§ 41-1608 — Inmate medical services; rate structure

If a prisoner in a secure care facility requires health care services that the department, the facility or a private prison provider contracted by the department cannot provide, the department shall pay approved claims from a facility or provider that provides these services as follows:

1. Except as provided in paragraph 3 of this section, for inpatient and outpatient hospital services, the department shall reimburse at a level that does not exceed the reimbursement methodology established pursuant to section 36-2903.01, subsection G.

2. For health and medical services, the department shall reimburse at a level that does not exceed the capped fee-for-service schedule that is adopted by the Arizona health care cost containment system administration pursuant to title 36, chapter 29, article 1 and that is in effect at the time the services are delivered.

3. For inpatient and outpatient hospital services that are provided in a fully locked unit setting, the department may establish an alternative reimbursement rate that does not exceed one hundred twenty percent of the current medicare rate. For the purposes of this paragraph, "fully locked unit setting":

(a) Means a ward or wing in which treatment and services are provided and that is secured in a manner that prevents patients from leaving the ward or wing at will.

(b) Does not include a ward or wing that is locked only for the purpose of preventing unauthorized entry and that allows a patient to exit the ward or wing at will.