CMS Issues Guidance on Providing Services to Justice Involved Individuals
Centers for Medicare and Medicaid Services (CMS) has issued S&C letter 16-21, acknowledging the role that the health care system plays in providing vital services to individuals during and following a period of incarceration. For example, some individuals were previously uninsured and may have long-untreated health conditions. Others have aged in prison and may be discharged under compassionate release policies or may need specialized care for chronic or debilitating conditions.
The S&C letter specifically addresses whether the provider of services qualifies for payment by virtue of having a Medicare or Medicaid provider agreement, and maintains continuous compliance with Medicare and Medicaid Requirements for Participation (Requirements) or Conditions of Participation (CoPs).
The letter addresses the following individuals:
- Inmates of a public institution: Individuals currently in custody and held involuntarily through operation of law enforcement authorities in an institution which is the responsibility of a governmental unit or over which a governmental unit exercises administrative control, such as a state or federal prisons, local jails, detention facilities, or other penal settings (e.g., boot camps, wilderness camps).
- Individuals under the care of law enforcement: Individuals who have been taken into custody by law enforcement. Law enforcement includes local and state police, sheriffs, federal law enforcement agents, and other deputies charged with enforcing the law.
- Individuals under community supervision. Individuals who are on parole, on probation, or required as an alternative to criminal prosecution by a court of law to conditions of ongoing supervision and treatment.
The Requirements for Long Term Care Facilities (Requirements for Participation) accommodate both short and long-range needs, with a primary focus on the fact that the nursing home often serves as the individual’s residence. Resident rights, choices, and dignity are therefore important features of the statutory and regulatory requirements. The requirements for nursing homes are the same for Medicare and Medicaid. The Medicaid nursing home benefit may also include levels of care in addition to the skilled nursing home care that is covered in Medicare. Individuals may be admitted as a resident of a nursing home, if they meet certain level-of-care and screening requirements, such as preadmission screening and resident review.
CMS acknowledges that surveyors must ask questions related to assessment, treatment, care, staffing and training in relationship to the treatment of all patients or residents. However, because of the nature of criminal justice supervision, it is at times more challenging to accommodate the supervision requirements expected by supervising authorities and still comply with CoPs, Requirements for Participation and other CMS requirements.
Contact: Elliott Frost, efrost@leadingageny.org, 518-867-8832