Initial Designation Process: Medical Health Care Levels I-IV

COVID-19 in prisons

Current COVID-19 Daily Tracking The Spread by The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU)

In most prisons and jails, 6′ of separation is practically not viable.

A State-by-State Look at Coronavirus in Prisons: The Marshall Project is collecting data on COVID-19 infections in state and federal prisons. See how the virus has affected correctional facilities where you live.

Medical Health Mental Health

Before any initial designation decision is made, DSCC staff assess a provisional BOP CARE LEVEL from I–IV for each inmate. BOP institutions also have a care level assignment that reflects the medical care resources available at that facility.

The Designation and Sentencing Computation Center (DSCC) designates those inmates with Medical (and Mental Healthcare), CARE LEVEL I and II.

For those inmates with Medical (and Mental Healthcare), Care Levels III and IV, the designation decision will be made by The Office of Medical Determinations and Transportation (OMDT).

Medical Health Care Level I
  • Inmates are generally healthy but may have limited medical needs that can be easily managed by clinician evaluations every 6 mos.
  • Inmates are less than 70 years of age.
  • Examples: mild asthma or diet-controlled diabetes not requiring medications.
  • Community Hospital Medical centers may be located over one hour away.
Medical Health Care Level II (the majority of BOP facilities)
  • Inmates are stable outpatients who require at least quarterly clinician evaluations.
  • It can be managed in chronic care clinics, including mental health issues.
  • Examples: medication-controlled diabetes, epilepsy, emphysema.
  • Hospital Medical centers may be located within one hour of the facility.
Medical Health Care Level III
  • Inmates are fragile outpatients who require frequent clinical contacts to prevent hospitalization.
  • May require some assistance with activities of daily living (page 2), but do not need daily nursing care.
  • Examples: cancer in remission less than 1 year, advanced HIV disease, severe mental illness in remission on medication, severe congestive heart failure, end-stage liver disease.
  • The designation is done by BOP’s Office of Medical Determinations and Transportation (OMDT).
Medical Health Care Level IV
  • Functioning is severely impaired.
  • Cannot perform Activities of Daily Living (ADL), such as caring for oneself, performing manual tasks, eating, sleeping, walking, standing, sitting, reaching, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, bathing, and cleaning oneself.
  • Requires 24-hour skilled nursing care or nursing assistance.
  • Examples: cancer on active treatment, dialysis, quadriplegia, stroke or head injury patients, major surgical patients, acute psychiatric illness requiring inpatient treatment, and high-risk pregnancy.
  • The designation is done by BOP’s OMDT.
  • There are seven Federal Medical Centers
    • FMC Butner (North Carolina); the cancer center for the BOP, provides inpatient medical/surgery and mental healthcare and sex offender treatment programs, along with housing all security levels.
    • FMC Carswell (Texas); the only facility just for women.
    • FMC Devens (Massachusetts); provides dialysis, one of several facilities that provide a residential sex offender program, along with inpatient mental healthcare.
    • FMC Forth Worth (Texas)
    • FMC Lexington (Kentucky); for lower security.
    • FMC Rochester (Minnesota); contracted with the Mayo Clinic providing all levels of complex medical care along with inpatient mental healthcare.
    • FMC, Springfield (Missouri); higher security, dialysis, and inpatient mental healthcare.

BOP 12 National Psychology Programs

Medication availability (~ 3000 different drugs), falls into 3 tiers;

  • Available- On Formulary (Which are they?)
  • Non-Formulary; Requires a lengthy Preauthorization Process. Which are they? How do you ensure their availability for your client upon their admission starting on day 1?
  • Just not available; what similar (equivalent) substitutions need to be requested? (What do you do here?)