Virginia Department of Corrections Medicaid Offender Inpatient Hospital Program Myra Smith, DOC Healthcare Reimbursement Specialist October 1, 2015

Mandate Item 388J of Chapter 806, 2013 Virginia Acts of the Assembly required the Department of Corrections (DOC) to coordinate with the Department of Medical Assistance Services (DMAS) and the Department of Social Services (DSS) to establish procedures to enroll eligible offenders in Medicaid, beginning July 1, Offenders who receive inpatient care will not be considered inmates of ineligible institutions during the period of hospitalization Medicaid funds could be utilized to pay for eligible offender’s inpatient expenses 2

Offender Medicaid Eligibility Criteria Aged – 65 years and older Pregnant Women Disabled – using Social Security Administration (SSA) disability criteria –Having illness or injury that would prevent individual from engaging in work for at least a 12 month period, or –Expected to result in death 3

Eligibility - Disability Offenders who do not meet the age/pregnancy eligibility criteria may qualify for the Offender Medicaid Program if determined disabled using SSA criteria DOC will identify offenders with a qualifying event who may meet the disability criteria The SSA Disability Report and a signed Authorization to Disclose Information form will be required to be submitted along with the Medicaid application. 4

Eligibility - Financial Financial Requirements* –$766 or less per month – Aged/Disabled $2,000 – Resources –Bank accounts, CDs, stocks, bonds –Trust accounts –Life insurance with cash value –$1,720 or less per month – Pregnant Women No resource test *income limits may increase annually, usually in January 5

Qualifying Event Per Centers for Medicare and Medicaid Services, offenders only qualify for Medicaid coverage during an inpatient hospital admission of 24 hours or more DMAS requires the offender meet the qualifying event criteria prior to Medicaid application submission Once approved by the LDSS, additional requests for inpatient services within one year of filing for Medicaid will not require a new Medicaid application 6

July 2015 Offender Population Assessment 800+ – Offenders age 64+  Meet program criteria – age 65 or older 65 – Offenders on dialysis  Meet program criteria – require disability determination using SSA criteria 15 – Pregnant (Fiscal Year 2015 total)  Medicaid Approved – Offenders with chronic, disabling conditions  Meet initial program criteria - require disability determination using SSA criteria and forms 7

Eligibility Intake reports are reviewed monthly to identify offenders with current Medicaid eligibility –Information will be submitted to DMAS Offenders assigned to DOC upon inpatient hospital admission from local jail will be screened for Medicaid eligibility The Health Authority at each facility shall notify DOC Healthcare Reimbursement staff of all offender inpatient hospital admissions 8

Medicaid Application – Healthcare Reimbursement Staff The DOC Healthcare Reimbursement staff will review the specific offender information for Medicaid eligibility criteria –Aged/Pregnant/Disability Condition –Offender Trust Account Assets –Inpatient hospital admission The DOC Healthcare Reimbursement staff will prepare the Application for Health Coverage and Appendix D for offender review/signature 9

Medicaid Application – Health Authority Offenders who have a potential Disability Condition and meet Medicaid eligibility criteria will be identified by the DOC Healthcare Reimbursement staff Notification will be sent to facility counseling, medical or mental health staff to initiate/obtain –Disability – Adult Report Adult SSA-3368-BK and a signed Authorization to Disclose Information SSA-827 forms –Applicable medical records 10

Medicaid Application – Disability Report – Adult DOC Healthcare Reimbursement staff will identify the medical documentation requirements based on the offender’s diagnosis Documentation may require any or all of the following: –Clinical history and physical finding –Diagnostic features –Laboratory results –Radiological results –Pathology reports 11

Medical Documentation Requests - Disability Determination Services (DDS) Diagnosis Specific –Test Results –Medical Consultant Reports –Pathology Reports Offender Medical Record Information –Original submission – Health Services Request Six months prior to application –Supplemental/Additional – DDS Request Specific documents and/or dates identified 12

Medicaid Offender Inpatient Program – Offender Approved Offenders approved for the Medicaid Offender Inpatient Program will be assigned a Medicaid Number –DOC information system, CORIS will be updated with the Offender’s Medicaid Number –The Medicaid number documentation will be added to the offender’s medical records The DOC Healthcare Reimbursement staff will send the offender’s Medicaid Number documentation to the hospital staff –Hospital staff will request KePRO authorization 13

Medicaid Offender Inpatient Program – Offender Approved The Medicaid number should included in the information sent to the hospital with the offender for subsequent planned/scheduled inpatient admissions. Medicaid eligible offenders admitted to the hospital with the institution Anthem coverage could potentially create unnecessary medical fees for the Department of Corrections 14

Medicaid Offender Inpatient Program – Annual Renewals DOC Healthcare Reimbursement Staff will submit ABD renewal documents to offenders for review and signature Copies of the completed documents will be submitted, with coversheet to the LDSS office responsible for the offender’s case

Health Services Reimbursement Staff – Contact Information Myra Smith (804) DOC Healthcare Reimbursement Specialist Teresa Harvey (804) DOC Healthcare Reimbursement Technician FAX :