Prisoner Health Care Standards
It is the policy of the U.S. Marshals
Service (USMS) to ensure that all U.S. Marshals Service prisoners
receive medically necessary health care while at the same time ensuring
that federal funds are not expended for unnecessary or unauthorized
health care services.
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
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.