SB 146 — HOSPITAL ACCEPTANCE OF HEALTH PLANS

SENATE FLOOR SUBSTITUTE FOR SENATE TAX, BUSINESS AND TRANSPORTATION COMMITTEE SUBSTITUTE FOR SENATE BILL 146 56TH LEGISLATURE -STATEOFNEWMEXICO-- STATEOFNEWMEXICO- SECOND SESSION , 2024 4This 6document 8may 10incorporate ANamendments ACTproposed RELATINGby TOa HOSPITALS;committee, but not yet adopted, as well as amendments that have been adopted during the current legislative session.

ENACTINGThe Adocument NEWis SECTIONa OFtool THEto HOSPITALshow FUNDINGamendments ACTin TOcontext REQUIREand COUNTYcannot HOSPITALSbe ANDused CONTRACTINGfor HOSPITALSthe TOpurpose ACCEPTof CERTAINadding QUALIFIEDamendments HEALTHto PLANSlegislation. AVAILABLE THROUGH THE NEW MEXICO HEALTH INSURANCE EXCHANGE AND PROVIDE AFFORDABLE PAYMENT PLANS TO UNINSURED PATIENTS UNDER CERTAIN CIRCUMSTANCES.

eh tg 17o wt lhr ng de 18AN BEACT ITi ENACTEDk BYh THEr LEGISLATURERELATING OFTO THEHOSPITALS; STATE OF NEW MEXICO:

=ENACTING =A 19NEW aSECTION OF THE HOSPITAL i s h FUNDING ACT TO PROVIDE AFFORDABLE PAYMENT PLANS TO PATIENTS , t, e u g e b l SECTIONUNDER 1.CERTAIN CIRCUMSTANCES.

Ae newe sectionh ofn thed Hospitald Fundingi Act= is= io ah el r] 20b enacted,d toBE read:IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

i a tº me mr 21i "[NEW= MATERIAL] COUNTY HOSPITALS AND CONTRACTING d r et 22 HOSPITALS--ACCEPTANCE OF CERTAIN QUALIFIED HEALTH PLANS-- c e sw kd 23SECTION PAYMENT1. PLANS FOR UNINSURED PATIENTS.-- e a n b 24 A.

A countynew hospitalsection orof contractingthe hospitalHospital thatFunding uAct [is acceptsm coverage for medicaid patients from a managedn careo .228251.4d STBTC/SBm 146: organization shall either:

(1)b contracte withd as healthº insuranceo carriert contractingn with= the.228378.1AIC healthFebruary care13, authority2024 department(8:31pm) ass ak managedm caree organizatione and offering a qualifiedn healthe pland thatr ise offeredl onu the[ NewA Mexicod healthenacted insuranceto exchange;read:

or"[NEW (2)MATERIAL accept] patientsCOUNTY enrolledHOSPITALS inAND aCONTRACTING non-HOSPITALS--PAYMENT contractedPLANS qualifiedREQUIRED healthUNDER planCERTAIN atCIRCUMSTANCES.-- aA. reimbursement rate at the sixtieth percentile of the allowed commercial reimbursement rate for a health care service performed by a provider in the same or similar specialty, in the same geographic area, as reported in a benchmarking database maintained by a nonprofit organization specified by the superintendent of insurance after consultation with health care sector stakeholders;

providedA thatcounty nohospital reimbursementor ratecontracting hospital shall beprovide paida atpatient lesswith thanHCPACº oneimmediate»HCPAC hundredHCPACºstandard fiftyof percentcare»HCPAC treatment HCPACºfor their location»HCPAC and an affordable payment plan if the county hospital or contracting hospital is the only provider of care HCPACºor services needed to treat the medicarepatient's reimbursementcondition»HCPAC ratein the county where the patient resides for a life-threatening condition, including cancer, that places the patient's health carein serviceserious provided.jeopardy, causes serious impairment to bodily function or causes serious dysfunction of any bodily organ as HCPACº validated by the hospital under the following circumstances»HCPAC HCPACºsoon as the patient provides the hospital all of the necessary h u documentation such that the hospital may validate that one of » r t h the following circumstances has occurred»HCPAC :

g e tl 17i B.h r (1) the patient's health insurance plan is not i s h , accepted by the county hospital or contracting hospital;

Ae countyh hospitalt oru contractingg hospital(2) shallthe w l n d 18 provide a patient withis anuninsured; affordable payment plan under the = = 19 following circumstances:

ae b l ie a e r, 20gh (1)n thed countyd hospitali or(3) contractingthe apatient t m m 21 hospital is theineligible onlyfor provider of care in the county where= the= do rh el 22] patient resides for a condition, including cancer, that places c e s k 23 the patient's health in serious jeopardy, causes serious e a n b 24,d impairmentindigent toprograms; bodily function or causes serious dysfunction of u [ any bodily organ;

.228251.4or -i 2a -º STBTC/SBr 146e (2)r = (4) the patient'spatient healthis insuranceineligible planfor isthe notNew acceptedt bye thew countyd hospitalm ora contractingn hospital;o d m :

orb (3)r thee patientt isº uninsured.o t n = .228378.1AIC February 13, 2024 (8:31pm) s k m e - 2 - e a n e d r e l u [ A d Mexico medical insurance pool.

C.B.

IfIn thecases patientof islife-threatening uninsured,conditions, thea county hospital or contracting hospital shall adhereprovide tothe patient with immediate treatment and an affordable payment plan until the medicaideffective ordate medicareof feecoverage schedule,by whichevera iscounty higher,indigent whenprogram assessingor charges.the New Mexico medical insurance pool.

D.HCPACº "»HCPAC HCPACº C.

AsThe usedtotal inpayment thisowed section,by "qualifiedan healthuninsured plan"patient meansshall abe healthcalculated planby thatapplying has in effect a certification from the superintendentmedicaid ofor insurancemedicare thatfee itschedule meets the standards set forth in applicableeffect federalfor and state law and rules, as well as any additional requirements established by the boardservice ofprovided, directorswhichever ofis thegreater. New Mexico health insurance exchange." - 3 - 15 e t 17 w l n d 18 = = 19 a l i a e r 20 a t m m 21 d r e 22 c e s k 23 e a n b 24 u [ .228251.4

A monthly payment pursuant to the affordable payment plan shall not exceed five percent of a patient's monthly household adjusted gross income."»HCPAC - 3 - h u » r t h g e l i h r i s h , e h t u g e b l e e , gh n d d i = = o h l ] b ,d i a º r e r = t e w d m a n o d m :

b r e t º o t n = .228378.1AIC February 13, 2024 (8:31pm) s k m e e a n e d r e l u [ A d