(a) The Department shall only provide patients with the health care services that are medically necessary. Such services may be subject to approval or disapproval by the licensed medical, mental health or dental care supervisors, or one or more of the following committees including subcommittees thereof: (1) Institutional Utilization Management (UM) Committee.(2) Headquarters UM Committee.(3) Statewide Medical Authorization Review Team.(4) Dental Authorization Review Committee.(5) Dental Program Health Care Review Committee.(b) Treatment refers to attempted curative health care services and does not preclude palliative therapies to alleviate serious debilitating conditions such as pain management and nutritional support. The following shall not be provided: (1) Treatment for conditions that improve on their own without treatment.(2) Treatment for conditions that are judged to inadequately respond to treatment including, but not limited to, the following: (A) Temporomandibular joint dysfunction.(B) Shrinkage and atrophy of the bony ridges of the jaws.(C) Benign root fragments whose removal would cause greater damage or trauma than if retained for observation.(E) Traumatic oral ulcers.(F) Recurrent aphthous ulcers.(3) Treatment for conditions that are cosmetic.(4) Surgery that is not medically necessary including, but not limited to, the following: (C) Extractions of asymptomatic teeth or root fragments unless required for a dental prosthesis, or for the general health of the patient's mouth.(D) Removal of a benign bony enlargement (torus) unless required for a dental prosthesis.(E) Surgical extraction of asymptomatic un-erupted teeth.(5) Treatment that has no established outcome on morbidity or improved mortality for acute health care conditions including, but not limited to, the following:(A) Root canals on posterior teeth (bicuspids and molars).(C) Fixed prosthodontics (dental bridges).(D) Laboratory processed crowns.(c) Treatment for those conditions that are excluded within these regulations may be provided in cases where the following criteria are met:(1) The patient's attending or primary medical, mental health, or dental care provider(s) prescribes the treatment as medically necessary; and(2) The treatment is approved by the Dental Authorization Review Committee and the Dental Program Health Care Review Committee for dental treatment, or the institutional Utilization Management (UM) Committee and the headquarters UM Committee for medical or mental health treatment. The decision to approve an otherwise excluded treatment shall be based on available health care outcome data or clinical evidence supporting the effectiveness of the treatment.(d) All terminally ill patients remaining in the custody of the Department will receive health care appropriate and necessary to their situation, including counseling, hospice and palliative care. Patients in the custody of CDCR shall not be provided aid-in-dying drugs under the End of Life Option Act (California Health and Safety Code, Division 1, Part 1.85, Sections 443-443.22). Employees, independent contractors, or other persons or entities, including other health care providers, shall not participate in activities under the End of Life Option Act on premises managed by or under the direct control or management of the Department or while acting within the course and scope of any employment by, or contract with, the Department.(e) Each facility shall maintain contractual arrangements with local off-site agencies for those health services deemed to be medically necessary as defined in section 3999.98, and that are not provided within the facility. Such services may include medical, surgical, laboratory, radiological, dental, and other specialized services likely to be required for a patient's health care.(f) When medically necessary services are not available for a patient within a facility, the facility's Chief Medical Executive or Supervising Dentist may request the institution head's approval to temporarily place that patient in a community medical facility for such services.(g) In an extreme emergency when a physician is not on duty or immediately available, the senior custodial officer on duty may, with assistance of on-duty health care staff, place a patient in a community medical facility. Such emergency action shall be reported to the facility's administrative and medical officers-of-the-day as soon as possible.Cal. Code Regs. Tit. 15, § 3999.200
1. Change without regulatory effect adopting subchapter 2 (articles 1, 2 and 5, sections 3999.200-3999.237) and article 1 (sections 3999.200-3999.206) and renumbering and amending former subsection 3350(a) and sections 3350.1, 3350.2 and 3359.8 to new section 3999.200 filed 8-6-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 32).
2. Amendment of section heading, section and NOTE refiled 1-7-2019 as an emergency, with further amendments; operative 1-9-2019. (Register 2019, No. 2). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 4-9-2019 or emergency language will be repealed by operation of law on the following day. (Original emergency action filed 8-1-2018, amending 15 CCR sections 3350.1, a portion of which was subsequently renumbered to 15 CCR 3999.98 on 8-6-2018.)
3. Certificate of Compliance as to 1-17-2019 order, including amendment of section and NOTE, transmitted to OAL 4-9-2019 and filed 5-20-2019; amendments operative 5-20-2019 pursuant to Government Code section 11343.4(b)(3) (Register 2019, No. 21). Note: Authority cited: Section 5058, Penal Code. Reference: Section 5054, Penal Code; Plata v. Newsom (No. C01-1351 JST), U.S. District Court, Northern District of California; and Sections 443, 443.1, 443.2, 443.3, 443.4, 443.5, 443.6, 443.7, 443.8, 443.9, 443.10, 443.11, 443.12, 443.13, 443.14, 443.15, 443.16, 443.17, 443.18, 443.19, 443.20, 443.21, 443.215 and 443.22, Health and Safety Code.
1. Change without regulatory effect adopting subchapter 2 (articles 1, 2 and 5, sections 3999.200-3999.237 ) and article 1 (sections 3999.200-3999.206 ) and renumbering and amending former subsection 3350(a) and sections 3350.1, 3350.2 and 3359.8 to new section 3999.200 filed 8-6-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 32).
2. Amendment of section heading, section and Note refiled 1-7-2019 as an emergency, with further amendments; operative 1/9/2019. (Register 2019, No. 2). Pursuant to Penal Code section 5058.3, a Certificate of Compliance must be transmitted to OAL by 4-9-2019 or emergency language will be repealed by operation of law on the following day. (Original emergency action filed 8-1-2018, amending 15 CCR sections 3350.1, a portion of which was subsequently renumbered to 15 CCR 3999.98 on 8-6-2018.)
3. Certificate of Compliance as to 1-17-2019 order, including amendment of section and Note, transmitted to OAL 4-9-2019 and filed 5-20-2019; amendments operative 5/20/2019 pursuant to Government Code section 11343.4(b)(3) (Register 2019, No. 21).