Prisoner Health Care Standards

I. Reasonable and Medically Necessary Care

II. Conditions Requiring Treatment

III. Non-authorized Medical Interventions/ Procedures

IV. Appeals/Denials Process

The prisoner health care standards described in these web pages provide U.S. Marshals guidance. They are not intended to, do not, and may not be relied upon to create any rights, substantive or procedural, enforceable at law by any party or person in any matter civil or criminal. Nor are any limitations hereby placed on otherwise lawful prisoner care prerogatives of the U.S. Marshals Service.

IV. APPEALS/DENIALS PROCESS

Nothing in the USMS Prisoner Health Care Appeals Procedure is intended to create or does create an enforceable legal right or private right of action.

A. APPEALS

The USMS reviews requests for health care services and supplies to ensure that prisoners in the custody of the USMS are provided basic minimum health care. The USMS Prisoner Healthcare Standards are used as the guideline for making health care recommendations to the districts. When a requested medical service is not in accordance with the standards, it will be referred to OIMS for review and determination.

Appeals for denial of a requested prisoner health care service that are based on OIMS interpretation of USMS medical policy may be initiated by:

• the prisoner;
• a medical provider, or a legally appointed advocate (defense attorney, legal guardian) in writing to the USMS

The appeal should state why there should be an exception to USMS medical policy (e.g. not in agreement with the policy or extenuating circumstances exist to form an exception). The USMS will review and recommend a resolution.

The USMS shall forward the recommendation and supporting medical records for review by the USMS Medical Appeals Board. After reviewing the request and records, the USMS Medical Appeals Board will either:

• uphold the decision of denial; overturn and approve the request; or
• seek further information or a second opinion from a consultant.

B. DENIALS

All denials of payment for prisoner health care services will be reviewed by the OIMS physician consultant. The following denials of payment may be recommended by the medical case coordinators without review by the OIMS physician consultant:

• The prisoner is not in the custody of the USMS;
• The requested services are not a covered benefit.

All other denials of payment will be reviewed for concurrence by the physician consultant.

Upon final review of all provided documentation, a written recommendation will be forwarded to the USMS. All communication will include an explanation for the recommendation.

C. USMS APPEALS BOARD

The USMS Medical Appeals Board shall meet to review appeals submitted to OIMS. The Board will consist of:

• one representative from the USMS Office of General Counsel (OGC);
• one health care professional representative from OIMS;
• one health care specialist in the relevant field;
• one representative from the Investigations and Detentions Branch.

The health care representative will not be the physician consultant nor the individual who initially reviewed the case.