1 .,STATE OF CALIFORNIA-OFFICE OF ADMINISTRATNE LAW ~' 1 ~ ~ ~ ~ `~ ~Of US@ b~ 8ecreta of Stete onINOTICE PUBLICATION/REGU~:A~€f~f~S St~6tCt~ISS1~~~ ~' ''`~•'~„` "`”""''~°" ~ ~ ~r _ reverie)STD.4~O fREV.014073)

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OAL BILE NOTICE FILE NUMBER REGULATORY ACTION NUMBER ,~~ ~ EMEFj,(~EtJ,QY,A[UtytBER

NUM8ER5 Z: '~' ~a ~ t~ ~r "~

For use by Office of Administrative Law (OAL) only

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~litifS~Nra~i°'~ L,A

I ~ NOTICE - REGULATIONS

AGEkC'S' H17H RULEMAKING AUTHORITY AGENCY FILE NUMBER of any)

Califacnia Department of Corrections and Rehabilitation NCHCR 19-01

A. PUBLICATION OF NOTICE (complete far publication in Notice Register)1. SUBJECT OF NOTICE TITLE{S) FIRST SECTION AFFECTED 2. REQUESTED PUBLICATION DATE

3. NOTICE TYPE 4. AGENCY CONTACT PERSON TELEPHONE NUMBER FAX NUMBER {Optional)

❑Notice re ProposedRegulatory Action ❑Other

OAL tJSE ACTfON ON PROPOSEII NOTfCE NOTICE REGISTER NUM3ER ?UBLICATION DATE

❑ APA~oveC 2s ❑ Aoproved as ❑ pisaporoved~~~L~ Modifietl YVithdrawr j

B. SUBM1S510id OF REGULATIONS (Complete when submitting regulations)

1a. SUBJECT OF REGULATIONS) 1b. ALL PREVIOUS RELATED OAL REGUTATORYACTION NUMBER{S)

Copayment and Artificial Appliances

2. SPECIFY CALIFORNIA CODE OF REGULATIONS TITLES) AND SECTION{5) (Including title 26, if toxics related)

SE~T80N(S) AFFEt7ED AooPT

(List all section numbers)individually. Attach AME"°

additional sheet if needed.) 3355.1; 3999.99, 3999.206, 3999.234, 3999.237, and 3999.375TITLES)

,..... ...REPEAL

.....

15

3. TYPE OF FILING

Regular Rulemaking (Gov. ~ Certificate of Compliance: The agency officer named Emer enc Reado t (Gov.Code §t 1346) ~ 9 Y p Changes Without Regulatorybelow certifies that this agency complied with the Code, §t 1346.1(h)) ~ Effect (Cal. Code Regs., title❑ Resubmittal of disapproved or provisions of Gov. Code §§71346.2-17347.3 either 1, §100)withdrawn nonemergency before the emergency regulation was adopted or

File &-Print Print Onlfiling (Gov. Code §§713493, within the time period required by statute. ~ ❑ y17 349.4)

Emergenty(Gov.Code, ~ Resubmittalofdisapprovedorwithdrawn Q otne~~sPec~ry) PC 5058.3 Operational Necessity§ll346.1(b)) emergentyfiling(Gov.Code, §11346.1)

4. ALL BEGINNING AND ENDING DATES OF AVAILABILITY OF,MODIFIED ftEGULATI0N5 AND/OR MATERIA~ADDED TO THE RULEMAKING FILE (Cal. Code Regs. title 7, §44 and Gov. Code §t 7347.7)

5. EFFECTIVE DATE OF CHANGES (Gov. Code, 4§17343.4, 7134fi.i (d); Cal.Code Regs., title i,§700)Effective January 1, Apnl 1, July 1, or Effective on filing with §100 Changes Without EffectiveOctober 1 (Gov. Code §11343.4(a)) ~ Secretary of State ~ Regulatory Effect ~ other (Specify)

6. CHECK IF THESE REGULATIONS REQUIRE NOTICE TO, OR REVIEW, CONSULTATION, APPROVAL OR CONCURRENCE BY, ANOTHER AGENCY OR ENTITY

Department of Finance (Form STD. 399) {SAM §6660) ~ Fair Political Practices Commission ~ State Fire Marshal

n Other (Specify) __ __.

/. LVIV IHI.I YCKSVN i e~erH~Nt Nurvtttttt FNc NUMBEK (optionaq E-MAIL ADDRESS (Optional)

Julie Inderkum (916) 691-0697 Julie.inderkum@cdcr.ca.gov

$• 1 certify that the attached copy of the regulations) is a true and correct copy For use by Office of Administrative Law {OAL) only

of the regulation(s~ identified on this form, that the information specified on this formis true and correct, and that I am the head of the agency taking this action,or a designee of the head of the agency, and am authorized to make this certification.

SIGNATURE OF CY HEAD OR DESIGNEE DATE

. WDTI LE OF SIGNATO

Ralph Diaz, Secretary (A), alifornia De rtment of Corrections and Rehabilitation

TEXT ~F P'R~POSED 12EGUI.A'~IONS

In the following, ski#et-~~ .indicates deleted text and underline indicates added,amended, or moved text. indicates text that is moved and deleted anddouble underline indicates text that is moved and amended.

.California Code of Regulations, Title 15, Division 3, Adult Institutions, Programs, and Parole.

Chapter 2. Rules. and Regulations of Health Care Services

Article 2. Health Care Forms

Section 3999.99. is amended to read:

3999.99. Forms.

The fallowing foi-~ns, referred to in this chapter, are hereby incorporated by reference:

CDCR 602 HC (Rev. 7/18), Health Care GrievanceCDCR 602 HC A (Rev. 12/17}, Health Care Grievance AttachmentCDCR 7362 (Rev. 03/~k19), Health Care Services Request Form

NOTE: Authority cited: Section SOS8, Penal Code. Reference:.Section 5054, Penal Code.

Subchapter 2. Patient's Entitlements and Responsibilities

Article 1. Provisions. of ~-Iealth Care Services

~ecg~~n 3999,206 is amended to read:

3999.206, ~g~~~~-€e~ Iai ht to I~e~itlh Care Services.

Section (a) remains unchanged but is shown to provide context.

(a) Patients shall be provided an opportunity to report an illness or any other health problem andreceive an evaluation of the .condition and medically necessary treatment and follow-up by healthcare staff.

... ._

Text of Proposed Regulations NCHCR 19-01 February 12, 2019 1

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NOTE: Authority cited:. Sections 5007.5 and 5058, Penal Code. Reference: Section 5054, PenalCode.

Article 5. Health Care Grievances

Section 3999.234 is amended to read:

3999.234. Health Care Grievance and Health Care Grievance Appeal Dejection.

~~ctians (a}(1) and ~2} remain unchanged.

(3) Tlie grievant submitted the health care grievance without a prior attempt to obtain health careservices through appro~~ed processes. In this case, HCGO staff shall submit a request far healthcare services, if medically necessary, to the appropriate facility clinic on behalf of the. grievant,

~eetions (a~(4) through (a)(7}, (b), end (b}(1} remain unchanged.

NOTE: Authority cited: Section 5058, Penal Code, Reference: Section 5054, Penal Code;Americans With Disabilities Act, Public Law 101-336, July 26, 1990, 104 Stat. 328; Civil Rightsof Institutionalized Persons Act, Title 42 U.S.C. Section 1997 et seq., Public T aw 96-247, 94 Stat.349; Section 35.107, Title 28, Code of Federal Regulations; Armstrong v. ~tr~~t-Newsom (No. C-

Text of Proposed Regulations NCHCR 19-01 February 12, 2019 2

94-2307-CW), U.S. District Caurt, Northern District of California; Cole~nun v. ~-Newsofn(No. S90-Q520 LKK JFM P) U.S. Dastriet Court, Eastern District of California; and Plata v. ~eNewsom (No. CO1-1351 JST), U.S. District Court, Northern District of California.

Section 3999.237 is amended to read:

3999.237. Changes. in Health Care Jurisdiction.

Section (a) remains unchanged.

(b) Paroled. If the grievant paroles before the time limits expire for responding to a health caregrievance or health care grievance appeal, the grievant shall not receive a response •~~

.,~~~~~~.

Section (c) remains unchanged.

NOTE: Authority cited: Section 5058, Penal Cade. Reference: Section 5054, Pei1a1 Code; CivilRights of Institutionalized Persons Act, Title 42 U.S.C. Section 1997 et seq., Public Law 96-247,94 Stat. 349; Section 35.107, Title 28, Code of Federal Regulations; ArmsC~~ong v. ~c~-r~~-Newsom(Na. C-94-2307-CW}, U.S. District Court, Northei77 District of California; C'oler~~ccn v. ~~e1Veu~.rom (No. 590-0520 LKK JFM I'} U.S. District Court, Eastern District of California; and Platerv. ~r~-l~jewsom Na. CO1-1351 JST), U.S. District Court, Northern District of California.

Subchapter 3. Health Care.Operations

Section 3355.1 is renumbered and amended to read:

Article 6. Dental Care

Section ~~ 3999.367. Dental Care.

Sections (a) and (a)(1) remain unchanged.

Sections (a){2) and (a)(3) are amended to read:

(2) Face-to-face triage encounter means a planned visit to assess and diagnose a patient's chiefcomplaint and to provide necessary treatment following submittal of a CDCR 7362 {-R~~-9-3~A4j,Health Care Services Request Farm,1~~~~a~~a~u~~~~-~~~,~ by a patient or when dentalstaff issues a ducat to a patient after performing a health record review.

(3} Limited problem focused exam encounter means an unplanned visit to assess and diagnose apatient's chief complaint and to provide treatmel2t if necessary tar a patient with a dentalemergency who arrives at the dental clinic unannounced without an appointment or v~Tho is referredto the dental. clinic by health care or custody staff and dental staff has not issued a ducat to the

Text of Proposed Regulations NCHCR 19-01 February 12, 2019 3

patient and there is also no record of recently receiving a CDCR 7362 from the patient addressingthe eme~~gent condition.

Sections (a)(4) through (a)(6), (b), and (b)(1) remain unchanged.

Section (b)(1)(A) is amended to read:

(A) Submitting a CDCR 73G2 requesting dental care for which ducated face-to-face triageencounters shall be scheduled to have specific. complaints addressed.

Sections (b)(1)(B) through (g){2)(b) remain unchanged.

Section (g)(2)(C) is amended to read:

(C) Patients requiring early treatment for any unusual hard or soft tissue pathology.Treatment shall be initiated within 60 calendar days from the date of diagnosis.

Sections (g)(2)(D) through (g)(3)(B) remain unchanged..

Section (g)(3){C) is amended to read:

(C) Patients with moderate or advanced periodontitis requiring non-surgical periodontal treatment(scaling and/or root ~i~g lapin ).

Sections (g)(3){D) through (g)(4)(G) remain unchanged.

Section ~g)~5) is amended to read:

(5) No dental care needed. Patients not appropriate for inclusion in Emergency, Urgent,Tr+~r~o~o+_tr~Interceptive, Routine Rehabilitative, or Special Dental Needs Care.

Sections (g)(6) through (h)(2) remain unchanged..

Section ~h)t3) is amended t~ read:

(3) Dental treatment provided to RC patients shall be limited to the treatment of Emergency andUrgent Care dental conditions, as defined in subsections (g)(1) and (g)(2). Patients who remain onRC status in an RC for 90 calendar days or longer may submit a CDCR 7362 to request InterceptiveCare, as defined in subsection (g)(3), excluding prosthetics. Upon receipt of a CDCR 7362, thedentist shall exercise professional judgment in considering treatment for an Interceptive Carecondition for the patient.

Section (i)(1) is amended to read:(h) Mainlil~e facility.(1) Within ten business days of arrival at a mainline facility= all patients shall be notified that theyare eligible to receive an initial comprehensive dental examination performed. by a dentist who

Text of Proposed Regulations NCHCR 19-01 February 12, 2019 4

shall formulate and document a dental treatment flanvvl✓u~~i L 1J 1V1i U11VK 1Vl l.lIS3~

Sections (i)(2) through (i)(5) remain unchanged..

Section (j) is amended to read:(j) Re-examination. After the initial comprehensive dental ex~tnination, mainline facility patientsshall be notified that they are eligible to receive a periodic comprehensive dental exaaniazatioll bya dentist :~~~~" :~~ ~+ ~ as as follows:(1) Every two years (biennially), up to the age of 5d.(2) Annually starting at the age of 50 and regardless of age if the patietlt is diagnosed with diabetes,HIV, or seizure disorder..

Sections (k) through (w} remain unchanged.

NOTE: Authority cited: Section 5058, Penal Code. Reference: Sections 3424 and 5054, PenalCode; and. ~'erez, et crl. v, Cate, et crl., (No, COS-OS241 JSW), U.S. District Court, Northern Districtof California.

Subchapter 3. Health Care Operations

~ectia~a 3999.37 is rene~mberec~ anc~ a~nermdec~ to .read:

Article 9. Durable Medical Equipment/Supplies and Accommodations

~4~':~~°-~-?~ 399.395, Artaca~l A.ppiiances,

(a} Appliance Ecategories. Appliances includes bud are not limited toy eyeglasses, artificial eyes,dental prosthesis, artificial limbs, ortlxapedic braces and shoes, and hearing aids. A patient's needfor such appliances shall be based. an medical necessity and prescribed. appliances shall be providedat state expense.(b) Possession of appliance. No patient shall be depri~~ed of a prescribed orthopedic or prostheticappliance in the patient's possession. upon arrivat into the Department's custody or properlyobtained. while in the Department's custody unless a Department physician ar dentist determinesthe appliance is no longer needed and the patient's personal physician, if any, concurs in thatopinion. If a patient's dental prosthetic appliance is confiscated for safety and security reasons, adentist s1~a11 be notified by the next business day to determine whether the patient will require anyaccommodations due to the loss of the prosthetic appliance.(c) ~'u~;,:~«~~,~o€-~~~-~~~Dental appliances.=~~~~-a~r~~ ,;,ao,a n+ * ,-

~~~. Departmental dentists shall not order prescribed dental appliances made from preciousmetal, and departmental dentists or dental laboratories shall not perform repairs to existing dentalprosthesis made from precious metal. If a patient's existing dental appliance made from preciousmetal needs repair, the dentist s11a11 offer the patient the option of hiving a new prosthesis made.

Text of Proposed Regulations NCHCR 19-01 February 12, 2019 5

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NOTE: Authority cited: Section 5058, Penal Code. Reference: Section SQ54, Penal Code.

Text of Proposed Regulations NCHCR 19-01 February 12, 2019 6

STATE OF CALIFORNIA

HEALTH CARE SERVICES REQUEST FORMCDC 7362 (Rev. 03i ".)

DEPARTMENT OF CORRECTIONS AND REHABILITATl9N

Page 1 of 2

PART I: TO BE COMPLETED BY THE PATIENT

If you believe this is an urgent/emergent health care need, contact the correctional officer on duty.REQUEST FOR: MEDICAL ❑ MENTAL HEALTH ❑ DENTAL ❑ MEDICATION REFILLNAME CDCR NUMBER HOUSING

PATIENT SIGNATURE DATE

REASON YOU ARE REQUESTING HEALTH CARE SERVICES. (Describe your health problem and how long you havehad the problem)

NOTE: lF THE PATIENT IS UNABLE TO COMPLETE THE FORM, A HEALTH CARE STAFF MEMBER SHALL COMPLETE THE FORMON BEHALF OF THE PATIENT AND DATE AND SIGN THE FORM

PART II: TO BE COMPLETED BY THE TRIAGE REGISTERED NURSE

Date /Time Received: Received by:

Date /Time Reviewed by RN: Reviewed by:

S: Pain Scale: 1 2 3 4 5 6 7 8 9 10

O: T: P: R: BP: WEIGHT:

A:P:❑ See iVursing Encounter Form

E:

APPOINTMENT EMERGENCY URGENT ROUTINESCHEDULED AS: (iMME~iATELY> ❑ (WITHIN 24 HOURS) ~ (WITHIN 14 CALENDAR DAYS)

REFERRED TO PCP: DATE OF APPOINTMENT:COMPLETED BY NAME OF INSTITUTION

PRINTlSTAMP NAME SIGNATURElTITLE DATElTIME COMPLETED

Unauthorized codtecPion. creafio». use. dlsclas rue m~difrc 'on ear destrucflon ofpersonaify identifrabie dnfarm ion a~proratected health informafron may subjecf indlvid+~ats focivil tiabiliPv under Ircab/e federal and sta e law.

v Distribution: Original - #~+k Health Record;. COpV -Patient -XeHew--! isa~+ej-6e

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Finding of Emergency(As required by Government Code (GC) section 113461 (b)(2))

Informative Digest (per. GC 11346.5 (a)(3))

GC section 1283$.5 provides that commencing July 1, 2005, the California Department o~Corrections and Rehabilitation (CDCR) succeeds to, and is vested with, all the powers, functions,duties, responsibilities, obligations, liabilities, and jurisdiction of abolished predecessor entities,such as: Department of Corrections, Department of the Youth Authority, and Board of Corrections.

PC Section 5000 provides that commencing July 1, 2005, any reference to the Department ofCorrections in this or any code, refers to .the CDCR, Division of Adult .Operations.

PC .Section 5050 provides .that commencing July 1, 2005, any reference to the Director ofCorrections, in this or any other code, refers to the Secretary of the CDCR. As of that date, theoffice of the Director of Corrections is abolished,

PC Section 5054 provides that .commencing July 1, 2005, the supervision, management, andcontrol of the state prisons, and the responsibility for the care, custody, treatment, training,discipline, and employment of persons confined therein are vested in the. Secretary of CDCR.

PC Section 5058 authorizes the Director to prescribe .and amend regulations for the administrationof prisons.

This action provides the following:.• Eliminates copayments for .health care services. for CDCR patients.• Clarifies that CDCR prescribed appliances shall be provided at no cost to patients.

Anticipated Benefits of the Proposed Regulation

The. Department anticipates the proposed regulations will benefit the Department and patients byencouraging patients to seek early treatment for health care issues. By eliminating copaymentsand the requirement for non-indigent patients to purchase prescribed appliances, patients will bemore likely to pursue early treatment forhealth care needs, which may result in increased treatmentefficacy, improved patient health care. outcomes, and decreased long-term .health care andadministrative. costs..Additionally, the. proposed .regulations will reduce .the number of submittedhealth care grievances and healthcaregrieuance appeals and ensure consistency in practice amongCDCR institutions.

Forms Incorporated by Reference (per 1 CCR 20(c)(3))

CDCR 7362 Health Care Services Request Form (Rev. 03/19)

Authority and Reference Citations (per GC 11346.5 (a)(2))

The Secretary of the CDCR, pursuant to the authority granted by GC section 12838.5 and PenalPC section 5055, and the rulemaking authority granted by PC section 5058, proposes to amendsections 3355.1, 3999.99, 3999.206, 3999.234, 3999.237, and 3999.375 of the California Code. ofRegulations (CCR), Title 15, Division 3, regarding copayment for health care services andprescribed artificial appliances.

References cited pursuant to this regulatory action are as follows: Sections 3424 and 5054, PC;Americans With Disabilities Act, Public Law 101-336, July 26, 1990, 104 Stat. 328; Civil Rightsof Institutionalized Persons Act, Title 42 U.S.C. Section 1997. et seq., Public. Law 96-247, 94 Stat.349; Section 35.107, Title 28, Code of Federal Regulations; Perez, et al. v. Cate, et al., (No. C05-05241 JSW), U.S. District Court, Northern District of California; Armstrong v. Newsom (No. C-94-2307-CVi~), U.S. District Court, Northern District of California; Coleman v. Newsom (No. 590-0520 LKK JFM P) U.S. District Court, Eastern District of California; and Plata v. Newsom (No.C01-1351. JST), U.S. District Court, Northern District of California.

Evaluation of Consistency I Compatibility with Existing Regulations

The Department has researched existing regulations and has determined that these proposedregulations are .consistent. and compatible with existing state laws and regulations.

Specific Agency Statutory Requirements

NIA

I,acal Mandate Determination

The proposed regulatory action imposes no mandates on local agencies or school districts, or amandate which requires reimbursement pursuant to GC sections 1500 — .17630.

Fiscal Impact Statements (per GC 1346.5{a)(6))

~ Cost or savings ,to any state agency: $545, 000 annually

e Cost or savings in federal funding to the state.: None

• Other nondiscretionary cost or savings imposed on local agencies: None

• Cost to any local agency or school district that is required to be reimbursed: None

Technical, ~'heoretical or Empirical Studies, Reports, or Documents Relied Upon

Not applicable.