Health Care Department Operations Manual

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Chapter 1 – Health Care Governance and Administration

Article 2 – Health Care Program Governance

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1.2.19 Headquarters Durable Medical Equipment and Medical Supply Committee and Interdisciplinary Team

  • Policy

  • The Headquarters Durable Medical Equipment and Medical Supply Committee (HDMEC) shall provide statewide oversight and management of Durable Medical Equipment (DME) and medical supplies provided by California Correctional Health Care Services (CCHCS) to California Department of Corrections and Rehabilitation (CDCR) patients. Institutions can request changes to the Durable Medical Equipment and Medical Supply Formulary and appeal denials of nonformulary DMEs to the HDMEC.

  • Responsibility

    • Statewide

      • CCHCS and CDCR departmental leadership at all levels of the organization, within the scope of their authority, shall ensure administrative, custodial, and clinical systems are in place, and appropriate tools, training, technical assistance, and levels of resources are available so that care teams can successfully implement the HDMEC policy.

      • The Deputy Director (DD) of Medical Services and the Deputy Medical Executive of Utilization Management are responsible for the statewide planning, implementation, and evaluation of the HDMEC policy.

    • Regional

      • Regional leadership is responsible for this policy at the subset of institutions within an assigned region.

    • Institutional

      • The Chief Executive Officer, or designee, has overall responsibility for adherence to this policy at the institution.

  • Procedure

    • HDMEC

      • Membership

        • The Chair shall be a Deputy Medical Executive or Assistant Deputy Medical Executive appointed by the DD, Medical Services. The Chair shall assist the DD, Medical Services, in the selection of other members of the HDMEC.

        • Voting Members (and alternate designees) are appointed by the DD, Medical Services, from among CCHCS and CDCR staff nominated by relevant leaders for each discipline:

          • Two or more physician executives or managers, or their designees, from Medical Services.

          • Two or more institution or regional physician executives or managers.

          • Two or more executives or managers, or their designees, from Nursing Services.

          • Two or more institution or regional nursing executives or managers.

          • The Chair may designate any voting member to chair the HDMEC in their absence.

        • Non-Voting Members

          • Members may include one executive or managerial representation from:

            • Dental Services.

            • Psychiatry Services.

            • Procurement Services.

            • Direct Care Contracts.

            • Health Care Correspondence and Appeals Branch.

            • Corrections Services.

            • Division of Adult Institutions.

            • CCHCS Office of Legal Affairs

            • Fiscal Management Section

          • The Chair is a non-voting member unless needed to reach a quorum, as noted below.

      • Meetings

        • The HDMEC shall meet as often as necessary but not less frequently than annually.

        • A quorum shall consist of at least 50% of voting members in attendance. In reaching the quorum requirement, alternate designees of the same clinical discipline may be counted toward a quorum, and the Chair may serve as a member for their clinical discipline, if necessary, to reach a quorum.

          • In the event of a tie amongst voting members, the Chair has the option to serve as the tiebreaker, if not acting as a voting member to reach a quorum, or request additional information and review the case a second time at a future HDMEC meeting with the same voting members present.

        • A record of the proceedings shall be kept and shall record activities, recommendations of the committee, and attendance.

        • The proceedings and records of the HDMEC shall be confidential and protected from discovery to the extent permitted by law.

      • Scope of Review

        • The HDMEC shall report to the Headquarters Utilization Management Committee.

        • The HDMEC is responsible for the following:

          • Review all approved requests for nonformulary DME from institutions.

          • Review and resolve provider appeals of denied nonformulary DME requests.

          • Review and resolve issues pertaining to security concerns versus health care needs.

          • Provide a written response to the requestor, if applicable.

          • Determine the necessity of DMEs and maintain the Durable Medical Equipment and Medical Supply Formulary.

      • Requests to HDMEC

        • To request an addition, change, or deletion of item(s) on the DME and Medical Supply Formulary, institutional staff shall submit a Form OBS 5002.

        • If a request for non-formulary DME or medical supply is denied at the institutional level the primary care provider may request a higher-level review by the HDMEC. The Chief Medical Executive, or designee, shall then forward the denied request for service through the “HQ DME Committee” message pool for further review.

    • Medical Equipment and Supply Interdisciplinary Team

      • Membership

        • The members shall be selected so as to represent the functional areas of the institution that are necessary for the appropriate and coordinated delivery of DMEs and medical supplies, including a minimum of two physicians and two nurses.

      • Meetings

        • The Medical Equipment and Supply (MES) Interdisciplinary Team shall meet at least monthly.

        • A record of the proceedings shall be kept and shall record activities, recommendations of the MES Interdisciplinary Team, and attendance.

      • Scope of Review

        • The MES Interdisciplinary Team shall:

        • Report to the HDMEC.

        • Utilize the Health Care Services Dashboard to monitor and review the timely distribution of DME.

        • Review and address out-of-compliance orders.

        • Review and address discrepancies of DME orders in the Electronic Health Records System and Strategic Offenders Management System.

        • Review and disseminate new statewide guidelines, policies, procedures, and recommendations.

        • Provide oversight and management of institutional practices and processes of DME and medical supplies that is consistent with CCHCS and CDCR standards.

  • References

    • Code of Federal Regulations, Title 42, Chapter 7, Subchapter XVIII, Part E, Section 1395 x(n), Durable Medical Equipment

    • California Civil Code, Division 1, Part 2.6, Section 56, et seq., Confidentiality of Medical Information Act

    • California Evidence Code, Division 9, Chapter 3, Section 1157

    • California Code of Regulations, Title 15, Division 3, Chapter 2, Article 1, Section 3999.98, Definitions

    • California Code of Regulations, Title 22, Division 3, Subdivision 1, Chapter 3, Article 2, Section 51160, Durable Medical Equipment

    • Armstrong Remedial Plan, Armstrong vs. Newsom, U.S. District Court of Northern California, Case No. C94-2307 CW, Amended January 3, 2001

    • California Department of Corrections and Rehabilitation, Department Operations Manual, Chapter 5, Article 43, Section 54030.6, Liability

  • Revision History

    • Effective: 07/22/2024