Fiscal impact reports (FIRs) are prepared by the Legislative Finance Committee (LFC) for standing finance
committees of the Legislature. LFC does not assume responsibility for the accuracy of these reports if they
are used for other purposes.
F I S C A L I M P A C T R E P O R T
SPONSOR Steinborn
/Stefanics/Charley/Nava/Figueroa
LAST UPDATED
ORIGINAL DATE 2/20/25
SHORT TITLE County Hospital Care, Services & Payment
BILL
NUMBER Senate Bill 392
ANALYST Chenier
ESTIMATED ADDITIONAL OPERATING BUDGET IMPACT*
(dollars in thousands)
Agency/Program
FY25 FY26 FY27
3 Year
Total Cost
Recurring or
Nonrecurring
Fund
Affected
See Fiscal
Implications
Recurring
Parentheses ( ) indicate expenditure decreases.
*Amounts reflect most recent analysis of this legislation.
Sources of Information
LFC Files
Agency Analysis Received From
Health Care Authority (HCA) New Mexico Public School Insurance Authority (NMPSIA)
SUMMARY
Synopsis of Senate Bill 392
Senate Bill 392 requires county hospitals in areas where the hospital is the only available
treatment option to offer affordable payment plans and use rates equivalent to Medicare or
Medicaid reimbursement rates (whichever is greater) as the basis for charges to certain patients
who lack medical insurance and do not qualify for Medicare or other coverage options.
The effective date of this bill is July 1, 2025.
FISCAL IMPLICATIONS
Both the Public School Insurance Authority and the Health Care Authority said there would be
no fiscal impact. However, there would be a fiscal impact on the hospitals affected by the bill
that is not calculated here. This impact would be offset by the Health Care Delivery and Access
Act, which is expected to raise Medicaid reimbursement to hospitals statewide by about $1.2
billion annually starting in April or May 2025.
Senate Bill 392 – Page 2
SIGNIFICANT ISSUES
HCA provides the following:
The bill requires county hospitals verify the patient’s insurance status before care is
provided and offer an affordable payment plan if certain conditions are met. Both the care
and the affordable payment plans will be provided once the patient can provide
documentation to the hospital to determine:
They do not have private health insurance;
[They] do not qualify for Medicare or Medicaid;
[They] have private insurance that does not include the county hospital in its
network or are uninsured;
[They] are ineligible for county indigent care; and
[They] are ineligible for the New Mexico Medical Insurance Pool (NMMIP).
It is not clear that any patients would meet these criteria, since all state residents who do
not have access to other coverage options qualify for NMMIP. The bill does not address
whether the coverage available to a patient is affordable. The bill does not define what
constitutes an affordable payment plan or establish a rulemaking process for determining
the criteria for an affordable payment plan or the period of time over which the county
hospital must offer the payment plan.
The bill is not clear in distinguishing between what is an immediate life-threatening
emergency medical condition and what is a non-immediate life-threatening condition.
Section A includes a mixed list of immediate and non-immediate life-threatening
conditions. The list of conditions should be revised to distinguish the differences between
immediate life threatening conditions, also known as emergency medical conditions,
which are governed by the Federal Emergency Medical Treatment & Labor Act
(EMTALA), Section 1867 of the Social Security Act and the accompanying regulations
in 42 CFR Section 489.24 and the related requirements at 42 CFR 489.20(l), (m), (q), and
(r), which imposes specific obligations on Medicare-participating hospitals that offer
emergency services to provide a medical screening examination when a request is made
for examination or treatment for an emergency medical condition, including active labor,
regardless of an individual's ability to pay. Hospitals are then required to provide
stabilizing treatment for patients with emergency medical conditions. If a hospital is
unable to stabilize a patient within its capability, or if the patient requests, an appropriate
transfer should be implemented.
Section A should also include a separate list for non-immediate life-threatening
conditions, which would allow hospitals to provide a standard of care for patients as soon
as they validate the patient's coverage circumstance.
Section B also needs to clarify and define whether a life-threatening condition is
immediate or non-immediate, to determine what would be subject to EMTALA
regardless of ability to pay, and what would be covered by the bill and a patient’s
circumstances for pay and coverage including developing an affordable payment plan.
Senate Bill 392 – Page 3
TECHNICAL ISSUES
As currently written, the bill requires patients to meet all five criteria in Subsection A. Some of
these criteria cannot coexist. For example, a patient cannot both lack a private health plan and be
enrolled in a plan that is out-of-network. In addition, the only time the bill states the patient must
be uninsured is in conjunction with having a health plan that does not include the plan in its
network. The bill could be clarified to state that the bill specifically applies to patients who are
uninsured and do not have access to affordable coverage or have an income below a certain
threshold.
OTHER SUBSTANT IVE ISSUES
Undue Medical Debt, a nonprofit focused on relieving medical debt for patients, suggests
solutions must include upstream interventions to ensure patients do not face financial hardship.
Although SB392 attempts to address this issue, it does so very narrowly and in a way that
requires patients to submit significant documentation to prove their insurance status before
receiving care or an affordable payment plan. As noted above, it is not clear whether any state
residents would qualify under the current criteria.
ALTERNATIVES
HCA stated that one alternative approach to SB392 is Colorado’s Hospital Discount Care
program, which establishes requirements for hospital discounted care for low-income patients.
Patients are given the opportunity to apply for financial assistance or charity care programs at the
healthcare facility where they receive care. Under Colorado’s model, payment plans that are
established to pay the bills may not exceed 4 percent of the patient's monthly household income.
For bills from healthcare professionals, the limit is 2 percent of the monthly household income.
EC/hj/hg