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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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Presentation Transcript
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ADOC Office of Health Services

August 2011

County and State Partnership

Ruth Naglich, Associate Commissioner

Alabama Department of Correction

agenda
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
slide3
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 ($2,000), the inmate shall be transferred within three days to a state owned or operated correctional facility or to the physical custody of the department as determined by the Commissioner of the Department of Corrections. The inmate shall receive treatment in the same manner as other state inmates. Nothing in this subsection shall be interpreted to relieve the department of its responsibility for the maintenance and upkeep, including the payment of medical costs, of an inmate sentenced to the custody of the department, nor shall this subsection be interpreted as conferring any additional responsibility upon a county for the maintenance and upkeep, or the payment of medical costs, of any inmate sentenced to the custody of the department.
  • (Code 1886, §4609; Code 1896, §4461; Code 1907, §6513; Code 1923, §3609; Code 1940, T. 45, §26; Acts 1995, No. 95-540, p. 1123, §1.)
sentenced to adoc
Sentenced to ADOC
  • ADOC is in receipt of the Court transcript
  • Assigned an AIS #
  • Inmate is awaiting transfer and placement in an ADOC facility
  • Sentenced inmate is transferred from ADOC to County Jail by order of Judge: awaiting trial on new charges
what does adoc pay directly
What Does ADOC Pay?$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
when does adoc pay call us
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

we want our sick inmates timely access and preventative health care is cost effective for everyone
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

what does adoc pay ind irectly
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
what does adoc pay ind irectly9
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
what adoc can t pay directly
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
how does the county collect for third party services
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
what went wrong
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
what went wrong13
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
pay now or pay later
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?

health care cost in jails
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/

health care cost in jails16
Health Care Cost in Jails

2014

Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act

PPACA

“Health Reform Law”

health care cost in jails17
Health Care Cost in Jails

2014

Good News – Community Coverage for Pre Sentenced – Detainees

Administration, Management and

Oversight

call or e mail
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