BOP Program Statement 6031.06 § 12

A CCC is also considered a comprehensive medical evaluation. A physician or APP will enroll

inmates who have chronic medical needs in a regularly scheduled CCC. The HSA will track the

enrolled inmates using the EHR to assure timely follow-up, completion of diagnostic testing and

labs by due date, and issuing of medications/treatments as ordered. Inmates with multiple co-morbidities will be assigned to each applicable CCC. A physician will evaluate all inmates

assigned to a CCC no less than once every 12 months. In the absence of a physician at a facility, the

RMD will be consulted to determine interim CCC coverage plans, which may be assigned to APPs.

 Medical Care Level 4 inmates. Must be seen by an APP or physician for CCC follow-up every

three months, or more often as clinically indicated (e.g., prescribed high-risk medications,

complex co-morbidities, poorly controlled disease states, etc.).

 Medical Care Level 3 inmates. Must be seen by an APP or physician for CCC follow-up every

six months, or more often as clinically indicated (e.g., prescribed high-risk medications, complex

co-morbidities, poorly controlled disease states, etc.).

Inpatient inmates at MRCs are not excluded from CCC enrollment. Inmates residing on an

inpatient unit will be enrolled as stated above and maintain CCC encounters at the frequency

established by this program statement.

The CD or attending physician will determine the frequency of follow-up care required between

CCC encounters based on clinical need. The APP will conduct interim follow-up encounters.

Pharmacists working under a CPA can also conduct interim follow-up CCC encounters. APPs

and pharmacists will refer or seek guidance from the physician when there is a significant change

in health status. The physician will review and cosign the APP and pharmacist’s CCC follow-up

6031.06 6/22/2026 PROPERTY OF US GOVERNMENT 23

encounters in the EHR.

The Medical Director will issue clinical guidance for management of specific disease states or

high-risk conditions. Clinical guidance should be followed in the absence of compelling

rationality to deviate based on an inmate’s individual health care needs. If care deviates from

clinical guidance, clinical decision making should be clearly documented in the clinical

encounter.

APPs can remove inmates from a CCC with a co-signature to the attending physician.

a. Components of CMEs. Physicians conducting annual comprehensive medical evaluations

are expected at a minimum to:

 Review and revise current medical care level or screening medical care level assignments

at each encounter to ensure the inmate’s health needs can be met locally. Medical care level

should also be reviewed and confirmed or revised after each major change in the inmate’s

health status (e.g., recent hospitalization, development of complications related to disease

progression, etc.).

 Review any length of stay designation to determine if the inmate is clinically appropriate

to return to their previous facility.

 Address all chronic diseases and any new concerns. All clinically significant conditions

should be documented in the clinical encounter note at each visit.

 Address any preventive health needs. Screening needs that require outside consultation

(colonoscopy, lung CT, etc.) will have consultations placed no greater than 18 months

prior to the target date of need. For screening due on more distant timelines, due dates

will be tracked via ongoing CMEs for future ordering within the 18 month window.

 Review all health problems to ensure only active diagnosis are currently listed, and all

others are resolved, in remission, or deleted as appropriate.

 Review all ordered, but not completed consultations to ensure they are still clinically

necessary with appropriate target dates and to identify and discontinue duplicative

consultations if needed.

 Review MDS accommodations, issued DME, and Medical Holds for appropriateness.

 Review nutritional needs and order any special Medical Diets or supplements as

clinically warranted.

 Review whether Reduction in Sentence (RIS) is appropriate. See clinical guidance

Compassionate Release Criteria for Requests Based on Medical Circumstances located

on the HSD page of the Bureau’s intranet site.

b. Medication Discontinuation. When a chronic care medication is discontinued for any

reason (including clinical determination, suspected diversion, non-adherence, abnormal

laboratory findings, or custody-related concerns) the ordering provider shall document in the

EHR that the patient was notified of the discontinuation and received appropriate patient

6031.06 6/22/2026 PROPERTY OF US GOVERNMENT 24

education regarding the rationale, potential risks, expected symptoms, available treatment

alternatives, and how to request reevaluation should the inmate wish to restart the discontinued

medication. The provider shall also document a revised or new plan of care that addresses the

patient’s ongoing diagnosis or condition and identifies clinically appropriate therapeutic options

to meet the patient’s medical needs in the absence of the discontinued medication.

Discontinuation of medication shall not occur solely through administrative note documentation

without direct patient notification and clinical reassessment.

When clinically appropriate, medications shall be discontinued using a medically indicated

tapering schedule to promote patient safety and minimize risk of withdrawal, symptom

exacerbation, or other adverse outcomes. Decisions regarding tapering shall be based on clinical

judgment and accepted standards of care, and patient health and safety shall take precedence

over operational or custody considerations, including concerns related to diversion. Any

deviation from tapering due to clinical contraindication or urgent safety concerns shall be clearly

documented, including the clinical justification and follow-up monitoring plan.

When medication discontinuation is related to patient non-adherence, refusal to take medication

as prescribed, or behavior resulting in the inability to safely continue the medication, the

provider shall obtain and document a signed refusal form. The form shall reflect that the patient

was informed of the risks associated with non-adherence or discontinuation, alternative treatment

options were discussed, and the patient was given the opportunity to ask questions.

The CD retains overall administrative and clinical responsibility for managing CCC inmates. The

CD or responsible physician will provide requisite consultation to APPs, pharmacists, and

therapists collaborating in CCC management in accordance with properly executed privileges,

practice agreements or protocols according to Program Statement Health Care Credential and

Privileging Program.