Transcript Robert Coupe

ASCA/CCHA Training
Thursday, September 11, 2014
Correctional Impact of the
Patient Protection and
Affordable Care Act/Cost
Containment
Commissioner Robert Coupe
Delaware DOC
Bureau Chief James Welch
Delaware DOC Bureau of Healthcare Services
Topics
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DOC Organization
DOC Demographics/ Budget and Costs
Cost Containment efforts
Initiatives & Vision for the future
DOC Organization
Delaware Department of Correction 2014
Commissioner
Deputy
Commissioner
Information
Technology
Planning & Research
Bureau of
Prisons
Baylor Women’s
Correctional Institution
Howard R. Young
Correctional Institution
James T. Vaughn
Correctional Center
Sussex Correctional
Institution
Special
Operations
Food Services
Facilities
Maintenance
Bureau of Community
Corrections
Bureau of Correctional Healthcare
Services
Internal Affairs Unit (IA), Media
Relations, Community Services,
Family Services , Victim Services
Bureau of
Administrative Services
Probation & Parole NC,
Kent, Sussex
Medical
Administration
Plummer Community
Correctional Center
Medical Contractor
Central Business
Office
Webb Correctional Center
Mental Health & Substance
Abuse Administration
Employee
Development Center
Morris Community
Correctional Center
Mental Health & Substance
Abuse Contractor
Training Academy &
Range
Central Violation of
Probation Center
Pharmaceutical Contractor
Sussex Community
Correctional Center
Sussex Violation of
Probation Center
Hazel D. Plant Women's
Treatment Center
Central Offender Records
Human Resources
Delaware is a Unified
Correctional System
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Jail Detention Population 25% of total population
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Detention accounts for 40% of females incarcerated
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Prison
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Work release and Violation of Probation Centers
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Probation & Parole
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Community Supervision
DOC Quick Facts
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$277 million budget (FY15)
2,500 employees (1700 CO’s, 300 PO’s)
18 facilities (4-Level V, 7-Level IV, 6 P&P,
1-Central Administration/Training)
Population 6,000 L-V, 1,100 L-IV, 15,000 P&P
Offender Per Diem - $99 per day or $36,232/yr.
Medical Per Diem - $20.00 per day or $7,373/yr.
Treatment Services - $3.00 per day or $963/yr.
Per diem updated at close of FY14
Offender Per Diem Costs
DAILY PER DIEM
FY 12
FY13
YEARLY PER DIEM
FY12
FY13
Prisons Only
$ 98.54
$ 95.12
Prisons Only
$ 35,966.93 $ 34,717.20
Work Release/VOP's
$ 92.28
$ 99.61
Work Release/VOP's
$ 33,682.07 $ 36,357.85
All Institutions
$ 97.50
$ 95.81
All Institutions
$ 35,586.61 $ 34,971.12
Medical
$ 18.60
$ 18.27
Medical
$ 6,790.08
$ 6,669.03
Food Service
$ 6.69
$ 6.46
Food Service
$ 2,442.28
$ 2,356.42
$
$ 2.81
Food Only
$ 1,098.22
$ 1,026.56
Food Only
3.01
Bureau of Correctional
Healthcare Services FY15
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Healthcare Services budget is $57.6 million
(21% of DOC Budget)
+/- $40.6 million for traditional medical services
+/- $12.6 million for mental health & substance
abuse
+/- $1.7 million for pharmaceutical services
Additional Expense for medications
+/- $6.7 million for prescription medication
Healthcare Services (continued)
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In April 2014 the medical contractor managed
3,254 inmate sick calls at DOC Level 5 and
Level 4 combined. In May 2014 they managed
3,383 inmate sick calls.
June 2014 total pharmaceutical costs were
$491,703.51 for one month
HIV Medications included in June 2014 were
$187,488 for 80 offenders (38% of monthly
expenditures)
Changing Demographic
DE Offender Population by Age
Age
Group
0-18
2004
Population
Count
2004
Percent of
Population
2014
Population
Count
2014
Percent of
Population
28
0.4
7
0.1
18-50
5985
91.8
5828
84.7
50+
510
7.8
1048
15.2
6523
100.0
6883
100.0
Totals
Source: Delaware Automated Corrections System (DACS)
Bureau of Prisons Population
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Referred to as Level 5 (SENTAC)
Population 5, 920 (operating capacity 5,250)
Pre-Trial Detention- (held on bail) 1,444 (24%)
Serving Life Sentence – 513 offenders
Death Penalty – 17 offenders
Population by race – 57% Black & 43% White
Female Population is 33% Black & 67% White
Male Population L5 – 59% Black & 40%White
Hispanic population 4%
08/06/14
DE Population US Census 22% Black 71% White
Bureau of Community
Corrections
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Level 4 – Work Release & Violation of
Probation Center (VOP)
L4 Population is 999
Probation & Parole
15, 365 Offenders under P&P supervision
Largest P&P Office is Cherry Lane responsible
for 5, 440 Offenders
Level 3 Offender visit 1 x per week
08/06/14
Level 2 Offender visit 1 x per month
Central Offender Records FY14
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Admissions Processed : 17,807
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Releases Processed :
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Sentences Calculated (L5, L4 & Probation):
37,425
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Victim Notification Letters generated:
32,883
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Legal Documents Received and Processed:
70,269
16,121
Offender Underlying Issues: MH & SUD
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*80% of inmates nationally have (1 or more):
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Mental Health (MH) and Psychiatric Disorders
Substance Use Disorder (SUD) and Addictions
Neuropsychological Deficits (developmental learning
disorders, ADHD, ADD, head trauma, brain injury)
History of Childhood and Domestic Violence Abuse
½ have MH disorders
2/3 have SUDs
¾ lack appropriate diagnosis & treatment
*Neuropsychological Features of Indigent Murder Defendants and Death Row Inmates in Relation to
Homicidal Aspects of Their Crimes; Arch of Clinical Neuropsychology; Vol 25; 2010
Transitional Slide
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Chief James Welch
Affordable Care Act
Cost Containment
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Hospital Medicaid, 19-64
EHR
Pharmacy Management/P & T
Telemedicine
Chronic Diseases
Meaningful Use
Patient Managers, Navigators, etc.
Delaware & the ACA
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Delaware is a Medicaid Expansion State
138% of Poverty Level
 Federal system is 133% of Poverty Level
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Benefit Suspension State v. Termination State
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Delaware is a Benefit Termination State for
incarceration
Individuals above 138% Poverty eligible for
ACA Marketplace
Males & Females eligible for Medicaid (based on
income)
Hospitalization - Community
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Activating Medicaid coverage for outside
medical services after 24 hours ages 19- up to 64
Partnership with private hospitals and Medicaid
Office
New challenge for DOC – offenders age 64 and
above not eligible for Medicaid or Medicare
Coverage now falls to the DOC and Medical
Contract Vendor
Delaware Medicaid System
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Created fast track system with hospitals and
Medicaid Office
Using unique zip code to “flag” DOC offender
cases to improve processing time
Automated Process improves billing with DOC
Medical Vendor, State Medicaid Office and
Federal Medicaid Office
ACA Navigators
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Medical Contractor provides patient manager
positions to sign up offenders in prisons
Prepare Medicaid/ACA applications for
offenders at sentencing in preparation of release
date
Hold the application in the queue of the Federal
ACA system
Submit on date of release
Medicaid eligible receive card within 30 days
Vision for the Future
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Developing strategy to reach detention
population for Medicaid/ACA application
process
Exploring concept of billing private insurance
and providers under ACA Marketplace for short
term detention population
Can the DOC pay monthly premium to keep
private insurance active for the detained
offender? Cost effective to pay premium?
Vision for Change
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Create Central Point of Entry at DOC
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Assess needs more appropriately to improve reentry
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Rehabilitation and Treatment plans developed from
ITP assessment
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Use Risk Need Responsivity (RNR) simulation tool
Include other assessments to form Individual Transition
Plan (ITP)
Address biological and behavioral MH & SUDs
Fill system failure gaps (education, job training, social skills,
etc.)
Programmatically placed in DOC & Promote
community groups involved in transitions
Risk Need Responsivity
Simulation Tool
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Partnership with George Mason University
Dr. Faye Taxman & Dr. Michael Caudy
Assess an Individual;
Assess a Program; and
Assess Jurisdiction’s Capacity
www.gmuace.org/research
Risk Need Responsivity
Simulation Tool
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Utilize the RNR tool to identify offender’s
individual needs and match him/her to best
course of programming to meet those needs
www.gmuace.org/research
Community Partnerships
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Pre-Trial Community Supervision – alternative
to detention
Reentry Services
I-ADAPT
HOPE Commission Achievement Center
Coordination of Services in the community
through Health and Social Services for Mental
Health & Substance Use Disorder Programs
Thank you
Questions?