Access to Care

Idaho
Department
of Correction Standard
Operating
Procedure
Title:
Access to Care

1 of 7

401.001
Version:
6
Adopted:
11/08/1998

Kim Brown, Chief of the Division of Management Services, approved this
document and it was published on 08/24/2026.
Open to the public: Yes No
SCOPE
This standard operating procedure (SOP) applies to all Idaho Department of
Correction (IDOC) staff, residents, and contract medical providers.
Version Summary
Version 6: This SOP renumbers previous SOP 401.06.03.001 v5.0, Access to Care.
This version updates terminology, responsibilities for the contract medical provider,
and oversight requirements.
TABLE OF CONTENTS
Scope ....................................................................................................... 1
Table of Contents ........................................................................................ 1
A. Statutory Authority .............................................................................. 2
B. Board of Correction IDAPA Rule ............................................................. 2
C. Governing Policy Statement .................................................................. 2
D. Purpose ............................................................................................. 2
E. Responsibility ..................................................................................... 2
F. Definitions.......................................................................................... 4
G. Standard Procedures ............................................................................ 4
1. Introduction .................................................................................... 4
2. Eliminating Barriers to Healthcare Services ........................................... 5
3. Providing Healthcare Services ............................................................. 5
4. Resident Concerns ............................................................................ 6
5. Compliance ..................................................................................... 6
H. References ......................................................................................... 7

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Access to Care

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A. STATUTORY AUTHORITY
1. Idaho Code § 20-217A, Appointment of Director – Salary – Powers and Duties
2. Idaho Code § 20-244, Government and Discipline of the Correctional Facility –
Rules and Regulations
B. BOARD OF CORRECTION IDAPA RULE
06.01.01.401, Medical Care
C. GOVERNING POLICY STATEMENT
1. It is the policy of IDOC and its contractors to provide proper medical, dental,
psychiatric, and psychological services and treatment to residents. All health
care must be provided in accordance with the National Commission on
Correctional Health Care (NCCHC) Standards for Health Services in Prisons.
2. Nothing in this SOP overrides or relieves contract medical providers of any
obligation or responsibility stipulated in their respective contractual
agreements.
D. PURPOSE
To establish a program ensuring residents have unimpeded and timely access to
healthcare services to meet their medical, dental, and mental health needs, when
in a qualified healthcare professional’s clinical judgment, it is appropriate to do so.
E. RESPONSIBILITY
1. Health Services Director
a. Monitor and oversee all aspects of healthcare services.
b. Review and approve (prior to implementation) all applicable contract
medical provider policies, procedures, and forms.
c. Monitor the contract medical provider’s performance to ensure compliance
with all healthcare-related requirements provided in respective contractual
agreements, this SOP, and NCCHC standard P-A-01.
2. Medical Contract Monitor Team
a. Support the health services director in monitoring compliance with this SOP
by contract medical staff.
3. Contract Medical Provider
a. Implement and practice all provisions of this SOP unless specifically
exempted by written contractual agreements.
b. Ensure all aspects of this SOP and NCCHC standard P-A-01 are addressed by
applicable contract medical provider policies and procedures and are enacted
by facility health services administrators.
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c. Submit all applicable contract medical provider policies, procedures, and
forms to the health services director, or designee, for review and approval
prior to implementation.
4. Statewide Health Services Administrator
a. Ensure an adequate number of appropriately trained staff and materials are
available to meet the requirements of this SOP.
b. Establish and monitor applicable contract medical provider policies and
procedures to ensure implementation of this SOP and NCCHC standard P-A-
01.
c. Establish formal relationships with community hospitals, specialists, and
others as needed.
d. Establish and monitor contract medical provider and IDOC procedures to
ensure residents receive care that is ordered by qualified health
professionals.
e. Establish procedures to ensure the medical co-pay program is administered
pursuant to SOP 411.06.03.001, Co-Pay for Medical Services.
5. Facility Health Services Administrator
a. Ensure the presence of an adequate number of appropriately trained staff
and materials to meet the requirements of this SOP.
b. Report any identified gaps in healthcare services to the statewide health
services administrator.
c. Enforce applicable contract medical provider policies and procedures to
ensure that all elements of this SOP and NCCHC standard P-A-01 are met.
d. Develop relationships with community hospitals, specialists, and others as
needed.
e. Support procedures to ensure residents receive care that is ordered by
qualified health professionals and share information regarding this care with
both statewide health services administrator and IDOC health services staff.
6. Qualified Health Professional
a. Provide information to residents detailing how specific healthcare services
are requested.
b. Perform a preliminary health screening, appropriate to the gender of the
resident, for all new residents at the Receiving and Diagnostic Unit (RDU).
c. Schedule timely appointments with the appropriate practitioner when a
medical or mental health need requires evaluation and/or intervention.
d. Provide timely and adequate healthcare services per referral from qualified
health professionals.
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e. Respond to healthcare needs in a timely, professional manner.
f. Document all clinical contacts in the resident’s electronic medical record
(EMR).
F. DEFINITIONS
1. Contract Medical Provider: A private company or other entity that is under
contract with the department to provide comprehensive medical, dental,
and/or mental health services to IDOC’s incarcerated resident population.
2. Facility Health Services Administrator: The contract medical provider
employee who is primarily responsible for overseeing the delivery of
contracted medical and behavioral health services in an IDOC correctional
facility.
3. Health Services Director: The IDOC employee primarily responsible for
oversight of auditing and monitoring services provided by the contract
medical provider.
4. Mental Health Professional: A person who has specialized training and
skills in the nature and treatment of mental illness to include, but not limited
to, a psychologist, psychiatrist, clinical social worker, or clinician who – by
virtue of education, credentials, and experience – is permitted by law to
evaluate and care for patients.
5. Qualified Health Professional: A physician, physician assistant, nurse
practitioner, nurse, dentist, mental health professional, or other health
professional who — by virtue of education, training, credentials, and
experience — is permitted by law (within the scope of his professional
practice) to educate, train, evaluate, provide services, and care for patients.
6. Resident: A person who has been convicted of a crime against the laws of
the state and ordered into the care and custody of the Board of Correction.
Resident includes any use in Idaho law, Board of Correction rule, or IDOC
policy or procedure of the terms “offender(s),” “prisoner(s)”, “inmate(s)”,
“incarcerated person(s)”, or any other term referring to a person residing in a
correctional facility in the care and custody of the Board of Correction.
7. Statewide Health Services Administrator: The contract staff member
who is primarily responsible for oversight of the IDOC medical and
behavioral health services contract at a statewide level.
G. STANDARD PROCEDURES
1. Introduction
a. Health care provided to residents during incarceration focuses on
maintenance of residents’ health and prevention. All routine and emergent
healthcare services depend on sufficient access to care.
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2. Eliminating Barriers to Healthcare Services
a. Each health services administrator, or designee, will ensure that procedures
are in place to identify and eliminate unreasonable barriers to residents’
access to healthcare services. Examples of unreasonable barriers include,
but are not limited to, the following:
i. Punishing residents for seeking care for their health needs.
ii. Assessing excessive co-payments that prevent or deter residents from
seeking care for their serious health need. Reasonable resident co-
payments are defined in SOP 411.06.03.001, Co-Pay for Medical
Services.
iii. Deterring residents from seeking care for their health needs, such as
holding a sick call at 2:00 a.m., when this practice is not reasonably
related to the needs of the facility.
iv. Delaying necessary healthcare services, on-site or off-site, due to
contract medical provider understaffing, or the cost of medical care
(including but not limited to medications, comprehensive workups,
specialist recommendations).
v. Using a utilization management process that unreasonably denies or
delays care.
vi. Having inadequate access to specialists and radiology test/procedures.
b. Healthcare services will not be denied or delayed based on a resident’s
inability to pay
3. Providing Healthcare Services
a. Within 24 hours of a resident’s arrival to IDOC custody at an IDOC facility,
the resident must receive written and verbal instructions regarding access to
healthcare services. Written information must be made available in both
English and Spanish. If a resident does not speak English, a written
interpretation or telephone interpretation service must be provided in the
language spoken.
b. The contract medical provider must complete a prison medical history and
screening form for each resident upon arrival into the correctional setting in
accordance with SOP 301.001, Reception and Diagnostic Unit.
c. Information about how specific healthcare services are obtained by a
resident during incarceration must be reviewed with the resident in the
following situations:
i. At the time of medical history and screening.
ii. Whenever a resident receives a particular service for the first time.
iii. On any other occasion when a resident displays a lack of understanding
about how healthcare services are obtained.
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d. The contract medical provider must complete a physical assessment form for
each resident and repeat the assessment as required by a qualified health
professional in consideration of the resident’s age, gender, and health
needs.
e. The statewide health services administrator, or designee, must establish and
monitor procedures to ensure residents have access to qualified health
professionals. Procedures must include clinical aspects; monitoring
appropriateness, timeliness, and responsiveness of care; treatment; and
review of recommendations for treatment made by healthcare providers.
f. Healthcare service request forms must be available in paper form to
residents in all housing units. Electronic request forms can also be used.
g. Resident requests for healthcare services must be reviewed daily and the
appropriate disposition made and noted in the EMR.
h. Changes in the contract medical provider procedures for obtaining
healthcare services must be posted in each housing unit no fewer than
seven calendar days prior to implementation of the change.
i. Non-healthcare services staff are not allowed to approve or deny requests
for health care made by a resident. Non-healthcare services staff must
forward requests for health care to contract medical provider healthcare
services staff at the facility for review and action if necessary.
j. Upon identification of any medical or mental health need requiring
evaluation and/or intervention by a physician, mid-level provider, dentist, or
mental health professional, arrangements must be made to provide timely
examination, assessment, and/or treatment by scheduling an appointment
with the appropriate practitioner following their protocols for care.
4. Resident Concerns
Residents who feel they have not been provided access to care have the right to
file a concern, which must be done by completing an IDOC Resident Concern
Form and submitting it to the proper authority for resolution (see SOP 316.001,
Grievance and Informal Resolution Procedure for Residents).
5. Compliance
a. Compliance with this SOP and all related protocols will be monitored by the
health services director or designee and the IDOC medical contract monitor
team.
b. Each facility will be assigned a IDOC lead medical contract monitor. The
monitors must conduct audits, site visits, and IDOC resident advocacy as
requested by the health services director.
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c. The health services director, or designee, must conduct at least two audits
per year, per facility. The audits will assess the contract medical provider’s
performance using established IDOC criteria, IDOC policy and procedures,
applicable NCCHC standards, and all applicable serious incident reviews.
H. REFERENCES
1. Forms
a. All standard healthcare forms used to carry out this SOP can be found in the
EMR system or from the contract medical provider.
2. Cited Documents
a. National Commission on Correctional Health Care (NCCHC), Standards for
Health Services in Prisons, Standard P-A-01, Access to Care
b. SOP 301.001, Reception and Diagnostic Unit
c. SOP 316.001, Grievance and Informal Resolution Procedure for Residents
d. SOP 411.06.03.001, Co-Pay for Medical Services
– End of Document –