20-237B. MEDICAL COSTS OF STATE PRISONERS HOUSED IN CORRECTIONAL
FACILITIES. (1) The state board of correction or any privatized medical
provider under contract with the department of correction shall pay to a
provider of a medical service, other than hospital inpatient or outpatient
services, for any and all prisoners, committed to the custody of the de-
partment of correction, confined in a correctional facility, as defined
in section 18-101A(1), Idaho Code, an amount equal to the reimbursement
rates of the Idaho medicaid reimbursement fee schedule in place at the time
services are provided. Hospitals shall be paid for inpatient and outpatient
facility services provided to such prisoners in an amount equal to the
interim Idaho medicaid rates in place at the time of service except for
outpatient services paid by Idaho medicaid according to the Idaho medicaid
fee schedule. These limitations apply to all medical care services provided
outside the facility, including inpatient and outpatient hospitalizations,
emergency services, professional services, durable and nondurable goods,
prescription drugs and medications provided to any and all prisoners
confined in a correctional facility, as defined in section 18-101A(1),
Idaho Code. For services that are not included in the Idaho medicaid fee
schedule or the interim Idaho medicaid rates, the state board of correction
or any privatized medical provider under contract with the department of
correction shall pay the reasonable value of such service. If a priva-
tized medical provider is contracted with the department of correction,
no hospital or any medical services provider shall be required to provide
medical services to prisoners, except for emergency hospital services, in
the absence of a contract between the privatized medical provider and the
hospital or medical services provider. Any contract between the department
of correction and a privatized medical provider must contain a requirement
that the privatized medical provider enter into contracts with each hospital
providing non-emergency services outside of the correctional facility.
The contract between the privatized medical provider and the department of
correction shall require, and the contracts between the privatized medical
provider and any hospital or non-hospital providers shall include, at least
the following terms reasonably and practicably consistent with those used by
Idaho medicaid:
(a) Claims adjudication processing;
(b) Timing;
(c) Payment;
(d) Authorizations;
(e) Utilization review;
(f) Audit; and
(g) Appeals processes.
(2) Subsection (1) of this section shall apply only to companies,
professional associations and other health care service entities whose
services are billed directly to the department of correction or any priva-
tized medical provider under contract with the department of correction.
Subsection (1) of this section shall not apply to:
(a) Privatized correctional medical providers under contract with the
department of correction to provide health care to prison inmates;
(b) Private prison companies;
(c) Out-of-state correctional facilities contracting with the depart-
ment of correction to house prisoners;
(d) County jails; and
(e) Companies, professional associations and other health care service
entities whose services are provided within the terms of agreements
with privatized correctional medical providers under contract with
private prison companies and county jails.
[20-237B, added 2005, ch. 157, sec. 1, p. 487; am. 2008, ch. 61, sec.
1, p. 153; am. 2018, ch. 321, sec. 2, p. 749.]