AAC F A M I L Y A N D F R I E N D S » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » » »
Medical costs for county, state prisoners Is your county paying the government rate?
that the state of California had to reduce its prison population by 30,000 prisoners, or by about 20 percent, due to the inability to pro- vide medical care to its massive prison popula- tions. Te United States Supreme Court held in Brown vs. Plata that the California prison system failed to deliver access to minimal care for prisoners with serious medical and mental health problems and produced “needless suf- fering and death” in violation of the Eighth Amendment of the United States Constitution’s prohibition on cruel and unusual punishment. Tere are significant challenges to reigning in the costs of medical care provided to inmates. Seeking out cost-saving arrangements for medical expenses should be a priority matter for the AAC, the Arkansas Sheriffs Association and each county. A major problem arises from medical services
A
rendered by hospitals to inmates. Fortunately, some local hospitals provide care to indigent inmates free of charge. Traditionally, hospitals in the United States were mostly nonprofit or charitable institutions supported by govern- ments or religious organizations. However, recently more for-profit hospitals
have emerged. Hospitals situated in county- owned buildings or supported by local prop- erty taxes should have prudent county officials negotiating for agreements for medical care for indigent inmates free of charge or at reasonable government rates, such as Medicaid. Does your county have an agreement with
your local hospital? Te Emergency Medical Treatment and Ac-
tive Labor Act of 1986 (“EMTALA”) provides that any patient who comes to the emergency department requesting examination or treat- ment must be provided with an appropriate medical screening examination to determine that the person is suffering from an emergency medical condition. Te intent of the legislation is to prevent a hospital in the United States from “patient dumping” and transferring pa- tients in need of emergency medical attention and treatment to a charitable hospital or county hospital. However, once the person is admitted and stabilized, the obligations under EMTALA
18
cross the country, inmate medi- cal costs are estimated to be about $3 billion. Medical care for inmates is such a major cost
end. A catastrophic illness or overnight stay by an inmate can destroy a county jail budget. County officials and the general public alike lack access to information to ascertain if the invoice from the medical provider is based on costs, and the invoice may be excessive. Health Reform Watch, a blog of Seton Hall
University School of Law, reported that when patients do not have the benefit of insurance, that hospitals and doctors “routinely double, triple or even quadruple the price for unpro- tected patients.”
Te authors of the report concluded that:
“such huge mark-ups can only be regarded as price-gouging — exploiting market power to charge price virtually unrelated to actual costs.” Arkansans can rightly consider it unconsciona- ble that a medical provider would price-gouge their aunt or uncle or any person. Do you have personal experience of receiving an inflated medical bill? A friend? A loved-one? Consumer watchdogs tell us to notify the prosecuting at- torney or the Attorney General to determine if the acts are illegal or violate the “Arkansas Trade Practices Act.” Are adequate laws and enforcement in place
in Arkansas to protect the sick from exploita- tion? Apparently not. In fact, there is no law in Arkansas to ensure that local governments are not price-gouged or sent inflated invoices on inmate medical costs. Te Legislatures of Kansas (K.S.A. § 22- 4612) and Colorado (C.R.S.17-26- 104.5) have enacted civil laws to assure their local gov-
ernments pay g o v e rnmen t rates, Medicaid rates, for inmate medical services. State Sena- tor Jim Luker, Chairman of Senate Judiciary Committee, courageously
Research Corner
Mark Whitmore AAC Chief Counsel
filed similar legislation (SB 847 of 2011) which has been submitted to interim study. Te Colo- rado statute recognized that hospitals that re- ceive state money should not bill the govern- ment in excess of the government rate. Many hospitals in Arkansas receive financial support from state and local governments. In 2009 the Arkansas General Assembly adopted a tobacco tax to fund trauma and emergency medical care systems in Arkansas. Given the state gov- ernment funding and EMTALA (above), why should county government subsidize the state trauma system or state or local hospital emer- gency departments? Arkansans and the members of the General Assembly may find it unconscionable that a hospital or medical provider would invoice local or state government in excess of the government rate — Medicaid — for services rendered to a county or state inmate. It’s plain that payments in excess of the gov- ernment rates are wasteful. Te government should simply pay only the government rate.
Dollars &
Sense Do you know what rate your county pays for medical services for inmates? Counties are not all invoiced at a government rate or even a consistent rate for medical services rendered to county inmates.
COUNTY LINES, WINTER 2012
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60