J-4_Offsite_and_Emergent_Care.pdf

HSCEDM-16-R-00002

J-4

J-4 Offsite and Emergent Care

Offsite and Emergent Care

A. Medical services shall submit a Medical Payment Authorization Request (MedPAR) to IHSC for payment for off-site medical care (e.g. offsite lab testing, eyeglasses, prosthetics, hospitalizations, emergency visits). Medical services shall enter payment authorization requests electronically as outlined in the MedPAR User Guide.

B. Medical services shall furnish twenty-four (24) hour emergency medical care and facility emergency evacuation procedures. In an emergency, as determined by medical services, and shall obtain the medical treatment required. Medical services shall have access to an offsite emergency medical provider at all times. The Health Authority of medical services shall notify the organization listed below as soon as possible, and in no case more than seventy-two (72) hours after resident receipt of such care. Authorized payment for all offsite medical services for the initial emergency need and for medical care required beyond the initial emergency situation will be made by the Veterans Administration Franchise Service Center (VA FSC) on behalf of IHSC directly to the medical provider(s).

IHSC VA Financial Services Center PO Box 149345 Austin, TX 78714-9345 Phone: (800) 479-0523 Fax: (512) 460-5538

C. Medical services shall allow IHSC Field Medical Coordinators, Managed Care Coordinators or any ICE personnel reasonable access to its facility and medical records of ICE residents for the purpose of liaison activities with the local IGSA Health Authority and associated Service Provider departments in accordance with HIPAA privacy exception at 45 C.F.R. §§ 164.512 (k)(5)(i).

D. Medical services shall provide ICE resident medical records to ICE whether created by medical services or its sub-Service Provider/Contractor upon request from the Contracting Officer’s Representative or Contracting Officer in accordance with HIPAA privacy exception at 45 C.F.R. §§ 164.512 (k)(5)(i), which allows disclosure without consent to a correctional institution or a law enforcement official having lawful custody of an inmate or other individual if the correctional institution or such law enforcement official represents that such protected health information is necessary for:

a. The provision of health care to such individuals;

b. The health and safety of such individual or other inmates;

c. The health and safety of the officers or employees of or others at the correctional institution;

d. The health and safety of such individuals and officers or other persons responsible for the transporting of inmates or their transfer from one institution, facility, or setting to another;

e. Law enforcement on the premises of the correctional institution; and

f. The administration and maintenance of the safety, security, and good order of the correctional institution.

g. Conducting a quality improvement / quality of care review consistent with an established quality improvement (medical quality management) program and interfacing with the IHSC quality improvement program consistent with federal, state, and local laws.

E. Medical services shall direct offsite medical providers to submit all medical invoices for authorized payment for medical, dental, and mental health services to the following address:

VA Financial Services Center PO Box 149345 Austin, TX 78714-9345 (800) 479-0523

F. The VA Financial Services Center provides prescription drug reimbursement for individuals in the custody of ICE Prescriptions are filled at local pharmacies which are part of the Script Care Network (or other designated Pharmacy Benefits Manager). Below is the process for obtaining prescriptions for ICE residents:

a. Medical services shall request a group number which should be used at the pharmacy in conjunction with the BIN# 004410 and Processor Control # IHSC assigned by Script Care Network to designate this is an ICE resident. The custodial facility should either fax or take a copy of the prescription to their participating pharmacy and indicate that this is an ICE resident.

b. The pharmacy shall run the prescription through the Script Care network for processing.

c. Formulary prescriptions will be dispensed; however, there will be no need for an exchange of cash between the pharmacy and custodial facility as the pharmacy will receive payment directly from Script Care.

d. Non-Formulary prescriptions will follow the same procedure as formulary prescriptions;

however, non-formulary medications will require prior authorization. The custodial facility will fax the Drug Prior Authorization Request Form to Script Care to 409-833-7435. The authorization will be loaded into the Script Care network and the pharmacy will receive a call indicating that the prescription has been approved. Non-Formulary urgent requests must be submitted in the above manner except an X should be placed on the form marked for URGENT REQUEST and faxed to 409-923-7391. The authorization shall be loaded into the Script Care network and the pharmacy shall receive a call indicating the prescription has been approved.

For further information regarding the Script Care Network please contact the VA Financial Services Center at 800-479-0523 or Script Care directly at 800-880-9988.