Compliance and Regulations
Compliance with InterQual Guidelines
Participating providers must comply with InterQual guidelines. California Correctional Health Care Services (CCHCS) may conduct an inspection and evaluation of participating provider's offices to determine compliance with InterQual guidelines, scheduling requirements and medical treatments. CCHCS has the right not to use participating providers if they are found to be non-compliant with CCHCS requirements. CCHCS does not pay for services performed by participating providers which are deemed unacceptable.
To protect the public from the spread of infectious, contagious and communicable disease, every health care provider knowing of or in attendance on a case or suspected case of any of the communicable diseases and conditions specified in Title 17, California Code of Regulations (CCR), Section 2500 and 2505, are required by law to notify the local health department (LHD) and/or the California Department of Public Health. A health care provider having knowledge of a case of an unusual disease not listed must also promptly report the facts to the local health officer.
Results must also be communicated to the institution Chief Executive Officer/Chief Support Executive (CEO/CSE) or Physician and Surgeon (P&S), or the Department of Juvenile Justice (DJJ) Chief Medical Officer (CMO) within two business days, or as required by disease or condition.
The term "health care provider" includes physicians and surgeons, veterinarians, podiatrists, nurse practitioners, physician assistants, registered nurses, nurse midwives, school nurses, infection control practitioners, medical examiners, coroners, and dentists.
Reports of cases of communicable diseases must be made using the Confidential Morbidity Report.
The notification must include the following, if known:
- Name of the disease or condition being reported
- The date of onset
- The date of diagnosis
- The patient name, race or ethnic group, Social Security number (SSN), age, gender, and date of birth for the case or suspected case
- The date of death, if death has occurred
- The name, address and telephone number of the person making the report
HIV is a reportable disease under California state law. Health care providers are required by law to submit specified information using the complete name of the patient for each confirmed HIV test to the local health officer within seven calendar days.
Providers must complete an HIV case report for each confirmed HIV test not previously reported and send it to the local health officer for the jurisdiction where the health care provider facility is located.
Providers must report confirmed HIV cases by either one of the following:
- Courier service, U.S. Postal Service Express or registered mail or other traceable mail
- Person-to-person transfer with the local health officer or his or her designee
Providers may not submit reports containing personal information by electronic fax, electronic mail or non-traceable mail.
A confirmed HIV test is a test used to monitor HIV, including HIV nucleic acid detection (such as viral load), or any test verifying one of the following:
- The presence of HIV
- A component of HIV
- Antibodies to, or antigens of, HIV, including:
- HIV antibody (HIV-Ab) test
- HIV p-24 antigen test
- Western (Wb) blot test
- Immunofluorescence antibody test
A health care provider that orders a laboratory test used to identify HIV, a component of HIV, or antibodies to or antigens of HIV must submit to the laboratory a pre-printed laboratory requisition form that includes all documentation specified in 42 CFR 493.1105 (57 FR 7162, Feb. 28, 1992, as amended at 58 FR 5229, Jan. 19, 1993) and adopted in Business and Professions Code, Section 1220.
The person authorized to order the laboratory test must include the following when submitting information to the laboratory:
- Complete name of patient
- Patient date-of-birth (2-digit month, 2-digit day, 4-digit year)
- Patient gender (male, female, transgender male-to-female or transgender female-to-male)
- Date biological specimen was collected
- Name, address and telephone number of the health care provider and the facility where services were rendered, if different
Most laboratories are also required to report confirmed tests to the local health office; however, this does not relieve the provider's reporting responsibility. Laboratories may not submit reports to the local health department for confirmed HIV tests for patients at alternative testing sites other anonymous HIV testing programs, blood banks, plasma centers, or for participants of a blinded or unlinked seroprevalence study.
Tuberculosis (TB) reporting is done immediately by telephone or fax to expedite the process. The Confidential Morbidity Report form should be used. When reporting a case of TB, the health care provider must provide information on the diagnostic status of the case or suspected case; bacteriological, radiological and tuberculin skin test findings; information regarding the risk of transmission of the disease to other persons; and a list of the anti-tuberculosis medications administered to the patient. In addition, a report must be made any time a patient ceases treatment for TB. Further, the local health officer may require additional reports from the health care provider.
The health care provider who treats a patient with active TB must maintain written documentation of the patient's adherence to his or her individual treatment plan. Reports to the local health officer must include the individual treatment plan, which indicates the name of the medical provider who specifically agreed to provide medical care, the address of the patient, and any other pertinent clinical or laboratory information that the local health officer may require.
In addition, each health care provider who treats a patient for active TB must examine or arrange for examination of all persons who have had contact with the patient. The health care provider must refer those contacts to the local health officer for examination, and must promptly notify the local health officer of the referral. The local health officer may impose further requirements for examinations or reporting.
Prior to discharge from an inpatient hospital, health care providers must report any cases of known or suspected TB to the local health officer and receive approval for discharge. The local health officer must review and approve the individual treatment plan prior to discharge.