Initial Designation Process: Medical Health Care Levels I-IV

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

The Designation and Sentencing Computation Center (DSCC) designates those inmates with Medical (and Mental Healthcare), Care Levels 1 and 2.

For those inmates with Medical (and Mental Healthcare), Care Levels 3 and 4, 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.

Medical Health Care Level II (the majority of BOP facilities)

  • Inmates are stable outpatients who require at least quarterly clinician evaluations.
  • Can be managed in chronic care clinics, including for mental health issues.
  • Examples: medication-controlled diabetes, epilepsy, emphysema.

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, 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.
  • Designation is done by BOP’s Office of Medical Determinations and Transportation (OMDT).

Medical Health Care Level IV

  • Functioning is severely impaired.
  • 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, high-risk pregnancy.
  • Designation is done by BOP’s OMDT.