Section 24A-8-2 - [Contingent effective date. See note below. Repealed effective 7/1/2030] DefinitionsAs used in the Health Care Delivery and Access Act:
A. "assessed days" means the number of inpatient hospital days exclusive of medicare days for each eligible hospital, with data sources to be defined by the authority and updated no less frequently than every three years;B. "assessed outpatient revenue" means net patient revenue exclusive of medicare outpatient revenue for outpatient services, with data sources to be defined by the authority and updated no less frequently than every three years;C. "assessment" means the health care delivery and access assessment;D. "assessment amount" means the assessment amount owed by an eligible hospital;E. "assessment rate" means the amount per assessed day and the percentage of assessed outpatient revenue calculated by the authority;F. "authority" means the health care authority department;G. "average commercial rate" means the average rate paid by commercial insurers as provided by the centers for medicare and medicaid services;H. "centers for medicare and medicaid services" means the centers for medicare and medicaid services of the United States department of health and human services;I. "eligible hospital" means a non-federal facility licensed as a hospital by the department of health, excluding a state university teaching hospital or a state-owned special hospital;J. "general acute care hospital" means a hospital other than a special hospital;K. "hospital" means a facility providing emergency or urgent care, inpatient medical care and nursing care for acute illness, injury, surgery or obstetrics. "Hospital" includes a facility licensed by the department of health as a critical access hospital, rural emergency hospital, general hospital, long-term acute care hospital, psychiatric hospital, rehabilitation hospital, limited services hospital or special hospital;L. "inpatient hospital services" means services that:(1) are ordinarily furnished in a hospital for the care and treatment of inpatients;(2) are furnished under the direction of a physician, advanced practice clinician or dentist;(3) are furnished in an institution that: (a) is maintained primarily for the care and treatment of patients;(b) is licensed or formally approved as a hospital by an officially designated authority for state standard-setting;(c) meets the requirements for participation in medicare as a hospital; and(d) has in effect a utilization review plan, applicable to all medicaid patients, that meets federal requirements; and(4) are not skilled nursing facility services or immediate care facility services furnished by a hospital with a swing-bed approval;M. "managed care organization" means a person or organization that has entered into a comprehensive risk-based contract with the authority to provide health care services, including inpatient and outpatient hospital services, to medicaid beneficiaries;N. "medicaid" means the medical assistance program established pursuant to Title 19 of the federal Social Security Act and regulations promulgated pursuant to that act;O. "medicaid-directed payment program" means the health care delivery and access medicaid-directed payment program created pursuant to Section 5 [24A-8-5 NMSA 1978] of the Health Care Delivery and Access Act providing additional medicaid funding for hospital services provided through medicaid managed care organizations, as directed by the authority and approved by the centers for medicare and medicaid services;P. "medicare days" means the number of inpatient days provided by an eligible hospital during the year to patients covered under Title 18 of the federal Social Security Act;Q. "medicare outpatient revenue" means the amount of net revenue received by an eligible hospital for outpatient hospital services provided to patients covered under Title 18 of the federal Social Security Act;R. "net patient revenue" means total net revenue received by a hospital for inpatient and outpatient hospital services in a year, as determined by the authority;S. "New Mexico medicaid program" means the medicaid program established pursuant to Section 27-2-12 NMSA 1978;T. "outpatient hospital services" means preventive, diagnostic, therapeutic, rehabilitative or palliative services that are furnished:(2) by or under the direction of a physician, advanced practice clinician or dentist; and(3) by an institution that: (a) is licensed or formally approved as a hospital by an officially designated authority for state standard-setting; and(b) meets the requirements for participation in medicare as a hospital;U. "quality incentive payments" means the portion of the medicaid-directed payment program paid to hospitals based on value-based quality measurements and performance evaluation criteria, as established by the authority pursuant to Section 5 of the Health Care Delivery and Access Act;V. "rehabilitation hospital" means a facility licensed as a rehabilitation hospital by the department of health;W. "rural emergency hospital" means a facility licensed as a rural emergency hospital by the department of health;X. "rural hospital" means a hospital that is located in a county that has a population of one hundred twenty-five thousand or fewer according to the most recent federal decennial census;Y. "secretary" means the secretary of health care authority;Z. "small urban hospital" means a hospital that is located in a county that has a population greater than one hundred twenty-five thousand and that has fewer than fifteen licensed inpatient beds as of January 1, 2024;AA. "special hospital" means a facility licensed as a special hospital by the department of health; andBB. "uniform rate increase" means the portion of the medicaid-directed payment program paid to hospitals as a uniform dollar or percentage increase.