CMS’ updated guidance to surveyors on facility treatment of justice involved individuals removes the previous disallowance of specialized units and the third example scenario (inmate Edward) that appeared in the previous guidance. The American Hospital Association (AHA) lauded this change, having previously taken the position that security units benefit staff, visitors, and all patients, including prisoners and jail inmates ( Revised CMS Letter, S&C: 16-21-ALL, December 23, 2016).
Patient rights. The first letter to state survey agency directors focused on ensuring that patients who are or have been incarcerated receive the same quality of care as all other patients and that their rights are preserved (see CMS tells providers how surveyors think about justice-involved care, May 4, 2016). Following Medicaid expansion, CMS noted that a significant number of justice involved individuals were newly eligible for Medicaid, but reminded providers that Medicaid payment is excluded for services provided to inmates unless that inmate is an inpatient in a medical institution.
Surveyors and providers were originally told that patient placement in a particular unit must be supported by a clinical basis. Hospitals were not permitted to establish a section exclusively for the treatment of justice involved individuals. The first guidance noted that hospitals may have units specializing in care for patients with common behaviors, such as violent behavior, and that certain units may commonly admit inmates. However, if a non-inmate presents with the same characteristics, the unit and specialized staff must not be off limits. If an inmate with different needs was admitted, such as a pregnant inmate in labor, she would not be placed in an unrelated unit simply because it held other inmates.
In the relevant example scenario, an inmate was brought to a local emergency department and then admitted for surgery. CMS stated that the hospital would be permitted to designate a selected nursing unit within departments where inmates would typically be placed, allowing for staff with specialized training to work with patients in custody. However, the patient was required to be placed in the same unit as a non-inmate with the same diagnosis.
Removal. The updated guidance simply stated that all references to specialty units were removed "to ensure that hospitals are able to meet the unique security needs for justice involved individuals receiving treatment." The AHA noted that CMS’ previous Questions and Answers letter to state health officials requires updating in order to maintain consistency.