- THCA

Volume XXXI, Number 5
May 2016

Guidance to Surveyors on Federal Requirements for Providing Services to Justice Involved Individuals

The Centers for Medicare & Medicaid Services (CMS) issued S&C: 16-21-ALL to clarify requirements for providing services to justice involved individuals in skilled nursing facilities (SNFs), nursing facilities (NFs), hospitals, psychiatric hospitals, critical access hospitals (CAHs), and intermediate care facilities for individuals with intellectual disabilities (ICFs/IID). Specifically, this guidance seeks to assure high quality care that is consistent with essential patient rights and safety for all individuals.

Many States are examining 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.

In particular, States are considering the role that Medicaid can play in facilitating better access to health care for individuals prior to, during, and after, a stay in a correctional facility. The Social Security Act (the Act) prohibits federal financial participation (FFP) under Medicaid for inmates of a public institution, but provides an exception to this exclusion for patients in a medical institution1. The CMS Center for Medicaid and Children’s Health Insurance Program (CHIP) Services (CMCS) recently issued a letter to State Health Officials (SHO) that clarifies the definition of inmate of a public institution for purposes of Medicaid eligibility and to whom this exception applies. The letter is available HERE.

S&C: 16-21-ALL can be found HERE.

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If you have any questions about the THCA Commitment to Care Initiative or would like to share your facilities successes please contact Gloria Bean-Williams by email or call (512) 458-1257.