Healthcare for Offenders Housed in Non-Idaho Department of Correction Facilities

Idaho
Department of
Correction

Standard
Operating
Procedure

Division of
Education
and
Treatment

Operational
Services
Control Number:
401.06.03.087
Version:
2.1
Page Number:
1 of 7
Adopted:
3-1-2001
Reviewed:
9-26-2008

Title:
Healthcare for Offenders Housed in Non-
Idaho Department of Correction Facilities

This document was approved by Dr. Mary Perrien, chief of the Division of
Education and Treatment, on 9/26/08 (signature on file).
BOARD OF CORRECTION IDAPA RULE NUMBER 401
Medical Care
POLICY STATEMENT NUMBER 401
Hospitalization, Institutional Clinical Services, and Treatment
POLICY DOCUMENT NUMBER 401
Hospitalization, Institutional Clinical Services, and Treatment
DEFINITIONS
Standardized Definitions List
Contract Medical Provider: A private company under contract with the Department to
provide comprehensive medical, dental, and/or mental health services to the incarcerated
offender population. A contract medical provider may include private prison companies and
other entities under contract with the Department to operate the Idaho Correctional Center
(ICC) and other out-of-state facilities housing Department offenders.
Health Authority: The Department employee who is primarily responsible for overseeing or
managing the Department’s medical and mental health services. The health authority is
commonly referred to as the health services director.
PURPOSE
The purpose of this standard operating procedure (SOP) is to establish a program to ensure
that offenders who are assigned to Non-Idaho Department of Correction (Non-IDOC)
facilities have unimpeded access to healthcare services.
SCOPE
This SOP applies to all IDOC healthcare services staff; offenders housed in out-of-state,
privately operated, and county facilities; contract medical providers and subcontractors; and
county jails.
Control Number:
401.06.03.087
Version:
2.1
Title:
Healthcare for Offenders Housed in
Non-Idaho Department of Correction
Facilities
Page Number:
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RESPONSIBILITY
Health Authority
The health authority is responsible for:
• Monitoring and overseeing all aspects of healthcare services,
• The implementation and continued practice of the provisions provided in this
SOP,
• Ensuring the appropriate quality and accessibility of all healthcare services
provided to offenders housed in Non-IDOC facilities,
• Establishing and monitoring procedures to ensure that all healthcare provided to
offenders housed in Non-IDOC facilities is consistent with healthcare provided to
offenders housed in IDOC facilities, and
• Reviewing and approving all medical authorization requests for payment (i.e.,
Appendix A, Medical Request for Payment Authorization) prior to the delivery of
the service to the offender.
When healthcare services are privatized, the health authority will also be responsible for:
• Monitoring the contract medical provider’s performance, to include but not limited
to reviewing processes, procedures, forms, and protocols employed by the
contract medical provider to ensure compliance with all healthcare-related
requirements provided in respective contractual agreements, this SOP, and in
National Commission on Correctional Health Care (NCCHC) standard P-A-01,
Access to Care.
Contract Medical Provider
When healthcare services are privatized, the contract medical provider is responsible
for:
• Implementing and practicing all provisions of this SOP, unless specifically
exempted by written contractual agreements,
• Ensuring that all healthcare services are provided within the terms of written
contractual agreements,
• Ensuring systems are in place to ensure healthcare provided to offenders housed
in Non-IDOC facilities is consistent with healthcare provided to offenders housed
in IDOC facilities, and
• Ensuring processes are conducted in accordance with NCCHC standard P-A-01,
or as indicated in their respective contractual agreement(s).
Note: Nothing in this SOP shall be construed to relieve the contract medical provider(s)
of any obligation and/or responsibility stipulated in respective contractual agreements.
Table of Contents
General Requirements ......................................................................................................... 3
1. Guidelines ...................................................................................................................... 3
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Title:
Healthcare for Offenders Housed in
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2. Criteria for Approving Requests for Healthcare Services ................................................ 3
Category 1—Medically Necessary - Acute or Emergent ........................................... 3
Category 2—Medically Necessary - Non-emergent .................................................. 4
Category 3—Medically Acceptable - Not Always Necessary ..................................... 4
Category 4—Limited Medical Value .......................................................................... 5
Non-category—Dental Conditions or Optometry Care .............................................. 5
3. Offender Concerns ......................................................................................................... 7
4. Compliance .................................................................................................................... 7
References ........................................................................................................................... 7
GENERAL REQUIREMENTS
1. Guidelines
• Offenders who are housed in Non-IDOC facilities shall receive healthcare services
consistent with services provided to offenders who are housed in IDOC facilities.
• It is anticipated that the scope of healthcare services to be provided shall be
delineated in written contractual agreements; however, in the absence of written
contractual agreements, the health authority must approve payment for all medical
services, including consultant appointments, scheduled hospitalizations, and dental
care. Failure to obtain prior approval, except in an emergency, could result in the
housing county or entity being held financially responsible. (See SOP 302.02.01.001,
Assessment and Placement of State-sentenced Offenders in County Jails.)
2. Criteria for Approving Requests for Healthcare Services
Requests for authorization of healthcare services shall be submitted using Appendix A,
Medical Request for Payment Authorization. All requests for provider visits, medications,
diagnostic tests, optometry, dental, or other healthcare service will be reviewed by the
Health Services staff (see Appendix A) using the following criteria:
Category 1—Medically Necessary - Acute or Emergent
This category includes medical conditions that are of an immediate, acute, or
emergent nature, which without care (1) would cause rapid deterioration of the offender’s
health or significant irreversible loss of function, or (2) may be life threatening.
Examples of medical conditions considered a category 1 include, but are not limited to:
• Myocardial infarction,
• Severe trauma such as head injury,
• Hemorrhage,
• Stroke,
• Status asthmaticus,
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Title:
Healthcare for Offenders Housed in
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• Precipitous labor or complications associated with pregnancy, and
• Detached retina (sudden loss of vision).
Treatments for conditions in this category are essential to sustain life or function and
warrant immediate attention.
Note: A medical condition in this category does not require approval from the health
authority prior to providing treatment; however, Appendix A, Medical Request for
Payment Authorization, must be submitted to the Health Services staff as soon as
possible but no later than 72 hours of transporting the offender to a medical facility. If the
offender is housed in a county jail, see SOP 302.02.01.001, Assessment and Placement
of State-sentenced Offenders in County Jails.
Category 2—Medically Necessary - Non-emergent
This category includes medical conditions that are not immediately life-threatening but
without care the offender could not be maintained without significant risk of serious
deterioration of health leading to premature death; significant reduction in the possibility
of repair later without treatment; or significant pain or discomfort, which impairs the
offender’s participation in daily living activities.
Examples of conditions considered a category 2 include, but are not limited to:
• Chronic conditions (e.g., diabetes, heart disease, bipolar disorder,
schizophrenia);
• Infectious disorders in which treatment allows for a return to previous state of
health or improved quality of life (e.g., HIV, tuberculosis); or
• Cancer.
Note: A medical condition in this category does require approval from the health
authority prior to providing treatment. Submit Appendix A, Medical Request for Payment
Authorization, to the Health Services staff.
Category 3—Medically Acceptable - Not Always Necessary
This category includes medical conditions that are considered “elective procedures”.
For example: Treatments that may improve the offender’s quality of life.
Other examples of “elective procedures” considered a category 3 include, but are not
limited to:
• Dental prosthetics,
• Minor surgical procedures,
• Diagnostic testing, or
• Treatment of non-cancerous skin conditions.
Note: A medical condition in this category does require approval from the health
authority prior to providing treatment. Submit Appendix A, Medical Request for Payment
Authorization, to the Health Services staff.
Control Number:
401.06.03.087
Version:
2.1
Title:
Healthcare for Offenders Housed in
Non-Idaho Department of Correction
Facilities
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Category 4—Limited Medical Value
This category includes medical conditions in which treatment provides little or no
medical value, is not likely to provide substantial long-term gain, or is expressly for
cosmetic purposes for the offender’s convenience.
Examples of conditions considered a category 4 include, but are not limited to:
Cosmetic/Acne Treatments
• Face cream, lotion, or wash of any kind;
• Acne cream, lotion, or wash of any kind; and
• Antibiotics for acne.
Supplements
• Vitamin or herbal supplements of any kind.
Nail Fungus
Insomnia
Miscellaneous
• Shoe inserts,
• Special footwear,
• Special shampoo, and
• Chiropractic care.
Dental
• Prosthetics,
• Night or occlusal guards,
• Teeth cleaning, and
• Root canals.
Note: A medical condition in this category does require approval from the health
authority prior to providing treatment; however, please be advised that only on rare
occasions will conditions in this category receive approval. Submit Appendix A, Medical
Request for Payment Authorization, to the Health Services staff. Any item or treatment in
this category that is recommended by a healthcare provider may be referred to the
health authority for review. The referral must include documentation from the licensed
medical provider stating that the item or treatment is medically necessary.
Non-category—Dental Conditions or Optometry Care
This category includes guidelines and the criteria for approving dental conditions or
optometry care that does not fit into any of the four (4) categories listed above.
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401.06.03.087
Version:
2.1
Title:
Healthcare for Offenders Housed in
Non-Idaho Department of Correction
Facilities
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Dental Conditions—Acute or Emergent
This subcategory includes dental conditions that are of an immediate, acute, or
emergent nature, which without care (1) would cause rapid deterioration of the
offender’s health or significant irreversible loss of function, or (2) may be life
threatening.
Examples of dental conditions considered acute or emergent include, but are not
limited to:
• Face / neck swelling,
• Face / neck pitting edema,
• Fractured jaw,
• Fever,
• Purulent drainage,
• Fractured tooth at gum line;
Note: A dental condition in this subcategory does not require approval from the
health authority prior to providing treatment; however, Appendix A, Medical Request
for Payment Authorization, must be submitted to the Health Services staff as soon as
possible but no later than 72 hours of transporting the offender to a dental facility. If
the offender is housed in a county jail, see SOP 302.02.01.001, Assessment and
Placement of State-sentenced Offenders in County Jails.
Dental Care—Non-acute or Non-emergent
• All other requests for dental care will be approved for extraction or filling only
and only on the one (1) tooth needing care (e.g. pain, cracked, broken, filling fell
out, etc.)
• If a licensed dental provider indicates that non-emergent, extensive dental work
is needed, include that documentation when submitting Appendix A, Medical
Request for Payment Authorization, to the health authority who may give
approval to (1) treat the offender at the county or (2) move the offender to a state
facility for further treatment.
Note: A dental condition in this subcategory does require approval from the health
authority prior to providing treatment. Submit Appendix A, Medical Request for
Payment Authorization, to the Health Services staff.
Optometry Care
• Shall consist of an optical examination at a cost not to exceed $96.00.
• Corrective eyewear, if indicated, will be approved at a cost not to exceed
$20.00.
• Optometry care may also, at the discretion of Health Services staff, be deferred
to a state facility. The offender may then pursue optical care when transferred.
Control Number:
401.06.03.087
Version:
2.1
Title:
Healthcare for Offenders Housed in
Non-Idaho Department of Correction
Facilities
Page Number:
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• If a licensed medical provider determines that an optical examination is
medically necessary, include that documentation when submitting Appendix A,
Medical Request for Payment Authorization.
Note: Optometry care does require approval from the health authority prior to
providing treatment. Submit Appendix A, Medical Request for Payment
Authorization, to the Health Services staff.
3. Offender Concerns
Offenders who feel as though they have been wrongly denied a requested healthcare
service shall have the right to file a concern, which must be done by completing an IDOC
Offender Concern Form and submitting it to the proper authority for resolution. (See SOP
316.02.01.001, Grievance and Informal Resolution Procedure for Offenders, for procedures
and the concern form.)
4. Compliance
Compliance with this SOP and all related Department-approved protocols will be monitored
by the health authority (or designee) by using various sources to include: this SOP, clinical
practice guidelines, routine reports, program reviews, and record reviews.
The health authority (or designee) must conduct two (2) audits a year (or more frequently as
desired based on prior audit results). The audits must consist of monitoring applicable
contract medical provider and IDOC policy and procedures, applicable NCCHC standards,
and the review of a minimum of 15 individual records.
REFERENCES
Appendix A, Medical Request for Payment Authorization
National Commission on Correctional Health Care (NCCHC), Standard P-A-01, Access to
Care
– End of Document –
IDAHO DEPARTMENT OF CORRECTION
Medical Request for Payment Authorization
Appendix A Page 1 of 2
401.06.03.087 v 2.1
(Appendix last updated: 9/26/08)
The purpose of the Medical Request for Payment Authorization form is to streamline the authorization/billing/payment
process and hopefully reduce the number of requests that have to be returned for clarification.
Please fill out as many of the sections on the form as possible. Failure to do so may result in your request being
returned to you to provide the missing information, which will delay authorization. Most of the form is self-explanatory.
Please note that “Inmate IDOC number” and “Responsible Licensed Medical Provider” are required fields. IDOC
Health Services staff will provide the Inmate IDOC number upon the initial request, but ask that you also make note of
the number so that you can use it for future medical requests.
Type of Service Requested: If you are only requesting medication authorization, please only check the “Medication
Request” box. If you have already requested a medical/dental/mental health visit and it has been authorized and you
only require medications, you do not need to check the “visit” box again. Checking only one (1) box will help IDOC
Health Services staff determine what is actually being requested, which will help them reduce the number of
payments being denied due to the lack of clarity or lack of information. However, you may request more than one (1)
service on the same form.
Details of Current Illness/Injury: Please briefly state the reason for the service being requested. If you are only
requesting medications, skip this section.
Treatment Plan: List treatment recommendation (e.g., needs glasses, medical visit, x-ray, etc.). If you are only
requesting medications, skip this section.
List Medications Requested: If you are only requesting medications you will need to complete this section of the
form. IDOC Health Services staff are now requiring more information when you are requesting medications. You will
only need to request authorization for a medication one (1) time (provided the offender is still housed in the county jail
and has not left and come back). However, there will be exceptions — for example, antibiotics will not have an
unlimited authorization.
Note: Prompt, accurate documentation of the form enables the IDOC Health Services staff to efficiently process all
bills submitted by the county and in turn ensure prompt payment. When submitting bills, please specify whether
the county or the vendor is to receive payment.

IDOC Health Services Staff Contact Information
Phone: [phone] Fax: [phone]
Technical Records Specialist II
Vicky Brady
Phone: [phone]
E-mail: [e-mail]
Fax: [phone]

If you have any billing questions or concerns, please contact Vicky.

Health Authority (Health Services Director)
Rona Siegert, RN
Phone: [phone]
E-mail: [e-mail]
Fax: [phone]

Registered Nurse (Virtual Prisons Program)
Zarah Martin, RN
Phone: [phone]
E-mail: [e-mail]
Fax: [phone]

If you have any medical/dental questions or concerns, please contact Rona or Zarah.

Mailing Address:
Idaho Department of Correction
Attn: Health Services
1299 N. Orchard, Suite 110
Boise, Idaho 83706
IDAHO DEPARTMENT OF CORRECTION
Medical Request for Payment Authorization
Appendix A Page 2 of 2
401.06.03.087 v 2.1
(Appendix last updated: 9/26/08)
County: Date: Phone #:
Requesting Attendant: Fax #: (Deputy, Nurse, etc.)
*************************************************************************************************************
Inmate: Inmate IDOC #:
Date of Birth: Date Patient Seen:
Responsible Licensed Medical Provider:

List Medications Required
Medication Strength Days Prescribed Diagnosis (Required)

*************************************************************************************************************
IDOC Health Services Response
Approved Deferred Denied Need More Information
Reason for Deferral or Denial:
Comments:

Authorized Signature Title
Date of Authorization / /

IDOC Health Services Phone: [phone] Fax: [phone]
Type of Service Requested
Check all that apply
□ Medical Visit
□ Medical Request
□ Dental
□ Optical
□ Mental Health Visit
□ Lab
□ X-ray
□ ER with Ambulance
□ ER w/o Ambulance

Details of Current Illness/Injury

Treatment Plan