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OCTOBER IS LIVER HEALTH AWARENESS MONTH
October is Liver Health Awareness month. Many are unaware of the many functions of the liver and how important it is to the human body. The liver is the largest gland in the human body. It is responsible for the manufacturing of plasma protein, storage of carbohydrates, detoxifying drugs and toxins, fat and carb metabolism, and bile formation.
30 million individuals within the United States have some form of Liver Disease with more than 100 diseases that affect the Liver. Hepatitis B and C are among those diseases that affect the liver with more than 75% of those infected being undiagnosed due to disease symptoms being masked. Some risk factors to developing liver disease are alcohol abuse, IV drug abuse, and unhealthy diet resulting in obesity.
Liver Health Awareness month aims at raising awareness of the different disorders that plague the liver, ways to prevent and manage diseases, and promote comprehensive health and wellness. The liver is a vital organ that needs to be cared for as it can be silently damaged without producing any immediate symptoms. For more information on liver disease or promoting liver health month in October, visit The American Liver Foundation.
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ACT 22 ELIGIBILITY DENIAL
After the online COMPASS application and County Prison Inpatient Eligibility Form (CPIEF) are completed by the County Prison and processed by DHS, an eligibility notification (PA162) is mailed out. Sometimes the County Prison will receive PA162 notifications from DHS with the following "denial" determination:
1. Your eligibility for benefits has been reviewed and you do not qualify for Medical Assistance because you do not meet any of the requirements to qualify...
This denial requires no additional action on the County Prison's end. The medical providers will find the inmate in the PROMISe system - the DHS claims processing and management information system. The provider will see MA Category/Program Status J00 in the PROMISe system. J is a special category of MA for individuals eligible to receive payments from Social Security Administration under the SSI program. When an application is submitted for an inmate who has an inpatient hospitalization, DHS will normally open coverage for the time period of the hospitalization. In the case of an inmate who is in J category, DHS cannot close the J coverage to open the inmate coverage. DHS denies the inmate application and covers the claims under the J category.
Claims for the J inmate who receives a denial on the inmate application will be processed just the same as for the inmates who receive an approval for the inmate application. Hospital can still bill for the services provided.
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PRISON MEDICAL MANAGEMENT WORKSHOP
PIMCC is proud to be sponsoring the 9th annual medical seminar! Topics this year include Vivitrol for Opioid addiction, Title 37, bipolar disorder and much more!
Join us at the CCAP Office in Harrisburg on September 29, 2017 from 8 a.m. to 4 p.m. All prison staff involved in inmate medical care are strongly encouraged to be in attendance.
More information and registration can be found in the GLIMPSE course catalog.
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ACT 22 AND INMATES' PRIVATE HEALTH INSURANCE COVERAGE
For purposes of MA eligibility, other than eligibility for inpatient hospital services, the needs of an
inmate in a
correctional institution are met by the government agency that runs the facility. These facilities include the following: Correctional institutions that are supervised or controlled by the Department of Corrections and Jails run by local authorities. However, if an inmate has private health insurance, the inmate's health insurance could be considered primary.
The exception is health insurance through Medicare and Medicaid, Medicaid managed care organizations or VA benefits that exclude incarcerated individuals.
Inquiries regarding current insurance coverage can be asked at the time of booking. If the inmate or family member has a private insurance card, a copy (front and back) should be kept in the inmate's medical record. If the inmate requires medical care outside of the facility, remind the provider that the inmate's private health insurance is primary and should be billed. If the private insurance denies payment, a copy of an Explanation of Benefits (EOB) should accompany the bill to the County. It is then that payment would be the responsibility of the County. Act 22 covers those inmates without private health insurance for qualified inpatient hospitalizations. For inmates who receive coverage through Medicaid MCOs, enrollment in the MCO is terminated effective the day before incarceration. In these instances, Act 22 coverage would be provided through traditional Medicaid. The COMPASS application should be completed when the inmate is discharged from hospital.
For reference,
here is a copy of all the current MCO member cards from Pennsylvania MA plans. When prison personnel sees one of these cards, they should be aware that this coverage will close effective the day before the incarceration date.
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ONLINE RESOURCES
Under the Act 22 Services section, several resources are at your disposal including the most recent version of the County Prison Inmate Eligibility Form (CPIEF), FAQs, COMPASS application screenshots and other references for both COMPASS Users and medical providers.
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PERSONNEL CHANGES
For our PIMCC Members, you may have seen some new names over the past year. Cost Management Plus, Inc. as Program Administrator for the PIMCC Program has added Julia Alday, RN as a Nurse Consultant in May 2016. Ruth Moraski Keller retired from Cost Management Plus as President and handed over the reins to Kirsten Bostjancic in September 2016. In July 2017, Kayla Comfort has joined the team to support the medical auditing process.
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UPCOMING EVENTS
Prison Medical Management Workshop
September 29, 2017
CCAP Office, Harrisburg
PCCA Fall Training Conference/Exhibit Hall
October 1-4, 2017
The Wyndham Garden Hotel, York
PIMCC Board Meeting
October 20, 2017
CCAP Office, Harrisburg
PPWA Fall Training Symposium
October 25-26, 2017
Toftrees Resort, State College
NCCHC Conference
November 4-8, 2017
Chicago, IL
CCAP Fall Conference
November 17-21, 2017
The Hotel Hershey
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DRUG INFORMATION CENTER
The Drug Information Center is staffed by very knowledgeable pharmacists with doctorate degrees and available at (800) 882-6337 ext 2826 or call (800) 882-6337 and ask for the Drug Information Center. As a reminder, this is a FREE clinical resource from Diamond Pharmacy for its PIMCC customers.
Please share this information with your Sick Line Medical Provider, Nursing Staff and Correctional Officers. Tap into the resources available to you as PIMCC members.
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