New Hampshire § 623-C-1 - Section 623-C:1 Medical Services for County Prisoners.

§ 623-C-1. Section 623-C:1 Medical Services for County Prisoners.

I. (a) Except as provided in subparagraphs (b) through (g), the county department of corrections or its agent shall pay health care facilities licensed pursuant to RSA 151 no more than 110 percent of the Medicare allowable rate for inpatient, outpatient, or emergency room care provided for prisoners in county correctional facilities. (b) Except as provided in subparagraphs (c) through (e), and subparagraph (i), the county department of corrections or its agent shall pay independent health care providers licensed in this state no more than 125 percent of the Medicare allowable rate for care provided for prisoners in county correctional facilities. (c) Allowances provided by hospitals shall qualify as community benefits under RSA 7:32-d, III(b). (d) The county department of corrections shall pay health care facilities licensed pursuant to RSA 151 and reported by the department of health and human services as having a negative operating margin in the most recent year for which audited financial data is available no more than 125 percent of the Medicare rate. (e) Nothing in this section shall preclude the superintendent of a county correctional facility from negotiating and executing medical service rate agreements with health care facilities licensed pursuant to RSA 151, or other licensed medical providers, for the provision of medical or dental services to county prisoners at the lowest rate possible, or utilizing rates in existing agreements. (f) 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. (g) 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. (h) The superintendent of a county correctional facility may at any time audit any claim or seek clarification on any payment made pursuant to this section, or both. Upon request by the superintendent, the provider shall furnish information on pricing methodology and shall detail any internal process controls for ensuring accurate pricing of claims processed under this section. Claim information shall be provided in the industry standard format, including but not limited to the application of global surgery provisions, billing for surgical assistants, and bundling. (i) If a county prisoner's medical care is covered by Medicaid, the health care facility licensed pursuant to RSA 151, or the licensed health care provider, or both, shall be paid at the Medicaid rate for services provided. II. 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 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.