FL/CS/SB 146/a HOSPITAL ACCEPTANCE OF HEALTH PLANS

Sen Jeff Steinborn

Actions: [2] SCC/SHPAC/STBTC-SCC [4]germane-SHPAC [7] DP-STBTC- DNP-CS/DP [9] fl/sub adptd- PASSED/S (21-16) [14] HCPAC-HCPAC- DP/a [15] PASSED/H (38-24)

Scheduled: Not Scheduled

 SB146 requires county and contracting hospitals to accept plans offered by the New Mexico Health Insurance Exchange and to offer reasonable payment plans for patiens.  

 Synopsis:SB146 relates to hospitals by enacting a new section of the Hospital Funding Act to require county hospitals and contracting hospitals to accept health benefits plans available through the New Mexico Health Insurance Exchange and provide affordable payment plans under certain circumstances. 
Analysis: SB146 adds a new section to the Hospital Funding Act that would require county and contacting hospitals to accept health benefits plans that are available through the New Mexico Health Insurance Exchange. 
SB 146 requires that a county hospital or contracting hospital shall provide a patient with an affordable payment plan under the following circumstances: (1) the county hospital or contracting hospital is the only provider of care in the county where the patient resides for a condition, including cancer, that places the patient's health in serious jeopardy, causes serious impairment to bodily function or causes serious dysfunction of any bodily organ; (2) the patient's health benefit plan is not accepted by the county hospital or contracting hospital; or (3) the patient is uninsured. 
The definition for, contracting hospital, means a hospital located in New Mexico that enters into a health care facilities contract with a county or counties or another political subdivision; and, county hospital, means a hospital owned by a county.
 

 Amended February 13, 2024 in HCPAC
HCPACa/SB146cs/SFcs/a: The House Consumer and Public Affairs Committee amended SB146cs/cs/a. Amending language now states:
“ 1.  page 1, line 22, strike "immediate" and insert in lieu   there of "standard of care". 2. On page 1, line 22, after "treatment", insert "for their location". 3. On page 1, line 24, after "care", insert "or services needed to treat the patient's condition". 4. On page 2, lines 3 and 4, strike "validated by the hospital under the following circumstances" and insert in lieu thereof "soon as the patient provides the hospital all of the necessary documentation such that the hospital may validate that one of the following circumstances has occurred". 5. On page 2, line 16, strike the closing quotation mark and between lines 16 and 17, insert: "C. The total payment owed by an uninsured patient shall be calculated by applying the medicaid or medicare fee schedule in effect for the service provided, whichever is greater. A monthly payment pursuant to the affordable payment plan shall not exceed five percent of a patient's monthly household adjusted gross income."
The amendment restricts the amount of interest that a patient may be charged related to family gross income and by including the application of Medicaid or Medicare fee schedules which ever is greater that the provider has contracted for. 
The amendment also requires that the patient provide documentation to validate the circumstances for which they may be qualified for the payment plan. 




 

 Committee Substitute February 09, 2024 in STBTC
STBTCcs/SB146 The Senate Tax, Business and Transportation Committee Substitute for SB146cs adds a new Section of the Hospital Funding Act requires a hospital that accepts Medicaid from a managed care organization shall either: “(1) contract with a health insurance carrier contracting with the health care authority department as a managed care organization and offering a qualified health plan that is offered on the New Mexico health insurance exchange; or (2) accept patients enrolled in a noncontracted qualified health plan at a 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; provided that no reimbursement rate shall be paid at less than one hundred fifty percent of the medicare reimbursement rate for the health care service provided.”
Paragraph 2 above provides new language from the original SB 146 by requiring a hospital to accept patients from a non-contracted health plan and sets a rate of sixtieth percentile of the allowed commercial reimbursement rate for a service provided in a similar specialty and the similar geographic area,  provided that no reimbursement rate shall be paid at less than one hundred fifty percent of the Medicare reimbursement rate for the health care service provided.
In Section 1,B  on page 2, language states” A county hospital or contracting hospital shall provide a patient with an affordable payment plan under the following circumstances: “(1) the county hospital or contracting hospital is the only provider of care in the county where the patient resides for a condition, including cancer, that places the patient's health in serious jeopardy, causes serious impairment to bodily function or causes serious dysfunction of any bodily organ; (2) the patient's health insurance plan is not accepted by the county hospital or contracting hospital; or (3) the patient is uninsured.”
Related to Section 1,B above new language provides that (Under Section C,) an affordable payment plan is defined to say. , “If the patient is uninsured, the hospital shall adhere to the Medicaid or Medicare fee schedule, whichever is higher, when assessing charges.”
A new definition  in SB146cs of qualified health plans states “qualified health plan" means a health plan that has in effect a certification from the superintendent of insurance that it meets the standards set forth in applicable federal and state law and rules, as well as any additional requirements established by the board of directors of the New Mexico health insurance exchange."


 

 Senate Floor Substitute February 12,2024 on the Senate Floor

Sfsub/STBTCcs/SB146cs: Senate Floor Substitute for Senate Tax, Business and Transportation Committee for Committee Substitute for  SB146cs relates to hospitals by enacting a new section of the Hospital Funding Act to provide affordable payment plans to patients under certain circumstances. 
The Senate Floor Substitute states: “A county hospital or contracting hospital shall provide a patient with immediate treatment and an affordable payment plan if the county hospital or contracting hospital is the only provider of care in the county where the patient resides for a life-threatening condition, including cancer, that places the patient's health in serious jeopardy, causes serious impairment to bodily function or causes serious dysfunction of any bodily organ as validated by the hospital under the following circumstances: (1) the patient's health insurance plan is not accepted by the county hospital or contracting hospital;(2) the patient is uninsured;(3) the patient is ineligible for county indigent programs; or(4) the patient is ineligible for the New Mexico medical insurance pool.”
SB146cs requires that a county or contracting hospital provide immediate lifesaving treatment and an affordable payment plan until the coverage date by the county indigent program or the New Mexico Medical Pool.