In recent weeks, there has been some confusion regarding what commissioners and sheriffs need to do regarding inmate health care – and in particular, whether the counties in the ACCG Inmate Health Program need to take action before July 1, 2011.
During the 2011 session, the General Assembly enacted HB 197. This law states, “A hospital or other health care facility licensed or established pursuant to Chapter 7 of Title 31 which is not a party to an emergency health care services contract with a sheriff or a governing authority or its agent on July 1, 2011, shall be reimbursed no more than the applicable Georgia Medicaid rate for emergency health care and follow-up health care services provided to a detainee.”
This law is designed to save county taxpayer money by limiting the amount that most hospitals can charge for “emergency health care” for inmates in the county jail. However, hospitals that have contracts for “emergency health care services” with counties, sheriffs or their agents on July 1, 2011 do not have to cut their charges to Medicaid rates. If your county currently has a contract for emergency health care service with a hospital, the hospital does not have to recognize the Medicaid rates on July 1, 2011 unless the contract is terminated.
Some counties have questioned whether they need to terminate their participation in the ACCG Inmate Health Program before July 1, 2011 to make sure that they take advantage of the Medicaid rates for emergency care for their inmates. The answer is, “no.” Counties can remain in the ACCG Inmate Health Program and still be eligible for Medicaid rates for emergency care. However, counties should not try to utilize the ACCG Inmate Health Program for emergency medical services for their inmates.
The ACCG Inmate Health Program/Blue Cross Blue Shield. Participation in the ACCG Inmate Health Program is not a contract for “emergency health care.” It is a contract for administrative services through Blue Cross Blue Shield of Georgia (BCBS). Further, Blue Cross Blue Shield does not have a contract for emergency health services with any hospital. They have contracts for acceptable rates. So, neither the contract with ACCG/BCBS and the counties, nor the contract between BCBS and the hospitals, would constitute contracts for emergency health care services. So, the fact that the county participates in this program after July 1, 2011 in no way effects their ability to take advantage of Medicaid rates for emergency health services for inmates.
What to do with Inmates who require Emergency Medical Services. Counties in the inmate health plan may still get Medicaid rates for emergency health care services for inmates. ACCG’s Inmate Health Program is only used by counties when they take an inmate to receive medical services, request that it be billed through BCBS (usually by presenting the county’s BCBS card) and log the inmate in to the BCBS system. When an inmate is receiving “emergency health services” (i.e., “bona fide emergency services provided after the onset of a medical or traumatic condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the [inmate’s] health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.”) or follow up services, counties should not use the ACCG Inmate Health Program if they would like to be charged Medicaid rates.
For more questions or additional information, contact ACCG Manager Insurance Programs Manager of Marketing and Field Services Ben Pittarelli at 404.522.5022 or bpittarelli@accg.org.
