Revision: Jan. 28, 2013, midnight
HB 432-FN – AS INTRODUCED
2013 SESSION
04/01
HOUSE BILL 432-FN
AN ACT relative to health care costs for county and state inmates.
SPONSORS: Rep. Pantelakos, Rock 25; Rep. Shurtleff, Merr 11; Rep. Charron, Rock 4
COMMITTEE: Health, Human Services and Elderly Affairs
This bill amends the procedures for reimbursement by the county and state departments of corrections for the costs of inmate medical care.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
13-0602
04/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Thirteen
AN ACT relative to health care costs for county and state inmates.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Medical Services for County Prisoners. Amend RSA 623-C:1 to read as follows:
623-C:1 Medical Services for County Prisoners.
I.[(a) Except as provided in subparagraphs (b) through (f), no hospital or emergency room shall charge a county or its agent more than 110 percent of the medicare allowable rate for inpatient or emergency room care provided for prisoners in county correctional facilities.
(b) Allowances provided by hospitals shall qualify as community benefits under RSA 7:32-d, III(b).
(c) Hospitals reported by the department of health and human services as having a negative operating margin in the most recent year for which hospital-audited financial data is available shall charge no more than 125 percent of the medicare rate.
(d) The superintendent of a county correctional facility may waive the application of subparagraph (a) if the superintendent determines such action is necessary to ensure prisoner access to medically necessary care.
(e) The superintendent of a county correctional facility may waive the application of subparagraph (a) if the superintendent determines such action to be necessary for the efficient operations of the county correctional facility.
(f) Nothing in this paragraph shall require a hospital to admit any person.] The county department of corrections shall reimburse health care providers and health care facilities providing inmate medical services at a rate not to exceed 70 percent of the amount charged based on the usual and customary charges in effect for all other patients as of July 1, 2013. Usual and customary charges shall be established for each health care provider or health care facility based on the schedule of usual and customary charges used for all other patients furnished by that provider or facility providing inmate medical services in effect on July 1, 2013. The limitation on payment for inmate medical services under this section shall not apply to reimbursement rates the county department of corrections has otherwise contracted for under contracts in effect as of June 30, 2013. This section shall apply to all medical and facility services provided outside the correctional facility, including hospitalizations, professional services, medical supplies, and other medications provided to any inmate confined in a county correctional facility.
II. The county department of corrections shall make every effort to contain inmate medical costs by making use of its own hospital and health care facilities to provide health care services to inmates. To the extent that the county department of corrections must utilize other facilities and services to provide health care services to inmates, the department shall make reasonable efforts to make use of hospitals or other providers with which it has a contract or, if none is reasonably available, hospitals with available capacity or other health care facilities in a region to accomplish that goal. The department shall make reasonable efforts to equitably distribute inmates among all hospitals or other appropriate health care facilities. With respect to any single hospital, the county department of corrections shall make best efforts to seek admission of the number of inmates representing no more than 5 percent of all inmates requiring hospitalization or hospital services on an annual basis, unless the failure to do so would jeopardize the health of an inmate or unless a higher level is agreed to by contract. The department shall also give preference to those hospitals or other health care facilities in the same county or an adjoining county to the correctional facility where an inmate requiring hospitalization is incarcerated.
III. The county department of corrections shall consult with the department of health and human services to develop protocols for prisoners who would be eligible for Medicaid if they were not incarcerated to access Medicaid while in custody or under extended limits of confinement. The department shall seek reimbursement from Medicaid for those health care costs incurred by the department in those instances when an inmate’s Medicaid eligibility has been temporarily reinstated due to a hospitalization. The county department of corrections shall also work with the department of health and human services to determine the feasibility of applying for a Medicaid waiver to cover the inmate population.
IV. The superintendent shall make every effort to explore other cost containment methods not expressly outlined in this section. These methods may include the following:
(a) Contracting with a private third party to manage and provide all inmate medical services;
(b) Partnering with the federal government to allow for treatment of inmates in federal correctional hospitals; and
(c) Purchasing a fixed number of beds at a hospital.
V. Pharmacists shall substitute generically equivalent drug products for all legend and non-legend prescriptions paid for by the county department of corrections, including the medicaid program, unless the prescribing practitioner specifies that the brand name drug product is medically necessary. Such notification shall be in the practitioner’s own handwriting and shall be retained in the pharmacist’s file. The superintendent may waive the application of [RSA 623-C:1, I] paragraph I if the superintendent determines such action is necessary to ensure the availability of prescription and other pharmaceutical services to persons served by the county or to avert serious economic hardship in the provision of prescriptions and other pharmaceutical services. The county commissioners shall adopt necessary rules and regulations to implement this paragraph.
VI. Allowances provided by hospitals shall qualify as community benefits under RSA 7:32-d, III(b).
2 Medical Services for State Prisoners. Amend RSA 623-C:2 to read as follows:
623-C:2 Medical Services for State Prisoners.
I.[(a) Except as provided in subparagraphs (b) through (d), the department of corrections or its agent shall pay health care facilities and hospitals 110 percent of the Medicare allowable rate for inpatient, outpatient, or emergency room care provided for prisoners in state correctional facilities. In this chapter, “health care facilities” mean ambulatory and specialty-medical services centers licensed under RSA 151, and shall include but not be limited to surgical, rehabilitation, long term, oncology, and dialysis centers, but shall not include physician practices and community health care clinics.
(b) Allowances provided by hospitals shall qualify as community benefits under RSA 7:32-d, III(b).
(c) The commissioner of the department of corrections may waive the application of subparagraph (a) if the commissioner determines such action is necessary to ensure prisoner access to medically necessary care.
(d) The commissioner of the department of corrections may waive the application of subparagraph (a) if the commissioner determines such action to be necessary for the efficient operations of the state correctional facility.] The department of corrections shall reimburse health care providers and health care facilities providing inmate medical services at a rate not to exceed 70 percent of the amount charged based on the usual and customary charges in effect for all other patients as of July 1, 2013. Usual and customary charges shall be established for each health care provider or health care facility based on the schedule of usual and customary charges used for all other patients furnished by that provider or facility providing inmate medical services in effect on July 1, 2013. The limitation on payment for inmate medical services under this section shall not apply to reimbursement rates the department of corrections has otherwise contracted for under contracts in effect as of June 30, 2013. This section shall apply to all medical and facility services provided outside the correctional facility, including hospitalizations, professional services, medical supplies, and other medications provided to any inmate confined in a correctional facility.
II. The department of corrections shall make every effort to contain inmate medical costs by making use of its own hospital and health care facilities to provide health care services to inmates. To the extent that the department of corrections must utilize other facilities and services to provide health care services to inmates, the department shall make reasonable efforts to make use of hospitals or other providers with which it has a contract or, if none is reasonably available, hospitals with available capacity or other health care facilities in a region to accomplish that goal. The department shall make reasonable efforts to equitably distribute inmates among all hospitals or other appropriate health care facilities. With respect to any single hospital, the department of corrections shall make best efforts to seek admission of the number of inmates representing no more than 5 percent of all inmates requiring hospitalization or hospital services on an annual basis, unless the failure to do so would jeopardize the health of an inmate or unless a higher level is agreed to by contract. The department shall also give preference to those hospitals or other health care facilities in the same county or an adjoining county to the correctional facility where an inmate requiring hospitalization is incarcerated.
III. The department of corrections shall consult with the department of health and human services to develop protocols for prisoners who would be eligible for Medicaid if they were not incarcerated to access Medicaid while in custody or under extended limits of confinement. The department shall seek reimbursement from Medicaid for those health care costs incurred by the department in those instances when an inmate’s Medicaid eligibility has been temporarily reinstated due to a hospitalization. The department of corrections shall also work with the department of health and human services to determine the feasibility of applying for a Medicaid waiver to cover the inmate population.
IV. The commissioner of the department of corrections shall make every effort to explore other cost containment methods not expressly outlined in this section. These methods may include the following:
(a) Contracting with a private third party to manage and provide all inmate medical services;
(b) Partnering with the federal government to allow for treatment of state inmates in federal correctional hospitals; and
(c) Purchasing a fixed number of beds at a hospital.
[II.] V. Nothing in this section shall preclude the commissioner of the department of corrections from having the discretion to negotiate and execute medical service rate agreements with hospitals or health care facilities for the provision of medical services to state prisoners at the lowest rate possible, or utilizing rates in existing agreements.
[III.] VI. Pharmacists shall substitute generically equivalent drug products for all legend and non-legend prescriptions paid for by the department of corrections, including the Medicaid program, unless the prescribing practitioner specifies that the brand name drug product is medically necessary. Such notification shall be in the practitioner’s own handwriting and shall be retained in the pharmacist’s file. The commissioner of the department of corrections may waive the application of [RSA 623-C:2, I] paragraph I if the commissioner determines such action is necessary to ensure the availability of prescription and other pharmaceutical services to persons served by the state or to avert serious economic hardship in the provision of prescriptions and other pharmaceutical services.
VII. Allowances provided by hospitals shall qualify as community benefits under RSA 7:32-d, III(b).
3 Effective Date. This act shall take effect July 1, 2013.
LBAO
13-0602
Revised 01/28/13
HB 432 FISCAL NOTE
AN ACT relative to health care costs for county and state inmates.
FISCAL IMPACT:
The Department of Corrections states this bill, as introduced, will increase state expenditures by an indeterminable amount in FY 2014 and each year thereafter. The New Hampshire Association of Counties states this bill may decrease county expenditures by an indeterminable amount in FY 2014 and each year thereafter. There is no fiscal impact on local expenditures, or state, county and local revenue.
METHODOLOGY:
The Department of Corrections states this bill amends the procedures for reimbursement by the county and the Department for the costs of inmate medical care. The Department states this bill will increase state expenditures by an indeterminable amount; however the Department is not able to determine the exact impact as the future medical needs of inmates cannot be determined. The Department does provide a couple of examples of where the bill may result in inmate medical care costs increasing as a result of this bill. The Department states the bill requires the Department to reimburse medical care providers at a rate of up to 70 percent of customary and usual charges. The base figure for customary and usual charges is unknown and varies with each provider dependent upon various factors. The Department uses a base figure of 110 percent of Medicare as mandated in RSA 623-C as a basis of negotiations for medical care contracts. Using the customary and usual charges as proposed by this bill may impact the Department’s ability to negotiate medical contracts effectively. The Department also states this bill attempts to utilize an equal distribution method in a region when using outside medical providers. The Department makes every effort to contain inmate medical costs by providing care within its facilities. If the Department has an inmate requiring care from an outside medical provider, the Department makes determinations of which outside medical provider to use based upon recommendations of its medical staff not based on the geographical location of a medical facility. Because medical facilities offer different levels of care and equipment within regions, the use of an equal distribution method for outside medical care may hinder the Department’s ability to place inmates in facilities based upon the level of services require by the inmates healthcare needs.
The New Hampshire Association of Counties states this bill may decrease county expenditures. The Association is not able to determine the actual decrease on expenditures as it would depend on the contracts and/or arrangements made with outside entities and the number of inmates needing medical services.