New Hampshire § 623-C-2 - Section 623-C:2 Medical Services for State Prisoners.

§ 623-C-2. Section 623-C:2 Medical Services for State Prisoners.

I. (a) Except as provided in subparagraphs (b) through (f), the state 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 state correctional facilities. (b) Except as provided in subparagraphs (c) through (e), and subparagraph (h), the state 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 state correctional facilities. (c) Allowances provided by hospitals shall qualify as community benefits under RSA 7:32-d, III(b). (d) The state 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) The commissioner of the state department of corrections may waive the application of subparagraph (a) if the commissioner determines such action is necessary to ensure prisoner access to medically necessary care. (f) The commissioner of the state department of corrections may waive the application of subparagraph (a) if the commissioner determines such action to be necessary for the efficient operations of the state correctional facility. (g) The commissioner of the state department of corrections may at any time audit any claim or seek clarification on any payment made pursuant to this section, or both. Upon request by the commissioner, 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. (h) If a state prisoner's medical care is covered by Medicaid, the facility or the licensed health care provider, or both, shall be paid at the Medicaid rate for services provided. II. Nothing in this section shall preclude the commissioner of the state department of corrections 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 state prisoners at the lowest rate possible, or utilizing rates in existing agreements. III. Pharmacists shall substitute generically equivalent drug products for all legend and non-legend prescriptions paid for by the department of corrections, unless the prescribing practitioner specifies that the brand name drug product is medically necessary. The pharmacist shall not select an equivalent drug product unless its price to the purchaser or payor is less than the price of the prescribed drug product. The department may enter into agreements or collaborative purchasing structures to buy or acquire therapeutic agents that will result in cost savings to the department. The commissioner of the department of corrections may waive the application of RSA 623-C:2, I if the commissioner determines such action is necessary to ensure the availability of prescription and other pharmaceutical services to persons served by the state or to avert serious economic hardship in the provision of prescriptions and other pharmaceutical services.