MOU with FSSA Line 116.pdf

MEMORANDUM OF UNDERSTANDING

Contract #0000000000000000000032416

This Memorandum of Understanding (“Memorandum” or “MOU”) is entered into by and between the Indiana Family & Social Services Administration (“FSSA”) and Indiana Department of Correction (“DOC”). In consideration of those mutual undertakings, the parties agree as follows:

Adult and juvenile offenders (“offenders”) may be eligible for Medicaid coverage as offered through the FSSA’s programs while receiving inpatient services delivered at a Medicaid approved facility during incarceration, and upon release or discharge. The intent of the parties is to make applicable health coverage available to offenders eligible to receive such coverage for inpatient services during the period of the offenders’ incarceration and upon the offenders’ release and to outline the DOC’s responsibilities for reimbursing FSSA the state share of Medicaid costs incurred under this MOU.

I. PURPOSE

Effective July 1, 2015, HEA 1269 requires FSSA and DOC to enter into an MOU for the purposes of making Medicaid available to cover eligible offenders who are incarcerated and to help coordinate benefits coverage for offenders transitioning to civilian life. The purpose of this MOU is to implement those requirements and outline the division of responsibilities between FSSA and DOC to carry out the terms therein. This MOU covers two scenarios:

1. Identifying and making Medicaid reimbursement available to eligible offenders during the time they receive inpatient services while incarcerated subject to the terms of this agreement and in accord with Federal and State laws; and

2. Assisting to make Medicaid coverage, including HIP 2.0 coverage, available to eligible offenders upon release on parole, assignment to a community transition program, or discharge from DOC.

II. AUTHORITIES AND DEFINITIONS

The following authorities and definitions are hereby incorporated into this MOU:

A. 42 U.S.C. § 1396d(a)(29)(A) prohibits Medicaid payments for services provided to an inmate in a public institution. However, Medicaid funding is available for medical services provided by an enrolled Medicaid provider to an eligible inmate not in a prison setting who becomes an inpatient in a medical setting. See also 42 C.F.R. § 432.1009(a)(1).

B. 42 C.F.R. § 435.1010 defines a “Public Institution” as “an institution that is the responsibility of a governmental unit or over which a governmental unit exercises administrative control.”

C. 42 C.F.R. 435.1009 provides that a public institution does not include the following: medical institution, intermediate care facility, a publicly operated community residence serving no more than 16 residents, or a child care institution.

D. 42 C.F.R. 435.1010 defines “Medical Institution” as an institution that meets all of the following:

1. Is organized to provide medical care, including nursing and convalescent care;

2. Has the necessary professional personnel equipment, and facilities to manage the medical, nursing, and other health needs of patients on a continuing basis in accordance with accepted standards;

3. Is authorized under State law to provide medical care; and

4. Is staffed by professional personnel who are responsible to the institution for professional medical and nursing services. The services must include adequate and continual medical care and supervision by a physician; registered nurse or licensed practical nurse supervision and services and nurses’ aid services, sufficient to meet the nursing care needs; and a physician’s guidance on the professional aspects of operating the institution.

E. IC 12-15-44.2 and IC 12-15-44.5 expanded Medicaid coverage to certain adult populations whose income is at or below 138% of the federal poverty level (HIP 2.0). See also 405 IAC

10. Such individuals, once determined eligible, cannot receive retroactive coverage. However, such individuals, if determined presumptively eligible, may receive immediate coverage for a specified period of time at a Medical Institution that is also qualified to provide such designations. See 405 IAC 10-4-11. Such individuals must subsequently submit an application in order to be enrolled in Medicaid including HIP 2.0.

F. IC 12-15-2-20 provides that an individual convicted of fraud under IC 35-43-5 or legend drug deception under IC 35-43-10 related to the application of or receipt of Medicaid is ineligible to receive Medicaid assistance for various periods of time depending on the number of repeat offenses. Medicaid coverage for such individuals is subject to the eligibility rules and restrictions as set forth in 42 C.F.R. § 435 et seq., IC 12-15-2 and IC 35-43-10.

G. Effective July 1, 2015, HEA 1269 amended various provisions of the Indiana Code as follows:

1. Defined an inmate as an individual “committed to the department and residing in a department facility or jail.” IC 11-10-3-7(b)(1). The term “offender” as used in this MOU shall refer to such individuals.

2. The DOC shall submit a Medicaid application on behalf of an offender whenever the offender incurs non-reimbursable medical expenses during an inpatient hospital visit, is unwilling to pay for the inmate’s healthcare services, and is potentially eligible for Medicaid. See IC 11-10-3-7(b).

3. The DOC, or its designee, shall be the offender’s Authorized Representative (“A/R”) for purpose of applying for Medicaid. See IC 11-10-3-7(b).

4. The DOC shall assist the offender in applying for Medicaid or other benefits on the healthcare exchange within a sufficient amount of time before the offender is released on parole, assigned to a community transition program, or discharged from DOC. See IC 11- 10-12-5.3(a) and (b).

5. Once FSSA determines an offender to be eligible for public assistance, the agency shall immediately suspend the person’s Medicaid status until such time as the offender is released. See IC 11-10-12-5.3(c).

6. DOC shall reimburse FSSA any administrative costs including the state share of costs incurred on behalf of the offender under the terms outlined in IC 11-10-3-7(d).

H. 7 C.F.R. 273.1(b)(7) outlines the individuals ineligible for Supplemental Nutrition Assistance Program (“SNAP”) benefits. Federal law prohibits SNAP benefits to anyone with a felony conviction.

I. IC 11-10-12-5 requires DOC to apply for Temporary Assistance for Needy Families (“TANF”) benefits for offenders being released from custody within a sufficient amount of time prior to the release. However, 12-14-1-1(b) states that “except as provided in IC 12-14-28-3.3, a person convicted of a felony under IC 35-43-5-7 or IC 35-48-4 is not eligible to receive assistance under TANF for ten (10) years after the conviction.”

III. CONSIDERATION

The consideration for this MOU is the mutual assurances and covenants set forth herein. This is a Zero Dollar MOU, which has no monetary consideration for the parties to perform their respective duties set forth herein. However, both FSSA and DOC will incur costs in order to implement the terms of this MOU, and DOC agrees to reimburse FSSA the costs incurred by FSSA in paying the State match for DOC offenders as set forth in Section IV, and to reimburse FSSA for DOC offender claims subsequently deemed not covered under Medicaid.

IV. COSTS

This MOU contemplates the occurrence of two categories of costs to the State of Indiana, the terms of which are outlined below:

1. Upgrading FSSA’s claims payment and eligibility systems; and

2. Covering the State’s share of Medicaid payments provided on behalf of offenders receiving inpatient medical services.

A. State’s share of Medicaid payments provided on behalf of offenders eligible for Medicaid

1. The cost of the Medicaid inpatient services provided to eligible offenders will be covered with Federal funding, based on the Federal Medical Assistance Percentages (“FMAP”) rate effective during the period in which the service is delivered and State funding, which is also referred to as the State match (“SMAP”).

2. FSSA agrees to provide the State match using funds from its appropriation for inpatient services provided to eligible offenders under this section. DOC agrees to reimburse FSSA in the amount of the State match.

3. The FSSA Office of Medicaid Policy and Planning (“OMPP”) will provide DOC with expenditure reports, along with SMAP estimate, of the amount the DOC will reimburse FSSA, on or near the quarter end dates of the applicable year as follows during the term of this MOU:

January 15

April 15

July 15

October 15

4. These reports will cover all expenditures FSSA incurred on behalf of DOC for services rendered during the period of this MOU.

5. On a quarterly basis, and within 15 days following generation on estimates, FSSA shall submit a request to the Board of Finance with the necessary chart field information provided by DOC to move appropriations form DOC to FSSA. The Board of Finance will move an amount equal to the SMAP for the services provided to DOC on behalf of Medicaid recipients.

6. FSSA will not contribute any funds to cover the SMAP amount if DOC determines that the funding needed to provide the SMAP amount is unavailable. Should an evaluation of financial strength indicate an ongoing concern, designated liaisons should proactively work together for resolution. If a resolution cannot be reached in accord with section VII prior to the depletion of the DOC funding, FSSA may take necessary steps to recoup funds owed and consider terminating this MOU.

7. FSSA OMPP will identify any changes in the applicable federal medical assistance percentage (“FMAP”) in the state share estimate it provides to DOC under section IV.B.3.

8. FSSA will make eligibility determinations for the offenders based on the information submitted by the offender or the offender’s A/R. As such, FSSA shall be primarily responsible for addressing overpayment determinations by the Federal government.

DOC agrees to cooperate with FSSA in providing documentation to address an overpayment determination upon FSSA’s request. Determination for financial liability will be made between parties as disallowances occur and payment made as necessary.

9. DOC will be responsible for any costs associated with any safety training required for

FSSA staff who must visit a DOC facility to assist an offender, excluding transportation costs and reimbursement of the salary or hourly rate of FSSA staff during such training.

10. DOC will be responsible for reimbursing FSSA for any costs associated with claims paid by FSSA for health care services subsequently deemed not covered by Medicaid.

B. Financial records and inspections

1. Both parties agree to maintain a proper accounting of expenditures under this MOU including their respective books, records, or documents.

2. Either party agrees to provide all audits, monitoring reports, documentation and records related to the administration of funds under this agreement upon request of the other.

3. DOC agrees to cooperate and provide all requested support to FSSA OMPP in all audits conducted by an authorized state or federal entity, including but not limited to the Indiana State Board of Accounts and Health and Human Services Office of the Inspector General.

V. DUTIES OF THE PARTIES

The parties agree to the following responsibilities:

A. Duties regarding incarcerated offenders

1. DOC agrees to:

a. Identify offenders potentially eligible for the Indiana Health Coverage Programs such as Medicaid and HIP 2.0 and assist such individuals and inpatient facilities as applicable with completing the necessary applications for those benefits and for presumptive eligibility upon inpatient admission of an offender if needed. Pursuant to HEA 1269, SECTION 2, DOC shall be the offender’s A/R. DOC shall permit an offender to revoke this designation of authority. A party revoking an A/R must submit a written statement to DFR.

b. Submit an application for health coverage within sixty (60) days of an application for presumptive eligibility for any offender receiving presumptive eligibility health coverage.

c. Include all necessary/requested verifications and medical records required to establish eligibility for the assistance. FSSA will contact the A/R or the offender if additional documentation is required.

d. Transfer funds on a quarterly basis to FSSA to cover the Medicaid State match on all

Medicaid expenditures paid for services provided to offenders.

e. Provide program information on a quarterly basis to FSSA regarding the number of offenders having inpatient stays and other data upon request so that FSSA can monitor and evaluate this program.

f. Submit monthly reports to FSSA providing a list of all currently incarcerated offenders who are enrolled in the Medicaid program.

g. Notify DFR of the incarceration of any offender who is a Medicaid recipient.

h. Notify DFR of the hospitalization of any offender who is enrolled in the Medicaid program. Such notice may be satisfied when completing the Presumptive Eligibility process.

i. Provide the required information on each inmate requiring hospitalization to complete the Presumptive Eligibility process upon admission of a medical Institution.

2. FSSA agrees to:

a. Provide all necessary assistance to DOC staff to convey information needed to carry out its responsibilities under this MOU including training on how to complete all necessary forms for public assistance.

b. Process the offender’s submitted application and all requested documentation. FSSA will mail the appropriate correspondence (i.e. Medicaid card, approval letter, request for additional information, or denial letter) to the appropriate addresses as provided on the application and to the appropriate A/R.

c. Provide quarterly reports to DOC including total Medicaid expenditures paid for offenders during the specific quarter and the State match owed on these expenditures based on the current FMAP percentage.

d. FSSA cannot make SNAP or TANF benefits available to offenders. As such, FSSA shall not process a SNAP or TANF application unless the individual is eligible for such benefits under State or Federal law.

e. Work cooperatively with any third party designated by or contracted with, DOC to perform any of DOC’s duties under this MOU.

B. Duties regarding offenders whose incarceration is ending

1. DOC agrees to:

a. A minimum of 45 days prior to an offender’s release, discharge or transfer from a

Public Institution, DOC shall:

1) Submit an application for health coverage for any offenders considered by DOC to be potentially eligible for Medicaid for HIP 2.0 coverage.

2) Initiate an application to the Social Security Administration for offenders who are eligible to receive coverage as Aged or Disabled.

3) Notify FSSA of the offender’s impending release date.

4) Notify FSSA of the date of revocation of DOC’s A/R status for the offender.

b. In some circumstances, the offender may need to obtain Medicaid coverage via presumptive eligibility upon release or discharge. In such situations, an entity qualified to make such determinations may need information in the possession of DOC. When appropriate, DOC will provide the information necessary for the entity to make the presumptive eligibility determination on behalf of a released offender.

c. Maintain the original application documentation in the offender’s release portfolio and provide this information to the offender upon release. Instruct the offender to take this paperwork to the local DFR office at the time of the offender’s scheduled appointment, if necessary. DOC will notify FSSA of any change in the offender’s release date.

d. If it becomes necessary for FSSA staff to travel to the DOC facility, provide appropriate safety and security training to FSSA staff who would need to be on-site assisting offenders with completing the application documentation.

e. Not to interfere with an offender applicant’s right to file an appeal of an FSSA determination under this section. DOC may assist with any offender appeal to the extent legally required, or may file an appeal on behalf of the offender as an A/R.

2. FSSA agrees to:

a. Where necessary, schedule a phone interview with the offender and/or A/R to receive information necessary to begin processing the offender’s application for Medicaid benefits (for the aged and disabled categories) upon receipt of the notice under section V.B.1.i of this MOU. This phone interview may include both the potentially eligible offender and the appropriate DOC staff where authorized to participate.

b. Process applications within the federally required timeframes, provide notices to the applicant or the A/R, and provide “pending verification checklists” requesting missing information from the applicant or the A/R, as applicable, in a timely manner.

c. FSSA shall cease routine correspondence with DOC as the A/R after the date that DOC or the offender revokes the A/R status by notifying DFR in accordance with the notice provided under V.B.1.l.c. of this MOU.

VI. TERM AND TERMINATION

Pursuant to Financial Management Circular 2009-02, this MOU shall become effective July 1, 2019 and terminate on June 30, 2021, unless earlier terminated pursuant to this section. Parties may renew this MOU under the same terms and conditions, subject to the approval of the Director of the State Budget Agency. The term of the renewed MOU may not be longer than two

(2) years. Any renewal of this MOU shall be made in writing.

When the Director of the State Budget Agency makes a written determination that funds are not appropriated or otherwise available to support the continuation of the performance of this MOU, the MOU shall be canceled. A determination by the Director of the State Budget Agency that funds are not available to support continuation of performance shall be final and conclusive.

Either party may terminate this MOU as follows:

A. The parties fail to resolve a dispute following the dispute resolution procedures in section VII of this MOU. This MOU may be terminated in whole or in part under this subdivision immediately upon the services of written notice to the other party.

B. Either party decides that termination is in the best interest of the terminating agency. A party terminating this MOU under this subdivision must provide written notice to the other party 30 days in advance of terminating this MOU.

C. All written notices required under this section shall state the reasons for termination.

VII. DISPUTE RESOLUTION

To ensure that problems and issues arising under this agreement are resolved expeditiously, DOC and FSSA Controllers are hereby designated as the primary liaison from each agency. If disputes cannot be resolved between the parties’ liaisons, the dispute shall be referred to the Commissioners of FSSA and DOC. The decision reached by the Commissioners shall be final. All parties agree to seek the most rapid resolution of all disputes.

VIII. MODIFICATION/AMENDMENTS

This MOU may be modified or amended upon the initiative of any party. Such modifications must be made in writing and must be agreed to and be signed by authorized representatives of the agencies that are party to this MOU. No oral understanding or agreement not incorporated herein shall be binding on any of the parties hereto.

To the extent that any change in law conflicts with this MOU, such law nullifies the conflicting provision within this MOU. However, the remaining provisions of this MOU shall remain in full force and effect.

IX. HEALTH INSURANCE PORTABILITY AND ACCOUNTING ACT (HIPAA)

DOC agrees to comply with all requirements of the health Insurance Portability and Accountability Act of 1996, Title II, Administrative Simplification (“HIPAA”), including amendments signed into law under the American Recovery and Reinvestment Act of 2009 (“ARRA”), in particular, Title XIII known as the health Information Technology for Economic and Clinical Health Act (“HITECH”), Subtitle D, in all activities related to this MOU, to maintain compliance during the term of the contract and after as may be required by federal law, to operate any systems used to fulfill the requirements of this contract in full compliance with HIPAA and to take no action which adversely affects FSSA’s HIPAA compliance.

X. DISCLAIMER TO NON-PARTIES

This MOU is intended solely to clarify the obligations and duties between DOC and FSSA, and is not intended to, nor should it be construed to, confer upon any non-party and contractual right or expectation.

XI. NOTICE TO PARTIES

Both parties agree to designate one liaison for purposes of this MOU. DOC may conduct routine correspondence with case workers in the local FSSA/DFR offices. Whenever any notice, statement, or other communication is required under this MOU, it shall be in writing and shall be sent to the address specified herein or such other address as a party may in the future specify in writing to the others.

Agency Contact for IDOC Agency Contact for FSSA Nicholas Law, Contracts Director Paul Bowling, Chief Financial Officer Indiana Department of Correction Family & Social Services Administration 302 W. Washington St., Room E334 402 W. Washington St., Room W461 Indianapolis, IN 46204 Indianapolis IN 46204 317-232-5672 317-233-4451

In Witness Whereof, Indiana Department of Correction and the Indiana Family & Social Services Administration have, through their duly authorized representatives, entered into this Memorandum. The parties, having read and understood the foregoing terms of this Memorandum, do by their respective signatures dated below agree to the terms thereof.

Indiana Department of Correction Indiana Family & Social Services Administration

By: By:

Title: Title:

Date: Date:

Electronically Approved by:

State Budget Agency

By: (for) Jason D. Dudich, Director Refer to Electronic Approval History found after the final page of the Executed Contract for details.

Chief of Staff

March 13, 2019

Allison Taylor

Medicaid Director

March 19, 2019