CARE level 1 inmates: This designation is made by the DSCC. These inmates are less than 70 years of age and are generally healthy, but may have limited medical needs that can be easily managed by clinician evaluations every six months. Examples of such needs include mild asthma, diet-controlled diabetes, and stable HIV patients not requiring medications. Level 1 institutions are located approximately one hour or more from community medical centers since medical care is not often needed.

CARE level 2 inmates: This designation is made by the DSCC. These inmates are stable outpatients who require at least quarterly clinician evaluations. Their medical conditions, including mental health issues, can be managed through routine, regularly scheduled appointments with clinicians for monitoring. Enhanced medical resources, such as consultation or evaluation by medical specialists, may be required from time to time, but are not regularly necessary.  Examples of issues at this level include medication-controlled diabetes, epilepsy, or emphysema. Level 2 institutions have no special capabilities beyond those that health services staff ordinarily provide; however, they are within about an hour of major regional treatment centers (for example, Fort Dix and Fairton, New Jersey), thereby permitting more immediate attention to medical emergencies. Most BOP facilities are classified as CARE level 2 facilities.

CARE level 3 inmates: This designation is made by the BOP’s Office of Medical Designation and Transportation in Washington, D.C. These inmates are fragile outpatients who require frequent clinical contacts to prevent hospitalization for catastrophic events. They may require some assistance with activities of daily living, such as bathing, dressing, or eating, but do not need daily nursing care. Other inmates may be assigned as “companions” to provide the needed assistance. Stabilization of medical or mental health conditions may require periodic hospitalization. Examples of these medical conditions include cancer in remission less than a year, advanced HIV disease, severe mental illness in remission on medication, severe congestive heart failure, and end-stage liver disease. Level 3 institutions are located adjacent to level 4 institutions, that is, federal medical centers.

CARE level 4 inmates: This designation is made by the BOP’s Office of Medical Designation and Transportation in Washington, D.C. These inmates require services available only at a BOP Medical Referral Center (MRC), which provides significantly enhanced medical services and limited inpatient care. Functioning may be so severely impaired as to require 24-hour skilled nursing care or nursing assistance. Examples include cancer on active treatment, dialysis, quadriplegia, stroke or head injury patients, major surgical treatment, and high-risk pregnancy.