NOTE:  As provided in LFC policy, this report is intended only for use by the standing finance committees of the legislature.  The Legislative Finance Committee does not assume responsibility for the accuracy of the information in this report when used for other purposes.

 

The most recent FIR version (in HTML & Adobe PDF formats) is available on the Legislative Website.  The Adobe PDF version includes all attachments, whereas the HTML version does not.  Previously issued FIRs and attachments may be obtained from the LFC in Suite 101 of the State Capitol Building North.

 

 

F I S C A L   I M P A C T   R E P O R T

 

 

 

SPONSOR:

Hurt

 

DATE TYPED:

1/31/03

 

HB

 

 

SHORT TITLE:

Mandatory Assignment of Health Claims

 

SB

150

 

 

ANALYST:

Wilson

 

APPROPRIATION

 

Appropriation Contained

Estimated Additional Impact

Recurring

or Non-Rec

Fund

Affected

FY03

FY04

FY03

FY04

 

 

 

NFI

 

 

 

 

 

SOURCES OF INFORMATION

 

Responses Received From

 

General Services Administration (GSD)

Agency on Aging (AOA)

Public School Insurance Authority (PSIA)

Retiree Health Care Authority (RHCA)

Public Regulation Commission (PRC)

Department of Health (DOH)

Health Policy Commission (HPC)

 

SUMMARY

 

     Synopsis of Bill

 

Senate Bill 150 enacts a new section of the Insurance Code.  It requires a health care provider to bill a patient’s health care plan directly, The provider may not collect any payment from the patient except a co-payment, coinsurance, deductible or other amount for which the patient is liable under  the health care plan.

  

     Significant Issues

 

 Patients should have the right to designate the payee associated with their health plan benefits.  “Assignment of Benefits” is widely accepted in the health insurance industry.  GSD notes that all vendors associated with health plans serving State of New Mexico employees, with one exception, honor a claim that assigns benefits to the provider of service.  Direct payment to the provider causes some of the administrative burden on patients who, in many cases, are overwhelmed with paperwork.  Blue Cross Blue Shield of New Mexico is the only health plan that does not honor “Assignment of Benefits”. 

 

Patients who have insurance are sometimes required to pay up-front for their health care and then wait to be reimbursed by their health care plan. For some people, this can cause financial hardship, and might act as a deterrent to seeking necessary medical assistance.  Delays in care can often lead to more serious, and more costly, health conditions.

 

ADMINISTRATIVE IMPLICATIONS

 

The PRC is responsible for enforcing the provisions of the Insurance Code. SB 150 will add only a very small increase to the workload.

 

POSSIBLE QUESTIONS

 

In the event that a health plan does not pay for services rendered by a non-participating provider,  will the provisions in SB150 require that those services go uncompensated?

 

DW/njw