2005 Legislation
Print Friendly

SENATE BILL NO. 1105 – Medically indigent, care, residents


View Bill Status

View Bill Text

View Statement of Purpose / Fiscal Impact

Text to be added within a bill has been marked with Bold and
Underline. Text to be removed has been marked with
Strikethrough and Italic. How these codes are actually displayed will
vary based on the browser software you are using.

This sentence is marked with bold and underline to show added text.

This sentence is marked with strikethrough and italic, indicating
text to be removed.

Bill Status

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

Bill Text

  ]]]]              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
 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.
  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-
  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:
 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
  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.
  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 / Fiscal Impact

                      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

Name:   Dan Chadwick, Idaho Association of Counties
Phone:  (208)  345 9126
        Maggie Colwell/Tony Elliott/Tony Poinelli

STATEMENT OF PURPOSE/FISCAL NOTE                           S 1105