Page 25

Pennsylvania Keystones of Health Section 1115 Demonstration Approval Period: December 26, 2024 through December 31, 2029 Page 12 of 90 5.3. Qualifying Criteria for Pre-Release Services. To qualify to receive services under this component of the demonstration, an individual must meet the following qualifying criteria: a. Meet the definition of an inmate of a public institution, as specified in 42 CFR 435.1010, and be incarcerated in a correctional facility specified in STC 5.1; and b. Have been determined eligible for Medicaid; c. Have an expected release date within 90 days; d. Be age 19 or older; e. Meet one or more of the health-related criteria, described below and further defined in Attachment I; i. Have one or more substance use disorders; ii. Have a serious mental illness; iii. Eligible for Medicaid funded 1915(c) home and community-based services administered by the Office of Long Term Living or Office of Developmental Programs upon release; iv. Have one or more chronic health conditions; v. Are pregnant or in the 12-month postpartum period; vi. Have Autism Spectrum Disorder (ASD). 5.4. Scope of Pre-Release Services. The pre-release services authorized under the reentry demonstration initiative include the following services, which are described in Attachment H, Reentry Demonstration Initiative Services. a. The covered pre-release services are: i. Case management to assess and address physical and behavioral health needs, and health-related social needs; ii. MAT for all types of SUDs as clinically appropriate, including coverage for medications in combination with counseling/behavioral therapies; b. The state must also provide a 30-day supply of all prescription medications and over-the-counter drugs (as clinically appropriate), provided to the individual immediately upon release from the correctional facility, consistent with approved Medicaid or CHIP state plan coverage authority and policy. c. The expenditure authority for pre-release services through this initiative constitutes a limited exception to the federal claiming prohibition for medical assistance furnished to inmates of a public institution at clause (A) following section 1905(a) of the Act (“inmate exclusion rule”). Benefits and services for inmates of a public institution that are not approved in the reentry demonstration initiative as described in these