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Healthcare Copay Report, 2010 - Bureau of Prisons

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Federal Prisoner Health Care Copayment Act of 2000
Report to Congress
Status Report: October 2010
Legislative Summary: On October 12, 2000, the President signed into law the Federal Prisoner

Health Care Copayment Act of 2000 (P.L. 106-294) (codified at 18 U.S.C. § 4048). The Act
allows the Bureau of Prisons (BOP) to charge a copayment fee of not less than $1.00 per visit to
inmates for health care services provided in conjunction with a health care visit requested by the
inmate. Preventive health care, emergency services, prenatal care, diagnosis and treatment of
chronic infectious diseases, mental health care, and substance abuse treatment are exempted from
the fee. The copayment fees are deducted from an inmate’s Trust Fund account. The statute
requires the Director of the BOP to transmit an annual report to Congress that includes: (1) the
amounts collected during the previous year, (2) an analysis of the effects of implementation of
the law, (3) the costs of implementing and administering the program, (4) a description of inmate
health status indicators as compared to the year prior to enactment, and (5) a description of the
quality of health care services during the preceding year as compared with the quality of services
provided during the year ending on the date of enactment of the law.
Current Status: The Final Rule implementing the Act was published in the Federal Register on

July 26, 2005 and the BOP implemented its corresponding policy1 on October 3, 2005. The Act
requires a 30-day period of notification to the inmate population on the provisions of the statute.
The BOP provided inmates with written and verbal notification between August 15 and
August 30, 2005 and informed them the program would be implemented on October 3, 2005 (the
first regular business day of fiscal year 2006). The BOP meets the 30-day notification
requirement for all new inmates by providing the information upon admission and giving them a
30-day grace period before charging a copayment fee.
The copayment fee is $2.00. Sentenced inmates and unsentenced detainees in the custody of the
BOP are subject to the copayment fee when they initiate a visit to Health Services; this is
commonly referred to as sick call.2 Federal inmates confined in privately-managed institutions
and federal inmates confined in facilities operated by State and local governments are not being
charged at this time due to the lack of electronic mechanisms to collect funds.
Amounts Collected:

Fiscal Year

Amount Collected



Analysis: From October 3, 2005, to September 30, 2006, inmates in the BOP made 579,961

visits to institution health services units. During fiscal years 2007 and 2008, inmates made
496,589 and 442,281 visits, respectively. In fiscal year 2009, inmates made 341,275 visits.

In fiscal year 2010, the number of visits increased to 346,754. The breakdown of these visits is
as follows:
Type of Visit3






Paid Visits
Non-Paid Visits
Indigent Inmate Visits
Grace Period Visits












The number of visits to institution health services increased in fiscal year 2010, after declining
each year since the implementation of the Federal Prisoner Health Care Copayment Act of 2000.
In fiscal year 2010, there were 1.6% more visits as compared to fiscal year 2009. However, in
fiscal year 2010 there 41% fewer visits as compared to fiscal year 2006.
Administrative Costs: It cost the BOP $23,780 to enhance computer software within the Trust

Fund inmate accounting systems to implement the Inmate Copayment Program. There were and
continue to be ongoing costs associated with staff support of the system, however, these costs are
imbedded in general operating and management expenses.
Inmate Health Status and Quality of Care: All BOP facilities are classified by “Care Level”

(one through four) corresponding to the level of heath care the facility can provide based on
staffing structure, community health resources, and the availability of community sub-specialists.
Facilities designated as “Care Level” two through four must be accredited by the Joint
Commission4 and all BOP facilities are accredited by the American Correctional Association
(ACA). Both the Joint Commission and ACA review the practices of the BOP with regard to the
quality of health care, patients’ rights, and patient access to care. During the past year, none of
the BOP facilities accredited by either of these two organizations received deficiencies in any of
these areas.
All indicators of morbidity and mortality demonstrate that the health status of inmates in BOP
custody has not changed significantly since the implementation of the Inmate Copayment
Program. All indicators of quality of health care demonstrate that the quality of medical care
provided to inmates in the custody of the BOP has not been impacted by the implementation of
the Inmate Copayment Program. A comprehensive review of the complaints regarding the
Inmate Copayment Program filed by inmates during the past year through the Administrative
Remedy Program5 revealed that inmates received the care that was necessary to meet their
medical needs and that the copayment was collected appropriately. The review also showed no
appreciable change in the rate or types of complaints regarding the delivery of health care.

1. BOP Program Statement P6031.02 titled “Inmate Copayment Program.”


2. Sick call encounters do not include visits initiated by a health care provider, visits by indigent
inmates, or visits under the 30-day grace period because these encounters do not result in the
collection of a copayment fee.
3. Paid visits are conducted at the request of the inmate for which a copayment fee was
collected. No copayment fee is collected for non-paid visits (e.g., emergency services,
preventive health care, diagnosis and treatment of chronic infectious diseases, and other visits
initiated by a health care provider). Indigent visits are conducted at the request of an inmate, but
no copayment fee is collected due to the inmate’s status as indigent. Grace period visits are
conducted at the request of an inmate, but no copayment fee is collected because the visit occurs
during the initial 30 days of the inmate’s incarceration.
4. The Joint Commission, formerly known as the Joint Commission on Accreditation of
Healthcare Organizations (JCAHO), is an independent, not-for-profit organization that accredits
and certifies more than 18,000 health care organizations and programs in the United States.
5. The Administrative Remedy Program provides inmates with a means to seek redress of
complaints or formal review of issues relating to their confinement. It allows the BOP to
examine its policies, programs, operations, and procedures based on inmates’ claims and to make
changes when necessary.