A. A hospital may submit eligible claims to the department on or before April 1 of each year for payment from the fund by June 30 of each year in an amount determined pursuant to this section.
B. A claim submitted by a hospital for payment from the fund shall be deemed an eligible claim if it is for:
(1) uncovered hospital charges of five thousand dollars ($5,000) or more for an illness of a medically indigent patient;
(2) hospital charges incurred within the twelve months immediately prior to the applicable April 1 closing deadline; and
(3) an amount determined by subtracting from the base claim the medically indigent patient's deductible and then reducing the resulting balance, based on the hospital's medicare cost-to-charge ratio, to an amount equal to medicare allowable costs.
C. The department shall pay from the fund to each hospital the amount of each eligible claim if there is sufficient money in the fund. If there is not sufficient money in the fund to pay all eligible claims of hospitals for that year, the amount of each claim that shall be paid shall be an amount derived from multiplying the full amount of the eligible claim by the percentage derived from dividing the balance in the fund, after administrative costs have been subtracted, by the sum of the eligible claims.
History: Laws 1990, ch. 93, ยง 5.
Structure New Mexico Statutes
Chapter 27 - Public Assistance
Article 2 - Public Assistance Act
Section 27-2-3 - Standard of need; income determination.
Section 27-2-4 - Eligibility requirements.
Section 27-2-6.1 - Supplemental postnatal assistance.
Section 27-2-7 - General assistance program; qualifications and payments.
Section 27-2-7.1 - Eligible person entitled to information.
Section 27-2-9 - Payment for hospital care.
Section 27-2-9.1 - Administration of shelter care supplement.
Section 27-2-10 - Food stamp program.
Section 27-2-11 - Scope of assistance programs.
Section 27-2-12 - Medical assistance programs.
Section 27-2-12.2 - Medical assistance program; eligibility of married individuals.
Section 27-2-12.6 - Medicaid payments; managed care.
Section 27-2-12.8 - Mammograms for medicaid recipients.
Section 27-2-12.9 - Medicaid; personal spending allowances; increases.
Section 27-2-12.10 - Clinical nurse specialists.
Section 27-2-12.11 - Prescription drug waiver program; purpose; eligibility.
Section 27-2-12.12 - Human services department; managed care contract credentialing provisions.
Section 27-2-12.13 - Medicaid reform; program changes.
Section 27-2-12.14 - Brain injury; services authorized.
Section 27-2-12.20 - Crisis triage center; medical assistance reimbursement.
Section 27-2-12.21 - Medical assistance; pharmacy benefits; prescription synchronization.
Section 27-2-12.24 - Medical assistance; plan of care; participation required.
Section 27-2-12.25 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.
Section 27-2-12.28 - Medical assistance; autism spectrum disorder.
Section 27-2-12.30 - Pharmacist prescriptive authority services; reimbursement parity.
Section 27-2-12.31 - Heart artery calcium scan coverage.
Section 27-2-13 - Conflict in federal and state laws.
Section 27-2-14 - Continuing effect of regulations and standards.
Section 27-2-15 - Cooperation with United States.
Section 27-2-16 - Compliance with federal law.
Section 27-2-17 - Custodian of funds.
Section 27-2-18 to 27-2-20 - Repealed.
Section 27-2-21 - Assistance not assignable.
Section 27-2-23 - Third party liability.
Section 27-2-24 - [Federal government entitled to share recovery.]
Section 27-2-25 - Funeral expenses.
Section 27-2-26 - Money received from other sources; duty and liability of funeral director.
Section 27-2-27 - Single state agency; powers and duties.
Section 27-2-28 - Liability for repayment of public assistance.
Section 27-2-29.1 - Compensation under contingent fee contracts; suspense fund created.
Section 27-2-30 - [Enforcement of support;] orders.
Section 27-2-31 - Judgments and proceeds.
Section 27-2-32 - Duty of agencies to cooperate.
Section 27-2-34 - Limitations of act.
Section 27-2-35 to 27-2-40 - Repealed.
Section 27-2-41 - Short title.
Section 27-2-42 - Legislative findings; purpose.
Section 27-2-43 - Definitions.
Section 27-2-44 - Indigent catastrophic illness hospital fund created.
Section 27-2-45 - Hospitals; claims for payment.