(1)The state board of correction or any privatized medical provider under contract with the department of correction shall pay to a provider of a medical service, other than hospital inpatient or outpatient services, for any and all prisoners, committed to the custody of the department of correction, confined in a correctional facility, as defined in section 18-101A (1), Idaho Code, an amount equal to the reimbursement rates of the Idaho medicaid reimbursement fee schedule in place at the time services are provided. Hospitals shall be paid for inpatient and outpatient facility services provided to such prisoners in an amount equal to the interim Idaho medicaid rates in place at the time of service except for outpatient services paid by Idaho medicaid according to the Idaho medicaid fee sc
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(1) The state board of correction or any privatized medical provider under contract with the department of correction shall pay to a provider of a medical service, other than hospital inpatient or outpatient services, for any and all prisoners, committed to the custody of the department of correction, confined in a correctional facility, as defined in section 18-101A (1), Idaho Code, an amount equal to the reimbursement rates of the Idaho medicaid reimbursement fee schedule in place at the time services are provided. Hospitals shall be paid for inpatient and outpatient facility services provided to such prisoners in an amount equal to the interim Idaho medicaid rates in place at the time of service except for outpatient services paid by Idaho medicaid according to the Idaho medicaid fee schedule. These limitations apply to all medical care services provided outside the facility, including inpatient and outpatient hospitalizations, emergency services, professional services, durable and nondurable goods, prescription drugs and medications provided to any and all prisoners confined in a correctional facility, as defined in section 18-101A (1), Idaho Code. For services that are not included in the Idaho medicaid fee schedule or the interim Idaho medicaid rates, the state board of correction or any privatized medical provider under contract with the department of correction shall pay the reasonable value of such service. If a privatized medical provider is contracted with the department of correction, no hospital or any medical services provider shall be required to provide medical services to prisoners, except for emergency hospital services, in the absence of a contract between the privatized medical provider and the hospital or medical services provider. Any contract between the department of correction and a privatized medical provider must contain a requirement that the privatized medical provider enter into contracts with each hospital providing non-emergency services outside of the correctional facility. The contract between the privatized medical provider and the department of correction shall require, and the contracts between the privatized medical provider and any hospital or non-hospital providers shall include, at least the following terms reasonably and practicably consistent with those used by Idaho medicaid:
(a) Claims adjudication processing;
(b) Timing;
(c) Payment;
(d) Authorizations;
(e) Utilization review;
(f) Audit; and
(g) Appeals processes.
(2) Subsection (1) of this section shall apply only to companies, professional associations and other health care service entities whose services are billed directly to the department of correction or any privatized medical provider under contract with the department of correction. Subsection (1) of this section shall not apply to:
(a) Privatized correctional medical providers under contract with the department of correction to provide health care to prison inmates;
(b) Private prison companies;
(c) Out-of-state correctional facilities contracting with the department of correction to house prisoners;
(d) County jails; and
(e) Companies, professional associations and other health care service entities whose services are provided within the terms of agreements with privatized correctional medical providers under contract with private prison companies and county jails.