Participation Agreement

Inmate Medical Claims Processing and Insurance

Participating County:______Effective Date: ______

The Montana Association of Counties (MACo) makes available and acts as administrator for a program operated by Correctional Risk Services, Inc. (CRS) that offers claims administration for medical services provided to detention center/jail inmates, and as a separate option, offers certain insurance for covered medical expenses for inmates that are a County responsibility.

  1. Program Descriptions:The following descriptions are general in nature. The precise description of each program is set out in Exhibit “A” - Correctional Risk Services Proposal for Claims Administration Management and/or Inmate Excess Medical Insurance, and Exhibit “B” -Statement of Inmate Medical Benefits.

a)Medical Claims Administration: Each participating County will be given a medical ID card issued by Correctional Risk Services which is similar to a medical insurance ID card. When an inmate is transported to a Hospital or other medical provider, the medical ID card is presented and the provider then bills Correctional Risk Services. Correctional Risk Services, which after verifying that individual to whom services were provided is a county inmate, will review the bill for errors, apply any discounts applicable, and invoice the county for the corrected amount of the bills. County will submit payment to CRS, who will pay the provider the corrected amount.

b)Inmate Excess Medical Insurance: Inmate medical benefits will be provided as excess insurance in accordance with the Statement of Inmate Medical Benefits, attached as Exhibit “B”, under a policy of excess insurance issued by an “A” rated carrier. A copy of the application for this policy is attached as Exhibit “C”. Inmate Excess Medical Insurance is not available under this program without acceptance of the Claims Administration Management Agreement.

The Insurance Benefit for covered claims is subject to a $10,000 per individual inmate deductible. This means that the County will be responsible for the first $10,000 in covered medical expenses that are incurred on behalf of an individual inmate. The maximum payment per inmate per year is $240,000 after the $10,000 deductible is met.

  1. Program Costs:

a)Medical Claims Administration: Correctional Risk Services is compensated by a fee of 30% of the savings based on the difference between the amount billed by off-site medical providers and the amount due after review for accuracy and the application of statutory discounts and/or additional discounts negotiated by CRS. If CRS is unable exceed current county provider discounts the amount owing is reduced to 10% of the savings. CRS will not bill for or retain a fee if there are no reductions to the original amount billed to the County by the provider.

b)Inmate Excess Medical Insurance:The initial rate will be based on a participation level of greater than 50% of the counties. After the first policy has been in effect for six months, the participation level will be reviewed and the rate will be adjusted to the appropriate premium rate based on county participation level. Following the initial rate period, the rates will be as follows:

If 50% (29) or more Montana Counties participate the rate will be $0.53 per inmate per day.

If 35% to 49% (21 – 28) Montana Counties participate, the rate will be $0.59 per inmate per day.

If less than 35% (20 or less) Montana Counties participate, the rate will be $0.65 per inmate per day.

  1. Plan Participation Requirements:

a)Medical Claims Administration: Counties that wish to participate in the medical claims management offered by Correctional Risk Services must complete and submit the Correctional Risk Services Proposal for Claims Administration Management and/or Inmate Excess Medical Insurance, which is attached as Exhibit “A”.

b)Inmate Excess Medical Insurance: Counties that wish to participate in both the Medical Claims Administration and the Inmate Excess Medical Insurance must execute the following:

1)This Participation Agreement; and

2)the Correctional Risk Services Proposal for Claims Administration Management and/or Inmate Excess Medical Insurance (attached as Exhibit “A”); and

3)the Statement of Inmate Medical Benefits (attached as Exhibit “B”). (Insurance for inmate medical expenses is not available under this program without acceptance of the Claims Administration Management Agreement); and

4)Complete the invoice (attached as Exhibit “D”) and submit initial payment with a copy of the invoice and the other exhibits. The number of inmates for the initial premium shall be calculated by using the county inmate count on the 15th of the month preceding the date of this agreement. Initial payment must be received before the agreements will be executed by MACo and CRS.

All executed documents and the initial payment shall be sent to:

Harold Blattie, Executive Director

Montana Association of Counties

2715 Skyway Drive

Helena, MT59602

  1. Plan Effective Date:
  1. Medical Claims Administration: Effective upon acceptance of the County by Correctional Risk Services, and remains in effect for twelve (12) months from the effective date.
  1. Inmate Excess Medical Insurance: Effective upon acceptance by Correctional Risk Services and receipt of the first months premium and remains in effect for twelve (12) months from the effective date, unless terminated by either party.
  1. Plan Termination: Either party may cancel on 30 days written notice,with the exception that Inmate Excess Medical Insurance is subject to immediate cancellation for nonpayment of premiums.

Monthly Premium Payments: CRS will bill participating counties on the 1st of the month for the prior month’s premiums. The premium amount will be calculated by using the county inmate population count on the 20th of the prior month, and multiplying it by the number of days in the prior month and by the established rate. Counties will submit payment to MACo by the 15th of the following month. MACo will combine all county payments received by the 20th of the month, and will pay CRS by the 25th of the month. Any disputes arising between CRS and a participating county regarding amounts due to CRS under the agreement between CRS and a participating County shall be resolved by CRS and the participating County. While MACo will attempt to facilitate and/or mediate such disputes, MACo assumes no responsibility for the payment or collection of any amounts which may be claimed by CRS as due from a participating County.

  1. Notice: Whenever this agreement requires or permits notice to be given to the other party in written form, such notice shall be deemed given when the written notice is either delivered to or mailed First Class, postage prepaid to:

Notice to MACo:Harold Blattie, Executive Director

Montana Association of Counties

2715 Skyway Drive

Helena, MT59602-1213

Notice to County:Notice shall be sent to the Board of County Commissioners of the County named in this agreement.

Copy to:Correctional Risk Services

PO Box 2132

Brentwood, TN37024-2132

  1. Disclaimer and Notice: MACo is making these programs available only as an agent of Correctional Risk Services and assumes no liability for either the provision of medical claims administration by CRS or for any inmate medical expenses. Counties contracting with CRS for these programs are contracting with CRS and not with MACo for these services. Accordingly MACo accepts no liability for claims that may arise out of these programs.

WHEREFORE, being the persons duly authorized to sign this agreement and thereby bind the above-named parties, we do hereby affix our signatures:

County:

______

NameTitleDate

Montana Association of Counties:

______

NameTitleDate

CRS/MACo/County

Participation Agreement

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