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ATTACHMENT B-1 <br />PRE -AUTHORIZATION AND MEDICAL BILLING INSTRUCTIONS <br />Definitions <br />Per Diem Rate — the cost per day per Department offender for all care, included in facility medical costs <br />housing which is the same or similar care provided to County/City inmates. <br />DOC Utilization Management Office (Nurse Desk_— the Department's medical contact that receives, <br />reviews and approves extraordinary medical expenses and non -formulary requests for DOC Offenders. <br />The Nurse Desk is available 24 hours a day via phones at (360) 725-8733 or during normal business hours <br />via email at NurseDesk@docl.wa.gov <br />Extraordinary Medical Care — medically necessary care that is not commonly available through the facility <br />health services and incurs additional cost. Examples of extraordinary medical care may include, but are not <br />limited to, specialty consults, emergency room care, hospital care, ancillary charges and ambulance <br />services. <br />Extraordinary Medical Expense — medical expenses that are beyond the medical expenses included in the <br />Base Rate per Diem for in -facility care for Department offenders including high cost/specialty medication <br />for chronic conditions. <br />In -Facility Care — medical care provided to Department offenders as part of the Base Rate per Diem to <br />include over-the-counter medications, routine medical, mental health and dental care, regular medical <br />screenings and emergent medical treatment, identical to services provided to other County inmates. <br />Formulary Medications — medications described in the DOC Pharmaceutical Management and Formulary <br />Manual. Medications in this category are described as medically necessary and require no further approval <br />for use provided the criteria listed in the formulary are met. The formulary is available online at the <br />following link: http://www.doc.wa.gov/corrections/services/docs/formulaiy_12 . <br />Medically Necessary Care — medical care that meets one or more of the following criteria for a given patient <br />at a given time: <br />• Is essential to life or preservation of limb, or <br />• Reduces intractable pain, or <br />• Prevents significant deterioration of activities of daily living (ADLs), or <br />• Is of proven value to significantly reduce the risk of one of the three outcomes above (e.g. <br />certain immunizations), or <br />• Immediate intervention is not medically necessary, but delay of care would make future <br />care or intervention for intractable pain or preservation of ADLs significantly more <br />dangerous, complicated, or significantly less likely to succeed, or <br />• Reduces severe psychiatric symptoms to a degree that permits engagement in <br />programming that advances correctional interests, or <br />• Is described as part of a Departmental policy or health care protocol or guideline and <br />delivered according to such policy, protocol or guideline, or <br />State of Washington K9561(6) Pagel of 5 <br />Department of Corrections Attachment B-1 <br />