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.

Medical necessity, or a “serious medical need” is defined as a valid health condition that, without timely medical intervention, will cause (1) excessive pain not controlled by medication, (2) measurable deterioration in function (including organ function), (3) death, or (4) substantial risk to the public health.

The U.S. Marshals Service subscribes to the following five rubrics for medical necessity decision-making:

1. The intervention must be intended to be used for a medical condition.
2. The peer-reviewed published evidence should demonstrate that the intervention can be expected to produce its intended effects on health outcomes.
3. There is no other intervention that produces comparable or superior results in a more cost-effective manner.
4. The intervention’s expected beneficial effects on health outcomes should outweigh its expected harmful effects.
5. While nurses working in a utilization management program can approve care, only a physician should recommend alternative treatments or deny care.

The USMS has authority (upon the recommendation of a competent medical authority or physician) to acquire and pay for reasonable and medically necessary care (to include emergency medical care) to ensure the well-being of all USMS prisoners. It is, however, NOT the policy of the USMS to provide either elective or preventative medical care. Necessary emergency medical care should be provided to all USMS prisoners immediately.

Prisoners in the custody of the USMS are usually in USMS custody for a short period of time (less than 1 year) during their pretrial and trial phase. Many medically appropriate, non-emergency procedures can and should be delayed until after the prisoner’s judicial status is resolved, as long as there is no significant health risk to the prisoner, Treatment of pre-existing conditions which are not life-threatening or medically necessary should be delayed until after the prisoner’s judicial status is resolved.

The purposes of these standards are to 1) define reasonable and medically necessary care for prisoner in custody of the USMS, 2) to define those prisoner medical conditions that require treatment, 3) to enumerate the specific elective or preventative medical interventions and procedures that are not routinely authorized for payment by the USMS unless otherwise ordered by the court. Justification for exceptions to these standards should be reviewed and approved by OIMS. These standards will be reviewed annually and updated as needed.

These standards refer to health care services and products which are to be charged to the USMS, and/or which require a prisoner in USMS custody to make visits anywhere outside of the facility to which he/she is confined. Services and products provided to USMS prisoners within correctional facilities and at no cost to the USMS are not prohibited.

Section I of these standards defines reasonable and medically necessary care. Section II defines conditions requiring treatment. Section III lists the medical interventions, procedures, medications, and medical devices that are not routinely authorized for payment by the USMS.

The medical interventions, procedures, medications and medical devices that are listed in Section III of this brochure are NOT routinely authorized for payment by the USMS unless ordered by the Court.