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ADOC Office of Health Services August 2011 County and State Partnership

ADOC Office of Health Services August 2011 County and State Partnership. Ruth Naglich, Associate Commissioner Alabama Department of Correction. Agenda. Ala. Code: Title 14-3-30 Identifying inmate claims Notification and Submission of Paid Claims Third Party Reimbursement

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ADOC Office of Health Services August 2011 County and State Partnership

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  1. ADOC Office of Health Services August 2011 County and State Partnership Ruth Naglich, Associate Commissioner Alabama Department of Correction

  2. Agenda • Ala. Code: Title 14-3-30 • Identifying inmate claims • Notification and Submission of Paid Claims • Third Party Reimbursement • County Cash Flow and Cost Avoidance • Contact Us

  3. Section 14-3-30Temporary confinement of convict pending removal; inmate developing medical condition which requires treatment. • (a) When any convict is sentenced to the penitentiary, the judge of the court in which the sentence is rendered shall order the inmate to be confined in the nearest secure jail. The clerk of the court shall at once notify the Department of Corrections as to the jail where the inmate is confined, forward to the department a copy of the judgment entry and sentence in the case, and inform the department if any special care is necessary to guard the inmate. Thereupon, the department shall direct where the inmate shall be taken for confinement or hard labor. • (b) When an inmate sentenced to the custody of the department and the department is in receipt of a transcript of such sentence, is being housed in a county jail, and the inmate develops a medical condition which requires immediate treatment at a medical-care facility outside the county jail, the department shall be financially responsible for the cost of the treatment of the inmate. The department shall receive any contractual discounts the medical-care facility has agreed to grant for the treatment of inmates housed in state correctional facilities. When an inmate sentenced to the custody of the department and the department is in receipt of a transcript of such sentence, is housed in a county jail, and the inmate develops a medical condition or has been diagnosed as having a medical condition which, in the opinion of a physician licensed in Alabama, would require treatment or a medical procedure or both, involving a cost of more than two thousand dollars ($2,000), the inmate shall be transferred within three days to a state owned or operated correctional facility or to the physical custody of the department as determined by the Commissioner of the Department of Corrections. The inmate shall receive treatment in the same manner as other state inmates. Nothing in this subsection shall be interpreted to relieve the department of its responsibility for the maintenance and upkeep, including the payment of medical costs, of an inmate sentenced to the custody of the department, nor shall this subsection be interpreted as conferring any additional responsibility upon a county for the maintenance and upkeep, or the payment of medical costs, of any inmate sentenced to the custody of the department. • (Code 1886, §4609; Code 1896, §4461; Code 1907, §6513; Code 1923, §3609; Code 1940, T. 45, §26; Acts 1995, No. 95-540, p. 1123, §1.)

  4. Sentenced to ADOC • ADOC is in receipt of the Court transcript • Assigned an AIS # • Inmate is awaiting transfer and placement in an ADOC facility • Sentenced inmate is transferred from ADOC to County Jail by order of Judge: awaiting trial on new charges

  5. What Does ADOC Pay?$Directly • Inpatient Hospitalization through SEIB Blue Cross and Blue Shield Network • Hospital Bills SEIB/BCBS Network – ADOC Pays SEIB • Costs are charged directly to ADOC County does not receive bill or incur charges

  6. When Does ADOC Pay?Call us !!!! • County must notify ADOC / OHS of emergency admission to hospital within 24 hours or any order for a planned admission 72 hours prior to admission • County must notify ADOC / OHS if medication or treatment is expected to exceed $2000 Don’t wait folks call us today ! 334-353-3887 or 334-353-5049

  7. We want our sick inmatesTimely access and preventative health care is cost effective for everyone • Dialysis • Pregnancy • HIV • Sickle Cell • Diabetics • Wheel Chair and Bed Bound • Mental Health Do not delay treatment 334-353-3887 or 334-353-5049

  8. What Does ADOC Pay?$ Indirectly 1st County pays directly • Physician Fees • Outpatient Services • Pharmacy 2nd County sends ADOC Office of Health Services (OHS) • Inmate’s name and dates of service • Copies of claims / invoices for services provided • Copies of Checks, Check #’s or Paid Receipts

  9. What Does ADOC Pay?$ Indirectly 3rd ADOC / OHS • Verifies inmate’s ADOC status on date of service • Verifies type of service • Verifies payment for service 4th ADOC / OHS • Sends approved charges to finance to cut checks • Checks are sent to County

  10. What ADOC Can’t Pay Directly • Third Party Providers • Medical Contractors hired by County to provides services • County or Private Ambulance and EMT Services • Pharmacy Contractor • Outpatient Procedures • Community Physicians and Clinics

  11. How Does the County Collect for Third Party Services • County Pays First then submits proof of payment and detail of services to OHS • Only Billable Services for care given inside the Jail Facility are pharmaceuticals and prosthetics • All other services as it relates to care outside of the Jail Facility

  12. What Went Wrong? • Not an ADOC inmate • Not an ADOC inmate at the time the service was provided: Service provided prior to receipt of transcript • Inmate Sentenced to serve time in County Jail • Inmate is County Jail Worker • Sentenced to Community Corrections

  13. What Went Wrong? • Dates of service, claims / invoices and payment occurred in a prior fiscal year • Prior fiscal year claims have to be processed and submitted to Alabama Board of Adjustment (BOA) for review and approval • BOA becomes sole decision maker in payment no longer within ADOC control

  14. Pay now or Pay later…….? Pro-active, identify state inmates at risk and utilize ADOC Resources up front (OHS). Submit claims at minimum: once per quarter. Wait and allocate resources When it becomes a problem?

  15. Health Care Cost in Jails • Identify potential third party coverage at intake • Establish rates up front with local physicians • Contract with pharmacy providers who specialize in corrections • Contract with Correctional Health Care Companies willing to share in your financial risk http://www.corrections.com/aja/ http://www.aca.org/

  16. Health Care Cost in Jails 2014 Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act PPACA “Health Reform Law”

  17. Health Care Cost in Jails 2014 Good News – Community Coverage for Pre Sentenced – Detainees Administration, Management and Oversight

  18. Call or E-mail OHS Administrative Assistant Rosie Brisbon 334-353-3887 Rosie.brisbon@doc.alabama.gov OHS Finance Manager Sekeena Holt 334-353-5049 Sekeena.holt@doc.alabama.gov Associate Commissioner of Health Services Ruth Naglich 334-353-4049 Ruth.naglich@doc.alabama.gov

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