[HISTORY: Adopted by the Board of County
Commissioners of Doña Ana County 6-8-2010 by Res. No. 2010-53. Amendments noted
where applicable.]
ADDITIONAL INFORMATION
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.
A.
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)
B.
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)
C.
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.
[Amended 6-28-2016 by Res. No. 2016-46]
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.
[Amended 9-27-2011 by Ord. No. 235-2011; 6-25-2013 by Res. No.
2013-55; 6-24-2014 by Res. No. 2014-69; 6-28-2016 by Res. No. 2016-46; 6-12-2018 by Res. No. 2018-47]
The Board of County Commissioners hereby directs staff to develop
policies and procedures consistent with the following:
A.
Identification. An applicant must provide one of the following forms
of photo identification:
(1)
United States passport;
(2)
Government-issued ID;
(3)
School ID;
(4)
Dependents age 17 and younger, or age 18 and enrolled in high school,
may use the parent/guardian declaration of identity in lieu of a photo
ID; or
(5)
Individuals may use the healthcare provider declaration of identity
in lieu of a photo ID.
B.
Residency. To qualify for indigent care, an applicant shall reside
in Dona Ana County. To establish residency, an applicant shall produce
at least one of the following documents:
(1)
Rental, lease, dorm, or residential agreement;
(2)
Property tax statement;
(3)
Residential utility bill;
(4)
Affidavit from Community of Hope; or Gospel Rescue Mission;
(5)
Current government-issued ID, such as driver's license;
(6)
Bank or credit card statement;
(7)
Pay stub;
(8)
Local property tax statement;
(9)
Mortgage statement;
(10)
Insurance bill, card, or binder.
C.
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 United States Department of Commerce. To establish
annual income, the applicant must produce one of the following:
(1)
Latest federal or state income tax return (for the most recent tax
return for the immediate preceding tax year);
(2)
Calculate based on current monthly income only if applicant is not
required to file income taxes;
(3)
Annual Form SSA-1099 of previous year only if applicant is not required
to file income taxes.
D.
Current income. To establish current income, an applicant shall produce
most recent document(s) of any or all of the following:
(1)
Pay stub or pay voucher from employer;
(2)
Self-employment record or CRS forms;
(3)
Personal wage record;
(4)
Workers' compensation statement;
(5)
Short-term or long-term disability statement;
(6)
Retirement income statement;
(7)
SSA/SSI statement;
(8)
Student financial aid statement;
(9)
Temporary assistance for needy families statement;
(10)
Unemployment benefits statement;
(11)
Child support or alimony checks or statements; or
(12)
Department of Defense income statement.
E.
Payer of last resort. If it is determined by the contractor that
the individual is not eligible for other coverage, is excluded from
the New Mexico Health Insurance Exchange, or is not mandated by the
Patient Protection and Affordable Care Act of 2010 to obtain coverage,
the County's indigent program will be considered the payer of
last resort. The contractor must document one of the following circumstances
as part of the enrollment process:
(1)
Hardship exemptions.
(a)
Being homeless.
(b)
Having been evicted in the previous six months or were facing
eviction or foreclosure.
(c)
Received a shut-off notice from a utility company.
(d)
Experienced domestic violence.
(e)
Experienced the death of a close family member.
(f)
Experienced a fire, flood, or other natural or human-caused
disaster that caused substantial damage to your property.
(g)
Filed for bankruptcy in the last six months.
(h)
Had medical expenses they couldn't pay in the last 24 months.
(i)
Experienced unexpected increases in necessary expenses due to
caring for an ill, disabled, or aging family member.
(2)
Other exemptions; or
(a)
Those for whom the premiums for the lowest-priced coverage would
cost more than 8% of household income.
(b)
Those who have been uninsured for less than three months within
a year due to changes in coverage status.
(c)
Members of a federally recognized tribe.
(d)
Members of a recognized health-care sharing ministry.
(e)
Members of a recognized religious sect with religious objections
to insurance, including social security and medicare.
F.
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.
[Amended 9-27-2011 by Ord. No. 235-2011; 6-25-2013 by Res. No.
2013-55; 6-24-2014 by Res. No. 2014-69; 6-28-2016 by Res. No. 2016-46; 6-12-2018 by Res. No. 2018-47]
A.
Healthcare providers with whom the County has contracted for the healthcare assistance program shall use the County's designated enrollment system to enter data indicating the applicant has satisfied the criteria and provided the documentation in § 52-3, above.
B.
Once the healthcare provider has entered the data based on the appropriate
documentation, the enrollment system will issue an approval letter
or denial letter on behalf of the Board and contractor.
C.
Healthcare providers with whom the County has contracted for the
healthcare assistance program shall require the following audit analysis:
(1)
At least once a fiscal year, the healthcare 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.
(2)
The independent audit firm shall report to the County the findings
of the alternative assessment.
(3)
If the findings indicate an error/noncompliance rate exceeding 2%,
the County shall issue a thirty-day cure notice.
(4)
Once the thirty-day cure notice is issued, the healthcare provider
shall have its independent audit firm perform another alternative
assessment to report limited assurances that the healthcare provider's
error rate is not exceeding 2%.
D.
The County's Health and Human Services Department shall continue
to pay claims from out-of-County hospitals and the associated physician
groups and air ambulance providers that provide medically necessary
care that is not available through in-County Safety Net Care Pool
qualifying 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.
[Added 5-27-2014 by Ord.
No. 270-2014]
Pursuant to the Indigent Hospital and County Health Care Act,
NMSA 1978, § 27-5-2 et seq., as amended, effective July
1, 2014, an amount equal to a gross receipts tax rate of 1/12% applied
to the taxable gross receipts reported during the prior fiscal year
by persons engaging in business in the County is hereby dedicated
to the Safety Net Care Pool fund. For the purposes of this section,
the County may use public funds from any existing authorized revenue
source of the County.
[Added 5-27-2014 by Ord.
No. 270-2014]
By the last day of March, June, September and December of each
year for three years, the County shall transfer to the Safety Net
Care Pool fund an amount equal to 1/4 of the County's payment
that is dedicated under the preceding section.
