BOP Program Statement 6400.03 § 12

Every institution has a Utilization Review Committee (URC). Only Emergency Dental Care

referrals are authorized at the institution level when it is essential to sustain life or function and

warrants immediate attention. A retrospective review of Emergency Dental Care referrals will

be done by the URC and the RCD. Conditions or procedures requiring RCD approval in the

Urgent, Non-Urgent, or Limited Value categories will be forwarded directly to the RCD for

utilization review.

The UR process is not limited to only outside referral consideration; specialty care provided by

contractors within the institution must be preauthorized by the RCD. Dental referrals are

forwarded to the RCD or designee for approval; if digital radiographs are not available, films are

forwarded by mail or other methods. Relevant factors to consider in approving proposed

treatments include:

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■ The risks and benefits of the treatment.

■ Available resources.

■ Natural history of the condition.

■ The effect of the intervention on inmate’s masticator function and oral health.

■ Time remainin on the inmate’s sentence.

a. Recommendations. The RCD selects the appropriate EMR decision for each case:

■ Approved: The request granted without modification.

■ Defer: Additional information is required. The consult has to be resubmitted.

■ Disapproved: The request for the procedure is denied. Reasons should be documented,

such as the procedure is contraindicated due to unacceptable risk to the inmate if it is

performed, etc.

■ Follow Up: No decision, pending additional information.

b. Decisions. The CDO or the designated HSU staff will ensure that a written notification of the

URC decision is made to the inmate and a copy is placed in the inmate’s health record. The

reason for the decision should be included, where applicable.

c. Recommendations From Clinicians External to the BOP. The CDO is under no obligation

to follow an outside dental consultant’s or private dentist’s recommendations. However, if the

recommendations are not followed, the CDO must document his/her justification in the health

record.

If a specific intervention is not pursued, the inmate is advised that his/her condition will continue

to be monitored and ongoing treatment provided as necessary, and that re-submission of the

request will be considered if dentally indicated.

d. Secondary Reviews. The CDO can appeal the RCD’s UR decision on a case-by-case basis to

the National Chief Dentist.

e. Retrospective Review. A retrospective review of emergency cases can be conducted by QM

staff based on URC findings and as part of the institution Quality Improvement Program.