authorized for each
hospital for the past fiscal year by September 30 of the current fiscal year based on a report
prepared by the hospital using a format jointly prescribed by the counties and hospitals that
provides aggregate data, including the number of indigent patients served and the total cost of
uncompensated care provided by the hospital;

D. negotiate agreements with each sole community provider hospital providing services for
county residents on the anticipated amount of the payments for the following fiscal year;
provided that the agreements shall be in compliance with federal regulations regarding
intergovernmental transfers and provider contributions and shall not include provisions for
reimbursements to counties of matching and sole community provider fund allocations; and

E. provide the department by January 15 of each year with the budgeted amount of sole
community provider hospital payments, by hospital, for the following fiscal year.

27-5-13. Claim shall not expire because of lack of funds; priority of claims.

A claim made to the board for payment for the care of an indigent patient shall not expire or
become invalid because of the lack of money in the fund during any fiscal year but shall be
carried over into the ensuing fiscal year and, notwithstanding the provisions of any other law,
shall be paid in the ensuing year. Whenever the balance of the fund is inadequate to pay all
qualified claims as they become due, the claims of in-state hospitals providing acute medical
care shall have priority for payment over all other claims regardless of the dates the other claims
were submitted. The board shall, however, on a regular basis, estimate future demands upon the
fund, based on past experience, and set aside sufficient funds to assure payment for in-state
hospitals providing acute medical care and shall then address, on a regular basis, the claims from
other hospitals or ambulance services.

27-5-14. Board to recover costs; presumption of payment.

A. The payment of any claim to an ambulance service, a hospital or health care provider on
behalf of an indigent patient creates a preferred claim in favor of the fund against the estate of
the indigent patient and a lien against all real property or interest in real property vested in or
later acquired by the indigent patient or any person legally responsible for his debts for the
amount of the payment made from the fund to the ambulance service, hospital or health care
provider, without interest. Such claims shall be preferred over all claims except charges of the
last sickness and funeral of the deceased and allowances made by the court for the maintenance
of the widow and children, taxes, municipal levies, cost of administration and attorneys' fees.

B. Proceeds recovered from such claims shall be placed into the fund.

C. The board shall file a certificate of payment to the ambulance service, hospital or health
care provider on behalf of the indigent patient. The certificate shall constitute notice to the public
that the lien created by the Indigent Hospital and County Health Care Act [27-5-1 NMSA 1978]
has attached. County clerks shall receive, index and file certificates and releases of liens created
by the certificate, free of charge.

D. In all cases where a lien has been created under Subsection A of this section and a period of
fourteen years has passed from the date the lien was created by the payment of any claim to an
ambulance service, a hospital or health care provider on behalf of an indigent patient, the
payment for which the lien is claimed shall be discharged due to the passage of time and the
board shall file a certificate releasing the lien due to the lapse of time.

27-5-15. Limitation on lien.

The provisions of Subsections A through C of Section 27-5-14 NMSA 1978 shall not apply to
any county having adopted a sales tax for the support of indigent hospital patients pursuant to the
provisions of Sections 7-21-1 through 7-21-7 NMSA 1978.

27-5-16. Department; payments; cooperation.

A. The department shall not decrease the amount of any assistance payments made to the
hospitals or health care providers of this state pursuant to law because of any financial
reimbursement made to ambulance services, hospitals or health care providers for indigent or
medicaid eligible patients as provided in the Indigent Hospital and County Health Care Act [27-
5-1 NMSA 1978].

B. The department shall cooperate with each board in furnishing information or assisting in
the investigation of any person to determine whether he meets the qualifications of an indigent
patient as defined in the Indigent Hospital and County Health Care Act.

C. The department shall ensure that the sole community provider payment and the
reimbursement to hospitals made under the state medicaid program do not exceed what would
have been paid for under medicare payment principles. In the event the sole community provider
payment and medicaid reimbursement to hospitals would exceed medicare payment principles,
the department shall reduce the sole community provider payment prior to making any reduction
in reimbursement to hospitals made under the state medicaid program.

27-5-17. Repealed.

27-5-18. Date of implementation.

No money shall be paid from the fund, and no judgment shall be rendered under the Indigent
Hospital and County Health Care Act [27-5-1 NMSA 1978], for any services rendered to any
indigent patient prior to the effective date of the Indigent Hospital and County Health Care Act.