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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1.2.20 Fiscal Impact Resource and Strategy Team

  • Policy

    • California Correctional Health Care Services (CCHCS) shall maintain the Fiscal Impact Resource and Strategy Team (FIRST) to review all proposed health care initiatives for cost-effectiveness, alignment with CCHCS strategic goals, and future sustainability.

  • Procedure

    • FIRST Membership

      • FIRST is comprised of all CCHCS Deputy Directors (DD), Regional Health Care Executives, and California Department of Corrections and Rehabilitation’s Division of Adult Institutions representatives. The FIRST chairpersons are DDs of Dental Services and Policy and Risk Management Services.

    • FIRST Responsibilities

      • FIRST shall review all health care initiatives prior to commencement, including:

        • Policies and Procedures (including training requirements and Policy Memoranda)

        • Care Guides

        • Formulary Changes (Pharmacy and Durable Medical Equipment)

        • Health Care Forms

        • Health Care Projects (including pilot and test projects)

      • The chairpersons shall report on activity of all health care initiatives presented at FIRST to the Governing Body on a quarterly basis, pursuant to Health Care Department Operations Manual, Section 1.1.1, Governing Body.

    • Meeting Activities

      • FIRST shall hold meetings twice each month or more frequently, as needed.

        • The Associate Director (AD), Risk Management Branch (RMB) shall provide an agenda for FIRST Chairperson approval.

        • Prior to a FIRST meeting, the AD, RMB shall ensure the approved agenda is distributed to attendees for review and project presenters.

        • FIRST shall review the agenda and attachments prior to the meeting and be prepared to discuss.

      • During the meeting, program executive sponsors or DDs will propose health care initiatives for a focused discussion of impacts to:

        • Fiscal, clinical, custodial, and operational resources.

        • Program areas.

        • CCHCS’ strategic goals.

        • Patient care.

        • Training.

      • For each proposed initiative, FIRST shall:

        • Ask questions to gather information.

        • Identify additional impacts including fiscal and operational risks.

        • Gain an understanding of goals and objectives and determine if the initiative aligns with CCHCS’ strategic goals.

        • Come to a consensus for programs to either:

          • Develop and provide quarterly updates.

          • Postpone until further information or necessity is identified. Programs may resubmit proposals at a later date based on feedback from FIRST.

    • Post-Meeting Activities

      • The AD, RMB shall provide an email to FIRST summarizing the meeting.

      • If the consensus of FIRST is for development of an initiative, each FIRST member shall respond to the email indicating if a subject matter expert with decision-making authority from their program shall be assigned to the Interdisciplinary Project Team.

      • Initiatives do not require resubmission to FIRST unless during development additional costs, resources, or changes in scope are identified.

      • RMB shall track ongoing initiatives, and FIRST members or their delegates shall provide updates on projects in process on a quarterly basis for reporting to the Governing Body.

  • References

    • Health Care Department Operations Manual, Chapter 1, Article 1, Section 1.1.1, Governing Body

    • Health Care Department Operations Manual, Chapter 5, Article 1, Section 5.1.1, Regulations and Policy Management

  • Policy Control Executive Sponsor: Deputy Directors, Dental Services and Policy and Risk Management Services
    Effective: 09/16/2026