Section 140.10 Medical Assistance Provided to Persons Confined or Detained by the Criminal Justice System

Section 140

Section 140.10  Medical

Assistance Provided to Persons

Confined or Detained by the Criminal

Justice System

a)         The Department shall pay for certain medical services provided

to the following groups of individuals who are confined or detained in county

jails or other detention facilities in Illinois, that are not operated by the

State, and who are eligible for, and enrolled in, medical assistance administered

under Article V of the Illinois Public Aid Code [305 ILCS 5]:

1)         Individuals who, at the time of confinement or detention, were

already enrolled for medical assistance.

2)         Individuals who, subsequent to their confinement or detention,

were determined eligible and enrolled for medical assistance.

b)         Reimbursement of hospital inpatient services.  The Department

will directly reimburse hospitals pursuant to 89 Ill. Adm. Code 147, 148 and

152 for inpatient hospital services provided to those covered under subsections

(a)(1) and (2) of this Section.

c)         Reimbursement of other services:

1)         With respect to medical services provided to individuals

described in subsection (a)(1), the Department shall reimburse the county or

arresting authority (a unit of local government other than a county that

employs peace officers who make the arrest) for a portion of the cost of

medical services, other than hospital inpatient services, that are:

A)        Provided

to the individual during his or her period of confinement or detention;

B)        Covered

for the class of persons described in Section 5-2 of the Public Aid Code under

which the individual is enrolled;

C)        Provided

by medical providers that are enrolled with the Department to participate in

the medical assistance program; and

D)        Provided

pursuant to a county or arresting authority ordinance or resolution providing

for reimbursement for the cost of medical services at the reimbursement levels

established by the Department for medical assistance under Article V of the Public

Ai

C)        Provided

by medical providers that are enrolled with the Department to participate in

the medical assistance program; and

D)        Provided

pursuant to a county or arresting authority ordinance or resolution providing

for reimbursement for the cost of medical services at the reimbursement levels

established by the Department for medical assistance under Article V of the Public

Aid Code.

2)         The county or arresting authority requesting reimbursement

from the Department must submit the following documentation in a form and

format specified by the Department:

A)        Information

necessary to adjudicate a claim for each service provided, including, but not

limited to:

i)          the

name, birth date, Social Security number and recipient identification number of

the individual receiving the medical service;

ii)         the

name, address and provider number of the health care provider that provided the

service;

iii)        the

service provided, including applicable diagnosis, procedure and national drug

codes; and

iv)        the

provider charges and the amount paid by the county or arresting authority for

the services.

B)        The

date of confinement and, if applicable, the date of release or transfer to

another criminal justice authority.

C)        Verification

that the services claimed for reimbursement correspond to the services

rendered.

D)        A copy

of the ordinance or resolution providing for reimbursement for the cost of medical

services at the reimbursement levels established by the Department for medical

assistance pursuant to Article V of the Public Aid Code.

3)         The Department will adjudicate each claim applying its

reimbursement rates and, to the extent that the cost of care for the individual

exceeds $500 accumulated over the individual's period of confinement, will

reimburse the county or arresting authority the amount in excess of $500.