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24-1127 Follow These Guidelines for CCHCS Patient-Inmate Service Delivery

Date: 10/23/24

Adherence to the guidelines is outlined in your PPA

Physicians and other providers contracting with the Prison Health Care Provider Network (PHCPN) must follow guidelines established by California Correctional Health Care Services (CCHCS) when treating California Department of Corrections and Rehabilitation (CDCR) patient-inmates. The guidelines listed below are requirements according to the Provider Participation Agreement (PPA).

Service delivery obligations

The following service delivery obligations apply.

  • Clinical documentation

Physicians and other providers shall provide all clinical documentation in a legible format to CCHCS, including but not limited to prescriptions, clinical notes, laboratory test results, discharge summaries, and brief operative notes sufficient to support continuity of care within the institution, and any other required reports within 48 hours of the patient’s visit. Providers who fail to provide clinical documentation by the stated timeframe may be subject to delay in payment or denial, until documentation is received.

  • Discharge summaries

Physicians and other providers performing hospital services shall issue a written discharge summary or transfer summary, upon hospital discharge of a CDCR patient, back to the appropriate CDCR institution or Reentry Programs (REPS) facility.

Physicians and other providers shall, in all cases, give the institution chief executive officer (CEO)/chief medical officer (CMO) or their designee a full, dictated or written formal discharge summary within three days of the discharge of a CDCR patient or REPS patient.

The discharge summary and/or transfer summary shall include the staff physician's recommendations for continuance of care for the CDCR patient or REPS patient. The summary should note medications, treatment and diet orders, along with instructions to the CDCR patient or REPS patient. The discharge or transfer summary shall precede or accompany the CDCR patient or REPS patient upon discharge and shall include the following essential information:

  • Diagnosis
  • Dietary requirements
  • Imaging studies ordered
  • Known allergies
  •  Lab tests ordered
  • Medications
  • Need for follow-up appointments
  • Recommendations for activities
  • Referrals for additional care
  • Rehabilitation potential
  • Wound care required

The treatment plan shall be signed by a physician in all cases. CCHCS may request for hospital physicians and other providers to use a standardized discharge summary form created by CCHCS. If lab or other test results are still pending when a discharge summary is issued, physicians and other providers shall provide an updated report within 24 hours of receipt of such lab or test results. Upon request, network hospitals shall grant CCHCS clinical employees access to hospital medical records systems, if feasible.

  • Medical imaging services
  1. Off-site medical imaging services:
    • Network providers who perform imaging services must issue a final, signed interpretive report within two business days.
    • Physicians and other providers who fail to provide documentation by the stated timeframe may be subject to delay in payment or denial, until documentation is received.
  2. Off-site radiology services:
    • The radiologist shall have the ability to fax, electronic transmit and/or email (encrypted) an interpretive report to the requesting CDCR institution’s radiology department and the imaging records center upon approval of the radiologist within two business days of receipt of exam(s), Monday through Friday.
    • Reports shall also be available via a portal provided by the radiology group for other off-site/on-site medical providers of CCHCS to review exam results within two business days of approval by the radiologist, Monday through Friday.
    • They shall follow the state’s policy and procedures for urgent and discrepancy finding notification of interpretation
  • Telemedicine services

Physicians and other providers must submit required dictated consultation reports to the institution within three business days. The dictated consultation reports shall be submitted electronically in PDF (preferred), JPEG, or TIFF format. Physicians and other providers shall use Medweb® or its successor to submit the dictated consultation report. Submitted dictated consultation reports must be final reports reviewed and approved by the licensed provider. Submitted dictated consultation reports must include the following:

  • The physician or other provider’s medical specialty. 
  • Full CDCR patient identification including CDCR.
  • Number and birth date identification including CDCR number and birth date. 
  • Dictated consultation reports must be signed and dated by the physician or other provider, either by hand or electronically. 
  • Provided services are considered incomplete until this report is submitted. 

Additional information

If you have questions regarding the information contained in this update, contact the PHCPN Provider Services Center by email, or by phone at 877-899-0561.

 

This information applies to Physicians, Hospitals, and Ancillary Providers.



Last Updated: 10/15/2024