The County Manager is authorized to approve all nonmaterial changes to this policy that may be required or recommended in the future. A summary of such administrative clarifications is included at the end of this chapter.
§ 52-1Findings, authority and administration.
§ 52-2Scope of County liability.
§ 52-3Overview of patient eligibility
§ 52-4Application and eligibility verification
Doña Ana County is the responsible agency for ambulance transportation, hospital care, and health care of indigent patients domiciled in Doña Ana County. (NMSA 27-5-2A)
The law of the State of New Mexico defines indigent patients as persons who can normally support themselves and their dependents on present income and liquid assets available to them but, taking into consideration this income and those assets and their requirement for other necessities of life for themselves and their dependents, are unable to pay the cost of ambulance transportation or medical care, or both. (NMSA 27-5-4C)
It is in the best interests of Doña Ana County to ensure that moneys dedicated to the health care of the County's indigent residents are used in accordance with state law and criteria established by the Board of County Commissioners for Doña Ana County.
Doña Ana County shall be the payer of last resort. Those individuals eligible for any other health coverage shall not be covered by the County's assistance program for the same type of care.
The Board of County Commissioners hereby directs staff to develop policies and procedures consistent with the following:
To qualify for indigent care, an applicant shall have been a resident of Doña Ana County for no less than 90 days.
Annual Income. To qualify for indigent care, an applicant (or parent/guardian) shall not have annual household income that is 50% greater than the per capita personal income for New Mexico for the most recent year as published by the U.S. Department of Commerce. To establish annual income the applicant must produce the following:
Latest federal or state income tax return (after April 15 of each year, it must be the tax return for the immediately preceding tax year).
Current income. To establish current income, an applicant shall produce one of the following. Of the following documents, an applicant shall produce at least one:
Pay stub or pay voucher from employer;
Self-employment record/CRS forms;
Workers compensation statement;
Short-term or long-term disability statement;
Retirement income statement;
Student financial aid statement;
Temporary Assistance for Needy Families statement;
Unemployment benefits statement; or
Child support or alimony checks or statements.
False incorrect information/documentation: If an applicant provides false or incorrect information as to identification/residency/income, the application shall be denied for one year from the date of discovery.
Health care providers with whom the County has contracted shall use the iReach System to enter data indicating the applicant has satisfied the criteria and provided the documentation in § 52-3 above.
Once the health care provider has entered the data based on the appropriate documentation, iReach will indicate that the application is approved. The iReach indication will constitute approval by the Board of the application. The iReach program will issue an approval letter or denial letter on the behalf of the Board and contractor.
The contracts entered into by the County with health care providers for indigent care shall require the following audit analysis by such health care providers:
At least once a fiscal year, the health care provider shall contract with a third party, professionally licensed, audit firm to conduct an alternative assessment of a random and statistically valid representative group of applications to verify compliance with the indigent criteria and documentation thereof.
The independent audit firm shall report to the County the findings of the alternative assessment.
If the findings indicate an error/noncompliance rate exceeding 2%, the County shall issue a thirty-day cure notice.
Once the thirty-day cure notice is issued, the health care provider shall have its independent audit firm perform another alternative assessment to report limited assurances that the health care provider's error rate is not exceeding 2%.
These health care providers shall provide a report of indigent care to the County Health and Human Services Department. The form of the report will be developed by the County Health and Human Services Department and provided to the health care providers.
The County Health and Human Services Department shall continue to pay claims from out-of county hospitals and air ambulance providers that provide medically necessary care that is not available through in-county Sole Community Provider Hospitals and with whom the County does not have a contract. Those claims that comply with the indigent criteria shall be paid up to a cumulative cap of $25,000 per person, per fiscal year at 36.1% of the current New Mexico Medicaid rate.