PIMCC - Public Institution Medical Cost Containment
Description and History | Services | Structure | Service Providers | Staff Contact Information
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Description and History
PIMCC - Prison Inmate Medical Cost Containment - is a medical cost management, educational program dedicated to assisting county prisons with the containment of all costs relating to prison inmate medical expenses. PIMCC's overall goal is to train, educate and provide a quality managed care program which allows the county to choose their own unique medical cost saving program. Since PIMCC started operations in April 1995 participating counties have received unique services which have resulted in new procedures, newly negotiated contracts with medical providers, and cost savings on a variety of medical services, especially on the cost of inmate medications (prescription and nonprescription).
Counties have unlimited liability for most medical costs for prisoners. Many have been struggling to find ways to control these costs, but most have not been able to purchase insurance to cap expenses, nor have they been successful at negotiating significant discounts from service providers.
In 1994 Cumberland County experienced a major medical claim for one of its inmates, and asked its insurance consultants to develop some recommendations for action. After reviewing these recommendations, the county suggested the consultants contact CCAP to see if their ideas could benefit counties across the state. When Cost Management Plus brought the concept for PIMCC to the Association in 1994, the CCAP Board established a special committee to investigate the idea and determine if a program could be developed to assist counties with prison inmate medical costs.
After surveying counties and examining the results and reviewing the concepts proposed by Cost Management Plus, meeting with health care providers, examining potential insurance products, and investigating programs currently being used by counties, the PIMCC Committee unanimously recommended CCAP start the PIMCC program. The CCAP Board of Directors approved the program and its bylaws at their March 19, 1995 meeting.
PIMCC - Public Institution Medical Cost Containment - is now available for county Nursing Homes. In June 2002, the PIMCC Board approved the availability for a Public Institution Medical Cost Containment Program for county Nursing Homes at the request of existing PIMCC (Prison Inmate Medical Cost Containment) Counties who could foresee economy of scale savings on contracted services at the prison/jail if nursing homes were added to the program. This is a purchasing (pharmaceutical, DME, orthopedic needs and cleaning supplies) to be expanded as the need arises. Cost Management Plus, in conjunction with CCAP Insurance Programs, will be the primary administrator of both programs. Twenty-one counties currently participate.
In March of 2008 an associate member program was introduced to non PIMCC members. This program was developed to provide further assistance in controlling inmate medical costs and evaluation of privatized services. The objective of this program is to assist county prisons with monitoring their terms and conditions with privatized medical providers as well as working with Stop Loss Carriers. Other services available are medical audits and assistance with requests for proposals.
Services
- Complete review of design and quality of existing medical program and service providers.
- Group prescription drug purchasing program.
- Drug formulary for sick line and other provider use.
- Discount fee negotiations with medical service providers including hospitals, rehab providers, ambulance companies, radiologists, sick line providers, and other related medical service providers and services.
- Auditing of all in-patient medical bills.
- Random auditing of other medical provider bills.
- On-site training of prison personnel, with follow-up visits.
- PIMCC Manual with recommended procedures and forms.
- Precertification program for all in-patient hospital stays.
- Utilization review of all hospitalizations.
- Subrogation to other medical insurance and workers' compensation.
- Overall case management.
- Toll free phone and fax lines for precertification and assistance.
- Communication with and coordination of sickline physicians/nurses.
- Contract Performance Auditing
- Medical Auditing
- Assistance with Proposals
- Request for Proposal (RFP)
Structure
PIMCC is a separate and independent governmental and legal entity formed by Intergovernmental Agreement by member counties, pursuant to Act 180 of July 12, 1972. Each participating county selects a member to the PIMCC Board of Delegates. The Delegates then select up to seven members of the PIMCC Governing Board, based on regional participation in PIMCC. CCAP appoints an additional six members of the PIMCC Governing Board. The Governing Board is responsible for the management of PIMCC, as outlined in the PIMCC Bylaws.
PIMCC Service Providers
Most PIMCC services will be provided by Ruth Moraski of Cost Management Plus (CMP). CMP was created to provide services to PIMCC. Ruth has extensive experience in insurance and claims management. Ruth Moraski, CPCU, AU, ARM is President of The Zigmund Company, Ltd., an insurance consulting and management firm based in Harrisburg. The primary business of the firm has been assisting governments with their insurance needs. Ruth can be reached at Cost Management Plus, 2319 Walnut Street, Harrisburg, PA 17103, (717) 232-7551, fax (717) 232-7552.
CCAP provides management services to PIMCC, including accounting, invoicing, marketing assistance, board liaison and other services. Patty Ensminger, is the contact at CCAP Insurance Programs, PO Box 60769, Harrisburg, PA 17106-0769, (800) 895-9039, fax (717) 526-1020.
PIMCC's Medical Advisor is Dr. Thomas Burke of Williamsport, PA and will be available for advice and communication with sick line physicians and nurses.
PIMCC has chosen Diamond Pharmacy to service PIMCC members' through a group drug buying program.
Staff Contact Information
For more information contact Patty Ensminger, CCAP Insurance Programs at (800) 895-9039.