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S1105.................................................by HEALTH AND WELFARE
MEDICALLY INDIGENT - Amends existing law relating to care for the medically
indigent to state policy to provide care to persons who are United States
citizens or legal residents; to further define terms; to govern authority
of the Board of County Commissioners to provide services to the point of
stabilization and transfer to the home country; and to establish liability
of certain employers of non-United States citizens.
02/10 Senate intro - 1st rdg - to printing
02/11 Rpt prt - to Health/Wel
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature First Regular Session - 2005
IN THE SENATE
SENATE BILL NO. 1105
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO CARE FOR THE MEDICALLY INDIGENT; AMENDING SECTION 31-3501, IDAHO
3 CODE, TO STATE POLICY TO PROVIDE CARE TO PERSONS WHO ARE UNITED STATES
4 CITIZENS OR LEGAL RESIDENTS; AMENDING SECTION 31-3502, IDAHO CODE, TO FUR-
5 THER DEFINE TERMS AND TO MAKE A TECHNICAL CORRECTION; AMENDING SECTION
6 31-3503, IDAHO CODE, TO GOVERN AUTHORITY OF THE BOARD OF COUNTY COMMIS-
7 SIONERS TO PROVIDE SERVICES TO THE POINT OF STABILIZATION AND TRANSFER TO
8 THE HOME COUNTRY; AND AMENDING SECTION 31-3510A, IDAHO CODE, TO ESTABLISH
9 LIABILITY OF CERTAIN EMPLOYERS OF NON-UNITED STATES CITIZENS.
10 Be It Enacted by the Legislature of the State of Idaho:
11 SECTION 1. That Section 31-3501, Idaho Code, be, and the same is hereby
12 amended to read as follows:
13 31-3501. DECLARATION OF POLICY. It is the policy of this state that each
14 person, to the maximum extent possible, is responsible for his or her own med-
15 ical care and to that end, shall be encouraged to purchase his or her own med-
16 ical insurance with coverage sufficient to prevent them from needing to
17 request assistance pursuant to this chapter. However, in order to safeguard
18 the public health, safety and welfare, and to provide suitable facilities and
19 provisions for the care and hospitalization of persons in this state, and, in
20 the case of medically indigent persons who are U.S. citizens or legal resi-
21 dents of the United States and who meet the definition of resident as pro-
22 vided in this chapter, to provide for the payment thereof, the respective
23 counties of this state and the administrator shall have the duties and powers
24 as hereinafter provided.
25 SECTION 2. That Section 31-3502, Idaho Code, be, and the same is hereby
26 amended to read as follows:
27 31-3502. DEFINITIONS. As used in this chapter, the terms defined in this
28 section shall have the following meanings, unless the context clearly indi-
29 cates another meaning:
30 (1) "Medically indigent" means any person who is in need of necessary
31 medical services and who, if an adult, together with his or her spouse, or
32 whose parents or guardian if a minor, does not have income and other resources
33 available to him from whatever source sufficient to pay for necessary medical
34 services. Nothing in this definition shall prevent the board of county commis-
35 sioners and administrator from requiring the applicant and obligated persons
36 to reimburse the county and the catastrophic health care costs program, where
37 appropriate, for all or a portion of their medical expenses, when investiga-
38 tion of their application pursuant to this chapter, determines their ability
39 to do so.
40 (2) "Hospital" means a facility licensed and regulated pursuant to sec-
41 tions 39-1301 through 39-1314, Idaho Code, excluding state institutions.
2
1 (3) "Dependent" means any person whom a taxpayer could claim as a depend-
2 ent under the income tax laws of the state of Idaho.
3 (4) "Applicant" means any person who is or may be requesting financial
4 assistance under this chapter.
5 (5) "Reimbursement rates" means the unadjusted medicaid rate of reim-
6 bursement for medical charges allowed pursuant to title XIX of the social
7 security act, as amended. For long-term care facilities, maximum
8 "reimbursement rates" means the unadjusted medicaid rate of reimbursement
9 allowed pursuant to the medical assistance program as determined by chapter 1,
10 title 56, Idaho Code, or the unadjusted medicare rate of reimbursement estab-
11 lished under title XVIII of the social security act, as amended, whichever is
12 greater.
13 (6) "Board" means the board of county commissioners.
14 (7) "Obligated persons" means those persons who are legally responsible
15 for an applicant.
16 (8) "County hospital" means any county approved institution or facility
17 for the care of sick persons.
18 (9) "Administrator" means the board of the catastrophic health care cost
19 program, as provided in section 31-3517, Idaho Code.
20 (10) "Catastrophic health care costs" means all necessary medical expenses
21 for services which are incurred by a recipient for which the reimbursement
22 rate exceeds in aggregate the sum of ten thousand dollars ($10,000) in any
23 twelve (12) consecutive month period.
24 (11) "Recipient" means an individual determined eligible for necessary
25 medical services under this chapter.
26 (12) "Resident" means a person with a home, house, place of abode, place
27 of habitation, dwelling or place where he or she actually lived for a consecu-
28 tive period of thirty (30) days or more within the state of Idaho. A resident
29 does not include a person who comes into this state for temporary purposes,
30 including, but not limited to, education, vacation, or seasonal labor or who
31 is not a citizen of the United States and who otherwise does not have legal
32 status pursuant to the laws of the United States. Entry into active military
33 duty shall not change a person's residence for the purposes of this chapter.
34 Those physically present within the following facilities and institutions
35 shall be residents of the county where they were residents prior to entering
36 the facility or institution:
37 (a) Correctional facilities;
38 (b) Nursing homes or residential or assisted living facilities;
39 (c) Other medical facility or institution.
40 (13) "Emergency service" means a service provided for a medical condition
41 in which sudden, serious and unexpected symptoms of illness or injury are suf-
42 ficiently severe to necessitate or call for immediate medical care.
43 (14) "Provider" means any person, firm, or corporation certified or
44 licensed by the state of Idaho or holding an equivalent license or certifica-
45 tion in another state, that provides necessary medical services as it appears
46 on an application for assistance pursuant to this chapter.
47 (15) "Third party applicant" means a person other than an obligated person
48 who completes, signs and files an application on behalf of a patient.
49 (16) "Clerk" means the clerk of the board or his or her designee.
50 (17) "Resources" means all property, whether tangible or intangible, real
51 or personal, liquid or nonliquid, including, but not limited to, all forms of
52 public assistance, crime victim's compensation, worker's compensation, vet-
53 erans benefits, medicaid, medicare and any other property from any source for
54 which an applicant and/or an obligated person may be eligible or in which he
55 or she may have an interest. Resources shall include the ability of an appli-
3
1 cant and obligated persons to pay for necessary medical services over a period
2 of up to three (3) years. For purposes of determining approval for medical
3 indigency only, resources shall not include the value of the homestead on the
4 applicant or obligated persons' residence, a burial plot, exemptions for per-
5 sonal property allowed in section 11-605(1) through (3), Idaho Code, and
6 additional exemptions allowed by county resolution.
7 (18) A. "Necessary medical services" means a requested or provided medi-
8 cal service required in order to identify or treat a medically indigent
9 person's health condition, illness or injury and is:
10 (a) Consistent with the symptoms, diagnosis or treatment of the med-
11 ical indigent's condition, illness or injury;
12 (b) In accordance with generally accepted standards of medical or
13 surgical practice then prevailing in the community where the services
14 were provided;
15 (c) Furnished on an outpatient basis whenever it is safe, efficient
16 and reasonable to do so;
17 (d) Not provided primarily for the convenience of the medically
18 indigent person or the provider;
19 (e) The standard, most economical service or item that can safely,
20 reasonably and ethically be provided.
21 B. Necessary medical services shall not include the following:
22 (a) Bone marrow transplants;
23 (b) Organ transplants;
24 (c) Elective, cosmetic and/or experimental procedures;
25 (d) Services related to, or provided by, residential and/or shelter
26 care facilities;
27 (e) Normal, uncomplicated pregnancies, excluding caesarean section,
28 and childbirth well-baby care;
29 (f) Medicare copayments and deductibles;
30 (g) Services provided by, or available to an applicant from state,
31 federal and local health programs; and
32 (h) Medicaid copayments and deductibles.
33 Provided however, each board may determine, by ordinance or resolution
34 duly adopted in its county, to include as necessary medical services addi-
35 tional services not covered in this section. Necessary medical services pro-
36 vided by this option shall not be paid by the catastrophic health care costs
37 program, and shall remain the liability of the respective county.
38 SECTION 3. That Section 31-3503, Idaho Code, be, and the same is hereby
39 amended to read as follows:
40 31-3503. POWERS AND DUTIES OF BOARDS OF COUNTY COMMISSIONERS. The boards
41 of county commissioners in their respective counties shall, under such limita-
42 tions and restrictions as are prescribed by law:
43 (1) Care for and maintain the medically indigent residents of their coun-
44 ties as provided in this chapter up to ten thousand dollars ($10,000) per
45 claim in the aggregate over a twelve (12) month period with the remainder
46 being paid by the state catastrophic health care cost program pursuant to sec-
47 tion 31-3519, Idaho Code.
48 (2) Have the right to contract, transfer patients, negotiate provider
49 agreements, and all other powers incident to the duties created by this chap-
50 ter.
51 (3) From July 1, 1997, through June 30, 1998, pPay for emergency services
52 for a nonresident person who is not a citizen of the United States or who
53 otherwise does not have legal status pursuant to the laws of the United States
4
1 to the point of stabilization as set forth in section 31-3507, Idaho Code, and
2 when necessary, for costs of transfer to the nonresident's place of residence
3 person's home country, up to five thousand dollars ($5,000) per claim in the
4 aggregate over a twelve (12) month period with the remainder being paid by the
5 state catastrophic health care cost program pursuant to section 31-3519, Idaho
6 Code, unless such nonresident is from a state which has a reciprocal agreement
7 pursuant to section 31-3503B, Idaho Code, and qualifies for necessary medical
8 services under that agreement.
9 (4) Have the jurisdiction and power to provide county hospitals and pub-
10 lic general hospitals for the county and others who are sick, injured, maimed,
11 aged and infirm and to erect, enlarge, purchase, lease, or otherwise acquire,
12 and to officer, maintain and improve hospitals, hospital grounds, nurses'
13 homes, shelter care facilities and residential or assisted living facilities
14 as defined in section 39-3301, Idaho Code, superintendent's quarters, medical
15 clinics, as that term is defined in section 39-1319, Idaho Code, medical
16 clinic grounds or any other necessary buildings, and to equip the same, and to
17 replace equipment, and for this purpose said boards may levy an additional tax
18 of not to exceed six hundredths percent (.06%) of the market value for assess-
19 ment purposes on all taxable property within the county. The term "public gen-
20 eral hospitals" as used in this subsection shall be construed to include nurs-
21 ing homes.
22 SECTION 4. That Section 31-3510A, Idaho Code, be, and the same is hereby
23 amended to read as follows:
24 31-3510A. REIMBURSEMENT. (1) Receipt of financial assistance pursuant to
25 this chapter shall obligate an applicant to reimburse the county from which
26 assistance is received and the catastrophic health care costs program for such
27 reasonable portion of the financial assistance paid on behalf of the applicant
28 as the board may determine that the applicant is able to pay from resources
29 over a reasonable period of time. Cash amounts received shall be prorated
30 between the county and the state in proportion to the amount each has paid.
31 (2) A final determination shall not relieve the applicant's duty to make
32 additional reimbursement from resources if the board subsequently finds within
33 a reasonable period of time that there has been a substantial change in cir-
34 cumstances such that the applicant is able to pay additional amounts up to the
35 total claim paid on behalf of the applicant.
36 (3) A final determination shall not prohibit the board from reviewing a
37 petition from an applicant to reduce an order of reimbursement based on a sub-
38 stantial change in circumstances.
39 (4) The automatic lien created pursuant to the chapter may be filed and
40 recorded in any county of this state wherein the applicant has resources and
41 may be liquidated or unliquidated in amount. Nothing herein shall prohibit an
42 applicant from executing a consensual lien in addition to the automatic lien
43 created by filing an application pursuant to this chapter. In the event that
44 resources can be located in another state, the clerk may file the lien with
45 the district court and provide notice to the recipient. The recipient shall
46 have twenty (20) days to object, following which the district court shall
47 enter judgment against the recipient. The judgment entered may thereafter be
48 filed as provided for the filing of a foreign judgment in that jurisdiction.
49 (5) The county shall have the same right of recovery as provided to the
50 state of Idaho pursuant to sections 56-218 and 56-218A, Idaho Code.
51 (6) The board may require the employment of such of the medically indi-
52 gent as are capable and able to work and whose attending physician certifies
53 they are capable of working.
5
1 (7) Moneys received by a county as reimbursement shall be credited to the
2 county indigent fund and need not be budgeted or appropriated in the manner
3 required by chapter 16, title 31, Idaho Code, but shall be available for
4 expenditure at any time for the purposes of the county indigent fund.
5 (8) If, after a hearing, the final determination of the board is to
6 require a reimbursement amount or rate the applicant believes excessive, the
7 applicant may seek judicial review of the final determination of the board in
8 the manner provided in section 31-1506, Idaho Code.
9 (9) Any person who knowingly and willfully employs a non-United States
10 citizen who otherwise does not have legal status as defined in section
11 31-3502(12), Idaho Code, shall be responsible for the cost of providing medi-
12 cally necessary services for those persons or members of their household who
13 are medically indigent pursuant to the provisions of this chapter, if the med-
14 ical condition leading to medically necessary services arises during the
15 course of employment. A cause of action for reimbursement plus costs and
16 attorney's fees shall accrue against any employer of persons as defined in
17 this subsection to any county or health care provider who provides such health
18 care services. Any person who, in good faith, relies on documentation estab-
19 lishing the legal status and the documentation appears on its face to be
20 authentic, shall not be subject to the provisions of this subsection.
STATEMENT OF PURPOSE
RS 14800
The provisions of this bill are designed to address responsibility for
payment of medical claims for persons who are not legally present in
the United States and the state of Idaho. Specifically, this bill
states that the county indigent program is not the appropriate method
for payment of health care claims in those instances where the
individual is not legally present in the United States and state of
Idaho. Property taxes are not the appropriate mechanism for payment of
these types of claims especially when the property tax system is under
such intense scrutiny and viewed with significant unpopularity by
Idaho s citizens. However, the law is clarified to provide that in
cases of medical emergency, counties will pay their appropriate share
up to the point of stabilization, at which time the individual should
be returned to his or her country of origin.
The bill further provides that an employer who knowingly and willfully
employs a person who is not legally present in the United States and
the state of Idaho may be held responsible for the cost of medical care
for the person or members of that person s household while the person
is employed by the employer. This occurs by the creation of a cause of
action on behalf of a county or health care provider.
FISCAL NOTE
Currently it is estimated that at least $1.5 million are spent by
counties for health care for persons who are not legally in the United
States and the state of Idaho. The adoption of this legislation may
result in fewer property tax dollars and state general fund dollars
appropriated to the Catastrophic Health Care Cost Program being used
for the payment of indigent health care claims. Some of the burden may
shift to private employers
Contact
Name: Dan Chadwick, Idaho Association of Counties
Phone: (208) 345 9126
Maggie Colwell/Tony Elliott/Tony Poinelli
STATEMENT OF PURPOSE/FISCAL NOTE S 1105