Corrections Alternative Advisory Committee

1
Corrections Alternative Advisory Committee

• County Jail Medical Services
• December 16, 2005

2
Health Care Delivery Model

• All 16 jurisdictions responded that they
  contracted for services
• Medical
• - Allied Resources for Correctional Health
  (ARCH)
• - Correctional Medical Services (CMS)
• - Med Pro
• - Stouton Springs Health Center
• - Houlton Regional Hospital- Company Doc
• - Al Blackadar RNP
• - Dr. Kaplan

3
Continued

• Psychiatry
• Allied Resources for Correctional Health (ARCH)
• Correctional Medical Services (CMS)
• Acadia Hospital
• Tri-County Mental Health
• Community Health and Counseling
• Charlotte White Center
• Aroostook Mental Health Center
• Crisis and Counseling
• Oxford County Mental Health Services
• Coastal Counseling Associates
• Down East Community Health

4
Continued

• Pharmacy
• Pharmacorr
• Omnicare
• Miller Drug
• Rexall
• Rite Aid
• Mars Hill Pharmacy
• Diamond Pharmacy
• Goodnow Pharmacy
• Waltz Pharmacy
• Ktner Pharmacy
• Some jurisdictions reported that they do not
  have formal contracts with their pharmacy
  provider, but have long standing agreements and
  financial arrangements.

5
Does your facility utilize telemedicine in the
delivery of care?

• Yes- 1
  No- 15
• The one jurisdiction using telemedicine uses it
  for mental health services
• Jurisdictions not using telemedicine noted lack
  of funding, uncertain of financial benefit,
  unfamiliar with technology, difficult to find
  providers with the technology and coordination
  issues.
• Interest in this area was noted particularly as a
  way to reduce transportation cost.

6
(No Transcript)
7
Comments

• Increased- population higher from previous year,
  cost of contracts, medication costs, catastrophic
  illness/injury, acuity of prisoner medical needs,
  provider fees, program expansion.
• Decreased- use of sample medication program,
  enrollment of eligible prisoners in MaineCare.

8
Medical Policies

• All 16 jurisdictions reported having written
  medical policies.
• Policies supplied by the contractor versus county
  jail (9 contractor / 7 county jail).
• Do policies conform to any accrediting
  organizations? (12 No / 4 Yes- AJA, ACA and
  NCCHC)
• All jurisdictions stated they conformed to the
  Maine Department of Corrections jail standards.

9
Do you have a medical co-pay plan in operation?

• Yes- 11 No- 5
• Comments
• No administrative staff available to assign to
  the task
• ? Small return for the effort

10
MaineCare Rate

• Do you pay off site medical services at the
  MaineCare rate?
• All jurisdictions reported that they did, however
  they offered the following comments
• Some local hospitals paid at agreed upon rate
• It has been difficult in general
• Specialists refuse the rate (especially dentists)

11
Does your facility seek alternative funding for
medical services?

• Yes- 15 No- 1
• Comments
• Assigning staff to the task is critical
• One jurisdiction stated that they will transport
  to a provider if the provider will accept the
  prisoners insurance

12
Is your facility currently involved in any joint
contracting for medical services?

• Yes- 2 No- 14
• Comments
• Two jurisdictions currently participate in the
  MDOC pharmacy contract

13
Infirmary Beds/Medical Floor Space

• Only two jurisdictions reported designated
  infirmary beds for a total of 12 beds
• Medical floor space was identified as being
• - adequate by 6 jails
• - generally adequate by 1 jail
• - inadequate by 8 jails
• - not applicable by 1 jail

14
Cost Drivers

• Cost of medications
• In-patient hospitalizations
• Lack of medical care prior to incarceration
• Impact of substance abuse
• Catastrophic illnesses/injury

• Acuity of general medical needs
• Cost of medical staff
• Increased need for off site services
• Level of need for mental health services
• Emergency services
• Transportation costs

15
Regionalization

• Comments
• Concerned about relationships with local
  businesses
• Liked the idea about increased purchasing power
• Partnering with other jurisdictions on a variety
  of services and programs, not just medical
• Concerned about administrative overhead cost with
  this concept

16
Continued

• Needs financial analysis
• Large facilities wonder what the impact on them
  would be
• Specialty facilities versus consolidation
• Concerned about displacing incarcerated
  individuals from their home communities
• Consolidate state and county facilities?
• Can improve continuity in services

17
(No Transcript)
18
Medical Staffing in County Jails

• Wide range of staffing plans and types of
  providers used to deliver care.
• Nursing coverage
• 0 hours per day 4
• 1-5 hours per day 6
• 6-12 hours per day 5
• 24 hours per day 1

19
Primary Care Providers

• - Physicians Assistant (PA) 11
• - Medical Doctor (MD) 1
• - Nurse Practitioner (NP) 1
• - NP/MD 1
• - PA/MD 1
• - N/A 1
• Jurisdictions with PAs reported having access
  to MDs.

20
Sick Call

• 3 jurisdictions reported having sick call two
  times per week
• 12 jurisdictions reported having sick call 1 time
  per week
• 1 N/A

21
Department of CorrectionsAlternative Corrections
Advisory Committee

• December 14, 2005

22
Health Care Delivery Model

• Medical Services, psychiatric services and
  pharmacy services are contracted.
• Medical- Correctional Medical Services (CMS)
• Psychiatric- Liberty Health Care, Acadia
  Hospital, Stroudwater Associates,
• Pharmacy- Pharmacorr

23
Telemedicine

• MDOC uses Telemedicine to provide psychiatry
  services as well as other intermittent specialty
  services i.e oncology and pain management
  consults

24
Medical Policies

• MDOC has written polices that conform to ACA and
  NCCHC standards

25

• MDOC does have medical co-pay plan in operation
• MDOC pays off site medical services at the
  MaineCare rate. (Claims processing managed by
  contractor)
• MDOC medical contractor does pursue alternate
  funding for medical services if known

26
Infirmary Beds/Medical Space

• MDOC has an infirmary located at the Maine State
  Prison with six beds (males only). This
  infirmary is managed by nursing staff 24-hours
  per day.
• Medical floor space adequate at newer facilities
  need improvements at older sites.

27
Joint Contracting

• MDOC currently has two county jails participating
  with them in the pharmacy contract
• All eight D.O.C. facilities fall under one
  comprehensive medical contract

28
MDOC Healthcare Priority List

• 1. Access to specialty Care
• 2. Staffing
• 3. Quality of Care
• 4. Cost/Budget
• 5. Mental Health Services
• 6. Infectious Disease

• 7. Hospitalizations
• 8. Chronically ill prisoners
• 9. Transportation
• 10. Female Services
• 11. Terminally ill prisoners
• 12. Detoxification Services

29
MDOC Medical Expenditures

• Increased from the previous year due to cost of
  staffing, increased population, program
  expansion, ? impact of non-categorical cap on
  MaineCare enrollments, acuity of medical needs of
  this population in general.

30
MDOC Medical Staffing

• Nursing Coverage
• - 24 hours per day 4 facilities
• - 8-12 hours per day 3 facilities
• - Pre-Release unit 3 days per week
• Primary Care Providers
• - MD 6 facilities
• - PA/MD 2 facilities