Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division

Transcription

1 Lane County Sheriff s Office Eugene, Oregon Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Technical and Cost Proposal April 7, :00 p.m. PDT Respectfully Submitted to: Paula Bearden, Contract Administrator Lane County Sheriff s Office, Fiscal Section 125 East 8 th Avenue Eugene, OR Submitted by: Correct Care Solutions, LLC 1283 Murfreesboro Road Suite 500 Nashville, TN x5777 Tax ID# Point of Contact: Patrick Cummiskey President of CCS Correctional Healthcare P: F: Patrick@correctcaresolutions.com This submission includes the following required copies: Technical and Cost Proposal 1 Master, 6 copies, and 1 electronic copy

2 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 April 3, 2015 Dear Ms. Bearden, Lieutenant Buckwald, Lieutenant Brown, and Members of the Evaluating Committee: Correct Care Solutions, LLC (CCS) appreciates the opportunity to present our proposal for Medical, Dental and Mental Health Services for the Lane County Adult Corrections Division. We have thoroughly reviewed Lane County s RFP, LCP 2015/16-01, its addenda, and the answers to questions, and we attended the mandatory pre-bid meeting and tour of the facilities on March 12, We are familiar with Lane County s requirements, and we fully understand the requirements of the National Commission on Correctional Heath Care (NCCHC) and the applicable standards established by the State of Oregon. CCS has the proven ability and track record to meet and exceed these standards in the counties and municipalities we serve. CCS, through its affiliated companies, currently provides services to six counties in the State of Oregon, including Columbia County, Umatilla County, Jackson County, Coos County and nearby Douglas County. We would be honored to partner with the Lane County Sheriff s Office and add you as another valued client in the State of Oregon. Our program for Lane County will receive on-site support by our qualified and experienced Regional Management Team located in the State of Oregon, and will be supported directly by our Home Office in Nashville. Our proposal for Lane County describes our enhanced programs, our advanced technology designed specifically for corrections, our Care Management Program for utilization management, and our successful transition experience providing turnkey solutions for our clients. CCS is very proud of the fact that we have transitioned 44 of our current clients from your incumbent provider. As one of the premier providers of correctional health care in the United States, CCS has the experience and resources required to be a true partner for the Lane County Sheriff s Office as we deliver the medical program for the patients in your custody. We believe our proposal clearly demonstrates that our focus on improving clinical results and cost efficiencies for Lane County makes CCS the right choice for the following reasons: Electronic Record Management Application (ERMA). CCS is offering Lane County a state-of-theart Electronic Medical Record (EMR) and electronic Medication Administration Record (emar) system. ERMA, a web-based technology, is successfully utilized in approximately 75 correctional institutions in the United States and is supported 24/7 by the CCS Information Technology Department. Utilization Management. CCS has the strongest utilization management system in the industry. The CCS Care Management Program is offered to Lane County at no cost and will be operational on Day One of the contract. CCS case managers, under the direction of our Vice President of Managed Care, will ensure proper management of all off-site services and costs. As a result, we can provide a more robust, integrated Utilization Management program to help improve accuracy of results and operational efficiencies, thereby creating budget savings for the Lane County Sheriff s Office. Lane County Sheriff s Office

3 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Proven Transition Ability. CCS has the verifiable ability to smoothly and successfully transition services within 30 days, and on occasion, with less than two weeks notice. CCS began providing services at the Onondaga County, New York facilities on November 15, 2013, six weeks earlier than originally scheduled, when we were notified by the Onondaga Sheriff that the incumbent provider would be leaving before their contract end date of December 31, The CCS Transition Team accelerated our transition plan and successfully began services, with our Care Management Program fully operational on Day One. Our proposal offers additional Transition Success Stories. As previously mentioned, CCS also been able to document great success in transitioning medical programs previously operated by your incumbent provider. Discharge Planning Program. CCS will work with community agencies, including the Lane County Behavioral Health Center and other community resources, to provide discharge planning services to the inmates of the Lane County Jail re-entering the community after incarceration. This, along with our intent to proactively register inmates for services under the Affordable Care Act, are vital steps in the initial attempt to reduce recidivism. We are passionate about what we do and we value the clients we serve. We appreciate our employees and we work hard to retain valued members of our team. Most importantly, we deliver quality health care for each of our patients. CCS continually strives to be the correctional health care company clients want to work with and employees want to work for! We have experienced tremendous success over the past twelve years by identifying the right business partners and understanding their unique needs; finding solutions to the challenges our clients face; and working hard each day to retain every client. CCS is prepared to commit the necessary resources to efficiently deliver high-quality, sustainable programs in Lane County. We look forward to discussing the details of our program with you and to forging a successful partnership with the Lane County Sheriff s Office. Sincerely, Patrick Cummiskey President of CCS Correctional Healthcare P: F: Patrick@correctcaresolutions.com Lane County Sheriff s Office

4 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Table of Contents 1 Statement of Assurances Questionnaire Response... 6 A. INDUSTRY AND PROFESSIONAL EXPERIENCE:...6 B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION: C. OPERATIONAL PLAN DESIGN / STRATEGY / SERVICE BASIC MEDICAL SERVICES (ALL REQUIRED): QUALITY CONTROL: COMPUTERIZED TOOLS: INVENTORY: UNUSUAL CIRCUMSTANCES: TRANSITION PLAN: INVOICING: CONTRACT: D. PROPOSED BUDGET AND COST BREAKDOWN E. References: Other Attachments A. Key Personnel B. Resumes C. Job Descriptions Contract Mark-up Lane County Sheriff s Office

5 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Statement of Assurances STATEMENT OF ASSURANCES Solicitation Number LCP-2015/16-01 Proposer's Name: Correct Care Solutions, LLC Proposer offers to provide the required services in accordance with the requirements of the Request for Proposals (RFP) stated above and the enclosed proposal. The undersigned Proposer declares that the Proposer has carefully examined the above-named Request for Proposals, and that, if this proposal is accepted, Proposer will execute a contract with the County to furnish the services of the proposal submitted with this form. PROPOSER'S STATEMENTS A. Proposer attests that the information provided is true and accurate to the best of the personal knowledge of the person signing this proposal, and that the person signing has the authority to represent the individual or organization in whose name this proposal is submitted. B. By execution of this Form, the undersigned Proposer accepts all terms and conditions of this Request for Proposals except as modified in writing in its proposal. Proposer agrees that the offer made in this proposal will remain irrevocable for a period of sixty (60) days from the date proposals are due. C. By execution of this Form, the undersigned Proposer acknowledges that its entire proposal is subject to Oregon Public Records Law (ORS ), and may be disclosed in its entirety to any person or organization making a records request, except for such information as may be exempt from disclosure under the law. Proposer agrees that all information included in this proposal that is claimed to be exempt from disclosure has been clearly identified either in the Proposer's Statement, or in an itemization attached hereto. Proposer further acknowledges its responsibility to defend and indemnify the County for any costs associated with establishing a claimed exemption. D. By execution of this form, the undersigned Proposer states that Proposer has a minimum of five (5) years experience in providing health care services for arrestees and inmates in a correctional setting. E. By execution of this form, the undersigned Proposer states that Proposer has experience in the management of health care programs in facilities of average daily population between inmates. Lane County Sheriff s Office 1

6 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 F. By execution of this form, the undersigned agrees to comply with all applicable federal, state, and local laws, regulations and requirements related to the RFP and performance of any resulting Contract, including but not limited to those referenced in this RFP. G. By execution of this form, the undersigned Proposer agrees that Proposer will meet the insurance requirements included in the proposed Contract included in the RFP and agrees that such coverage will be kept active during the entire term of the Contract, if awarded. H. By execution of this form, the undersigned Proposer agrees that this Proposal will irrevocable for a period of sixty (60) days from the deadline for receiving proposals under this RFP. PROPOSER'S CERTIFICATIONS I. By execution of this document, the undersigned Proposer certifies that, to the best of its knowledge and belief, neither it nor any of its principals: 1. Are presently debarred, suspended, proposed for debarment, or declared ineligible from submitting bids or proposals by any federal, state or local entity, department or agency; 2. Have within a three (3) year period preceding this offer, been convicted or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performance of a public (Federal, state or local) contract or subcontract; violation of Federal or state antitrust statues relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statement, tax evasion, or receiving stolen property; 3. Are presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph 28.2 of this certification; 4. Have within a three (3) year period preceding this offer, had one or more contracts terminated for default by any Federal, state or local public agency. J. By signing this Proposer's Certification form, Proposer certifies that: 1. Proposer is is not X (check one) a resident bidder, as defined in ORS 279A Proposer has not discriminated and will not discriminate against a subcontractor in awarding a subcontract because the subcontractor is a minority, women, or emerging small business enterprises certified under ORS or a business enterprise that is owned or controlled by or that employs a disabled veteran, as defined in ORS This proposal is made without connection or agreement with any individual, firm, partnership, corporation, or other entity making a proposal for the same services, and is in all respects fair and free from collusion or collaboration with any other proposer. Lane County Sheriff s Office 2

7 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Lane County Sheriff s Office 3

8 ADDENDA Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Proposer has received and considered, in the accompanying proposal, the terms of the following addenda: Addendum 1, rec d 3/20/15; Addendum 2, rec d 3/24/15; Addendum 3, rec d 3/30/15 The undersigned, by signature here, acknowledges, accepts, and certifies to the Proposer's Statements and Certifications as stated above. 1. Company As registered with the State of Oregon: Company s Full Legal Name: Correct Care Solutions, LLC City and State of Company Headquarters: Nashville, Tennessee 2. Contractor Authorized Signature: Name: Patrick Cummiskey Signature: Title: President Date: 3. Office that would service Lane County: Address: CCS Home Office 1283 Murfreesboro Road, Suite 500 Nashville, TN Phone: Fax: Address: Patrick@correctcaresolutions.com Lane County Sheriff s Office 4

9 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Contractor s RFP contact for this project: Name: Patrick Cummiskey Phone: Title: President Address: Patrick@correctcaresolutions.com Office Address: 1283 Murfreesboro Road, Suite 500 Nashville, TN If you would like additional contacts to be alerted to courtesy s regarding this RFP, please include here: Name: Jack Jadin, Director of Business Development Address: JJadin@correctcaresolutions.com Name: Angela Davis, Proposal Specialist Address: ajdavis@correctcaresolutions.com Lane County Sheriff s Office 5

10 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Questionnaire Response A. INDUSTRY AND PROFESSIONAL EXPERIENCE: 1. Provide the date (and number of years) your company organized to provide medical services in institutional and correctional facilities in the United States and provide the same data separately for world-wide services (if applicable). Correct Care Solutions (CCS) was founded in August 2003 to meet a growing industry need for a correctional health care provider with an innovative approach. Today, CCS is a privately owned Limited Liability Company (LLC) in our twelfth year of operation. 2. Describe briefly your corporate background. CCS is specifically organized to provide comprehensive correctional health care services to facilities just like the Lane County Jail Facilities. Our programs in these facilities include the design and successful operation of comprehensive medical, dental, and mental health services for inmate populations. Given the opportunity to work with the Lane County Sheriff s Office (LCSO), we will provide the same dedicated level of service that our clients have come to expect from CCS. The CCS Executive Team has over 250 years of combined correctional health care experience, and the entire team will be fully engaged in the operation of programs and services for the LCSO. CCS is focused on a strategic plan that allows our organization to work efficiently and promotes success through enhanced communication. All CCS employees function as a team, and every team member expects to be part of the solution. Our corporate organizational structure is simple, effective, and functional by design. It ensures that everyone, from the highest level of management to each member of our line staff, understands accountability and responsibility for all actions. As such, the full extent of our company resources will be available to you as we serve the LCSO. 3. Provide gross sales volume and number of employees for medical services provided in institutional and correctional facilities in the United States and provide the same data separately for world-wide services (if applicable). Our combined team of more than 10,000 employees cares for approximately 250,000 patients in 37 states each day. Our gross sales volume for 2014 was approximately $714 million, and we maintain a high level of cash flow through our profitable operations. 4. Please provide a list of all medical services contracts with correctional facilities that your firm has had in the last five (5) years and include the number of years serving those clients. We have provided our comprehensive Client List with detailed contract information, including dates of service, on the following pages. Lane County Sheriff s Office 6

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35 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Identify those contracts in the last five (5) years that your company did not retain, and please provide a brief summary of why your contract was not renewed for non-current clients. We have provided a list of inactive contracts where CCS provided services within the last five years on the following pages. Lane County Sheriff s Office 7

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41 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Please include a list of litigations or class action law suits filed against your organization in the last five (5) years that were either financial settled or judgment resulted against your organization. CCS maintains arguably the strongest and most successful litigation history in our industry. We feel this is directly reflective of not only the high standard of care we provide, but also the emphasis CCS places upon quality and effective risk management. Utilizing a collaborative and cross-functional team approach, CCS proactively identifies areas of risk before they develop into serious problems, then works to eliminate and mitigate those risks. This, coupled with a stringent quality assurance and patient safety program, enables CCS and its partner clients to avoid negative outcomes and costly litigation. We view this as a major differentiator between CCS and other companies that sets us apart in our industry. We are pleased that CCS has never had a judgment entered with regard to any trials with any patient, client, hospital, government entity, or vendor. We have never received a judgment against us by a jury, nor have we ever received an adverse jury ruling. Unlike our competitors, when litigation does arise, the overwhelming majority of all CCS lawsuits result in early case dismissals via aggressive litigation defense strategies carried out by an experienced in-house litigation and risk management team. As our references can attest, CCS has dramatically decreased or eliminated litigation for each of our clients. This is one of the many extraordinary value-added services that CCS offers our partners. There is no pending or expected litigation or other conditions that would affect the stability of our company in any way. CCS has no judicial or administrative proceedings that are material to our business or financial capability, or our ability to perform the work requested in the RFP. We have provided the requested litigation history for the past five years on the following pages. Please note that this information is confidential and proprietary. Lane County Sheriff s Office 8

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44 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Is your firm licensed to do business in the State of Oregon? Provide the full legal name of your business as registered with the State of Oregon. Correct Care Solutions, LLC is registered to do business in the State of Oregon. Our Registry Number is What unique qualities or perspective (competitive edge) would your company bring to this engagement? CCS has proven ourselves time and again through our unmatched track record within the correctional healthcare industry, resulting in client relationships forged through collaborative operational successes. We have an impeccable reputation within our industry based on our exceptional clinical on-site programs and strong community provider relationships. We perform methodical due diligence on all contracting opportunities to ensure the success of our partnerships. Our strategy for the management of this contract will be simple: We have the best possible team and will hold our team members accountable for meeting and exceeding all contract requirements. We will work diligently to contain costs wherever possible, and provide extensive reporting capabilities that can be customized to the needs of the Lane County Jail Facilities. CCS is equipped with the right experience, the right resource network, and the right staff to provide a comprehensive medical services program best suited to manage the LCSO medical program. Following are just a few qualities that make the CCS Difference. Industry-leading Recruitment and Retention CCS focuses on prudent staff deployment in order to promote high efficiency and improved morale. As a result, we have an excellent retention rate with low turnover. In order to consistently recruit and retain highly qualified employees, CCS has developed industry-leading employee retention programs, including competitive benefits programs and opportunities for professional development. By showing our employees that they are a valued part of our company, CCS is able to save our clients unnecessary operational expense and added costs created by turnover. For information regarding CCS recruiting practices, please see section 6. TRANSITION PLAN. For information regarding CCS employee retention initiatives, please see section B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION. Uniquely Experienced Regional Management Team Strengthening communication and operational workflows in the CCS program will be our Regional Management Team, led by individuals who are familiar with State of Oregon requirements and will be readily available to the LCSO. Moreover, our Regional Management team has unique experience within the Lane County Jail Facilities. Specifically, Stevens Hyppolite, Regional Vice President, was involved with the startup of the Lane County Jail Facilities as a Regional Manager. Mandy Forsmann, Regional Manager, has traveled to the Lane County Jail Facilities to train nursing personnel and assisted with onboarding the current Health Services Administrator (HSA). Mental Health Experience Our Regional Management team has first-hand experience with Director s Holds. They have worked with Mental Health Professionals in the past to obtain this certification. Stevens Hyppolite, Regional Vice President, helped establish the Director s Holds protocols at the Lane County Jail Facilities with the current mental health staff. We plan to bring this level of understanding and expertise to Lane County. Lane County Sheriff s Office 11

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47 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Superior Technology If desired by the LCSO, CCS will implement our Electronic Record Management Application (ERMA) at the Lane County Jail Facilities. ERMA is a web-based application designed to operate as part of the health care delivery system inside correctional facilities, making implementation straightforward so clients can start benefitting from the solution right away. Our advanced technology creates operational efficiencies by giving clients the information they need to better manage patient care. CCS will also implement online pharmaceutical ordering and administration through the erx and emar modules of ERMA. We have provided detailed information regarding ERMA in section 3. COMPUTERIZED TOOLS. Proven Success Managing Chronic Care CCS has successfully established many on-site programs and specialty care clinics for our current clients. Our continued focus on the identification, referral, and treatment of inmates with chronic conditions allows CCS to manage our patients needs before they escalate and require off-site consultation, or result in grievances or litigation. Community Connection CCS is dedicated to establishing relationships within the communities we serve. We partner with local organizations to maximize continuity of care for each patient; we work with local agencies to develop training programs for nursing students and new correctional staff; and we seek out local charities that allow us to give back to the community. As we perform due diligence for the LCSO medical program, we will reach out to area providers to form partnerships and enhance the continuity of care for your inmate population. Hands-on Approach The CCS Executive Team is closely involved with the implementation and operation of services for our clients. Continuous communication helps minimize surprises and ensures a mutual understanding of decisions and protocols. To ease the transition of services, CCS prefers to meet with new clients and valued medical personnel within 48 hours of notice of contract award; the members of our proposed Regional Management Team will become familiar faces as they provide guidance and insight to members of the on-site medical team at the Lane County Jail Facilities. 9. Provide 1 or 2 examples of how your organization improved a new client s efficiencies by replacing their existing medical services operation. Describe the biggest roadblocks, how you and your client approached them, and the outcomes. In all programs we design and operate, the CCS objective is to uncover all possible areas of economy without sacrificing quality. CCS demonstrates value through our cost saving initiatives, timely reporting, and overall improved quality of people, programs, and processes. By applying our Savings through Value-Added Efficiency (SAVE) initiative, CCS is continually reviewing best practices at all of our sites to share success with all of our clients. Three areas of significant cost in any program are goods and services, staffing, and off-site trips for care. CCS generates efficiencies and savings in these areas through contract negotiations with providers, staffing level management, and utilization management. Lane County Sheriff s Office 14

48 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 CCS is highly confident that we can work with the LCSO to reduce and contain costs for on-site and offsite services, based on our track record of cost savings success at our client sites. Our passion for doing things the right way has led to phenomenal success not only in the quality of our care programs, but also in cost containment for our clients. By reviewing the specifics of each client s inmate healthcare needs and maximizing facility and staff capabilities, we create efficiencies and cost savings. CCS forms successful partnerships that help our clients contain costs and improve the quality of healthcare in correctional facilities throughout the country. Following are just two examples of our proven success for your consideration, verified by accompanying documentation. We have also provided additional Cost Containment Success Stories for your review. Richland County, SC Under its previous health care provider, the Alvin S. Glenn Detention Center in Columbia, South Carolina was unaccredited, had no Mental Health screening in place at intake, and had a troubling history of suicides and other critical clinical events. Within two years of taking over as the health care provider at Richland County, CCS managed a significant turnaround for the Detention Center and with it a positive impact for its mentally ill incarcerated patients, and ultimately the community at large. We contracted with the local mental health agency to create a cooperative effort and have since continued to expand that partnership to include shared patient information within confidentiality guidelines. With our oversight and commitment to standards and quality of care, the Center is now NCCHC and ACA accredited, Mental Health screenings have been implemented at intake, and the Mental Health program has received recognition for its improvement and quality. Lane County Sheriff s Office 15

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51 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Durham County, NC CCS was presented with the challenge of taking over a program that had no nurses prior to our arrival, as nearly the entire staff was comprised of agency personnel. We were also challenged with opening an infirmary, expanding staffing to 24/7 coverage, improving a strained relationship with the local hospital, and collaborating with the Durham Center, a community mental health agency. CCS helped stabilize healthcare costs in Durham County by reducing off-site trips and thereby overall program costs. We brought more services on-site by expanding nursing services and opening an infirmary, significantly decreasing off-site trips and hospital stays. CCS was also able to improve by 50% the discount the County had with the local hospital provider. Much of this success is attributable to our determination and creativity in increasing the level and quality of on-site services to save the County in off-site and thereby overall program costs. Overall, CCS has reduced the County s per inmate per day costs below what they were paying previously, and they have stayed that way consecutively under CCS management. Quotes from our Client CCS was able to creatively structure a contract that managed skyrocketing inmate health care costs in a manner that was consistent with our philosophy of care. This was an amazing feat I recommend CCS as a service provider without reservations. Gayle Harris Director, Durham County Health Department We think they have done remarkably well particularly given the very short amount of time they have had to come into the detention center. Brian Letourneau Health Director, Durham County Emergency room visits, days inmates spent in the hospital, and the need for specialty consultations dropped significantly. Virginia Bridges The Herald-Sun, February 9, 2005 Lane County Sheriff s Office 18

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55 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION: 1. Please provide a staffing plan (with a list of proposed wages, salaries, and benefits for each position) and an organizational chart for providing medical service in compliance with these specifications (Attach to Exhibit C). a. Include a staffing (a compensation) plan needed for the following inmate jail population levels (or similar totals): 1) 1 to 237 Jail Beds 2) 238 to 281 Jail Beds 3) 282 to 355 Jail Beds 4) 356 to 437 Jail Beds 5) 438 to 507 Jail Beds CCS has developed comprehensive staffing plans for the Lane County Jail Facilities based on the requirements of the RFP, a review of the current staffing levels, the information provided to us during the pre-bid tour, and our expertise in other facilities of similar size and scope. The CCS proposed staffing takes into consideration the specific needs of the inmate population, capabilities of the LCSO staff, details of the physical plant, and a recommended level of providers to efficiently and cost effectively perform all necessary duties and functions. It has been developed with what we believe to be a thorough understanding of your facilities and the services to be provided. This proposal also reflects our understanding of the standards of care and the expectations of the local community that we will be serving. We have provided staffing plans based on the five population levels described in the RFP, with population level #3 being the primary staffing plan based on the bidding ADP of 326. In some instances, we felt comfortable with a decrease of staff, such as Medical Record Clerk hours, as we plan to create efficiencies at the Lane County Jail Facilities with our ERMA program. CCS welcomes the opportunity for further discussion regarding any staffing adjustments that may need to be made. We have also provided proposed salary rates and benefits and a proposed organizational chart for the Lane County Jail Facilities. Lane County Sheriff s Office 22

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63 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 b. Discuss a plan to include sufficient back-up staffing. CCS will ensure the same staff category coverage for all direct health care positions during periods of absence, including holidays, earned time off, sick time, etc. The CCS staffing plan and relief factor calculations ensure adequate coverage for holidays, weekends, vacation and sick days, emergencies, and any other extenuating circumstances that may arise. CCS will maintain a PRN pool to ensure backfill and relief coverage is available when needed. PRN pool employees are staff members who are committed to several shifts per month and who are open to working when full-time staff members are absent due to vacations, holidays, or sick leave. Our PRN staff will complete orientation and ongoing training consistent with our full-time team members to ensure they are capable and ready to provide continuity of services. 2. Please identify the key positions you deem to be necessary to manage Lane County s account, and the minimum requirements needed to fill each position. Be sure to distinguish between primary contacts and secondary or back-up representatives. CCS will provide a full range of professional management services to support the LCSO medical program. We have established policies and procedures to ensure the continued quality of our medical programs, and we are dedicated to maintaining a high quality of care for our clients and the patients we serve. The primary contacts for this contract will be, in order: 1. Health Services Administrator 2. Regional Manager Mandy Forsmann 3. Regional Vice President Stevens Hyppolite Health Services Administrator CCS will assign a Health Services Administrator (HSA) who will be the designated Responsible Health Authority for the Lane County Jail Facilities and will oversee the administrative requirements of the medical program, including recruitment, staffing, contracts, data gathering and review, monthly reports as required, medical record keeping, and other contract services management. The HSA will manage the LCSO medical program based on defined goals, objectives, policies, and procedures, and will ensure that the medical program is conducted in accordance with state and local regulations, as well as NCCHC and ACA standards. The HSA will be responsible for coordinating contract requirements with the Medical Supervisor and Jail Administration. The HSA will monitor the implementation and effectiveness of procedures and programs, and will work with the LCSO to address and resolve any issues in the performance of services. The HSA will provide administrative supervision for the CCS Medical Director and all other medical staff, and will also perform the following essential job functions for the LCSO: Monitor the implementation and effectiveness of procedures and programs Evaluate financial/statistical data and program needs/problems, and make recommendations for improvements Develop, utilize, revise, interpret, and ensure compliance with CCS and facility policies and procedures Monitor subcontracted services, including pharmacy, lab, X-ray, and specialty providers Maintain communication and a good working relationship with facility administration, CCS employees, correctional personnel, contracted providers, and outside agencies Lane County Sheriff s Office 30

64 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Regional Management Strengthening communication and operational workflows in the CCS program will be our Regional Management Team, containing individuals who are familiar with State of Oregon requirements and will be readily available to the LCSO. Moreover, our Regional Management team has unique experience within the Lane County Jail Facilities specifically. Stevens Hyppolite, Regional Vice President, was involved with the startup of the Lane County Jail Facilities as a Regional Manager. Mandy Forsmann, Regional Manager, has traveled to the Lane County Jail Facilities to train nursing personnel and assisted with onboarding the current Health Services Administrator (HSA). The CCS leadership team for the Lane County Jail Facilities will include: Regional Vice President: Stevens J. Hyppolite, MBA, ACHE Regional Manager: Mandy Forsmann, RN Regional Medical Director: Vivek Shah, MD Regional Behavioral Health Manager: Julie Weigand, JD, LMCH, LPC a. Additionally, describe any needed cooperation and interactions from client staff with these positions in order to successfully perform their jobs. CCS will participate in monthly administrative meetings for the purpose of evaluating statistics, program needs, problems, and coordination between custody, health, and mental health services personnel. We believe that active, open, and honest communication is an essential component to a successful healthcare program. The HSA for the Lane County Jail Facilities will focus on maintaining open communication and a good working relationship with facility administration, CCS employees, correctional personnel, contracted providers, and outside agencies. As part of this focus, the HSA will serve as a liaison between the medical and security staff, and will hold interdisciplinary meetings to ensure continued communication and cooperation between custody and care providers. CCS will work to improve communication between nursing personnel and correctional personnel. Ongoing communication will ensure that all parties are fully aware of any special needs or concerns within the LCSO s inmate population. CCS will provide data necessary for the classification, security, and control of inmates to the appropriate LCSO command staff. We will share special needs treatment plans with the LCSO as needed to facilitate housing in the appropriate area of the Lane County Jail Facilities, and to ensure proper treatment of inmates with long-term and individualized healthcare needs. We will notify custody staff whenever a patient has a significant illness that will affect the patient s housing or program assignment, disciplinary sanctions, or transfer to another institution. 4. Submit resumes of any current individual(s) who would fill any of the key positions, along with an overview of their qualifications, experience in the industry, notations of professional licensing/certifications, and any unique skills they bring. We have provided this information in section 3 Other Attachments as required by the RFP. Lane County Sheriff s Office 31

65 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Please provide job descriptions of all key staff and sub-contractors assigned to this Contract. All positions in our staffing plan will work within their scope of practice, directed by job descriptions that include qualifications and specific duties and responsibilities. CCS will provide the LCSO with written job descriptions and protocols for all assignments at the Lane County Jail Facilities. Employees are given a copy of their job description to review at the time of their employment and the job description is used for performance evaluations. We have provided sample job descriptions in section 3 Other Attachments. 6. Provide your plan toward maintaining health and sanitation requirements within the medical, dental and mental health sections (contract cleaning company, hazardous and medical waste disposal, etc.). CCS will be responsible for the day-to-day housekeeping of the medical unit. We will contract with a local cleaning company to provide these services. We have made preliminary attempts to obtain competitive pricing from local cleaning companies in the area, including Brothers Cleaning Services. Stevens Hyppolite, Regional Vice President, was instrumental in establishing the relationship with the current cleaning provider and will again continue this partnership upon award, or will contract with another local provider subject to the approval of the LCSO. CCS is familiar with the expectations of Lane County regarding standards of cleanliness and sanitation. We are committed to ensuring that our client populations live, work, recreate, and eat in a safe and healthy environment. We will coordinate with the LCSO to conduct monthly safety and sanitation inspections of food service, housing, and work areas. CCS will make appropriate recommendations for corrections on discrepancies or citations noted. Copies of all inspection reports will be provided to the Jail Administration. CCS has a national contractual relationship with Stericycle to ensure safe disposal of used needles, sharps, and biohazardous waste. We will be responsible for annual registrations with state and federal agencies and will ensure that all medical waste and sharps are disposed of in accordance with federal and Oregon State regulations. 7. Describe employee training plans for managers, supervisors, and employees starting with your company, to include (if any) the number of training hours, the method of training (internet, classroom, documents, etc.), location of training, etc. Our employees are our most valued assets, and we are committed to equipping CCS team members with the necessary tools for success. CCS provides our site leaders with management training that allows them to foster the proper culture for working in a challenging environment. It is our belief that in order to be the company that clients want to work with, we must be the company that employees want to work for. Orientation CCS provides a comprehensive training program for our employees. New staff members go through the CCS Onboarding process, and all employees receive ongoing skills/knowledge assessment through our Performance Enhancement and Leadership Development programs. All CCS staff members are required to participate in each phase of training. The frequency and focus of each training phase will be determined by the position and learning capacity of individual employees. Lane County Sheriff s Office 32

66 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Phase 1: Onboarding Critical to the future success of any new employee is his or her initial experience with the organization. To start the employee off on the right foot and to ensure a smooth transition, CCS offers a three-part onboarding process: Orientation, On-the-Job Training, and Follow-up. Onboarding Step 1: Orientation Each new hire is scheduled to participate in an eight-hour learning experience (the physician orientation program has additional requirements), where they are introduced to the CCS culture, policies, and procedures. The program is designed to clearly establish expectations and to involve new employees in the success of the company. We have provided a CCS New Hire Welcome DVD with our proposal. Onboarding Step 2: On-the-Job Training (OJT) On-the-Job Training is guided by standards, detailed checklists, and a qualified preceptor. While there are time schedules with expected milestones, the preceptors will work with the new employees to ensure that the expected knowledge is transferred. This portion will not be considered complete until the new employee feels capable of performing the job and satisfactorily passes the post-test. Onboarding Step 3: Follow-up Follow-up is the last component of the onboarding process. During this component, the new employee has an opportunity to provide feedback about his or her experience with the Health Services Administrator (HSA). During this discussion, the HSA also shares information about his or her leadership style and performance expectations. Phase 2: Performance Enhancement Performance Enhancement training consists of skills labs and webinars. On a scheduled basis, the medical team will participate in online training, as well as in-service learning opportunities such as Lunch and Learn sessions. In addition, webinars and DVDs that interface with a variety of Subject Matter Experts (SMEs) will be offered to staff members as applicable for their roles. Training CCS routinely offers continuing development and training opportunities for our employees, and we will work with the LCSO to ensure that on-site personnel receive corrections-specific training opportunities. We offer both in-house and community opportunities for continuing education programs applicable to a career in correctional healthcare. By encouraging our employees to take advantage of these opportunities, CCS is building an even stronger, more professional staff equipped to meet our clients diverse needs. Lane County Sheriff s Office 33

67 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 In-Service Training CCS maintains a video library and other reference materials that facilities can use to build site-specific training programs. Additionally, the CCS Training Department offers self-study continuing education and training programs on a monthly basis. These programs build on the foundation established during the orientation process and are conducted in accordance with professional and legal standards. For example, CCS ensures that all staff members are trained on PREA standards by providing education, testing their knowledge, and providing certification based on demonstrated competency. Suicide Risk Reduction training is a mandatory part of CCS new employee orientation and is also required annually for all CCS employees and subcontractors. CCS distributes the self-study training programs electronically, and participants who successfully complete a skills program receive a certificate of completion. The CCS Training Department is available for technical assistance as needed. Continuing Education While employees maintain the greatest responsibility for their own grown and development, we strongly believe it is incumbent upon us to provide CCS team members with the proper tools to build on their knowledge and further their success. CCS maintains a continuing education provider license that allows us to offer continuing education credits to nursing personnel as an employee benefit. Employees have the opportunity to complete at least 40 hours of continuing education training annually. The HSA will be responsible for ensuring that healthcare personnel receive, at a minimum, one hour of continuing education per month, to include topics on issues specific to the Lane County Jail Facilities. We identify new topics on an ongoing basis through the Continuous Quality Improvement Program (CQIP). The HSA will maintain documentation of completed training in an individualized training record for each employee. CCS will ensure that all employees complete any annual training necessary to maintain their licenses and/or certifications. All healthcare personnel maintain current first aid and CPR/AED certification and attend appropriate workshops to maintain their licensure. Our Deputy Chief Clinical Officer and Regional Medical Directors mentor and coach our providers. CCS physicians and mid-level providers receive continuing education from the Chief Medical Officer and Deputy Chief Medical Officer through webinar events. Topics are selected based on timely and relevant correctional healthcare issues. CCS also offers web-based training tools for our healthcare practitioners. CCS has also arranged for employees to receive Continuing Education Credits (CNEs) from Medscape, an online repository of clinical information and educational materials. Through Medscape, employees can access medical articles, recaps from conferences, research links, and other materials. Please see the following example of a self-study continuing education and training schedule. Lane County Sheriff s Office 34

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69 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 CCS has created a comprehensive Nursing Competency program to ensure that our nurses are well-equipped to care for our patients. The program presents nursing professionals with a variety of scenarios to assess their clinical competency and decision-making ability. By offering Nursing Competency workshops and exams, CCS ensures that our nurses keep their skills sharp and stay on top of the latest developments in clinical practice. In addition to our cuttingedge training programs, CCS has developed educational materials that can be placed conspicuously in our sites to remind nurses of basic protocols, like SBAR communication (Situation, Background, Applicable nursing data, Request/Recommendation). CCS has adopted several outreach techniques for our valued nursing professionals, including advanced training opportunities and open communication through the Nurse Channel, an online resource for CCS nursing professionals. In addition to providing useful information, the Nurse Channel also recognizes CCS nurses that have done an outstanding job upholding our high standards for patient care. The CCS Nursing Services team has also established a Nursing Services Hotline for nurses to call and ask questions related to nursing practice, training questions, or resource needs. The Nursing Services Hotline is answered each day by a Registered Nurse who is knowledgeable about state-specific scope of practice and CCS clinical policies, resources, and processes. 8. Describe employee training plans for any positions you intend to hire specifically for Lane County s account, to include (if any) the number of training hours, the method of training (internet, classroom, documents, etc.), location of training, etc. CCS will provide leadership training specifically for the Health Services Administrator assigned to the Lane County Jail Facilities. We use Leadership Development training to invest in the continued growth of our employees in order to develop leaders from within. Each training session varies in delivery and duration, and is designed to strengthen the leadership competencies of all of our staff members. The Leadership Development training sessions are a collaborative effort between our Home Office and onsite leaders. CCS Leadership Boot Camp CCS HSA Leadership Boot Camp, held at our Home Office in Nashville, gives our new leaders the opportunity to learn about CCS values, policies, practices, and culture. Boot Camp is a three-day interactive experience focusing on People Skills, Patient Care, Processes and Procedures, Partnering with our clients, and operations. CCS will ensure that the HSA for the Lane County Jail Facilities has the opportunity attend our Boot Camp program. Lane County Sheriff s Office 36

70 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 GPS Great People Skills By request, CCS offers a six-month intensive group development program for leaders designed around the following concepts: A. Who Am I? (assessing management and personality style, personal goals, and priorities) B. Who Are You? (interpersonal skills, conflict styles, mediation negotiation) C. Who Are We? (ethics and culture of CCS) New Leader Transition By request, CCS offers one-on-one on-site development with HSAs provided by Leadership Development strategists, including assessments, building the team, and specific development in areas of growth potential. 9. Describe your plan to successfully retain employees hired to Lane County s account. CCS understands the importance, for continuity of care, of ensuring the majority of our employees are full-time employees. Consistent staffing improves the quality of patient care and minimizes issues that can lead to grievances and lawsuits. CCS offers benefit-related incentives to entice those who may be looking at a slightly higher rate of pay as per diem staff to commit to full-time employment with our company. We are proud to say that over 96% of all CCS jail positions are filled with permanent employees. Any open positions are temporarily filled through overtime and PRN staffing pools. Pride in Our People As our references will attest, CCS is constantly taking action to improve employee retention rates for all of our locations. We are proud to say that over 96% of all CCS jail positions are filled with permanent employees. Commitment to People Development CCS created our People Development program to invest in our employees long-term professional satisfaction and well-being. Our dedication to People Development creates lower employee turnover, reduces costs due to replacement and training, and strengthens team spirit through mutual respect and recognition of each employee s contributions. CCS believes that a successful operation begins with motivated employees who are well-equipped to satisfy the needs of our clients. We begin with the identification, validation, and recruitment of the very best people, then we orient them to our CCS culture and operations through an established onboarding process. CCS offers a full range of opportunities for our employees continued professional development, including training programs, continuing education, clinical exposure, promotion preparation, succession planning, and peer reviews. Professional Development/Tuition Assistance CCS encourages employees to take advantage of opportunities for advancement and professional growth. The CCS education and training program facilitates professional development and provides tuition assistance to employees as an opportunity to advance their skills and their career. Each year, CCS employees and their children who have graduated high school are encouraged to apply for CCSsponsored college scholarships. In 2014, CCS awarded three scholarships, two to CCS employees and one to the child of a CCS employee. Lane County Sheriff s Office 37

71 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Responses from Employee Surveys Working for and with CCS has been a great opportunity for me. I enjoy everything the company does for the sites as a whole as well as on an individual basis. They continue to help us grow and develop as a group through effective communication, patience, and understanding. When I started in corrections, I worked for [a competitor] I know CCS has a vested interest in my success and personal well-being. I have the tools needed to do my job, and through CORE and startups I have been able to expand my knowledge and believe my opinion and talents are important. This is the company I want to retire from. Employee Recognition CCS has a formal Employee Recognition Program based on our company slogan: The Right People Doing the Right Things Right. The program, known as R 3 Recognition, is designed to reward employees for outstanding performance and exemplary service. The purpose of the Employee Recognition Program is to motivate positive job behavior and build a sense of pride in each employee. CCS presents recognition awards each quarter based on attendance, customer service, teamwork, and overall performance. Flexible Scheduling When possible, CCS allows flexible scheduling to meet the needs of our employees. We employ parttime and per diem personnel to provide coverage for scheduled absences and to supplement any fulltime staffing needs. Human Resources Hotline CCS offers a 24/7 Human Resources hotline for employees who need guidance regarding an issue outside of regular business hours. Wellness Program CCS places a great deal of importance on the health and well-being of our staff. Employees are encouraged to participate in the CCS Wellness Program, which offers exercise programs, healthy eating tips, and other initiatives that promote a healthy lifestyle. Various CCS sites offer incentives or contests to encourage employee participation in programs that create a healthier staff, including smoking cessation and weight control programs. Employee Assistance Program CCS offers an Employee Assistance Program (EAP) through Aetna. All CCS employees and their household dependents have 24/7 access to a range of free services and educational materials to help with a variety of life/work challenges and crisis management. Assistance is available through a confidential phone call or referral to a specialist for up to three sessions of in-person support. The Aetna EAP also gives employees access to a variety of discounted services and programs designed to promote health and wellness. Lane County Sheriff s Office 38

72 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Dare to Care CCS established our Dare to Care Employee Assistance Fund to support our valued team members when they need it most. CCS employees and their eligible dependents can apply for economic assistance to help meet their needs in the event of unexpected economic hardship. Employees may be eligible for assistance if they experience extreme or catastrophic circumstances beyond their control, including loss of property due to natural disaster; life-threatening illness or injury; or the loss of a family member. CCS started Dare to Care with a generous gift of $50,000 and continues to support the fund by matching up to $20,000 of employee donations annually. To date, the Dare to Care fund has provided $200,000 to CCS employees in need. CCS uses the Community Foundation of Middle Tennessee to manage all funds and award gifts, which keeps the application process private and ensures that requests for assistance are reviewed by an impartial and experienced third party. 10. Describe your standard expectations of professionalism for your staff and how you train your staff to meet these standards. Discuss consequences for noncompliance. CCS conducts employee evaluations using designated forms for each full-time, part-time, and relief employee. Reviews are conducted three months from the date of active employment and annually thereafter according to hire date or date of contract renewal, depending on the specifications designated from the Home Office. Regular full-time and regular part-time employees are eligible for merit increases annually when they receive their performance evaluation. PRN/on-call employees are not eligible for merit increases annually, although the appropriateness of PRN rates is reviewed periodically. However, PRN/on-call employees may receive a merit increase as long as written approval is received from the Chief of Institutional Services or Executive Vice President. If any problems are identified, CCS will conduct performance reviews more frequently and report any unsatisfactory performance to the LCSO. The CCS Human Resources Department maintains a Policies and Procedures manual ensuring compliance with all governing laws available for our Health Services Administrators, DONs, and Nursing Supervisors. Policy and procedure governs activities including the new hire process, workplace policies such as fraternization, employee performance reviews, and progressive discipline procedures. Additionally, CCS offers a 24/7 Human Resources hotline in the eventuality that guidance regarding an issue is needed outside of regular business hours. CCS uses a progressive discipline approach to most employee performance issues, which involves verbal warnings and written warnings. CCS, however, reserves the right, in its sole discretion, to determine when performance issues are such that immediate termination is required. Lane County Sheriff s Office 39

73 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C. OPERATIONAL PLAN DESIGN / STRATEGY / SERVICE 1. BASIC MEDICAL SERVICES (ALL REQUIRED): a. Medical / Lab / X-Ray Services: 1) Describe in detail how your company intends to provide this service within the requirements listed in Exhibit B of the Sample Personal Services Contract (Scope of Services), Section C (Medical Services) and Sections H (On-site Services), and J (Off-site Referrals) as applicable. C.1.a.1 Medical Oversight CCS will assign a Site Medical Director to be the designated Responsible Physician for clinical services. The Medical Director will provide clinical oversight to the site medical program in accordance with NCCHC and ACA standards. This singularly designated physician health authority will work to ensure the appropriateness and adequacy of healthcare for the incarcerated population. The Medical Director will be overseen by our Regional Management Team, including Regional Medical Director, Dr. Vivek Shah, and Regional Manager, Mandy Forsmann, who will work with medical personnel to ensure standardscompliant programming as well as consistency of care and continuous quality improvement. The CCS staffing plan also includes coverage by a mid-level provider. C.1.a.2 Policies and Procedures Within 60 days of on-site startup, following a discovery period, CCS will develop a Policies and Procedures Manual tailored to healthcare services provided at the Lane County Jail Facilities and subject to approval by the LCSO. The CCS Policies and Procedures Manual will meet or exceed NCCHC and ACA standards. We anticipate that certain policies will undergo some revision within the first 120 days of the contract. The manual will subsequently be reviewed and revised as CCS/LCSO policies are modified, no less than once per year. For your reference, we have provided the table of contents from our standard CCS Policies and Procedures manual on the following pages. Please note that this information is confidential and proprietary. Lane County Sheriff s Office 40

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76 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.a.3 On-site and Off-site Care CCS will identify the need, schedule, coordinate, and pay for all non-emergency and emergency medical health care rendered to inmates either inside the Lane County Jail Facilities or outside at local medical care facilities. Additionally, we will provide emergency medical treatment and first aid to stabilize any staff, visitors, employees, or subcontractors of the Lane County Jail Facilities who become ill or injured and require emergency care while on the premises. Once the individual s condition is stabilized, they will be referred to a personal physician or to a local hospital. CCS will document any services provided. C.1.a.4 Emergency Services CCS will provide emergency medical services 24 hours a day for any person accepted into the custody of the LCSO pursuant to Oregon State law. On-site medical staff may make emergency off-site referrals based on guidelines and their professional interpretation of a patient s need. CCS will coordinate with local hospitals, including Sacred Heart Medical Center River Bend and McKenzie-Willamette Hospital, as appropriate in emergency situations, and will coordinate emergency transport and ambulance services. A CCS staff member will respond to all emergencies upon notification by reporting to the area of the emergency with necessary emergency equipment and supplies. Correctional healthcare personnel are trained to respond to emergencies within four minutes. The on-call physician and/or psychiatrist will be notified as soon as the situation allows. The inmate will be stabilized on-site, and then transferred to an appropriate healthcare unit if necessary. CCS staff will determine if the inmate needs to be transported to local emergency room for treatment. The CCS Medical Director will conduct a retrospective review following an ER referral to ensure that the action was appropriate and to identify any additional staff training needed. Retrospective Review Form for Emergency Services Care Management System Lane County Sheriff s Office 43

77 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.a.5 Physician Rounds CCS will assign a responsible physician to provide healthcare services that are consistent with care available in the community. CCS will provide timely sick call triage within 24 hours of the inmate s request and access to provider sick call consultation within the next 24 hours. The CCS sick call process uses combinations of nurses, mid-level providers, and physicians for sick call services as defined within their scope of practice. Qualified nursing staff will conduct sick call triage at least once daily, seven days a week, including holidays. The physician and/or mid-level provider will be on-site to conduct scheduled sick call clinics in accordance with a schedule agreed upon by CCS and the LCSO. The physician will conduct scheduled rounds one day per week, while the mid-level provider will conduct scheduled rounds four days per week. We have provided our proposed staffing schedule, including physician coverage, in section B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION. C.1.a.6 On-call Service A licensed physician will be on-call 24 hours a day, 7 days a week for emergency situations at the Lane County Jail Facilities. CCS will also establish a physician/mid-level provider "call back" schedule during off hours so that urgent but non-emergent services such as suturing can be provided on-site. C.1.a.7 Alternate Physician Coverage CCS will ensure coverage by an alternate physician or mid-level provider in the event the assigned physician is unavailable, as permissible by applicable law and for no longer than seven consecutive days. The assigned physician will appropriately review activities of the mid-level provider. C.1.a.8 Restraint When an inmate is placed in a restraint chair, on-duty medical staff will immediately notify the site Medical Director, who will advise on-duty medical staff of recommended treatment, as necessary. C.1.a.9 Medical Records CCS will maintain up-to-date medical records at all times, consistent with NCCHC and ACA standards; LCSO policies and procedures; community standards of practice; and all federal, state, and local laws. Following the receiving screening, healthcare staff will initiate a comprehensive medical record that will be the single source of all medical, dental, and mental health information for each inmate. CCS will maintain up-to-date medical records at all times, and will be responsible for the transcribing and entry of patient information in the individual medical record. Each record will contain an accurate account of the inmate s health status at the time of admission, all patient-provider encounters, and all on-site and off-site services provided. At a minimum, medical records will contain: Identifying information (i.e., name, number, date of birth, sex) A problem list containing medical and mental health diagnoses and treatments as well as known allergies Intake screening and health assessment forms Progress notes of all significant findings, diagnoses, treatments, and dispositions Clinician orders for prescribed medication and medication administration records Reports of laboratory, X-ray, and diagnostic studies Flow sheets Consent and refusal forms Release of information forms Results of specialty consultations and off-site referrals Discharge summaries of hospitalizations and other inpatient stays Lane County Sheriff s Office 44

78 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Special needs treatment plans, if applicable Immunization records, if applicable Place, date, and time of each clinical encounter Signature and title of each documenter Confidentiality of Medical Records CCS will adhere to all laws relating to confidentiality of patient information. We will secure medical records as required by law and other applicable state or federal statutes and regulations. All records will be maintained in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as well as the Health Information Technology for Economic and Clinical Health (HITECH) amendment to HIPAA. Compliance training for HIPAA/HITECH is a mandatory part of CCS new employee orientation and is also required annually for all CCS employees. Access to Medical Records CCS will manage the security and accessibility of resident medical records in compliance with state and federal privacy regulations. The CCS Medical Director will approve medical record policies and procedures, and will define the format and handling of medical records. Each resident s medical record will be kept separate from the confinement record. The HSA for the Lane County Jail Facilities will control access to medical records to ensure patient confidentiality. The LCSO will have access to any information deemed necessary in determining an inmate s security rating, housing assignment, job suitability, etc. Worker Clearances CCS staff will provide examinations and medical clearance for all intra-system transfers and inmate workers prior to placement in their assignment. Medical clearance for work will be made with consideration for the inmate s condition, including known illnesses or any sign of illness or injury observed during examination, which will be documented in the patient s medical record. Examinations typically take place during the 14-day health appraisal, but can also be completed upon request within 24 hours from the time the names are provided. Food service workers will be medically cleared prior to working in the facility kitchen, or as food servers, according to procedures defined by the responsible physician. Medical Summaries for Transfer Pertinent medical information will be prepared to accompany all inmates when traveling off-site to a specialty appointment or emergency room, or when transferring to another detention/correctional facility. Upon transfer to another facility, a medical transfer form will accompany the patient. This form provides all necessary information required for the continuation of treatment. Documentation and Follow-up All information and documentation returned with the inmate from an off-site provider will be made part of the inmate s medical record. This will include a disposition and instruction sheet to indicate actions taken, orders written, findings from consults, and treatments performed, and a detailed discharge summary for patients returning from an inpatient hospitalization. CCS staff will see patients returning from an off-site hospital stay for follow-up during the next practitioner sick call clinic, and will document the follow-up in the patient s medical record. Lane County Sheriff s Office 45

79 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Informed Consent Examinations, treatments, and procedures will be governed by informed consent practices applicable in the jurisdiction. For invasive procedures or any treatment where there is risk to the patient, informed consent is documented on a written form containing the signatures of the patient and healthcare staff witness. The informed consent process includes informing the patient of the benefits and risks of the procedure. Informed consent is obtained and documented in the patient s health record prior to the performance of any procedures and treatment governed by informed consent in the jurisdiction. Refusal for any health evaluation, treatment, or medication is documented with an explanation and the patient s signature. If there is concern regarding the patient s decision-making capability, the patient will be referred to the appropriate medical or mental health provider. Records Retention CCS will maintain medical records for the length of an inmate s stay, in accordance with HIPAA rules and regulations. We will retain inactive medical records in accordance with NCCHC and ACA standards, as well as laws of the State of Oregon and requirements of the American Medical Association. Although CCS is the custodian of medical records, they will be the property of the LCSO. Upon conclusion of the contract, medical records will remain the property of the LCSO, and CCS will work to ensure a smooth transition of records. Release of Medical Information CCS will ensure that all medical information about residents is treated as confidential and is not shared with entities outside the Lane County Jail Facilities, except as may be permitted by law. In any criminal or civil litigation where the physical or mental condition of a resident is at issue, CCS will provide the LCSO with access to the records upon written request. Lost Records If an inmate's medical record cannot be located within eight hours of the discovered loss, CCS staff will verbally notify the Jail Commander or designee and a duplicate record will be immediately generated. The CCS Electronic Medical Records Solution We have provided information regarding the CCS Electronic Record Management Application (ERMA) in section 3. COMPUTERIZED TOOLS. C.1.a.10 Weekly Meetings CCS nursing staff will participate in weekly Medical-Psychiatric meetings with the Security Supervisor, Mental Health staff, and Jail Programs representatives to discuss and evaluate inmate mental health status. CCS staff will ensure that continuity of care is maintained and appropriate communication of needs is conveyed in these meetings. Lane County Sheriff s Office 46

80 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.a.11 OB/GYN Services CCS understands the special healthcare needs of female inmates, and we have established a program that addresses these needs in accordance with NCCHC and ACA standards. All medical staff working with the female population will be familiar with the specialized aspects of care required. The CCS Female Health program includes the following elements: As part of the receiving screening, female inmates will be asked questions regarding known/determined pregnancy (currently pregnant), past pregnancies, menstrual cycle, and gynecological problems CCS will provide special housing and dietary (by a licensed consulting dietician) recommendations for known-pregnant inmates Medical clearance for work will be made with consideration for the inmate s condition (including known pregnancy) Daily count of known-pregnant inmates in the facility Sexually transmitted disease screening On-site prenatal/ob care with provisions for diet and vitamins Management of chemically dependent pregnant inmates, including education Postpartum care with provisions for lactation, monitoring of postpartum depression, and education Annual Pap testing and breast examinations will be completed as medically indicated Access to obstetrical and gynecological specialists Health education on issues specific to the female population Continuation of contraceptive medication as medically necessary based on guidelines set forth by the American Public Health Association Coordination of comprehensive counseling and assistance to pregnant inmates planning to keep their child, considering adoption, or seeking abortion services Prenatal Care Pregnant inmates will receive timely and appropriate prenatal care, specialized obstetrical services, and postpartum care when indicated. These services will be provided through a scheduled on-site clinic whenever possible. Typically, routine obstetrical care up to 24 weeks can be managed on-site. The pregnant inmate will be referred to an obstetrical specialist after 24 weeks of gestation, but we will continue to facilitate all testing that can be performed on-site. CCS will analyze utilization statistics and evaluate the potential benefits of establishing an OB/GYN clinic on-site at the Lane County Jail Facilities. Upon determining that a female inmate is pregnant, CCS staff will ensure that she receives family planning counseling and discussion of options with regard to the outcome of the pregnancy. We will coordinate comprehensive counseling and assistance to pregnant inmates planning to seek abortion services. CCS will ensure that female inmates have a legally protected right to an abortion at their own expense. We will arrange for therapeutic abortions necessary to preserve the health or life of the inmate, as well as elective abortion services for any pregnant inmate seeking to terminate a pregnancy, in accordance with law. Our mental health staff will also provide counseling services as needed. Lane County Sheriff s Office 47

81 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Prenatal care will include: Pregnancy testing Medical examinations Comprehensive counseling and assistance Family planning services prior to discharge Laboratory and diagnostic tests, including offering HIV testing Dietary supplements Observation for signs of toxemia Routine urine testing for proteins and ketones Routine and high-risk care Vital signs Counseling on appropriate levels of activity, safety precautions, and nutritional guidance Assessment of fetal height and heart tone Management of chemical dependencies High-risk pregnancies will be consistently monitored, and if the inmate does not require hospitalization, she will be housed in medical observation. Perinatal care will be provided in accordance with specialists recommendations. Postpartum patients will be evaluated by an OB/GYN, and upon discharge from the hospital, the inmate will be admitted to medical observation for a minimum of 23 hours. Since separation from a child can be a trigger for self-harming behavior, mental health staff will also evaluate the inmate s emotional status for her safety and refer her for psychiatric care as needed. Methadone Program CCS will provide and pay all costs for a methadone program to serve pregnant addicts. We are wellversed in the provision of a methadone maintenance program and we have significant experience handling pregnant addicts. CCS staff will identify opiate-addicted pregnant women during intake assessments. Inmates on methadone or similar substances will receive appropriate treatment for methadone withdrawal syndrome. Pregnant inmates entering the Lane County Jail Facilities on methadone treatment will be continued on the treatment when possible. If not already on methadone, they will be converted to methadone with a community provider and will remain on methadone through their release or the birth of their baby, when they are subsequently tapered off methadone. CCS will partner with Lane County Behavioral Health and Human Services (Mental Health Division) as appropriate for the provision of the methadone maintenance program for pregnant inmates. C.1.a.12 Lab and X-ray Services CCS will authorize, schedule, and coordinate necessary diagnostic services, including phlebotomy, X-ray, EKG, and ultrasound services. Healthcare personnel will make referrals for diagnostic services and prioritize tasks for appointment scheduling through the CCS Care Management system. Lane County Sheriff s Office 48

82 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Laboratory Services CCS will identify the most cost-effective and comprehensive laboratory program in consultation with the LCSO. We have a national contract with Laboratory Corporation of America (LabCorp), with corporate headquarters in Burlington, North Carolina. With more than 35 years of experience serving physicians and their patients, LabCorp operates a sophisticated laboratory network, performing more than one million tests on more than 370,000 specimens each day. The laboratory program for the Lane County Jail Facilities will include necessary supplies and a dedicated printer, timely pickup and delivery, and accurate reporting within 24 hours on most labs. The majority of all phlebotomy and lab services will be processed on-site, including: Dipstick urinalysis Blood chemistry Cultures Finger-stick blood glucose Peak flow monitoring Pregnancy testing Stool blood testing Timely pickup and delivery Routine, special chemistry, and toxicology analysis Provision of laboratory supplies Crisis levels reported to the physician designee immediately Accurate reporting within a reasonable time frame (typically 24 hours) Blood borne pathogen testing when it is determined that medical or security staff have been exposed by an inmate The laboratory program for the Lane County Jail Facilities will comply with all standards set forth by the American College of Pathology and all Oregon State requirements for medical pathology, specimen handling, testing, and reporting. On-site services will be performed in accordance with the Clinical Laboratories Inspection Act (CLIA) and will comply with the Clinical Laboratory Improvement Amendments of CCS will train all on-site staff on our laboratory policies and will ensure that all qualified healthcare personnel are trained in the collection and preparation of laboratory specimens. We will also provide a diagnostic procedure manual that includes reporting on STAT and critical values. Providers will review all laboratory results within hours (72 hours for weekends and holidays) and will be notified immediately to review abnormal test results. If test results indicate a critical situation, the medical provider will also receive an alert via telephone. The medical provider will be notified immediately of all STAT lab test reports. Where preliminary results are available, they will also be presented for medical review. The provider will review and sign off on all test results. All diagnostic laboratory reports and any resulting plans for follow-up care will be made part of the inmate s medical record. The provider will review and sign off on all laboratory results, which will be reported via a dedicated printer until an ERMA interface is established. Lane County Sheriff s Office 49

83 X-ray Services Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Consistent with the CCS care philosophy, radiology services will be provided on-site to the extent possible. CCS will identify the most cost-effective and comprehensive radiology program in consultation with the LCSO. We have a national contract with MobilexUSA (an affiliate company of Diagnostic Laboratories, your current provider) to provide on-site radiology services. Mobilex is the country s leading provider of mobile X-ray and ultrasound services, serving more than 6,000 facilities nationwide. Since Diagnostic Laboratories is your current provider, there will be no interruption in services. CCS will work with Mobilex and the LCSO to establish a routine schedule for on-site radiology services, including: Mobile X-ray services Ultrasounds Sonograms Doppler studies Mammograms Pulmonary function tests Holter monitor studies Upper GI X-rays All X-rays and radiology special studies will be read by a board-certified radiologist, who will provide a typed and/or automated report within 24 hours. The radiologist will call the institution if a report necessitates immediate intervention. The CCS Medical Director or physician/mid-level designee will be notified of all abnormal radiology results and will review, initial, and date all X-ray reports within five working days. The Medical Director or physician/mid-level designee will meet with the patient to discuss their results and will establish a plan of care as appropriate. CCS will document and store digital images and radiology reports in the patient s medical record. Results can be received electronically, via fax, or manually on paper. Any follow-up with the patient will be noted in the medical record. CCS will also maintain a log to document the type and number of X-rays completed and the results received. CCS medical personnel will review the log on a daily basis to determine if any test results are outstanding. This process will ensure that test results are reported in a timely manner. C.1.a.13 Backup Physician CCS will provide Medical Doctor back-up in the primary physician s absence. C.1.a.14 BOP Inmates CCS nursing staff will complete physicals on Bureau of Prisons (BOP) Public Law inmates who are housed at the Community Corrections Center (CCC). Physicals will be completed within five days of the inmate s arrival at the CCC. C.1.a.15 Work Release Medications CCS will supply 3-4 days of necessary medications (e.g., cardiac, seizure, mental health, and antibiotic medications) for inmates who are transferred from the Lane County Jail to the CCC to become work release residents in order to afford the inmates an opportunity to obtain their own medications. Lane County Sheriff s Office 50

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86 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 CCS understands the importance of maintaining a timely and proper booking and admission screening process to ensure the well-being of all inmates and of the overall facility operations. We will provide adequate staffing to allow for the timely evaluation of intake orders and inmates in need of mental health evaluations so that inmates with medical and mental health issues can be stabilized as quickly as possible and medications can be initiated. CCS will allocate properly trained and authorized medical personnel to complete receiving screenings. Medical staff will available to conduct receiving screenings 24 hours a day, 7 days a week, including holidays. We have provided our proposed staffing schedule, including nursing coverage, in section B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION. Admission to the Lane County Jail Facilities will be dependent upon clearance for any injuries or medical problems. Any injured or ill individual requiring treatment beyond that which can be provided on-site will be transported by the local police to a local hospital for treatment and medical clearance prior to booking. If the screener determines that an incoming inmate may be in need of urgent or emergency healthcare services, and the need for care exceeds the scope of services provided on-site, the screener will refer the patient to the local emergency room or approved hospital. CCS will perform Quality Improvement reviews on all admission deferrals, as well as utilization review on all emergency room and hospital-direct admissions/pre-booking injuries/illnesses, to ensure that inmates return to the Lane County Jail Facilities as soon as is clinically indicated. Receiving Screening and Intake Nursing Interventions CCS strongly believes that early identification of problems using a systematic intake evaluation prevents many more serious and costly problems from developing at a later date. We have established physicianapproved Receiving Screenings and Intake Nursing Interventions to guide the assessment, treatment, and referral process of inmates admitted with healthcare needs. The results of the receiving screening will be documented on a form approved by the LCSO, which will be reviewed and signed by the physician/mid-level provider and filed in the inmate s medical record. CCS medical personnel also use Intake Nursing Interventions to gather disease-specific health information in order to formulate a consistent plan of care. C.1.a.19 Observation CCS intake screenings include observation of the following: Appearance, which includes state of consciousness, mental status, conduct, tremors, and sweating Disorderly, inappropriate, or insensible behavior Ease of eye and bodily movement, and any bodily deformities Identification of disabilities and special equipment needed Persistent cough or lethargy Condition of skin including trauma markings, bruises, lesions, jaundice, scars, tattoos, rashes and infestations, and needle marks or other indications of substance abuse Notation of the inmate s disposition based on the information obtained in the admission screening process will include one of the following: General population, with or without referral for appropriate healthcare services Emergency referral to appropriate healthcare services Medical isolation and observation as applicable Lane County Sheriff s Office 53

87 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.a.20 Health Assessments CCS will conduct a comprehensive health appraisal, including a complete medical history and physical, for all inmates prior to their being in custody for 14 calendar days. We typically target day 10 for health appraisals to ensure its completion within the 14-day period required by NCCHC standards. CCS will also provide health assessments for United States Marshal or other federal agencies in regards to federal inmates housed at the jail. Additionally, we will provide health assessments/physicals for the Bureau of Prisons inmates housed at the Community Corrections Center (CCC) within five days of their arrival. During the health appraisal, qualified personnel will perform an initial dental screening and will instruct the inmate on maintaining proper dental hygiene. Visual acuity tests will be conducted during the appraisal, and again each year during the inmate s annual physical. For female inmates, Pap testing and breast examinations will be completed as medically indicated. Any necessary immunizations and therapy will be initiated during the appraisal. The appraisal will include any court-ordered testing or mandates, with records and interpretations sent to the requesting agency. The comprehensive health appraisal will minimally include: A review of the receiving screening Review of health history and any additional data needed to complete the standard health history Recording of vital signs, height, and weight Mental health appraisal Dental screening PPD test for tuberculosis (if not previously administered) and laboratory and/or diagnostic tests when clinically indicated or judicially mandated The collection of additional health data to complete the medical, dental, mental health, and immunization histories A physical examination (including breast, rectal, and testicular exams as indicated by the patient s gender, age, and risk factors) For female inmates, inquiry into menstrual cycle and unusual bleeding, current use of contraceptives and medications, breast masses and nipple discharge Vision screening and hearing screening Other tests and examinations as appropriate, required, and indicated (diagnostic panel, urinalysis, EKG, etc.) The initiation of therapy and immunizations as indicated Any abnormal results of the health appraisal will be reviewed by a physician or mid-level provider for appropriate disposition Any court-ordered testing or mandates with appropriate records and interpretations sent to the requesting agency Date and time of the health appraisal will be recorded Title and signature of the individual performing the appraisal; a CCS physician will review, sign, and date any appraisals completed by RNs and any abnormal appraisals completed by the midlevel provider CCS staff will record the number of inmates who refuse physicals, as well as the reasons for refusal. A physician, a mid-level provider, or an RN trained by the Medical Director will conduct the health appraisal in accordance with local regulations and will record their findings on gender-specific forms approved by the LCSO. Lane County Sheriff s Office 54

88 Follow-up Care Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 CCS will provide the necessary follow-up care for health problems identified by any health screenings or diagnostic tests. Healthcare personnel schedule referrals for physicians according to clinical priority. Referrals are approved based on appropriateness and necessity. CCS will allocate sufficient healthcare staff to ensure that all patients scheduled for clinics will be seen as scheduled. Sick call is conducted daily until completed; the maximum number of clinic appointments is determined by the number and types of providers on staff. Healthcare staff can be shifted from one area of need to another to ensure that the needs of the patient population are met, and that all services are provided as contracted and per national standards. Inmates referred for treatment as a result of the health appraisal will be seen no later than the following day unless the provider making the referral orders them to attend physician sick call on another day. Restraint CCS nursing staff will evaluate persons placed in the Restraint Chair within 15 minutes of placement, with follow-up assessments and vital signs performed every 15 minutes thereafter in order to review the inmate s ability to breathe properly and assure blood flow is unimpeded by the restraints (except when exigent circumstances are present). Examination and treatment rendered will be documented in the inmate s medical record. C.1.a.21 Inmate Requests for Health Care Services During the receiving screening process, CCS advises all inmates of their right to access care and the process for requesting healthcare services. Inmates will have immediate access to sick call request forms that meet all standards and guidelines. Corrections staff can also make referrals if they have concerns for the health status of an inmate. All health services will be provided in a manner that complies with state and federal privacy mandates. CCS will allocate sufficient healthcare staff for the sick call process to allow all inmates to be seen in a timely manner in accordance with NCCHC and ACA standards. The CCS sick call process uses combinations of nurses, mid-level providers, and physicians for sick call services as defined within their scope of practice. CCS will provide timely sick call triage within 24 hours of the patient s request and access to provider sick call consultation within the next 24 hours (72 hours for weekends). Qualified nursing personnel will conduct sick call triage at least once daily, seven days a week, including holidays. Nursing sick call is conducted daily; the physician or mid-level provider will be on-site to conduct scheduled provider sick call clinics five days a week in accordance with a schedule agreed upon by CCS and the LCSO. Should the need arise outside the scheduled sick call, inmates who require urgent or emergent medical attention will be seen on the same day they request such services. C.1.a.22 Protocols CCS has established Nursing Documentation Pathways (NDPs) that represent a standard of care to be provided to patients in a variety of situations. These nursing protocols were developed by our Deputy Chief Clinical Officer to assist nurses with diagnoses and to ensure consistency of care. The NDPs provide a consistent structure for patient care, justification for actions, and a set of interventions specific to the patient s presenting condition. In its simplest form, an NDP is a decision-tree process for nurses to follow, which also improves ease of training and maximizes practitioners time. All Nursing Documentation Pathways and assessment protocols will be included in the CCS Policies and Procedures Manual upon approval by the LCSO. The NDP for Fever is provided on the following pages. Lane County Sheriff s Office 55

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91 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.a.23 Segregation Rounds If an inmate is unable to attend a sick call session due to custody status (e.g., segregation patients) or as a result of physical condition, CCS will arrange to conduct sick call services at their cell. Segregation rounds will be made at least three times weekly, with checks recorded on a cell card or segregation log. All inmates on direct or psychiatric observation will be seen daily by the psychiatrist or designee. CCS will maintain a record of segregation rounds, and clinical encounters will be noted in the patient s medical record. C.1.a.24 Medical Rounds Licensed medical personnel will perform medical rounds on inmates housed in the intake, segregation, and medical unit a minimum of three times per day in order to monitor health status, distribute medications, and ensure access to health care services. The CCS staffing plan includes nursing coverage to provide medication pass, per physician s orders, at least twice daily for inmates in general population, and more frequently as needed for inmates in medical housing or observation. Licensed medical personnel will also monitor blood glucose levels and calculate insulin dosages for diabetic inmates as needed, but no less than a minimum of three times per day. CCS staff will maintain records of medical rounds, with clinical encounters noted in the inmate s health record. C.1.a.25 Women s Preventative Health Care For information on women s preventative and prenatal healthcare services, please see section C.1.a.11 OB/GYN Services. C.1.a.26 Infectious Disease CCS has a written infection control policy that will ensure a safe and healthy environment is created and maintained for the inmates, staff, and visitors of the Lane County Jail Facilities. While prevention is always a first concern, it is recognized that individuals entering the correctional environment will benefit from an active program that encompasses all aspects of infection control. The CCS Infection Control Program aims to effectively control the occurrence and spread of communicable diseases by providing guidelines for their prevention, diagnosis, and treatment. The goals of the CCS Infection Control Program are: To identify those individuals who are at high risk for infectious diseases To monitor and report the incidence of infectious diseases among staff and inmates To promote a safe and healthy environment through the use of regular inspections, education, communication, and role modeling To ensure that surveillance begins at the time of entry into the facility and is effective in identifying those individuals who present a risk of spreading an infectious disease To provide timely, effective treatment when an infectious diseases is identified To administer vaccinations to prevent the spread of infectious diseases when appropriate To protect the health and safety of staff and inmates by use of appropriate isolation precautions To establish effective decontamination techniques for cleaning of medical equipment and contaminated reusable items To provide safe means of disposing of biohazardous waste and used needles and sharps To implement and use strict Standard Precautions to minimize the risk of exposure to blood and body fluids To file all required reports in a manner that is consistent with local, state and federal laws and regulations Lane County Sheriff s Office 58

92 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 To establish and maintain a good working relationship with the Health Department, the community, and the facility in all matters that relate to the prevention infectious diseases To ensure that all staff are well trained initially through their orientation training and then on an on-going basis to all areas of the Infection Control Program To monitor the effectiveness of the Infection Control Program through on-going Quality Improvement data collection and statistical reporting CCS is committed to ensuring early identification through constant surveillance of potential and actual occurrences of infectious disease. As part of the receiving screening process, CCS staff will routinely inquire into any past history of tuberculosis or other infectious or communicable diseases. Patients at risk for spreading a communicable disease will be segregated from the general population. The CCS Infection Control Program maintains compliance with universal precaution procedures. The program ensures provision of appropriate cleaning and personal protective equipment, and includes training on general sanitation issues and preventing the transmission of blood borne pathogens. Tuberculosis As part of the receiving screening process, CCS personnel routinely inquire into any past history of tuberculosis or other infectious or communicable diseases. Typically, CCS will administer a PPD test for tuberculosis during the receiving screening to ensure complete clearance for the inmate s assignment to general population. If documentation of a positive test is in the record or if the detainee indicates such, CCS will make a referral for a chest X-ray on the next clinic day. The results of tuberculin tests will be read and documented on a daily basis. HIV/AIDS If clinically indicated, CCS will test for STDs, HIV, and Hepatitis A, B, and C during the receiving screening, and will ensure complete clearance for the inmate s assignment to general population. We will also provide HIV testing and counseling on a confidential, case-by-case basis to those inmates who request it. CCS staff will evaluate all inmates identified as having HIV, and will ensure that these inmates have access to infectious disease specialists and HIV medications as medically necessary. MRSA CCS will provide identification, testing, counseling, education, care, treatment, and follow-up of MRSA and related conditions. We have worked with several of our clients to establish health education videos that are played in intake and housing areas and address topics such as TB testing, HIV/AIDS, substance abuse, MRSA, and accessing health care services. Influenza CCS will develop an influenza response program consisting of surveillance, treatment, and monitoring consistent with community standards and established LCSO policies and procedures. Healthcare staff will evaluate inmates identified as having contagious upper respiratory infections and will isolate or separate these inmates as necessary. The CCS staffing plan includes a designated staff member solely responsible for the Infection Control Program in accordance with NCCHC and ACA standards. Lane County Sheriff s Office 59

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96 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Suicidal Tendencies For information regarding observation for inmates with suicidal tendencies, please see section C.1.e.12 Mental Health Specialists. Chemical Restraints CCS has an established Psychotropic Medications Protocol for emergent and non-emergent use of psychotropic medications. The right to refuse mental health treatment is inherent in informed consent; however, psychiatric emergencies do occur. In accordance with NCCHC standards, CCS has developed an emergency medication protocol for patients determined by a physician to be dangerous to themselves or others due to acute psychiatric symptoms. The emergency administration process complies with applicable laws and regulations governing emergency use of forced psychotropic medications. Emergency psychotropic medications are prescribed only when clinically indicated, and are not used for disciplinary reasons or for the management of negative behaviors associated with personality disorders. CCS has a Quality Improvement screen covering emergency administration of psychotropic medications that will be completed after such an event occurs. When an emergency medication is administered, the patient is placed on continuous observation watch for no less than one hour to monitor vital signs, including respiratory status. The patient must then remain on continuous observation watch until a mental health staff member, through a face-to-face evaluation and consultation with a psychiatric practitioner, determines that the patient no longer poses an imminent threat to self or others. If a second dosage of emergency psychotropic medication is considered, the psychiatrist must reconsider the entire course of care during the immediate event. In no case may a psychiatrist order a third dose of emergency psychotropic medication without a face-to-face evaluation of the patient. Additionally in these cases, the psychiatrist will consider the need to petition for commitment to an inpatient psychiatric unit if the patient is determined to present a need for this level of care. C.1.a.28 Emergency Services We have responded to this requirement in section C.1.a.4 Emergency Services. C.1.a.29 Emergency Response Plan We have responded to this requirement in section 5. UNUSUAL CIRCUMSTANCES. C.1.a.30 Medication Management We have provided information regarding all aspects of the CCS pharmaceutical program in section c. Pharmaceutical Management Services. C.1.a.31 Laboratory Services We have responded to this requirement in section C.1.a.12 Lab and X-ray Services. C.1.a.32 Radiological Services We have responded to this requirement in section C.1.a.12 Lab and X-ray Services. C.1.a.33 Physician Services We have responded to this requirement in sections C.1.a.5 Physician Rounds, C.1.a.6 On-call Service, and C.1.a.7 Alternate Physician Coverage. Lane County Sheriff s Office 63

97 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.a.34 Psychiatric Services We have responded to this requirement in section e. Mental Health Services. C.1.a.35 Medical Clinic Staffing CCS will staff the Lane County Jail Facilities appropriately to ensure the timely provision of healthcare services as required by the RFP. We have provided our proposed staffing schedule, including nursing coverage, in section B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION. Hours worked by CCS employees will be spent on-site at the Lane County Jail Facilities, except as otherwise agreed by both parties. For information on documentation of staffing, please see section 7. INVOICING. Security CCS will exercise security measures consistent with LCSO rules, regulations, policies and procedures. Healthcare personnel are subject to the same security regulations as other facility employees, and CCS will collaborate with the LCSO to ensure that security regulations are maintained without compromising access to care. We will ensure that all new hires are appropriately oriented to the operations of the Lane County Jail Facilities. The CCS orientation program for newly hired health service employees includes training on security and contraband regulation. Medical staff will receive training on security classification and other security concerns as appropriate. CCS staff will wear the appropriate uniform and/or identification badge as directed by the Jail when onsite. Any CCS employee in violation of LCSO security regulations may be denied access to the Lane County Jail Facilities, in which case, CCS will provide alternate personnel to supply the contracted services, subject to the LCSO s approval. We understand that the Jail Commander or designee reserves the right to request the removal of any employee from the Lane County Jail Facilities. C.1.a.36 Mental Health Services We have responded to this requirement in section e. Mental Health Services. C.1.a.37 Health Records Management We have responded to this requirement in section C.1.a.9 Medical Records. C.1.a.38 Nutritional Services The special needs screening performed at intake includes verification of medically necessary special diets. Based on the patient s medical history and physical evaluation, a special needs treatment plan is established that acts as a reference for healthcare personnel involved in the patient s care and provides instructions regarding any special dietary needs. CCS will also provide medically required special dietary supplements (e.g., Ensure, electrolyte-stabilizing drink, etc.). C.1.a.39 Inmate Complaint/Grievance Procedure CCS recognizes our first responsibility is to our patients, to allow them access to care and treatment sufficient to meet their medical needs. We train and expect our staff to operate efficiently and appropriately while respecting those needs. Our excellent litigation history and our record of reduced grievances are indicative of the exemplary care CCS team members provide. All CCS personnel receive grievance resolution training, which teaches them to address concerns at the point of contact prior to the inmate initiating a grievance. The CCS grievance process will be consistent with national standards and with LCSO policies. CCS staff will respond to grievances, complaints, and inquiries as soon as is practical, generally within 72 hours of receipt. CCS will utilize the LCSO s current inmate grievance system to track complaints from receipt to resolution. Lane County Sheriff s Office 64

98 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Resolution and Review All CCS health care staff will be available to attend to medical grievances, which include complaints like not being seen in a timely manner for a sick call request, medications not being started in a timely manner, and conduct of healthcare staff. The CCS Medical Director or designee will resolve urgent grievances, which are defined as those complaints that involve an immediate need on the part of the inmate for health care services. CCS will resolve concerns and grievances in collaboration with the HSA and mental health, dental, pharmacy, or other appropriate service providers. The HSA or appropriate designee will work with the LCSO in the investigation, follow-up, and resolution of complaints in accordance with LCSO policies, and will implement the LCSO s recommendations. When necessary, CCS will conduct a face-to-face interview with the inmate and participate as a part of the grievance committee. Our Quality Improvement Committee (QIC) and Medical Administration Committee (MAC) will review and categorize grievances to identify potential issues and to determine if patterns exist or develop. Grievance Reporting CCS will establish a mechanism to report on the volume of grievances received, the nature of the grievances, the resolution status, corresponding timeframes, and whether or not the grievance is substantiated. We will maintain a daily log of all grievances that will include the name of the person filing the grievance and the date and nature of the complaint. If the grievance process substantiates a grievance, then the HSA or designee will develop and implement a corrective action plan for that grievance. CCS will categorize complaints and grievances and will report specifics as a part of the medical services monthly statistical report. This report will contain a description of the grievance or complaint, an explanation of the circumstances surrounding the grievance, and all actions taken to investigate and resolve the grievance. CCS will submit a monthly report identifying inmate grievances, along with copies of all medical grievance requests and their resolutions, to the Jail Commander or designee. C.1.a.40 Dental Care We have responded to this requirement in section d. Dental Services. C.1.a.41 On-site Medical Services for Sheriff s Office Staff CCS will provide all required services for LCSO staff, including: Annual tuberculin skin testing and referral as appropriate Hepatitis B vaccinations Emergency intervention for on-site injuries until ambulance service arrives OSHA record keeping Post-bodily fluid exposure follow-up and documentation Lane County Sheriff s Office 65

99 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Health Education CCS will ensure that Lane County Jail staff receive adequate training specific to policies and procedures of the Lane County Jail Facilities, as well as NCCHC and ACA standards. We will extend appropriate educational offerings and will train security staff on medical issues as requested by Jail Administration. CCS routinely trains security staff on responding to potential emergency situations, on handling lifethreatening situations, and on their responsibility for the early detection of illness and injury. We will also offer suicide risk reduction training to security staff in order to recognize when an inmate is in need of emergency mental health care, based on questions asked during the receiving screening and any warning signs of self-harming behavior. CCS presents health-related training for detention staff at many of our facilities, and we have developed a variety of training curricula for this purpose, including but not limited to: Emergency response Symptom recognition (e.g., shortness of breath, choking, bleeding, etc.) First Aid administration Cardio Pulmonary Resuscitation (CPR) Recognizing signs and symptoms of mental illness Change of mental status Psychological trauma Recognizing suicidal behavior Procedures/protocols for suicide risk reduction MRSA Airborne and blood borne pathogens Urgent and emergent medical conditions Recognizing acute manifestations of chronic illnesses Recognizing chronic medical and disabling conditions Acute and chronic serious functional impairments Signs and symptoms of chemical dependency Management issues related to substance abuse Infectious and communicable diseases Handling of inmates with HIV/AIDS Stress management On the following pages, we have provided a sample of Quick Facts for Intoxication and Withdrawal that security staff can use as a quick reference for patients experiencing such symptoms. Each page contains a reminder for security staff that Quick Facts is intended to be a general guideline and overview of information and not an all-inclusive listing. Always contact health care staff if you are concerned about a patient s condition. Lane County Sheriff s Office 66

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102 First Aid Kits Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 CCS will be responsible for maintaining adequate first aid equipment and supplies in the housing areas, visitation area, administration, reception area, kitchen, warehouse, and basement area. All first aid kits and AEDs will be inspected monthly and inventoried annually. CCS will ensure the availability of adequate supplies for restocking first aid kits at all facilities. C.1.a.42 Off-site Referrals CCS will make arrangements with specialists for the treatment of patients with healthcare problems beyond the scope of primary care provided on-site. In the event that a patient requires hospitalization or specialty services that cannot be provided on-site, CCS will authorize, schedule, and coordinate the provision of all outpatient services, including but not limited to outpatient surgery, diagnostic testing (e.g., MRI, CT scan, etc.), and ER ambulance services. Off-site treatment is limited to the chief complaint(s) indicated through a referral form and/or medical consultation. Referrals are approved based on appropriateness and necessity. Inmates will not be informed of scheduled appointment dates, times, or the location of outside providers. Network Development CCS has a Network Development department focused on creating correctional provider networks through partnerships with hospital systems and specialty physicians. They will work to negotiate the best rates for 24-hour service with hospitals, physicians, ambulance companies, and other local providers of ancillary services. At the direction of the LCSO, the CCS Network Development team will contact on-site and off-site subcontractors and specialists to develop and finalize agreements on behalf of the LCSO. CCS will establish a strong provider network to ensure the best possible programs for the Lane County Jail Facilities, and will provide copies of clearly defined written agreements of understanding for approval by the LCSO. CCS Partnership with Cigna Provider Network CCS has entered into an agreement with Cigna to utilize their provider networks throughout the United States. This agreement gives CCS access to Cigna s network of specialty providers and established hospital agreements for all of our client facilities across the country. Our relationship with Cigna also allows us to partner with their subsidiary, Allegiance Benefit Plan Management, Inc., to adjudicate the medical claims for outpatient healthcare services provided to inmate patients under the Cigna Open Access Plus (OAP) network. Allegiance will coordinate inmate eligibility with CCS and provide customer service support for claims submitted to Cigna. This program will ensure that the LCSO s inmate population has ready access to Cigna providers and facilities in Lane County, and will be treated like any other patients covered under the Cigna network. CCS will give the network provider a letter of authorization containing the patient s information so the provider can submit the claim to Cigna. The claim will be processed and paid in the same manner as any other Cigna claim, and no co-payments or co-insurance will be required from the patient. By partnering with Cigna and Allegiance, CCS is able to offer the greatest availability of specialty provider care for the patients in your care and significant cost savings for the LCSO. Lane County Sheriff s Office 69

103 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Transportation Services CCS will coordinate with security staff to arrange emergency transport and ambulance services when needed. Health care staff will work cooperatively with corrections staff to ensure that transportation services are provided in a timely and safe manner. CCS will coordinate with the LCSO to arrange security for all off-site specialty care. Inmates will not be informed of scheduled appointment dates, times, or the location of outside providers. Medical Summaries for Transfer Pertinent medical information will be prepared to accompany all inmates when traveling off-site to a specialty appointment or emergency room, or when transferring to another detention/correctional facility. Upon transfer to another facility, a medical transfer form will accompany the patient. This form provides all necessary information required for the continuation of treatment. Medical Necessity The CCS Care Management Program uses evidence-based guidelines to determine medical necessity as part of our approval process. The CCS Care Management Program is clinically overseen by Medical Director of Care Management, Tammy Kastre, MD, and is operationally managed by Vice President of Care Management, Vicki Wisdom, RN, CCM. Dr. Kastre and the Care Management team will work together with the Regional Medical Director and on-site medical personnel to ensure that inmates receive medically necessary healthcare services in the most appropriate healthcare setting. For detailed information regarding the CCS Care Management system, please see section 3. COMPUTERIZED TOOLS. Monthly Reports CCS will provide a customized monthly report package that best fits the needs of the LCSO. Reports will delineate the status of the healthcare program, including potential problems and suggested resolutions. CCS will also provide reports on monthly paid and project costs, as well as monthly aggregate and projected aggregate costs. We have had marked success in reducing off-site medical and security costs for our clients by ensuring the provision of cost-effective, medically necessary healthcare services to our contracted populations. We are confident that we will make the same positive impact in Lane County. Our clients can speak to the success that CCS has had in reducing off-site costs, and in bringing appropriate services on-site so that valuable security and transportation staff hours are not consumed and the public s safety is ensured. Customized monthly reports for the Jail Commander or designee will reflect the previous month/term workload, with data including but not limited to: Inmates requests for various services Inmates seen at sick call Inmates seen by physician Inmates seen by dentist Inmates seen by psychiatrist Inmates seen by psychologist Infirmary admissions, patient days, and average length of stay Mental health admissions Receiving medical screenings History and physical assessments Psychiatric evaluations Diagnostic studies Lane County Sheriff s Office 70

104 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Percentage of inmate population dispensed medication Inmates testing positive for TB or STDs Inmates testing positive for HIV or HIV antibodies Inmate mortality Other data deemed appropriate by the LCSO Telemedicine CCS supports the use of telemedicine in facilities with the infrastructure to support this type of health care provision. Telemedicine allows access to remote health care specialists and removes potential barriers to accessing necessary health care services. Telemedicine will reduce the need for inmate travel by creating easy access to a remote provider, and will allow the LCSO to provide consistent access to high-quality medical and mental health services for both routine and emergent consultations. Specialty clinics may include cardiology, dermatology, orthopedics, infectious disease, and psychiatry based on individual facility needs, patient volume, technological accessibility, and facility work flow. CCS recognizes the many benefits that a well-developed telemedicine program can bring to a correctional health care program. When appropriate, CCS will use telemedicine consultations as an alternative to off-site transports to connect doctors and patients after hours or as a means of creating better access to specialists. CCS has unique experience with telemedicine that we can use to establish a successful program for the LCSO. Dr. William Ruby, CCS Deputy Chief Medical Officer, created the Correctional Medicine Telemedicine Project at the John Hopkins School of Medicine. CCS provides telemedicine programming at facilities across the U.S., including: Charles B. Webster Detention Center (GA) Rockdale County Jail (GA) McHenry County Jail (IL) Wyandotte County Adult Detention Center (KS) Jetson Center for Youth (LA) Wicomico County Detention Center (MD) Garrett County Detention Center (MD) Downeast Correctional Facility (ME) Charleston Correctional Facility (ME) Maine State Prison (ME) Androscoggin County Jail (ME) Two Bridges Regional Jail (ME) York County Jail (ME) Westchester County Correctional Facility (NY) Mecklenburg County Jail (NC) Monmouth County Correctional Institution (NJ) Douglas County Correctional Center (OR) Montgomery County Jail (TN) Shelby County Correctional Center (TN) Hays County Jail (TX) Park County (CO) Pennsylvania Department of Corrections (all facilities) Lane County Sheriff s Office 71

105 Services Offered Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 The CCS telemedicine program covers a broad range of services and specialties, including but not limited to: Psychiatry services o Mental health intake screenings o Follow-up mental health screenings o Medication checks o Evaluation of suicidal inmate o Referral for commitment o Off-shift evaluations Orthopedic services HIV and infectious disease clinics Sick call clinics and the evaluation of individuals with chronic health care needs Wound care Dermatology Tele-emergency triage Each of these clinics can be conducted using a secure video conferencing platform, a high-definition exam camera, and the assistance of on-site nursing staff. We understand, according to Addendum #2, that the Lane County Jail s Medical Section is already equipped for telemedicine. This means that CCS will be able to save the LCSO money by reducing off-site specialty trips with no added cost to the County for equipment. We look forward to using our expertise in the area of telemedicine to create better access to care for your patients while creating cost savings for the LCSO. Telemedicine Policy Appropriate use of telemedicine involves obtaining a thorough understanding of relevant state statutes or professional licensing requirements that may govern telemedicine provision, confidentiality and protected health information, appropriate technology services to support a telemedicine platform, selection and onboarding of health care providers, and obtaining informed consent that addresses issues specific to telemedicine. Any site utilizing telemedicine services will ensure that procedures are in place for integrating health care provider documentation into the patient s health record. It is CCS policy to conduct telemedicine encounters in a manner that complies with all state and federal laws, including those relating to the licensing of health care providers and the privacy of patient information. The decision whether to use telemedicine in connection with the treatment of any patient is committed to the judgment of the treating health care providers ultimately responsible for the care of the patient, and that decision must be made in accordance with the proper exercise of professional judgment by the health care providers. 2) Include descriptions of key positions (other than managers described in B2 & 3 above) needed, and minimum requirements for any individual who will fill these positions. We have provided job descriptions for all medical personnel in section 3 Other Attachments. Lane County Sheriff s Office 72

106 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ ) Discuss your plan to provide x-ray and laboratory services and equipment/space needs. We have provided information on our plan to provide X-ray and laboratory services in section C.1.a.12 Lab and X-ray Services. We do not foresee any additional equipment or significant space needs for X-ray and laboratory services. 4) Provide your company s criteria for medically rejecting inmates prior to the jail accepting them into custody. Admission to the Lane County Jail Facilities will be dependent upon clearance for any injuries or medical problems. Any injured or ill individual requiring treatment beyond that which can be provided on-site will be transported by the local police to a local hospital for treatment and medical clearance prior to booking. If the screener determines that an incoming inmate may be in need of urgent or emergency healthcare services, and the need for care exceeds the scope of services provided on-site, the screener will refer the patient to the local emergency room or approved hospital. CCS will perform Quality Improvement reviews on all admission deferrals, as well as utilization review on all emergency room and hospital-direct admissions/pre-booking injuries/illnesses, to ensure that inmates return to the Lane County Jail Facilities as soon as is clinically indicated. b. Nursing Services: 1) Describe in detail how your company intends to provide this service within the requirements listed in Exhibit B (Scope of Services), Section D (Nursing Services), Sections H (On-site Services) and Section J (Off-site Referrals) as applicable. C.1.b.1 On-site and Off-site Care We have responded to this requirement in section C.1.a.3 On-site and Off-site Care. C.1.b.2 Nursing Coverage The CCS proposed staffing plan includes 24/7 nursing coverage for the Lane County Jail, including weekends and holidays. We have provided our proposed staffing schedule, including nursing coverage, in section B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION. C.1.b.3 Emergency Services We have responded to this requirement in section C.1.a.4 Emergency Services. C.1.b.4 Nursing Qualifications Healthcare services will be provided by persons who are fully qualified and appropriately licensed, certified, or registered in the State of Oregon. CCS will provide appropriate nursing coverage to provide comprehensive nursing services at the Lane County Jail Facilities, including but not limited to: Intake screening Neurological examination Ears, nose and throat assessment Respiratory assessment Cardiovascular assessment Musculoskeletal assessment Lane County Sheriff s Office 73

107 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Gastrointestinal examination Genitourinary assessment, including sexually transmitted disease Skin assessment Mental and emotional status and counseling Dental condition assessment Intoxication assessment and monitoring Assessment, monitoring and discontinuation of arrestee/inmate suicide risk, in the absence of mental health staff C.1.b.5 OB/GYN Services We have responded to this requirement in section C.1.a.11 OB/GYN Services. C.1.b.6 Lab and X-ray Services We have responded to this requirement in section C.1.a.12 Lab and X-ray Services. C.1.b.7 Medical Records We have responded to this requirement in section C.1.a.9 Medical Records. C.1.b.8 BOP Inmates We have responded to this requirement in section C.1.a.14 BOP Inmates. C.1.b.9 Restraint CCS nursing staff will evaluate persons placed in the Restraint Chair within 15 minutes of placement, with follow-up assessments and vital signs performed every 15 minutes thereafter in order to review the inmate s ability to breathe properly and assure blood flow is unimpeded by the restraints (except when exigent circumstances are present). Examination and treatment rendered will be documented in the inmate s medical record. 2) Include descriptions of key positions (other than managers described in B2 & 3 above) needed, and minimum requirements for any individual who will fill these positions. We have provided job descriptions for all nursing personnel in section 3 Other Attachments. c. Pharmaceutical Management Services: 1) Describe in detail how your company intends to provide this service within the requirements listed in Exhibit B (Scope of Services), Section E (Pharmaceutical), Section H (On-site Services) and Section J (Offsite Referrals) as applicable. C.1.c.1 Provision of Medications CCS will provide all prescription and non-prescription medications as required. We will provide pharmaceutical services in accordance with all applicable laws, guidelines, policies and procedures, and accepted community standards. Our pharmaceutical management program includes formulary and nonformulary oversight; prescribing, filling, and dispensing of medications; record keeping; appropriate licensure; DEA management; and the secure and proper storage of all medications. Lane County Sheriff s Office 74

108 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 CCS plans to subcontract the LCSO s pharmaceutical services to Diamond Pharmacy Services. Diamond is the United States largest provider of pharmaceuticals to correctional institutions. As our pharmacy vendor, Diamond will maintain all pharmaceutical licenses in accordance with state and federal regulations. CCS and Diamond work together to provide medication for tens of thousands of patients in jail, prison, and detention facilities nationwide. Our strong partnership with Diamond allows us to receive the industry s most cost-effective and competitive pricing for pharmaceutical services. We can then pass our savings onto our clients. Consultant Pharmacist Diamond provides full-time customer care including access to a registered pharmacist 24 hours a day for routine and emergency consultations. At Diamond, their pharmacists are never on call. They have staff scheduled on-site with direct access to all systems so they are readily able to answer any operational questions and provide clinical consulting, day or night. With the pharmacy open 24 hours a day, Diamond staff members are always available to view patient profiles and the databases necessary to ensure safe and efficacious therapeutic decisions. This is critically important for around-the-clock order processing so that pharmacists check orders in a reasonable time frame for the next available medication pass. A pharmacist can always be easily reached, directly via phone or via Diamond s afterhours answering service. Questions will be answered immediately in real time. We are not aware of any other correctional pharmacy providers with a registered pharmacist available to answer calls 24/7/365. Reimbursement of Unused Medications CCS and Diamond realize the importance of issuing credit on returned medications. CCS has a written returns policy with Diamond that allows for credit on full or partial blister cards of medication. Returns are refunded for 100% credit, assuming that the medications are still within blister cards, less a $1.00 return fee. Diamond is responsible for the shipping costs for all returned medications and will provide the LCSO with prepaid preaddressed FedEx Package Returns Program (PRP) or UPS Authorized Return Service (ARS) labels. These labels are simply affixed to the return box, which can be handed to express delivery personnel during their normal pickup/delivery at the Lane County Jail Facilities. CCS will ensure that medications are returned in a timely manner in order to maximize credits for the LCSO. When and where permitted by the State Board of Pharmacy and the U.S. Food and Drug Administration (FDA), Diamond offers credit on full and partial blister card medications returned, provided the medications: Remain in their original, sealed blister packs Have been stored under proper conditions Are not defaced or adulterated Are not within 3 months of expiration Have not been released to the inmate population or labeled/dispensed as keep on person Are not controlled substances Have a minimum value of $1.50 per card Have not been billed to a private insurance or Medicaid Lane County Sheriff s Office 75

109 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Many state boards of pharmacy have strict requirements for returning medications for credit, and Diamond rigorously complies. State boards often require that each bubble of the blister card contain the medication name, manufacturer, lot number, and expiration date. When medications are returned, the medication is not permitted to be punched out and reused. The actual individual bubble can be redispensed only in its original intact packaged piece. Diamond has made a substantial investment in designing a system that enables them to safely reuse individual, intact bubbles to credit medications so our customers receive the highest allowable credit. Pharmacies offering credit on partial cards without such a system may be in violation of state board regulations. All pharmacies in the correctional industry accept medications for return and reclamation. Diamond believes that the ability to preserve the lot number, expiration date, and sanitary condition of each bubble of the blister pack is critical when a medication is returned. They do not punch out medications from returned cards to re-dispense, a common practice with other pharmacies. Those vendors cannot guarantee the integrity of the dispensed tablets, the lot number, or the expiration date from cards received from their facilities around the country once the pills are mixed into a large manufacturer s stock bottle and subsequently re-dispensed to other patients. With Diamond, we are assured that they do everything legally required to accept medications for return while protecting patient safety. Purchase of Medication Carts CCS will purchase the necessary medication carts at the beginning of the contract and will replace the medication carts after two years for the duration of the contract. Emergency Backup Pharmacy Plan CCS will use in-house stock medications as appropriate and as allowable within state guidelines. Currently, Diamond is the only correctional pharmaceutical supplier with Joint Commission and Verified- Accredited Wholesale Distributor (VAWD) accreditation in the provision of stock medication. This accreditation is very important to CCS as we know that Diamond can provide the highest levels of service in accordance with the standards established by these accrediting bodies. These accreditations are available to others in the correctional pharmacy industry, but only Diamond has voluntarily sought and gained accreditation. With the very large volume of stock provided to correctional facilities, we feel this differentiation between Diamond and other providers is significant. Diamond realizes that receiving emergency medications in a timely fashion is important, and they do everything in their power to expedite processing, filling, and delivery. They also realize that emergencies are costly in terms of the patient s well-being and the expense of providing emergency care. Consequently, Diamond will continually collaborate with the CCS Medical Director to determine which medications need to be added to the emergency stock supply list to help minimize future emergency orders. Emergency medications not found in the emergency medication kit or the starter packs and unavailable from Diamond in sufficient time will be provided in a minimum quantity by a backup pharmacy. Lane County Sheriff s Office 76

110 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Emergency Medications Medications for life-threatening or mental illnesses or serious chronic diseases will not be delayed upon admission. CCS has established a list of no-miss medications to facilitate this process. All efforts are made to verify and dispense these medications within six hours after presentation to the medical staff and within eight hours for all other conditions. If there is an immediate need to initiate medication, the medication will be obtained from the backup pharmacy within two hours. CCS will use local pharmacies to supply emergency prescription medications and as backup for pharmacy services. Due to Diamond s size and volume, the company has aggressive national contracts with most chain pharmacies and is willing to negotiate with any pharmacy of your choice that is not in their network. Barcode Inventory Management System CCS will utilize a barcode inventory management system for medications. C.1.c.2 Formulary Management CCS will introduce a formulary to better manage pharmaceutical costs for the LCSO. We will prescribe generic medications whenever possible unless the clinician provides justification for a brand name request. We will track the percentage of generic versus non-generic use and will provide statistical reports on all areas of pharmaceutical management. CCS can provide a wide range of statistical reports for pharmaceutical management. CCS will provide adequate staffing to allow for the timely evaluation of intake orders and inmates in need of mental health evaluations so that inmates with medical and mental health issues can be stabilized as quickly as possible and medications can be initiated. When it is determined that an inmate received care prior to incarceration, efforts will be made by the nursing staff to obtain treatment information and verify medications from community providers to facilitate continuity of care. Individuals who report current medication use at intake are asked to complete a Release of Information (ROI) so that the medication verification process can begin. Medications that are verified are reviewed by a prescribing physician and continued as clinically indicated. If the medication verified is not considered a formulary medication within CCS, the medication order is bridged for up to seven days to ensure no break in care while allowing time for a prescribing physician to review the clinical necessity of the medication. Typically, given the nature of jails as short-stay facilities, verified medications (whether formulary or not) are continued throughout the duration of an individual s placement unless the person reports side effects, poor response to the regimen, or a different medication is considered more clinically appropriate for the person s current symptom constellation. If a non-formulary medication is to be continued after the initial bridge order, the prescribing physician will request continuation of the medication, to include a brief clinical rationale for the medication, through the CCS Non-Formulary Medication Request process. These requests are reviewed on a daily basis by a CCS Regional Medical Director or Psychiatric Director. If there is an immediate need to initiate medication, the medication will be obtained from the backup pharmacy. Medications for lifethreatening or mental illnesses or serious chronic diseases will not be delayed upon admission. Lane County Sheriff s Office 77

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113 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 The CCS emar offers an advanced administration feature that allows the user to easily track vitals, administer OTC/KOP/PRN medications, and document injection sites and quantities through a customized interface. The system provides a completely paperless medication administration system and allows users to work both online and offline. Because the system is web-based, there is no software to install. All data is maintained in a secure and redundant environment to ensure accessibility and continuous maintenance of all patient information, despite natural or man-made catastrophes. The CCS emar in ERMA Lane County Sheriff s Office 80

114 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Point of Care Companion CCS also offers our Point of Care Companion (POCC) system for more efficient medication administration. The POCC is an off-network laptop attached to a medication cart that allows nursing staff to mark and electronically sign off on the administration of medications. If a patient does not receive his or her medication for any reason, this is noted in the POCC system during the medication pass. Once the nurse returns to the medical unit, the laptop is docked and the information from the medication pass is synced within ERMA so administration records are immediately up-todate. The ability to synchronize data provides increased flexibility for nursing staff by allowing them to use the system in facilities where Wi-Fi or mobile internet connectivity is unavailable. This also allows medication passes to continue even if the facility loses internet connectivity, and since the laptop is battery-powered, loss of power won t affect its use. Point of Care Companion The features and benefits of ordering through this user-friendly software include: The ability to order (or reorder) prescriptions or stock orders quickly, through use of drop down screens or order refill buttons Increased accuracy, reduced transcribing errors and clarity issues that may result from faxed order sheets Improved formulary compliance, since non-formulary alerts are automatically sent to the prescribing physician s queue if a medication is not on the approved list. From that queue, he/she can easily complete the non-formulary request process online; once the non-formulary request is approved, the order is automatically forwarded to the pharmaceutical provider to facilitate expedited ordering OTCs, stock and emergency medications are all easily initiated and documented as profile meds on the electronic Medication Administration record Time savings through the elimination of paper physician s order sheets, which are no longer needed The ability to view patient profiles and determine when a medication was last filled prior to transmitting the order Password-protected access for approved staff to patient profiles, medication orders and history from any web based computer located on- or off-site Tracking and documentation of patient allergies and/or drug interactions Exceptions are immediately noted in the patient s health record: missed doses, refusals, complications Lane County Sheriff s Office 81

115 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.c.4 Pharmacy Inspections A consultant pharmacist will review the on-site pharmaceutical program on a quarterly basis. The pharmacist s review will be documented and a report will be provided to the CCS Medical Director, as well as the Medical Supervisor and Jail Administration. The Quality Improvement Committee (QIC) will review the report and establish action plans for identified problem areas. The consulting pharmacist will perform the following duties: On-site audits consistent with NCCHC guidelines Quality assurance reviews on a quarterly basis Written reports identifying any areas of concern and/or recommendations for improving pharmacy services Quarterly inspections of stock medication storage areas Assure that all medications are stored under proper conditions Remove and replace all compromised or expired medications Participate in quarterly meetings of the Pharmacy and Therapeutics Committee C.1.c.5 Pharmacy Statistics CCS will maintain and track budgetary cost and formulary and forward monthly statistics to the Alternative Programs Lieutenant. Reporting capabilities are yet another way Diamond separates themselves from others in the industry as well as locally. They have the most dynamic and complete reporting capabilities in the correctional pharmacy industry. Diamond s statistical reports make it easy to analyze monthly usage and expenditures and understand prescribing habits and trends. For more information, including a sample Monthly Formulary Management Report, please see section 7. INVOICING. 2) Include descriptions of key positions (other than managers described in B2 & 3 above) needed, and minimum requirements for any individual who will fill these positions. All medications, including over-the-counter medications, will be administered by personnel appropriately licensed in the State of Oregon. We have provided job descriptions for all personnel in section 3 Other Attachments. d. Dental Services: 1) Describe in detail how your company intends to provide this service within the requirements listed in Exhibit B (Scope of Services), Section F (Dental Services), Sections H (On-site Services) and Section J (Offsite Referrals) as applicable. C.1.d.1 Dental Health Care CCS will provide dental services to satisfy the dental care needs of the inmate population in accordance with NCCHC and ACA standards. We take the dental needs of our patients very seriously, as dental health can have a serious impact on the overall physical health of a patient. Neglect of dental needs can lead to serious infection, affecting both the health of the patient and cost of treatment. Consistent with the CCS care philosophy, services will be provided on-site to the extent possible. Lane County Sheriff s Office 82

116 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Dental Screening and Prioritization Inmates will receive a dental screening within 14 days of admission during the comprehensive health assessment. The dental screening includes: Prevention of dental disease and oral hygiene education Charting of decayed, missing, and filled teeth Taking dental history Keeping a dental record for each patient Dental specialist referrals, if needed Provision of all dental prosthetics and lab services as required Provision of maxillofacial surgery services when indicated A qualified healthcare professional will perform the screening and instruct the inmate on maintaining proper dental hygiene. Inmates can also request dental services through the sick call process. The dentist will evaluate the inmate s initial dental screening, assess the severity of their specific complaint, determine the medical impact of the issue, and prioritize and schedule treatment as needed. Inmates will receive a dental examination by a dentist within 90 calendar days of admission. Those incarcerated for more than 12 months will receive a dental treatment plan, including X-rays. C.1.d.2 Dentist The CCS staffing plan includes a dentist to provide all dental services, including consultations, diagnosis, treatment, necessary medications, and referral to appropriate specialists as required. C.1.d.3 Dental Coverage The primary CCS staffing plan (ADP: 326) includes dentist coverage for six hours per week. We have provided our proposed staffing schedule, including dental coverage, in section B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION. C.1.d.4 Dental Records All dental services rendered will be documented in the inmate s medical record. For more information, please see section C.1.a.9 Medical Records. C.1.d.5 Licensed Dentist Dental care will be provided under the direction and supervision of a dentist licensed to practice in the State of Oregon. C.1.d.6 Timing for Dental Services If it is determined that non-treatment would compromise the inmate s health, the appropriate dental services will be provided as soon as possible. The CCS Dental Classification and Priority Treatment program shall give priority scheduling to: Inmates who need emergency dental treatment, including but not limited to those with abscessed teeth, trauma, and facial swelling Inmates who have chronic medical conditions such as diabetes, heart conditions, or any condition that compromises their immune system Inmates who do not have sufficient teeth to masticate the food provided by the correctional facility Lane County Sheriff s Office 83

117 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.d.7 Extractions and Other Services Dental services will include exams and treatment (e.g., emergency fillings and extractions) necessary to relieve pain and preserve salvageable teeth. C.1.d.8 Emergency Dental Services Emergency dental services will be available as needed. Medical staff will evaluate the emergency in accordance with dental emergency protocols and will refer the patient to an off-site emergency or dental provider if clinically appropriate. 2) Include descriptions of key positions (other than managers described in B2 & 3 above) needed, and minimum requirements for any individual who will fill these positions. We have provided job descriptions for all dental personnel in section 3 Other Attachments. e. Mental Health Services: 1) Describe in detail how your company intends to provide this service within the requirements listed in Exhibit B (Scope of Services), Section G (Mental Health Services), Sections H (On-site Services) and Section J (Off-site Referrals) as applicable. C.1.e.1 Mental Health Professionals CCS believes in taking a proactive approach to the mental health needs of our client populations. Mental health issues are a growing concern for all correctional facilities and a key focus in all CCS sites. Our mental health programming is evidence-based, targeted to specific presenting issues, and is designed to address recidivism risk factors. The CCS Mental Health Program, which emphasizes identification, referral, and treatment, is based on documented policies and procedures addressing the provision of mental health services, including inmate assessment and evaluation, suicide risk reduction, special needs treatment plans, referrals for care, ongoing care, and discharge planning. If the LCSO decides to implement a Moral Reconation Therapy (MRT) program at the Jail, CCS will use our experience with MRT programming to assist in the establishment of a successful MRT program. However, we feel that our other mental health programming options will better suit the needs of the LCSO s inmate population. The CCS Mental Health Program is overseen by Charlene Donovan, Ph.D., and Johannes Dalmasy, MD, who will work directly with the on-site mental health and psychiatric staff. Our corporate and regional mental health teams will coordinate with local providers to deliver a mental health program that is fully standards-compliant and designed to meet the needs of the incarcerated population. Fully licensed mental health professionals will provide psychiatric care, including in-house emergency crisis evaluations, psychiatric assessments/referrals, medication checks, and any required follow-up/discharge planning. A mental health professional will provide on-site assessments of patients with clinical symptoms. Additionally, a licensed psychiatrist will be on-call 24/7. Lane County Sheriff s Office 84

118 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Initial Mental Health Screening CCS will perform an initial mental health screening during intake and refer patients to mental health staff as needed. Urgent referrals will be managed by mental health staff immediately, with follow-up by the CCS psychiatric practitioner as needed. Medical staff will address urgent referrals received after hours and contact the on-call psychiatrist as needed to manage these cases. CCS will provide adequate staffing to allow for the timely evaluation of intake orders and inmates in need of mental health evaluations so that inmates with medical and mental health issues can be stabilized as quickly as possible and medications can be initiated. Mental Health Evaluations Unless an emergent concern is identified during the intake screening, inmates referred to the Mental Health Program will receive a complete evaluation by qualified mental health personnel within hours of intake. Mental health evaluations will follow NCCHC and ACA standards for Mental Health Screenings and Evaluations and will include: History of psychiatric treatment and outpatient treatment Current psychotropic medication Suicidal indication and history of suicidal behavior Drug and alcohol usage History of sexual offenses History of expressively violent behavior History of victimization due to criminal violence History of cerebral trauma or seizures Emotional response to incarceration Documentation of informed consent When it is determined that an inmate received mental health care prior to incarceration, efforts will be made by the nursing staff to obtain treatment information and verify medications from community providers to facilitate continuity of care. Individuals who report current psychotropic medication use at intake are asked to complete a Release of Information (ROI) so that the medication verification process can begin. Medications that are verified are reviewed by a psychiatric prescriber and continued as clinically indicated. Psychiatric Services CCS will provide psychiatric services as requested for inmates housed at the Lane County Jail Facilities. Lane County Sheriff s Office 85

119 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Director s Hold Evaluations CCS mental health staff will conduct Director s Hold Evaluations as required for inmates pending release who may pose a risk to themselves or others. Mental health staff will provide treatment, conduct medication evaluations for the inmate, monitor the inmate, provide on-site or off-site referral to a County-approved mental health facility to ensure continuity of care, provide a Director s Hold, and coordinate with Lane County Jail Security staff for transport to an Oregon State certified and secured mental health facility. Our Regional Management team has first-hand experience with Director s Holds. They have worked with Mental Health Professionals in the past to obtain this certification. Stevens Hyppolite, Regional Vice President, helped establish the Director s Holds protocols at the Lane County Jail Facilities with the current mental health staff. We plan to bring this level of understanding and expertise to Lane County. Fitness to Proceed Evaluations CCS mental health staff will conduct Fitness to Proceed Evaluations as requested by the Court or attorneys. When requested, mental health staff will arrange and complete the evaluations, write the necessary reports and provide the reports to the court, and present their findings to the court if requested. If the Court finds an inmate unfit, CCS mental health staff will coordinate with Oregon State Hospital and Jail Records to oversee the transition of the inmate to and from Oregon State Hospital, including coordination with Lane County Jail Security staff and/or LCSO Transport Section to prepare the inmate for transport. Crisis Intervention CCS will work with the LCSO to determine our role in a site-specific policy for the management of mental health emergencies. Designated mental health housing will be used as a protective environment for inmates exhibiting behavior serious enough to require notification of the mental health staff. Inmates demonstrating self-injurious behaviors and those identified with suicide potential will be placed under constant observation until a comprehensive mental health evaluation can be completed and an appropriate disposition determined. Upon notification that an inmate will be placed in segregation, a qualified healthcare professional will conduct a chart review to ensure there is not a contraindication to the placement. The chart review will be documented. Inmates isolated for psychiatric purposes will be examined by the physician or designee within 48 hours after initial confinement. Monitoring of the Mentally Ill Inmates demonstrating self-harming behaviors and those identified as suicide risks will be referred to mental health personnel for evaluation. These patients will be placed under constant observation until the mental health evaluation can be completed and an appropriate disposition determined. Inmates isolated for psychiatric purposes will be examined by a Licensed Mental Health Professional or designee within 24 hours after initial confinement. Medical and mental health staff will be notified when an inmate is placed in observation, and will be available 24/7 to participate in the ongoing monitoring of the patient s progress. Our medical and mental health staff will meet daily with security staff to share relevant information, to review the status of inmates under constant observation, and to make determinations regarding continued observation or return of inmates to general population. The psychiatrist or designee will approve each inmate s return to general population when recovered. Lane County Sheriff s Office 86

120 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Segregation Monitoring As part of the intake process, CCS will conduct a special needs screening that will address housing and follow-up care for inmates with special healthcare needs, those who require monitoring, and those who may be in danger of harming themselves or others. If it is determined that an inmate requires ongoing care, appropriate housing, work assignments, program participation, and health care services will be provided. CCS staff will coordinate with the Medical Director to establish individualized treatment plans for special needs patients, which will include information regarding the patient s housing assignment and ability to function in general population. We will share special needs treatment plans with security staff as needed to facilitate housing in the appropriate area of the Lane County Jail Facilities and to ensure proper treatment of inmates with long-term and individualized health care needs. For more information on the CCS Special Needs Program, please see section C.1.a.27 Chronic Illness and Special Needs Inmates. Upon notification that an inmate will be placed in segregation, a qualified health care professional will conduct a chart review to ensure there is not a contraindication to the placement. The chart review will be documented. Medical and mental health staff will be notified when an inmate is placed in observation, and will be available 24/7 to participate in the ongoing monitoring of the patient s progress. Segregation rounds will be made at least three times weekly, with checks recorded on a cell card or segregation log. All inmates on direct or psychiatric observation will be seen daily by the psychiatrist or designee. CCS will maintain a record of segregation rounds, and clinical encounters will be noted in the patient s medical record. Response to Inmate Requests CCS mental health staff will respond to inmate requests for mental health services and transitional care, including drug and alcohol services. Substance Abuse Treatment Services CCS has experience providing medical management of inmates requiring detoxification and has developed clinical protocols for inmates with substance abuse disorders. During the receiving screening, medical personnel will use a standardized form to evaluate all inmates for signs and symptoms of substance abuse. The receiving screening also includes questions regarding types of substances used, time of last usage, frequency and amount of usage, length of time using, and side effects experienced when ceasing use in the past. Inmates who report alcohol and/or drug dependence or who are identified as being at risk for withdrawal will receive a more in-depth assessment. Effective treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences. Addiction treatment must help the individual stop using drugs, maintain a drug-free lifestyle, and achieve productive functioning in society. Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives. Community connectivity is therefore an integral component to the CCS Substance Abuse Program. CCS will coordinate with community providers to arrange postrelease treatment to enhance continuity of care and reduce recidivism. Lane County Sheriff s Office 87

121 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Research shows that treatment can help patients addicted to drugs stop using, avoid relapse, and successfully recover their lives. Based on this research, key principles have emerged that should form the basis of any effective treatment program: Addiction is a complex but treatable disease that affects brain function and behavior. No single treatment is appropriate for everyone. Treatment needs to be readily available. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. Remaining in treatment for an adequate period of time is critical. Individual and/or group counseling and other behavioral therapies are the most commonly used forms of drug abuse treatment. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. An individual's treatment plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. Many drug-addicted individuals also have other mental disorders. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Treatment does not need to be voluntary to be effective. Treatment programs should assess patients for the presence of HIV/AIDS, Hepatitis B and C, tuberculosis, and other infectious diseases, providing targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases. Referrals Mental health referrals can occur at any time during the inmate s incarceration. If the mental health evaluation indicates that ongoing care and evaluation are required, mental health personnel will establish a treatment plan, schedule the inmate s next evaluation, and make the appropriate referral if a psychiatrist s services are required. Inmates currently being prescribed psychotropic medications, those currently receiving mental health treatment, and those identified as having a history of mental illness or self-harm will be referred for care. Prescriptions CCS emphasizes high standards of psychiatric care by providing quality treatment, including psychotropic medication, to those patients with serious mental health issues. We have developed written policies, procedures, and clinical letters for psychiatric services that address treatment plans, laboratory studies, informed consent, non-compliance, and management of various conditions. A medical evaluation, routine lab work, and regular blood pressure monitoring will be performed as indicated on inmates requiring psychotropic medications. The results of all such monitoring will be documented in the patient s medical record. All inmates placed on drug therapy will be seen within one week by the psychiatrist. Every inmate on psychotropic medication receives routine individual counseling. Lane County Sheriff s Office 88

122 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Medication Education Education will be provided at the time of the medication order regarding the risks associated with each prescribed medication and will be documented in the patient s medical record. Education will consist of informed consent, verbal information, and (where available) written information related to contraindications. Female inmates will be specifically educated regarding the risks of taking medication while pregnant. All female inmates will be tested for pregnancy prior to orders being written for medications, if a pregnancy test has not already been provided and the inmate consents to being tested. Informed consent is obtained and documented in the patient s health record prior to the initiation of psychotropic medication. Post-Release Referral Mental health presents a challenge for most jails and a great opportunity to make a significant impact on the community. CCS extends continuity of care by helping connect patients with community resources and thereby reducing recidivism. We are committed to being active in connecting our programs with community efforts, which allows us to obtain information regarding community treatment regimens and refer patients before release to appropriate community programming. CCS will partner with community providers to enhance continuity of care for the LCSO s inmate population. We will place special focus on continuity of care for those patients with mental health issues and chronic diseases. Discharge Planning CCS believes that discharge planning must start on Day One in order to be effective, and we have policies in place regarding discharge planning for released inmates. During initial contact with the clinical provider, inmates will be informed about community resources available upon discharge. CCS will work with local mental health providers to develop processes to ensure continuity of care for discharged patients, especially those with dual diagnoses of mental illnesses and substance abuse. We will strive to enhance these patients state of health and reduce the likelihood of recidivism by providing them with as many resources as possible to continue their treatment plans. When an inmate is discharged from the Lane County Jail Facilities, CCS will assist in creating discharge plans that detail the needed post-release care. Within 48 hours of notification of an inmate s pending release into the community, CCS will perform a discharge screening to determine the need for postrelease medications and medical assistance. We will medically clear inmates for discharge and secure a medical necessity form signed by the practitioner for any discharge medications. CCS will ensure that inmates have an adequate supply of required medications to accommodate the transition of care to a community provider. We will also assist the LCSO in making post-release referrals as necessary for continuing care. If immediate post-release care is needed, CCS will coordinate with the LCSO to secure post-release appointments. We will also assess the need for medical assistance, and will assist with the completion of necessary paperwork. C.1.e.2 Mental Health Care Protocols CCS will participate in the development and implementation of mental health care protocols, including counselling services, as necessary. Lane County Sheriff s Office 89

123 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Group Counseling Services CCS may refer inmates to a program of group and/or individual counseling services designed to address the mental health needs of the inmate population. Mental Health Professionals are trained to work with inmates entering the system who present as naïve to the correctional environment or particularly vulnerable based on stature, mental illness, or developmental disability. They provide assessments, treatment, education, case management, and discharge planning services in both individual and group settings. As part of the intake and health assessment process, inmates identified as having significant mental health needs are evaluated by a member of the mental health staff for appropriateness in enrollment in group or individual counseling services. CCS will complete referrals to appropriate community resources for individuals upon release and will consult with the LCSO to ensure continuity of care for inmates entering a drug or alcohol treatment facility upon release from the Lane County Jail Facilities. CCS will also consult with the LCSO regarding the continuation of any current groups offered at the Lane County Jail Facilities. C.1.e.3 On-call Coverage A licensed psychiatrist will be on-call 24 hours a day, 7 days a week for advice and consultation to mental health and/or nursing staff at the Lane County Jail Facilities. C.1.e.4 Backup Psychiatrist CCS will provide psychiatric back-up in the primary psychiatrist s absence. C.1.e.5 Detoxification and Withdrawal CCS will provide medically supervised on-site detoxification services in accordance with all applicable standards of treatment. When medically indicated, inmates will undergo a complete detoxification program, minimizing risk of adverse symptoms and the need for off-site treatment. The CCS Withdrawal/Detoxification Program is comprised of the following steps. Receiving Screening Many inmates arrive in the correctional setting under the influence of drugs or alcohol, and significant histories of substance abuse increase the possibility that they will experience some degree of withdrawal. During the receiving screening, medical personnel will use a standardized form to evaluate all inmates for signs and symptoms of withdrawal, including: Anxiety and agitation Disorientation Visual and auditory disturbances Nausea and headache Tremors Paroxysmal sweats Elevated pulse, respiratory rate, and blood pressure Lane County Sheriff s Office 90

124 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Inmates who report alcohol and/or drug dependence or who are identified as being at risk for withdrawal will receive a more in-depth assessment. The receiving screening includes questions for the inmate regarding types of substances used, time of last usage, frequency and amount of usage, how long the inmate has been using, and side effects experienced when ceasing use in the past. CCS completes the evaluation using the Addiction Research Foundation Clinical Institute Withdrawal Assessment Alcohol (CIWA-Ar) or the Clinical Opioid Withdrawal Scale (COWS). These tools have been extensively researched and shown to be viable methods for assessing the severity of withdrawal symptoms based on observation of the inmate s behavior or the inmate s response to questioning. Observation and Monitoring Inmates determined to be at risk for alcohol or drug withdrawal will be placed on a detoxification watch. CCS medical personnel use the CIWA-Ar/COWS tools and information gathered during the receiving screening to classify inmates as being in mild, moderate, or severe detoxification. Mild Detoxification: When possible, CCS houses inmates undergoing mild to moderate detoxification in an observation cell until the completion of detoxification. Moderate Detoxification: CCS houses inmates experiencing more advanced cases of detoxification in medical housing under close watch. Severe Detoxification: Inmates diagnosed with delirium tremens (characterized by profound confusion, hallucinations, and severe autonomic nervous system over-activity) who cannot be safely managed in the detention environment may need to be transferred to an inpatient setting. Any hospitalizations will be by the order of the CCS physician and in consultation with the LCSO. CCS employees are trained to ensure that inmates do not progress to this stage of detoxification. Any hospitalization for delirium tremens is considered a critical incident and requires retroactive review. Nursing staff will contact the physician/mid-level provider on duty or on call when monitoring results are outside the established parameters of mild withdrawal. If medical personnel determine that an inmate is at risk for moderate to severe withdrawal, or if an inmate indicates a history of complications from past periods of abstinence, CCS will recommend placing them in medical housing. These inmates will be assessed by medical personnel three times daily and anytime requested by facility staff. Inmates experiencing withdrawal from alcohol, opiates, or benzodiazepines will be monitored for as long as they are symptomatic. Treatment CCS establishes a physician treatment plan as soon as we assess the potential for withdrawal from alcohol or sedative-hypnotics. Medical personnel will establish an individualized treatment plan based on their assessment of the patient s condition. The treatment plan may include prescribed pharmaceutical therapy, as indicated. Due to variability both in the severity of withdrawal symptoms and in the metabolism of therapeutic agents, it is difficult to establish standard or routine dosage schedules. Treatment plans generally include a benzodiazepine during the acute withdrawal period, which is then tapered off if there are no other indications. Lower dosages might be anticipated in inmates with significant liver disease. Lane County Sheriff s Office 91

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127 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Credential Verification Organization (CVO) CCS forwards the file to a third party CVO that is certified under the NCQA Certification Verification Certification Program for the following: Application Processing Education and Training DEA Certification License to Practice Malpractice Claims History Medicare/Medicaid Sanctions Ongoing Monitoring of Sanctions Medical Board Sanctions Work History Medical Staff Organization Once the file is completed by the CVO, it is forwarded to Risk Management for review and approval by the MSO. Re-credential Process The MSO requires all HCPs be re-credentialed every two years. C.1.e.7 On-site Psychiatric Coverage The primary CCS staffing plan (ADP: 326) includes on-site psychiatric coverage for 30 hours per week, utilizing a combination of psychiatrist and psychiatric nurse practitioner hours. We have provided our proposed staffing schedule, including psychiatric coverage, in section B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION. C.1.e.8 Pharmacy Meetings CCS will establish a Pharmacy and Therapeutics (P&T) Committee that will be responsible for monitoring pharmaceutical processes and utilization practices. The P&T Committee will be responsible for managing the CCS formulary and will be chaired by the CCS Medical Director. Throughout the formulary process, the P&T Committee will help balance efficacy, safety, and cost of certain medications by requiring prior approval. The P&T Committee will be multidisciplinary and will include the CCS psychiatrist. The P&T Committee will meet on a quarterly basis. Copies of the P&T Committee meetings and related reports will be provided to the Medical Supervisor or designee. C.1.e.9 Formulary Management CCS will adhere to the formulary approved by the LCSO. C.1.e.10 Mental Health Records All mental health services rendered will be documented in the inmate s medical record. For more information, please see section C.1.a.9 Medical Records. Lane County Sheriff s Office 94

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130 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C.1.e.14 Confined Inmates Inmates demonstrating self-harming behaviors and those identified as suicide risks will be referred to mental health personnel for evaluation. These patients will be placed under constant observation until the mental health evaluation can be completed (within 24 hours) and an appropriate disposition determined. CCS suggests the following options for security observation of suicide/special observation watch: Continuous Watch: Constant observation of the inmate 15 Minute Watch: Full sight of the inmate at least every 15 minutes on an irregular schedule Medical and mental health staff will be notified when an inmate is placed in observation, and will be available 24/7 to participate in the ongoing monitoring of the patient s progress. All inmates on direct or psychiatric observation will be seen daily by the psychiatrist or designee. C.1.e.15 Weekly Meetings CCS mental health staff will participate in weekly Medical-Psychiatric meetings with the Security Supervisor, medical staff, and Jail Programs representatives to discuss and evaluate inmate mental health status. CCS staff will ensure that continuity of care is maintained and appropriate communication of needs is conveyed in these meetings. C.1.e.16 Professional Licenses We have responded to this requirement in section C.1.e.6 Professional Licenses. C.1.e.17 Director s Holds and Fitness to Proceed Evaluations CCS is authorized by the State of Oregon to place Director s Holds on inmates as needed and to conduct Fitness to Proceed Evaluations. C.1.e.18 Mental Health Assessments CCS will establish policies and procedures for inmate mental health assessments, which will be subject to review by the Alternative Program Lieutenant or designee. Detailed policies and procedures will be in place for both the on-site treatment of such inmates and for referrals to the mental health preferred provider when medically necessary for continued treatment. For more information on mental health evaluations and referrals, please see section C.1.e.1 Mental Health Professionals. C.1.e.19 Process Monitoring and Evaluation CCS will monitor and evaluate inmate mental health process, which includes preparing all required documentation and forms, including fitness and unfit-to-proceed evaluations. 2) Include descriptions of key positions (other than managers described in B2 & 3 above) needed, and minimum requirements for any individual who will fill these positions. We have provided job descriptions for all mental health personnel in section 3 Other Attachments. Lane County Sheriff s Office 97

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133 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Scope of CQIP CCS will use our CQIP to establish a site-specific quality assurance plan for the Lane County Jail Facilities, based on the scope of care provided. Within 90 days of contract implementation, CCS will develop written, site-specific plans that will define the QI review process and meeting format. CCS will coordinate with the LCSO to integrate our program with any quality assurance initiatives currently in place. We will be responsible for monitoring relevant areas for quality improvement, including accreditations, credentialing, environmental inspections, emergency drills, nursing, intake, medication management, special housing, and ancillary services. Routine CQI studies examine areas where overlap or hand-off occurs, as well as other problem-prone, high frequency/volume, and risk management processes, including but not limited to: Informed Consent, Receiving Screenings, Screening and Evaluation at Health Assessment, Special Needs, Segregation, Treatment Planning, Suicide Risk Reduction, Medication Administration, Initiating Medication at Intake, as well as processes exclusive to the client facility. Each site will complete monthly CQI screens as outlined in the CCS CQI Calendar, plus at least one ad hoc screen per quarter to evaluate a site-specific issue presenting challenges. Examples of ad hoc screens include: Missed Medication (investigative study) TB Screening Health Assessment Periodic Grievances Communication with Custody Initiating Essential Medications Return from Hospital Prenatal and Postpartum Care HEDIS and Outcome Study Please see the following sample CQI Calendar, with monthly CQI screens broken out by responsible party. Lane County Sheriff s Office 100

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138 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Following is a summary of the CCS Care Management process. 1. When an on-site provider determines that an inmate may need community-based services, the provider uses the Care Management system to document and communicate the Consultation Request. 2. On a daily basis, our Corporate and/or Regional Medical Director will access the Care Management system to review requests and take one of the following actions: Authorize a specific diagnostic or therapeutic modality Recommend an alternative treatment plan Request additional information A Valuable Utilization Management Tool for Clients CCS provides our clients with complete access to the easyto-use Care Management system, including real-time utilization reporting. CCS is fully transparent in our Care Management process, assuring our clients that only necessary off-site trips are being made. 3. If it is determined that the requested service is medically necessary, the request is approved and an authorization number is established in the Care Management system, which automatically sends the authorization number to the site and to the CCS claims department. 4. Once the site receives an authorization number, an appointment can be scheduled within the system. Authorization numbers are only valid for a specific time period. CCS will communicate service approval to the community provider and will require pre-approval in order to assume financial responsibility for services rendered. CCS also verifies that all invoiced charges are appropriate. Since the system sends the authorization number to our claims department, they are able to review every invoice to ensure that the LCSO is only billed for the approved services. 5. If an inmate is released from custody prior to a scheduled appointment, CCS will notify the community provider that the LCSO is no longer financially responsible, and CCS will remove the pending appointment from the system. 6. The CCS Medical Director will review and address discharge summaries and medical recommendations that the community provider makes. Lane County Sheriff s Office 105

139 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Appointment Scheduling Healthcare staff will make referrals for specialty services through our powerful Care Management system. The CCS Care Management system allows healthcare personnel to easily schedule appointments for upcoming healthcare services, both on- and off-site. This robust scheduling function makes our Care Management system an integral tool in the provision of care. Appointment scheduling through the Care Management system creates more efficient chronic care clinics and establishes a valuable tool for medical staff as they prioritize tasks and ensure that sick call, health assessments, lab draws, specialty appointments, and other important events happen as needed and within the required timeframe. Features include: Recurring appointments (ideal for chronic care patients) Cancellation of appointments for patients who have been released Rescheduling of pending appointments for patients who are re-admitted to the facilities Easy-to-view daily/weekly/monthly calendars for staff review Queues show missed appointments (due to security, court appearances, etc.) and allow for rescheduling Appointment Scheduling Module Lane County Sheriff s Office 106

140 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Utilization Review CCS uses an established review process to ensure that off-site referrals are medical necessary, and that any payments made are appropriate. We will coordinate, validate, and track off-site care and invoicing through the Care Management system, which generates reports that allow us to analyze the utilization of off-site services on behalf of our clients. CCS uses this data to assess the need for additional on-site and off-site services, as well as the potential impact that systems such as telemedicine may have. We will continuously evaluate both the number of cases as well as the costs associated with transporting inmates in determining which clinics are held on-site. Constant evaluation of specialty services will ensure the most cost-effective solution for clinics. The CCS Review Process Lane County Sheriff s Office 107

141 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Utilization Statistics The CCS Care Management system is capable of producing reports containing detailed cost data for purposes of cost analysis and cost containment. These reports include information related to all medical, dental, and mental health services and associated costs, including laboratory, radiology, and other ancillary services; specialty services; pharmaceuticals; and medical supplies. CCS will analyze utilization statistics and continuously evaluate the potential benefits of establishing on-site clinics. Services brought on-site would typically result in cost savings for the LCSO as a result of clinic (rather than per patient) rates and decreased officer transportation expenditures. Please see the following sample Utilization Management report generated in the CCS Care Management system. Sample Utilization Management Report Care Management System Lane County Sheriff s Office 108

142 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 CCS has had marked success in reducing off-site medical and security costs for our clients by ensuring the provision of cost-effective, medically necessary healthcare services to our contracted populations. The Care Management system is a powerful tool for tracking, analyzing, and trending data through visual dashboards. Care Management Dashboards will allow the LCSO to compare historical data as well as to analyze, trend, and compare data. Operational and outcome trending can be provided on: Admits per 100/1000 Admits by diagnosis Re-admission rates ER visits per 100/1000 ER visits by diagnosis ER conversion rates Infection rates Non-formulary utilization trends Non-formulary lab trends Prior authorization turnaround times Prior authorization outcome rates Standard vs. expedited authorization requests Standard Dashboard Care Management System CM Details Year Month Date.Calendar = February 2014 Org Region VP Name = Org Region VP CareManagement ADP 14,249-2,237 6,873-1,650 5,907-15,907 10,812 14,488 72,123 ER Visits YTD ER Benchmark ER Visits Variance ERConvert Ratio YTD 24.38% 0.00% 19.26% 37.42% 40.00% 16.35% 10.79% 14.29% 38.31% 12.81% 24.46% 20.37% ERConvert Ratio Benchmark 35.00% 35.00% 35.00% 35.00% 35.00% 35.00% 35.00% 35.00% 35.00% 35.00% 35.00% 35.00% ERConvert Ratio 25.96% 0.00% 14.29% 39.13% 80.00% 7.69% 11.11% 28.57% 34.69% 12.22% 23.68% 19.75% Variance % % % 11.80% % % % % -0.87% % % % Admits YTD Admits Benchmark Admits Variance Readmit 7 Day YTD Readmit 7 Day Benchmark Readmit 7 Day Variance IP Days YTD , IP Days Benchmark , IP Days ,521 Variance ALOS YTD ALOS Benchmark ALOS Variance Outpatient YTD , Outpatient Benchmark , OP Visits ,234 OP Visits w/procedures Outpatient Total Visits ,242 Variance OP Surgery YTD OP Surgery Benchmark OP Surgeries Variance Lane County Sheriff s Office 109

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146 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 The CCS Care Management system will be implemented upon transition and will be operational Day One; the full ERMA implementation typically takes place within the first 12 months of the contract. The ERMA implementation project for the LCSO will start on Day One of the contract with integration of the CCS Care Management system into day-to-day processes for utilization management. For implementation of the full ERMA system, CCS typically divides the process into three phases, as illustrated in the following graphic. Each phase is dependent upon the completion of the prior phase. We have found that this method of implementation ensures a smoother transition from paper records, and creates less stress for the on-site medical professionals as they continue to complete their daily responsibilities. Phase 1: Discovery In the Discovery phase, CCS will determine ERMA/JMS interface needs and network requirements, and will define ERMA application, reporting, and workflow requirements. We will analyze current operational and clinical processes in order to develop a standardized approach for ERMA integration. CCS will make recommendations for ERMA utilization associated with these processes, including the use of forms related to specific workflows. The Discovery phase also includes the identification of user responsibilities and compliance indicators. Activities Identify key operational and clinical workflows Identify forms and customization Document workflows Identify users and roles Identify compliance indicators NCCHC/ACA Develop a Statement of Work Deliverables Scope of work ERMA customization requirements o Forms o Workflows o Chart definition o ERMA module configuration definitions Implementation schedule Training plan overview Lane County Sheriff s Office 113

147 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Phase 2: Development In the Development phase, CCS will establish the ERMA/JMS interface and install any required hardware. Additionally, any site-specific customizations to ERMA will take place during this phase of the project. Activities Configure document types Configure treatment types Configure chart sections Customize paper forms Create new dynamic forms Create form signature workflows Document clinical workflows (Standard and Site Specific) Document operational workflows (Standard and Site Specific) Identify user roles and responsibilities Create standardized operational and clinical processes Create training materials Create training plan and schedule Deliverables Standardized clinical and operational workflows Site specific documentation and training material Phase 3: Implementation In the Implementation phase, CCS will implement the software at each facility and establish a Go Live date. Prior to implementation, CCS will conduct on-site training sessions to familiarize users with the system and answer any questions that may arise. CCS will also conduct load testing of the system to insure communications resources are adequate to support the efficient use of the system. On the date chosen to Go Live, CCS will provide resources for support during the critical first 72 hours of the implementation process. Activities Prepare training plan Provide initial training to on-site staff Develop Go Live plan Perform Go Live cutover Follow up and adjustments Implementation/mastery of each module Deliverables Training plan Go Live plan CCS resource support for training and Go Live dates Lane County Sheriff s Office 114

148 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Training Many other EMR systems require intense training sessions that can leave staff feeling overwhelmed and unsure of how to work the system into their everyday processes. Due to the user-friendliness of ERMA, medical personnel can be trained as competent beginner users in as little as 30 minutes. Medical personnel are trained to integrate ERMA into their workflow so that data is captured as close to the time of service as possible. CCS also uniquely provides on-site training and transition support resources, as well as HSA mentoring, throughout the transition. Patient Management Capabilities ERMA organizes inmate records in a manner that allows record indexing and retrieval by inmate number, social security number, patient name, date of birth, incarceration date, or other identifiable data elements. ERMA organizes data into a virtual medical chart within each patient record with sections of the medical chart customized to each client s needs, including: Receiving Screening & Health Appraisal Chronic Care Master Problem List Patient Consent Forms Sick Call Notes Provider Orders Patient Grievances Mental Health Dental Off-Site Care Medication Administration Records Lab Results Document Imaging ERMA supports both dynamic (interactive data entry) and static (scanned) documentation. Scanned documents can be barcoded and rescanned, reducing the time required to attach the document to the patient s chart. Our flexible configuration allows custom workflows to be attached to all documents, including the capturing of electronic signatures from all types of users. For example, receiving screenings can be routed to nurses, physicians, and mental health providers for review, capturing electronic signatures at each step. Dynamic Documents and Patient Profile In today s correctional environment, the need to collect data is greater than ever. Healthcare professionals are able to document patient encounters quickly and easily through ERMA s dynamic documents feature, which allows each facility to create a library of customized forms that are used for documentation. These forms, also known as templates, are created through an administrative tool with strict business rules applied. Administrators determine requirements, options, explanations, and other useful elements to capture in the templates. Lane County Sheriff s Office 115

149 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Data flows easily between a dynamic document and the patient profile. For instance, if a nurse documents a problem found during a patient encounter, it will be automatically added to the patient s master problem list. Essential information such as allergies, diets, appliances, and special needs can be easily integrated with dynamic documents. By using dynamic documents to capture data, ERMA improves patient encounters and saves medical staff valuable time. Patient Profile in ERMA Lane County Sheriff s Office 116

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151 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Reporting and Work Queues ERMA allows for the creation of customized reports and work queues based on each site. Reports can be sent to security staff to ensure prompt and accurate communication of movement needs. Integration with Microsoft SharePoint Services allows reports to be scheduled and delivered automatically as needed. Report automation is often used to notify third parties such as food service vendors or custody staff of special needs and medically ordered diets. Medical staff can also quickly review and reschedule any missed appointments. Results Capturing and Tracking ERMA allows for automatic tracking of intake screenings, health assessments, chronic care visits, and other activities. ERMA can generate statistical reports and identify any outliers beyond agreed-upon time periods. The ERMA report library contains over 100 standard reports that can be customized to meet the specific requirements of the LCSO. The following sample reports show the amount of time between a patient s booking and preliminary medical screening, number of health assessments completed within the required timeframe, and time between chronic care visits. Sample Tracking Report Time from Admission to Intake Screening Lane County Sheriff s Office 118

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153 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 ONC Certification The Medicare and Medicaid EMR Incentive Programs, established by the Center for Medicare and Medicaid Services (CMS), provide financial incentives for the meaningful use of certified EMR technology (CEMRT) to improve patient care. To receive an EMR incentive payment, providers have to demonstrate that they are meaningfully using their EMRs by meeting thresholds for a number of objectives. First, the provider s EMR system must be certified as being capable of providing the features and functionality that can lead to this meaningful use. Qualifying CEMRTs are certified for meaningful use by the Office of the National Coordinator (ONC) HIT Certification Program. ERMA qualifies as a CEMRT and has been certified for meaningful use by the ONC. A copy of our certification letter from the Drummond Group, an official ONC Authorized Certification Body (ACB), is provided below. Lane County Sheriff s Office 120

154 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 b. Include configuration diagrams which must also denote whether the Contractor or Lane County is responsible for providing each component of the system. Please pay particular attention to document any data interfaces to existing Lane County software systems, Internet access requirements and/or VPN requirements. ERMA is a web-based system, so there is very little needed for implementation and subsequent use. The system is hosted off-site, so there are no server or infrastructure requirements. CCS will provide desktop computer equipment, and we will require the LCSO to provide internet access. ERMA will interface with your Jail Management System (JMS), Executive Information Services (EIS), and the LCSO will need to provide JMS extract of patient data on a regular basis. Technical Specifications ERMA will interface with your jail management system (JMS) to give medical and security staff instant access to important healthcare information for each inmate. Because ERMA is a web-based system, there is no software to install. Implementation is simple so clients can immediately start benefitting from the solution. CCS would only require the following from the LCSO: High-speed internet connectivity and access to wireless service (if available) or electrical outlets in areas where medical services occur A simple data extraction from your JMS, which will allow us to build the interface between these systems; the interface will allow for initiation of the medical record at intake, as well as exchange of information that security staff may need, such as medical orders for a bottom bunk or PREA directives Database Structure CCS will provide all system and database administration services for ERMA. The system operates on Microsoft SQL Server and all documents, indexes, and data elements are contained within the SQL Server Database. ERMA is built on a Microsoft Server platform and can exchange data in a variety of formats, including XML, HL7, CSV, Web Services, and others. We support multiple encryption models to ensure that data is exchanged reliability and securely. Terminal Services ERMA is a browser-based internet application, so no VPN is required. Our authentication model eliminates the need for complicated firewall or internet configurations. Our unique two-factor authentication only allows ERMA access on devices that have been pre-approved, thereby securing ERMA to the device level. New devices can be quickly authorized with the proper approvals. Lane County Sheriff s Office 121

155 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Network Components and Architecture CCS is focused on the security and accessibility of your health records. All data is maintained in a secure and redundant environment to ensure accessibility and continuous maintenance of all patient information, despite natural or man-made catastrophes. We guarantee that all health information is stored on redundant servers within two separate data centers. These centers are SAS 70 certified (the equivalent of NCCHC accreditation for information technology security), ensuring that security and HIPAA standards are met. The CCS data centers offer the following features: Two redundant data centers (Colocation) 15 min replication window Load Balancing and Fail Over Cisco, HP, 3PAR, F5 Hardware CommVault Simpana Backup Amazon Cloud Lane County Sheriff s Office 122

156 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Technical Support CCS provides the highest level of technical support programs in the industry. The CCS Information Technology (IT) Department, located in our Nashville Home Office, is under the direction of our Chief Information Officer, Bob Martin. Our IT specialists are available 24/7 to troubleshoot any software or hardware problems that occur at any of our contracted facilities. The CCS IT Department provides a helpdesk hotline for ERMA support during normal business hours. After-hours emergency support is provided through a voic call-back process. CCS monitors ERMA 24/7 and will respond to all outages. Updates CCS will be responsible for all maintenance and scheduled upgrades of the ERMA system. We will work closely with the LCSO through implementation of the system and thereafter to provide continued, uninterrupted support. Following completion of the ERMA implementation, CCS will provide operational support consisting primarily of system maintenance and upgrades. We will also provide repairs for any programming issues. CCS continually strives to make our care delivery systems better through process and technology. We release monthly updates to resolve any existing issues, and we release quarterly updates for new feature additions. No installation is required. CCS will provide a thorough training plan and documentation for all new system changes. System Transition Upon conclusion of the contract, medical records will remain the property of the LCSO, and CCS will work to ensure a smooth transition of records. All licenses and portals would be provided to the LCSO for archive retrieval and maintenance. CCS offers the following two options for transitioning electronic medical records: 1. CCS would provide a complete SQL Server data dump of all records and fields. This would allow the LCSO to merge these into a new system if one has been chosen. This would be done at no cost to the LCSO. 2. The LCSO would also have the option to continue to utilize ERMA via a licensing agreement with CCS. We would maintain all storage of the records with the same safeguards that exist today inclusive of duplicate systems running in two separate SAS 70 data warehouses located in separate cities. Any programming requests or report creation, if necessary, would be billed at a negotiated hourly rate which currently is $125 per hour. Software costs include two consecutive days of training support per year. Any additional training requested by the LCSO would be negotiated separately, although typically a train-the-trainer program works best to minimize costs. c. Lane County will provide computer workstations to access our Jail Management System to obtain inmate head counts, lodging assignments and inmate information. 1) The workstation will not be available for loading Contractor software. CCS understands that Lane County will provide computer workstations for accessing the JMS to obtain inmate information. We further understand that the workstations will not be available for loading CCS software. CCS will provide all hardware, software, and training necessary to implement the ERMA system. Lane County Sheriff s Office 123

157 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ INVENTORY: a. Include your plan for accounting for and security of all equipment and supplies. CCS will ensure that the Lane County Jail Facilities have the necessary staff and supplies to provide onsite care and treatment of the inmate population, including but not limited to laboratory, radiology, medical, and dental supplies. We have par level ordering lists and will order the supplies necessary to ensure the continuation of proper care at the Lane County Jail Facilities. Inventory Control CCS staff will verify the contents of all medication containers. Medication, supplies, and equipment are stored in locked areas and signed out to individuals when in use. Bulk supplies are kept separate and inventoried weekly or when accessed. Records are maintained to ensure adequate control. Medication Disposal Regular audits will be conducted to remove discontinued or expired medications. Any unit dose medication that is outdated at the time of inspection or has been discontinued will be returned or destroyed in accordance with current federal or state guidelines. Security of Medication The medication room and all cabinets will be locked at all times when healthcare staff are not present. No inmates will have access to any medication other than those administered by a qualified staff member. No inmates or visitor will be left unattended or unobserved within any treatment or procedural area at any time. Controlled Substances A limited supply of controlled drugs will be kept in the facility. These drugs are under the control of the responsible physician. These medications will be monitored and accounted for by the HSA or designee in coordination with the Jail Administrator. Class II, III, and IV drugs will be counted at the end of every shift by a staff member going off duty and one coming on duty. Any discrepancies in the count must be reported immediately, and resolved prior to the present staff going off duty. All controlled substances must be signed out to the inmates receiving them at the time they are administered. Sharps and Supplies During Orientation, each employee receives instruction on how to how to handle sharp instruments, utensils, and supplies. Needles, syringes, and other high-risk items are stored in locked areas and signed out to the individuals when they are used. Sharps are never to be left in any area when not in use. Sharps will be inventoried weekly in accordance with the Health Services Manual, and each employee will be responsible for ensuring that the sharp count is correct. Employees are instructed to never take the word of co-workers when conducting sharp counts. Used sharps are considered biomedical waste, and shall be discarded directly into leak-proof, puncture resistant containers that have been designed and approved for this purpose. Lane County Sheriff s Office 124

158 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Example of a Sharps Inventory Sheet Sharps Inventory Sheet Date Patient Name Nurse Signature Time Insulin Syringe TB Syringe 21g Butterfly 23g Butterfly 21g Vacudraw 22g Vacudraw 18g Intracath 20g Intracath 22g Intracath 24g Intracath Huber Needle 3cc syringe 25g X 5/8" 3cc syringe 22g X 1-1/2" 18g 1" Needle 20g 1" Needle 23g 1"Needle Razors #10 Scalpel #11 Scalpel #12 Scalpel Suture Removal Kit Staple Removal Kit 5. UNUSUAL CIRCUMSTANCES: a. Include a contingency plan to provide for services in the event of unexpected interruptions of the normal working conditions; i.e., power failure, fire, inclement weather, riot, lock-down, labor strikes or acts of God that would preclude normal expectations. CCS prides itself on being a solutions-oriented company that considers all aspects of our clients needs. We have established contingency and emergency procedures to ensure continuity of care during unexpected events, disruptions, and natural or man-made disasters. CCS will act quickly throughout and following the transition period to develop a comprehensive plan that addresses all aspects of these possible emergencies. We will work collaboratively with the LCSO to develop a cooperative Emergency Preparedness Plan to ensure proper staff recall and allocation, patient movement to designated safe areas, and presence of emergency equipment and supplies. CCS will coordinate with Jail Administration to incorporate our CCS Emergency Preparedness Plan into the overall emergency plan for the Lane County Jail Facilities. The CCS Emergency Preparedness Plan will comply with NCCHC and ACA standards, and will be thoroughly outlined in the CCS Policies and Procedures Manual developed for the Lane County Jail Facilities within 60 days of contract award. The CCS Emergency Preparedness Plan will include: Medical staff participation in facility emergency procedure drills Continuity of care and safety of patients Triage plan Evacuation routes and means of transport out of the institution for injured, ill, disabled, or restrained individuals Outline of where care will be provided, including alternative sites Location of community resources Prevention of interruption in medication Contingency pharmacy and medical supplies plan The protection and accessibility of patient care data at predetermined locations Contact list for recall of key healthcare staff CCS believes in anticipating and recognizing unique problems and situations at all of our client locations, including severe weather and other adverse conditions. The CCS Emergency Preparedness Plan covers the four major phases of emergency preparedness management Mitigation, Preparedness, Response, and Recovery as illustrated in the following graphic. Lane County Sheriff s Office 125

159 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 All CCS personnel will be aware of and familiar with the CCS Emergency Preparedness Plan, which will also cover man down incidents, fires, and hostage situations. New employees will be trained on the health aspects of the plan during orientation, and all healthcare staff will review the plan annually. A health emergency man down drill will be practiced once a year on each shift where CCS personnel are regularly assigned in accordance with applicable standards. CCS will also participate in disaster drill planning programs as requested by the LCSO and will perform a critique of the drills on an annual basis. The CCS Emergency Preparedness Plan will address, at a minimum: Training modules Disaster bag/mobile equipment contents, breakaway seals system Crash cart equipment Communications system and procedures Recall process for medical personnel Emergency assignment of health services staff Establishment of a command post A method to ensure safety and security of patient and staff areas Use of emergency equipment and supplies Establishment of primary and secondary triage areas Triage procedures Transportation guidelines Evacuation procedures in coordination with security personnel Procedure for conducting man down and emergency drills Backup assignments for each of the contingency elements Emergency treatment documentation CCS is committed to ensuring all personnel are adequately trained to respond to a crisis situation. Correctional healthcare personnel are trained to respond to emergencies within a four-minute response time. We offer periodic proficiency training for medical personnel on emergency response and other integral components of our program using established Core Competency Checklists. Core Competency is assessed at least annually dependent upon an individual s needs or responsibilities. Staff members are also trained on the implementation of an Incident Command System (ICS). Lane County Sheriff s Office 126

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161 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ TRANSITION PLAN: a. Include a detailed, transition plan to assume provision of Medical Services within 45 days of signing a contract. If this timeline is not feasible, please suggest an appropriate transition time. CCS is prepared to implement a comprehensive turnkey program for Lane County. We take accountability very seriously. Once we receive notification of intent to award the contract, we will immediately prepare for the transition. CCS will complete a detailed transition plan to ensure proper delegation of responsibility and completion of tasks and to ensure that our program meets all tenets of the contract. We will use this transition plan to communicate responsibilities and to ensure the completion of all required tasks. Transition Timeline To ease the transition of services, CCS prefers to meet with new clients and valued medical personnel within 48 hours of notice of contract award. We will provide informational sessions to medical personnel and distribute applications and paperwork to all on-site staff. CCS will conduct meetings with LCSO command staff to ensure a clear understanding of expectations and channels of communication. Continuous communication helps minimize surprises and ensures a mutual understanding of decisions and protocols. CCS will develop a comprehensive Contract Implementation Plan (CIP) describing our approach for transitioning the LCSO medical program, including specifications for the recruitment of current and new staff; on-site medical services; pharmaceutical, laboratory, radiology, and medical supplies; equipment and inventory; and medical records management. The CIP will provide a comprehensive listing of tasks, the individuals responsible, and the projected dates for completion. CIP meetings will include various members of the Nashville-based Regional Support departments to ensure that all transition planning activities are efficient and effective. The final site-specific CIP will be revised as needed to meet the specific needs of the LCSO and will be updated weekly. CCS has transitioned many of our clients within 30 days of contract award, and we will work to ensure a successful and smooth transition for the Lane County Jail Facilities. With that in mind, we present the following sample timeline for on-site services beginning July 1, Lane County Sheriff s Office 128

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166 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 College and University On-site Recruitment A key part of the CCS recruitment plan includes reaching out to local nursing schools to attract healthcare professionals to a career in corrections. CCS has developed programs for nursing students in several of our client facilities. CCS successfully partnered with the University of Kansas to develop a rotation for students in the Nurse Master s Program. CCS partnered with Creighton University in Omaha, Nebraska to develop a correctional nurse training curriculum and rotation. In the State of Delaware, CCS developed a correctional clinical rotation for University of Pennsylvania Advanced Registered Nurse Practitioners at the Howard Young Correctional Institution in the Delaware Department of Corrections. In Kansas and Nebraska, Mental Health Professionals have completed internships working with CCS Mental Health providers. These are just a few examples of the local programs CCS has developed in our local communities. We have found that by increasing community interest and education regarding corrections, we have been able to attract and recruit healthcare providers who may have otherwise overlooked a career in our industry. National Searchable Databases CCS uses a wide variety of national recruiting databases that provide access to healthcare professionals throughout the country, including: CareerBuilder.com Indeed.com MiracleWorkers.com PracticeLink.com PracticeMatch.com DocCafe.com NurseCafe.com DentistJobsCafe.com CCS also uses resources that blast job postings and information across dozens of other recruiting databases and job sites through a single source. Our strategic use of various databases ensures a continuous feed of the newest resumes and candidates into the Workforce System that our recruiters use to find the best candidates in the shortest amount of time. Training The lives and health of our patients depend on the knowledge, practice skills, and competencies of the professionals who care for them. Caring for and respecting patients in correctional facilities requires hiring ethical and competent professionals, and then building upon their skills through continued training initiatives. CCS will provide appropriate orientation and training for all healthcare personnel. Additionally, we will extend appropriate educational offerings to LCSO employees and will train corrections staff in medical issues as requested. For information on CCS training initiatives, please see section B. PROPOSED ON-SITE STAFFING / STABILITY / RETENTION. Lane County Sheriff s Office 133

167 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 c. Include information about all current managers and supervisors who will be in charge of the transition, how long each person will be on-site during the transition, and what they will be in charge of overseeing. Accomplishing a successful transition and implementation means looking beyond the tasks themselves and placing experienced CCS team members on-site working hand-in-hand with our new staff. The members of our proposed Regional Management Team will become familiar faces as they provide guidance and insight to members of the on-site medical team at the Lane County Jail Facilities. The CCS Executive Team will also be closely involved with the implementation and operation of services for the LCSO. CCS has assembled a strong leadership team to manage the start-up and implementation process at the Lane County Jail Facilities. The following individuals will support the transition and operation of the LCSO medical program: Regional Vice President: Stevens J. Hyppolite, MBA, ACHE Regional Manager: Mandy Forsmann, RN Regional Medical Director: Vivek Shah, MD Regional Behavioral Health Manager: Julie Weigand, JD, LMCH, LPC Chief of Behavioral Health: Charlene Donovan, Ph.D. Chief Psychiatric Officer: Johannes Dalmasy, MD Deputy Chief Clinical Officer: Dean Rieger, MD Chief of Jail Operations: Chris Bove Each of these team members will be will be responsible for ensuring that programming follows the tenets of the contract between CCS and the LCSO, as well as CCS protocols and industry standards. CCS also has more than 200 additional Home Office team members prepared to support the LCSO medical program. We will communicate with the LCSO and with current medical and mental health teams throughout the transition process to identify and care for those inmates requiring medical attention. We will require knowledge of any inmates currently hospitalized, those in need of specialized chronic care, those with off-site appointments scheduled for the next 30 days, and all inmates currently on suicide watch. Quote from Our Client In the past year, I have seen major improvements in the quality of services provided to prisoners. We now provide Nurse Sick Call, H&P s and other clinical encounters in the Medical Unit, as opposed to housing units. We also have streamlined and shortened med pass, which saves us countless hours each week. Medical records are (for the first time) computerized; healthcare encounters are scheduled electronically and receiving screenings are done dynamically. The result is that prisoners are being seen in a timely manner, information is shared and available at each encounter; care is a coordinated effort, and safeguards are in place to prevent negative outcomes. Michelle Sanborn Jail Administrator Macomb County Sheriff's Office (Transitioned from Corizon) Lane County Sheriff s Office 134

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173 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ INVOICING: a. Explain procedures for monthly billings and include sample forms. CCS will provide for monthly billings that include a breakdown of all costs actually incurred. Documentation included with the monthly invoice will detail: Actual time worked reported in the same format as it was estimated in the approved staffing plan Aggregate cost reports, including documentation of payments by third-party insurance vendors for all eligible services rendered to inmates Pharmacy cost report A list of all hospital stays and proof of ACA Medicaid eligibility for cost coverage Documentation of Staffing CCS realizes the importance of delivering what we promise, especially regarding on-site staffing, and we will work to keep these costs as low as possible. We will track and report to the LCSO all staff hours worked, as well as hours not provided. To demonstrate compliance with the contracted staffing plan, CCS will provide the LCSO with a monthly statistical report showing staffing fill rates. Our automated FTE reporting system allows for 100% auditable reporting of contract versus worked staffing reports. Each month, we will provide accounting of actual days/hours worked by the entire medical staff to the LCSO in the form of an FTE report. These reports, which are compiled by pay period, provide true transparency and allow for auditing down to the individual and shift. Because these reports are automatic, all historical reports can be searched, queried, and drilled down in mere moments. We have provided a sample FTE report on the following page. Lane County Sheriff s Office 140

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175 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Cost Reports CCS asks every inmate at intake if they have insurance. The inmate s response is documented in their electronic medical record, which allows CCS to run a report showing how many patients have insurance coverage. As part of our monthly report package, CCS can provide a monthly off-site activity/cost report upon request that includes: Inpatient hospitalizations and costs (except when direct billed to Medicaid or insurance) Emergency room admissions and costs (except when direct billed to Medicaid or insurance as part of an inpatient stay) Off-site hospital observations and cost Outpatient and inpatient services and cost Medical specialty consultation referrals and cost Clinical service visits Report of third-party reimbursement, pursuit, and recovery Pharmacy Reports The LCSO will have access to your choice of over 300 standard reports and charts and over 400 figures depicting yearly trends. Diamond can customize and create reports to meet each facility s specific needs. Data fields include patient name, inmate/patient number, correctional facility, provider name, date of service, prescription number, medication name, medication class, medication strength, quantity dispensed, days supply, and drug cost. For more information, please see section C.1.c.5 Pharmacy Statistics. Basic, ad hoc, requested, and customized reports all are provided at no additional cost. In addition to standard monthly, quarterly, and annual reports, Diamond provides ad hoc reports upon request. Most ad hoc reports are provided within 1-2 business days, depending on complexity. Reports can be provided in hard copy or electronically in Microsoft Excel. Diamond presents its statistical data with graphs to illustrate usage and trends. We have provided a sample Monthly Formulary Management Report on the following pages. Lane County Sheriff s Office 142

176 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Medicaid Eligibility CCS has been proactive in determining how the implementation of the Affordable Care Act (ACA) will affect the correctional healthcare industry. Since the start of the ACA implementation in 2014, we have set up effective eligibility and enrollment processes in 18 expansion and 5 non-expansion states, covering state and/or county inmates and ensuring that eligible inpatient stays are paid by Medicaid or the third-party payer and billed by the hospital. When the inmate has private insurance, the hospital and providers are directed to bill the insurer and the inmate is responsible for any co-pays or deductibles. CCS will use our experience to assist the LCSO in deferring all eligible inpatient hospitalization expenses when possible. We are successfully enrolling inmates in Medicaid in four Oregon county jails. CMS Certification CCS has been designated as a Certified Application Counselor (CAC) organization by the federal government s Centers for Medicare and Medicaid Services (CMS). We have employees who are specially trained to help individuals enroll in a Healthcare Exchange or Medicaid plan and we can train our own employees to serve as CACs in Oregon. A CAC can assist with online Medicaid applications, eliminating the need to complete paper applications. As a CAC organization, CCS will be fully aware of all current requirements, regulations, and processes regarding Medicaid eligibility enrollment. CCS can also leverage our Care Management system to facilitate the exchange of patient medical information encouraged by the Affordable Care Act. Medicaid Enrollment CCS will assist the LCSO in appropriately charging Medicaid and third-party payers. Identification of insurance companies begins at intake when we ask all inmates if they have insurance coverage and document their response in our Care Management System. The Oregon Health Authority (OHA) has a DMAP 3113 Provider Enrollment Short Form to request access to the Provider Web Portal, which has not been a successful vehicle for us to use. Even after discussions with the OHA, our DMAP 3113 application requests went unanswered. As a result, we have created an alternative process for the identification of insurance companies that is equally effective. First, we contract with hospitals and providers who agree to bill Medicaid or thirdparty insurers. CCS has a dedicated insurance reimbursement team who review inpatient hospitals stay daily, gather inmate insurance information documented at intake, and contact the hospitals as soon as we have an admission. Hospitals and providers have access to the OHA Provider Web Portal so they can determine if the inmate has coverage and advise us of the inmate s insurance status. After they advise CCS of the inmate s insurance status, we take one of three actions: For previously eligible Medicaid inmates with active Medicaid, we complete the DMAP 7100 form for Medicaid coverage for off-site, inpatient hospitalizations and fax it to the OHA. Previously eligible inmates who do not have active Medicaid follow the newly eligible process. For newly eligible adults between the ages of who need coverage, we complete the DMAP 7100 form for Medicaid coverage for off-site, inpatient hospitalizations, along with Medical Assistance Forms OHA 7210 and MSC 2099, and fax the forms to the OHA. Should an inmate refuse to sign the Medicaid documents, under Oregon law, the jail can sign on behalf of the patient, and we can submit the document with an authorized jail signature. Lane County Sheriff s Office 143

177 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 For patients showing private health insurance, we obtain the name of the private insurer and we have the hospital work directly with the insurer to obtain the necessary authorizations for services. Billing Insurance Carriers As part of the CCS Care Management Program, we properly account for all adjustments and reimbursements from applicable sources, and ensure that hospitals are aware of any Medicaid or thirdparty payees and/or insurer avenues. When a previously eligible inmate has Medicaid or a newly eligible inmate is approved for Medicaid, the hospital and providers bill the OHA Medicaid program directly for the inmate inpatient stay. Because we have submitted the DMAP 7100, this lets the state know to make the proper changes to the state Medicaid Management Information System (MMIS), which allows the hospital and providers to bill Medicaid fee for service for the inpatient stay. The Medicaid fee for service designation for inmate inpatient stays is important because it eliminates any co-pays or deductibles for the inmate inpatient stay. This designation does not mean that the OHA Medicaid program will pay any hospitalization costs; the hospital and providers must still only perform services that are medically necessary. If Medicaid denies any portion of the service, we will complete our own medical review and deny any payment for services that were not medically necessary. Our claims payer, Allegiance, a Cigna-owned company, receives regular updates from our Care Management system regarding payable claims. When an inmate has an inpatient stay, our system notes that we are not financially liable for the inpatient stay covering these dates of service. Any claims a hospital or provider submits for the inmate that matches our system s inpatient dates of service will automatically be denied. The denial explanation to the hospital and provider is that the patient has Medicaid or has private insurance. CCS will notify LCSO staff about potential high-cost claims as they are happening or are scheduled. Inpatient Reports CCS tracks inmate inpatient stays on a control file that identifies the dates of service, hospital, inmate name, jail ID number, date of birth, and provides a status on insurance. If the inmate has Medicaid, we list the Medicaid ID number and put in the status pending until the DMAP 7100 is submitted and an acknowledgement is received. We then notify the hospital that the paperwork has been completed and they bill Medicaid fee for service. When the hospital successfully completes the billing, we change the status to approved. If we are submitting a new application, we put in the status pending, and when the Medicaid is accepted and we are notified, we change the status to approved, document the Medicaid ID number, and give the number to the hospital to complete the Medicaid fee for service billing. If the inmate has private insurance, the status lists as approved and documents the insurer s name and the inmate s insurance number. CCS has a deep understanding of Medicaid and private insurance and can provide a monthly report showing the application status. Medicaid may deny an inmate application request for several reasons. The most common denial reason is the inmate s income level exceeding the maximum; the second reason for a denial is that they have Medicare and SSI and are aged or disabled; and the third reason is that they are not a U.S. citizen. When we receive a denial, we change the financially liable status in our Care Management system and notify Allegiance to process the inpatient claims, which receive the pricing benefit of the Cigna network. We have provided a sample Medicaid Control File and a sample Explanation of Benefits in on the following pages. Lane County Sheriff s Office 144

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181 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 b. Please provide a detailed explanation to ensure accuracy and quality control of all invoices billed to the Sheriff s Office. CCS will coordinate, validate, and track off-site care and invoicing through the Care Management system, which generates reports that allow us to analyze the utilization of off-site services on behalf of our clients. CCS also verifies that all invoiced charges are appropriate. Since the system sends the authorization number to our claims department, they are able to review every invoice to ensure that the LCSO is only billed for the approved services. CCS will review and verify that all invoices are appropriate and accurate prior to payment using County funds. This will include verification of services provided and accuracy of all co-pays and deductibles. If a patient has third-party insurance or other payment options available, CCS will notify the hospital of the appropriate agency to invoice. 8. CONTRACT: a. Contract - Included in this RFP as Section III is a Sample Personal Services Contract, which is substantially similar to the contract that will be signed by the successful Proposer for this project. b. Please have your legal counsel review and mark-up proposed modifications for the Sample Personal Services Contract and the Scope of Services found on Exhibit B. Proposers requesting any significant modifications to the contract should state such changes on the sample contract and attach at the end of the response packet. c. It is not necessary to note granular, insignificant changes. d. For the purpose of the Proposal, the County is interested in hearing from you about clauses or sections that you see as a chief concern before signing this contract, how you would change them, and why. e. You may either use MS Word Track Changes for this purpose, OR you may simply include a paragraph below the clause you are discussing, OR you may insert comments into the clause. The key is to ensure your intended changes are easily identifiable and communicated. We have provided a marked-up Sample Contract in section 4 Contract Mark-up as required by the RFP. Lane County Sheriff s Office 148

182 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 D. PROPOSED BUDGET AND COST BREAKDOWN Note: Proposer should assume a 2 year contract with an option for the County to renew for an additional 3 years. 1. COST PROPOSAL (scored) Using the 2014 data on Page 13 and 14 as a guide (326 housed inmate capacity), and your understanding of the RFP requirements, provide your company s fixed price Proposed Total Cost First Full Year. The proposal should address the Scope of Services, Exhibit B. Proposer should expect that the Proposed Total Cost First Full Year will be used to compare against actual cost of Lane County Jail current medical services programs. In the cost proposal category, proposals will be scored according to the amount of savings to be realized by Lane County the higher the potential savings, the higher the number of points to be awarded in this category. Considerations will be given to proposers who can show cost savings programs utilizing technologies such as Tele-Med or similar abilities for tele-conferencing with off-site providers for services (i.e., EKG s, X-rays, and consults with physicians) which could lead to less off-site transfers for services. Additional consideration will be given to proposers who do not require an aggregate cap model on any of their cost proposals. However if proposer includes an aggregate cap, any cap on outside medical costs cannot include medical costs associated with a claim against the proposer for conduct they are otherwise liable for. The following costs should be included in the Contractor s proposal(s) price: Labor cost for Contract medical service employees to include sick time, vacation time, training time, and benefits which include medical, dental, vision and prescription All overhead charges, equipment, equipment repair and associated supplies Insurance cost, license and permit fees Uniforms for medical service employees Medications and supplies Janitorial supplies, office supplies and equipment Procurement cost, delivery cost, training cost and background investigation cost Vehicle costs and fuel charges Lane County Sheriff s Office 149

183 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Please note: The County may, at its discretion, choose to consider proposals with the selected Contractor for the following outside of this RFP Proposal: Lease of existing County vehicles assigned to Medical Service operations. Laundering services of items other than uniforms. Institutional supplies. a. PROPOSED TOTAL COST FIRST FULL YEAR: Cost: 1) Medical Services = $1,112,211 2) Nursing Services = $941,747 3) Pharmaceutical Management Services = $172,555 4) Dental Services = $53,010 5) Mental Health Services = $484,017 TOTAL SERVICES: =$2,763, COST BREAKDOWN (Informational Not Scored): a. Using the Proposed Total Cost First Full Year, please provide a breakdown of the makeup of that cost: Breakdown of Cost Drivers as a % of Total Cost Percent Cost Driver of Total Administrative salaries (Management/Supervisors, Administrative & 4% Financial Staff) Benefits for Administrative staff 1% Prescription/Medication Costs (not total Cost of Goods) 6% Non-Management personnel salaries including temporary and permanent 59% employees (MD, Dentist, Psychiatrist, etc.) Non-Management personnel benefits 11% Insurance 4% All other Expenses, excluding income tax and interest 15% TOTAL 100% b. Please indicate if there would be additional fees for special services (optional services that would not necessarily be utilized within the two (2) year term of the Contract). List each separate fee below and give a detailed explanation of the special service. Lane County Sheriff s Office 150

184 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 CCS has included all services in our cost proposal and has no additional fees. The proposed services include the implementation of our electronic medical records system, ERMA. ERMA is a basic and core part of our programming and we offer it at no additional cost to Lane County. ERMA will allow the medical services team to better track and monitor inmate needs and interactions, and will provide our medical staff, managers, and Lane County with real-time information that can lead to cost efficiencies and better outcomes. c. Please indicate if you will require Lane County to utilize any special equipment/software tools in keeping with your service practices. If so, please outline in detail and tell us how the costs to install and utilize them will impact your cost proposal. If you are including software tools, please include the technology requirements. CCS has reviewed the extensive Medical Equipment Inventory List provided with the RFP. We do not foresee any additional equipment/software needs for the implementation of the CCS medical program at the Lane County Jail Facilities. The implementation of ERMA, our electronic records system, will require no additional servers or data storage from Lane County as ERMA is a web-based system. 3. Local government budgets change every year, which could necessitate a reduction in Jail beds. Using your Proposed Total Cost First Full Year as the middle total for a tier compensation plan, please should your Proposed Total Cost First Full Year for the following inmate housing capacity numbers: 1 to 237 Jail Bed Capacity (housed) $2,140, to 281 Jail Bed Capacity (housed $2,628,707 $2,763, to 355 Jail Bed Capacity (housed (cost proposal) 356 to 437 Jail Bed Capacity (housed $3,350, to 507 Jail Bed Capacity (housed $3,833,426 We have prepared our cost proposal to provide for the content and provisions of LCP 2015/16-01, subsequent addenda and answers to questions, and information gained from the pre-bid conference on March 12, Our proposal will allow us to provide a seamless transition, including the ability to retain qualified staff and effectively recruit staff when needed. CCS has been quite successful in transitioning contracts smoothly from your incumbent provider. Our cost proposal is based on the request and preference of Lane County for no aggregate caps on offsite services or pharmaceuticals. CCS has budgeted for medical, dental, mental health, administrative, and other personnel needed to meet or exceed your specifications. Our proposed staffing plans were developed with careful consideration of the requirements of the RFP, as well as our experience providing services to facilities in the State of Oregon, in the Pacific Northwest, and across the country. Although your RFP does not require NCCHC accreditation, our staffing proposal reflects NCCHC standards taken into consideration. Lane County Sheriff s Office 151

185 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 E. References: We seek three (3) references from clients of similar size ( bed correctional facility) and scope to our project. Although the intent is to check references for shortlisted finalists, the County reserves the right to investigate the past performance of any Proposer with respect to its successful performance of similar projects, compliance with contractual obligations, and its completion or delivery of a project on schedule. Please ensure that your references are prepared to speak to us regarding your service and operation. CCS is the industry leader in designing and operating health care programs in facilities similar to those in Lane County. The significant difference with CCS is that we have a proven history of success with similar sites. Many of our clients are the same size or larger than the Lane County Jail Facilities. CCS currently provides services for 38 correctional clients with beds. We have developed proven best practices for these sites that will translate to success in Lane County. We believe the following clients can best articulate our strengths and our ability to meet and exceed the requirements and expectations of the RFP. CCS will also gladly arrange for LCSO staff to tour any of our client facilities to see our programming in action. We offer all of our clients as references! Reference #1 Name of Organization: Johnson County Sheriff s Office Length of Time as Client: 1/1/08 Present City or region service Client is located in: Olathe, KS Name of Contact: Capt. Tom Sybesma Contact s Telephone and , tom.sybesma@jocogov.org Reference #2 Name of Organization: Wyandotte County Sheriff s Office Length of Time as Client: 1/1/06 Present City or region service Client is located in: Kansas City, KS Name of Contact: Linda Hendrix, Sheriff s Admin. Mgr. Contact s Telephone and , lhendrix@wycosheriff.org Lane County Sheriff s Office 152

186 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Reference #3 Name of Organization: Douglas County Length of Time as Client: 5/1/98 Present City or region service Client is located in: Castle Rock, CO Name of Contact: Capt. Attila Denes Contact s Telephone and , adenes@dcsheriff.net END OF RESPONSE FORM Lane County Sheriff s Office 153

187 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Other Attachments A. Key Personnel Following is an overview of key leadership staff who will be involved with the implementation of services at the Lane County Jail Facilities and the subsequent management of operations. These are more than just names in a proposal, but rather faces you will see walking the hallways of the Lane County Jail Facilities, supporting our program. To demonstrate the qualifications of our staff, we have provided detailed resumes for key personnel, including the CCS Regional Management Team, following their biographies containing an overview of their qualifications, experience in the industry, notations of professional licensing/certifications, and unique skills. Stevens J. Hyppolite, MBA, ACHE Regional Vice President Mr. Hyppolite has been in the healthcare field for over 20 years, with more than 8 years of correctional healthcare experience. As Regional Vice President of the Northwest Region, he provides operational leadership, supervisory training, quality improvement, risk minimization, and accreditation compliance to CCS sites in Oregon, Washington, and Idaho. Mr. Hyppolite also severed in the United States Air Force for 13 years, where he worked as a Hospital Manger in multiple departments in the hospital setting. He brings his operational experience along with his military leadership experience to the Northwest Region of CCS. Mr. Hyppolite holds a Bachelor of Science degree in Computer Information Resource Management and a Master s degree in Business Administration with a concentration in healthcare from Wilmington University. Mandy Forsmann, RN Regional Manager Ms. Forsmann is a Registered Nurse with 19 years of experience in the healthcare field. She has worked in corrections for over 14 years, in both prisons and jails. Ms. Forsmann formerly served as the Director of Nursing and later the Health Services Administrator at the Washington County Jail from As a Regional Clinical Specialist for CCS, she promoted Quality Improvement standards, provided clinical supervision, identified operational issues, and proposed targeted solutions for CCS sites in the Northwest region. As the current Regional Manager for Oregon and Washington, Ms. Forsmann is responsible for operational and clinical oversight of HSAs and DONs in her region. She has been involved in three NCCHC accreditation processes in her career, where the sites received reaccreditation and 100% compliance on their medical standards. Lane County Sheriff s Office 154

188 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 Vivek Shah, MD Regional Medical Director Dr. Shah joined CCS in 2006 as a Regional Medical Director and provides clinical management and oversight to our contracted facilities in the Northwest region. Prior to joining CCS, he spent six years in group internal medicine practices in the states of Washington and Kentucky. Dr. Shah is affiliated with the American Medical Associating, the American College of Physicians, and the Society of Correctional Physicians. After completing his medical education in India, he completed his primary care internal medicine residency at Mt. Sinai School of Medicine in New York. Julie Weigand, JD, LMHC, LPC Behavioral Health Manager Ms. Weigand serves as the Behavioral Health Manager for the CCS Northwest Region. She originally joined Conmed in 2010 as Mental Health Coordinator for the Kitsap County Jail and served as the Regional Mental Health Supervisor for the Northwest Region. Following the acquisition of Conmed by CCS, Ms. Weigand now provides support and oversight for CCS behavioral health programs in Washington, Oregon, Idaho, and Nevada. She holds a JD degree from the Seattle University School of Law and an MA in Counseling Psychology from St. Martin s University in Lacey, Washington, bringing extensive legal and clinical experience to her role. Ms. Weigand practiced law for 20 years prior to becoming a licensed Mental Health Counselor, and she was a cofounder of City Center Counseling Services, PLLC, in Tacoma, Washington. She is also a certified Guardian ad Litem in the State of Washington. Jack Jadin Director of Business Development CCS provides each client with a dedicated Director of Business Development. Initially, Mr. Jadin will ensure that CCS is the right inmate healthcare provider through his thorough understanding of the facility and the facility s needs. He will help to establish the foundation of designing the right program for the facility, and will continue to support the facility and its administration throughout the contract. Mr. Jadin has more than 28 years of law enforcement experience with approximately 20 of those years directly related to service in the corrections division. He has more than 12 years of supervisory experience in corrections with progressively increasing levels of responsibility. Mr. Jadin formerly served as the Jail Administrator for the fourth largest jail in Wisconsin with a budget of over $19 million and a staff of approximately 180 people. He also has experience in contract management and bid writing. Lane County Sheriff s Office 155

189 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 John Roth Director of Client Services Mr. Roth joined CCS in 2014 following the acquisition of CHC. He has 20 years of experience in government leadership, public affairs, sales, and business development. Before joining CHC in 2013, Mr. Roth was an elected County Commissioner in Texas for eight years. He has worked extensively in state, national, and international government relations, non-profits, community affairs, and sales management. Mr. Roth earned his bachelor s degree in Business Finance from Texas Lutheran University. B. Resumes We have provided resumes for key personnel on the following pages. Lane County Sheriff s Office 156

190 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/16-01 C. Job Descriptions We have provided sample job descriptions for the positions in our staffing plan on the following pages. Lane County Sheriff s Office 157

191 Medical, Dental, and Mental Health Services for the Lane County Adult Corrections Division Lane County LCP 2015/ Contract Mark-up We have inserted a marked-up contract with tracked changes on the following pages. Lane County Sheriff s Office 158

192 STEVENS J. HYPPOLITE 134 NW Camp Ireland Street Hillsboro Oregon Home: (503) Cell: (302) Stevens OBJECTIVE: To obtain a position where my proven skills in Executive Operations Leadership and Multi-Facility Regional Management will contribute to the success of your organization. EDUCATION: Wilmington University- Delaware Degree: MBA/ Health Care concentration, 2006 Degree: BS in Computer Information Resource Management, 2005 SKILLS: Multi-facility management and Operational experience. Leadership Training. Ability to Lead and Coach a team of professionals. Program and Project Management experience Cultural Diversity Training and understanding. Program and Project Management experience Able to prepare Annual Budget and forecasting. Ability to implement equity and diversity in the workplace. Able to Monitor Monthly Financials and performance. Can complete Month-end process. Contract Negotiation experience, with Hospitals, Governmental Agencies, and Contract Providers. Understands and enforced Compliance from regulatory agencies. Understands LEAN and used this to implement new and improve current processes. Electronic Health Record EHR implementation & Management experience. Super User trained. WORK EXPERIENCE: Regional Vice President, Correct Care Solutions, July 2014 Present. Regional oversight of Northwest for Correct Care Solutions. Responsible for 18 Healthcare facilities within the Northwest Region and ensures those healthcare services were being delivered to our Patient population in accordance with Community Healthcare standards. Responsible for Regional budget for Northwest. Health Care Consultant, Robert Half Management Resources. October 2013 March Health Care Consultant for ATRIO Health Care, Salem Oregon. October November Lead Project Manager for PEBB RFP for the State of Oregon employees, and provision of Health services contract. I provided guidance and advice to ATRIO Management team. Responsible for managing information and ensuring that all Project objectives were accomplished. Worked directly with the CEO as the advisory and council to the CEO, for Procurement process. Regional Director, Corizon Health Care, March 2010 Sept Regional oversight of the Pacific Northwest for Corizon Healthcare. Responsible for 3 Healthcare facilities within the Northwest Region and ensured those healthcare services were being delivered to our Patient population in accordance with Community Healthcare standards. Responsible for Regional budget of over 12 million dollars. Ensured that target profit margin of 8% was being achieved annually. We made target profit margins 5 consecutive Years. Met with outside hospital/agency administration to ensure a close working relationship between them and our Company. Was able to negotiate for lower rates with hospitals for our patients. This resulted in lower cost to the County and tax payers. Involved with Strategic Planning and overall Vision for entire Northwest Region. Utilized LEAN for process improvements. Implemented process improvements which enhanced the level of health care delivery to our patients.

193 Oversight for two new Corizon Contract start-up facilities. Responsible for the delivery of the two Contract s Scope of Services. Resulted in a successful transition for County Staff, Medical Staff and patient population. Labor Management. Responsible for over 100 employees. Ensured that labor hours were met, while minimizing unnecessary Overtime costs to the Company by 20% during this time. Project lead on implementation of CorrecTek Electronic Medical Record into Medical facility. Integral in the Procurement process. Assists in seeking out potential new contracts, fostering renewal opportunities, and assists in proposal writing. Resulted in the awarding of 2 new Contracts, and 3 Contract renewals. Performed fiscal responsibility by evaluating and implementing methods of improving operational efficiency and cost effectiveness. Conducted Surveys for Healthcare facilities, to include: Post Implementation surveys, National Commission of Correctional Health Care (NCCHC) Pre-Audit Surveys, RFP Pre-bid Surveys, as well as Site Surveys to determine whether Company would like to pursue possible RFP with County Jail health care facility. Ensured that facility is meeting its (Key Performance Indicators) KPI performance measures on a Monthly basis. Two of my facilities won quarterly awards as best performance out of 500 medical facilities in the Company Nationwide. Managed the Accreditation process including ensuring compliance with National Correctional Health Care standards (NCCHC) and contract requirements. Resulted in being accredited 3times. As well as winning the (NCCHC) National Award for Program of the Year in Health Services Administrator, Corizon Healthcare, Washington County Sheriff s Office, Jail Medical Facility, Oregon, July 2007 February Regularly evaluated the provisions of all medical services to ensure the appropriateness of those services. Oversaw services rendered by contractors and professional staff. Was able to reduce grievances by 40% over a 6 year period. Closely monitored all potential catastrophic illnesses and explores/utilizes all appropriate means of limiting both Corizon and corrections medical and legal liabilities. Implemented Discharge Planning Program at Washington County, Resulted in reduced recidivism by 30% over next 6 Years. Regularly scheduled peer review evaluations using principles of Quality Improvement, reviewed the data, and reported it to Corporate QI Program and made revisions to the program necessary to improve the services. Monitored and ensured the provision of all required contractual services. Reviewed processes and responded to all laws. Testified and represented Company in court. Managed staffing compliance including hiring, orientation, supervision, training and evaluations. United States Air Force (USAF), Health Service Management/ Information Technology Manager, Dover Air Force Base Hospital, Delaware, August 1994 June Managed Tricare Medical Insurance office for 3 years; ensured over 6,000 beneficiaries care was optimized and available. Managed Medical Records section for 5 years; In charge of 12 members that were responsible for over 40,000 Medical Records. Managed operations of Information Systems Department ; Lead a staff of 9 employees responsible for development and implementation of 17 programs, four networks, system education and user training program. Received Secret Security Clearance (Jan 2004) PROFESSIONAL ORGANIZATIONS American College of Health Care Executives (ACHE) Academy Member of National Commission of Correctional Health Care Oregon Health Forum Planning Committee Carrington College Advisory Board Member

194 Mandy Forsmann 387 Jessica Dr. Forest Grove, Oregon (503) I have worked in corrections for over 15 years. I worked for Prison Health Services starting in 2000, in Idaho, Oregon and Washington. In 2011, Prison Health Services merged to become Corizon. Now working for Correct Care Solutions. Work Experience 02/01/15 Current Correct Care Solutions Regional Manager Directly involved with the operations and oversight of 9 jails in Oregon and Washington. 10/ /01/15 Correct Care Solutions Regional Clinical Specialist The Clinical Specialist provides necessary guidance to assist operational management teams in making clinical decisions, assist in obtaining operational goals, and in developing appropriate policies of CCS and the facility; and to maintain compliance with accreditation standards. 2/2007 9/2014 Prison Health Services and Corizon Health, Washington County Jail 2/ /2013 Director of Nursing Services 11/2013 9/2014 Health Services Administrator Left to pursue advancement opportunity as Clinical Specialist with Correct Care Solutions. 8/2005 2/2007 Prison Health Services at Clark County Jail, Vancouver Washington Director of Nursing and Health Service Administrator Director of Nursing for one year. Promoted to Health Service Administrator. The contract ended and I wanted to stay with Prison Health Services, so I transferred to Oregon. The DNS directs and supervises nursing services and scheduling assignments of nursing personnel, and evaluates work performance. The DNS monitors and implements training and staff meetings, and evaluates medical department workplace conditions and medical supplies. The HSA manages the operations and administration of health care services in the facility; they manage delivery of the contract health services, including personnel selection/retention, budgeting, and coordinating care with internal and external resources. 5/2005 8/2005 Prison Health Services, Idaho Staff RN I passed medications, did health assessments, worked with MD and mid-level provider in clinic, performed sick calls, and paperwork. I received a promotion and transferred to the Clark County Jail in Washington State. 10/2000 5/2005 Prison Health Services, Idaho Correctional Medical Specialist I worked under the license of a Physician and completed tasks in the medical clinic of the prison. I passed medication, assisted in clinics, and general office duties. Education Walla Walla Community College - Associates Degree in Nursing, May 2005

195 Vivek Shah, MD, CCHP Regional Medical Director for Northwest Correct Care Solutions 1283 Murfreesboro Rd, Suite 500, Cell Fax Nashville TN A board-certified internist and a Certified Correctional Healthcare Professional practicing correctional health care exclusively since Responsibilities include: Direct patient care Responsible for the clinical elements of the entire healthcare delivery system of Correct Care Solutions in Northwest Supervise physicians and mid-level practitioners and provide general supervision to practitioners in clinical disciplines other than medicine Provide services to prisoners and consult professional and custodial staff Assist in the development of the clinical and managerial skills of the site medical staff Assume responsibility for clinical program operations in accordance with ACA, NCCHC, CCS and facility policy and procedure and state standards and regulations Directly impact patient care through the development of appropriate clinical guidelines, polices, and procedures, as well as discussion of individual case management and as needed individual patient evaluation through physical assessment and chart reviews Supervise the Quality Improvement Coordinator in the development, implementation, training and monitoring of the Continuous Quality Improvement (CQI) program; maintain ultimate responsibility for the CQI program Apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations Active Medical License: State of Washington Affiliations: American Medical Association, American College of Physicians, and Society of Correctional Physicians Group internal medicine practices in states of Washington and Kentucky Primary care internal medicine residency at Mt. Sinai School of Medicine, New York, NY Prior to 1997 Medical education and experience in India

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197 2026 Lake Street Algoma, WI Phone (920) John M. Jadin Objective To obtain a high level of knowledge, skill and ability, while demonstrating professionalism as a leader within my community and work environment. Employment 2010-present Correct Care Solutions, Nashville, TN Director of Business Development Provide customer services for existing clients Relationship manager for over 150 existing contracts Search, cultivate and qualify leads for potential new clients Review requests for proposals and prepare accurate proposal response bids based on site assessments and bidding documents Deliver proposals and presentations to stakeholders in efforts to develop new business Brown County Sheriff s Department, Green Bay, WI Division Director, Jail Administrator Manage and lead an organization of 180 officers and support staff Procure and manage service contracts with support providers, wrote technical specifications for Request for Proposals for jail services to include, Inmate Medical Services, Inmate Food Services, Commissary & Canteen, Inmate Phone Services and the Jail Management System. Oversee operations of the Brown County Jail facilities and provide safety and security to the community and the 750 inmates that it incarcerates Secure budgetary resources and provide policy directives to allow team members to be successful in the achievement of department goals Served as a member of the Wisconsin State Supreme Court Chief Justice s Task Force on Mental Health Issues in the Jail Appointed to Wisconsin Counties Association subcommittee on deferred compensation Served as Vice-President of Wisconsin County Police Association Participant in many organizations and associations including; Wisconsin Sheriff and Deputy Sheriffs Association Wisconsin Law Enforcement Executive Development Association Brown County Criminal Justice Coordinating Committee Brown County Volunteers in Probation Advisory Committee Northeast Wisconsin Technical College Correctional Advisory Committee Wisconsin Jail Nurses Association Brown County Sheriff Benevolent Association

198 Brown County Sheriff s Department, Green Bay, WI Lieutenant Facility administrator for Brown County Jail Work Release facility, with 33 staff and 204 inmates Assist in jail budgeting, planning and policy preparation Provide work programs for inmates reintegration into the community upon release from jail Oversee jail diversion programs Brown County Sheriff s Department, Green Bay, WI Sergeant Assigned to Jail Division and Investigation Division provide supervision and leadership to others at a shift level Brown County Sheriff s Department, Green Bay, WI Patrolman Assigned to Patrol, Courts, Jail, Transportation sections of the department Served as Secretary/Treasurer of Brown County Sheriff s Nonsupervisory Labor Association Kewaunee County Sheriff s Department, Kewaunee, WI Patrolman Assigned to Patrol, Communications and Jail Sections of the department Education September 2008 National Institute of Corrections Longmont, CO Certificate Jail Management Instruction in budgeting, staffing analysis, jail operations, planning and organizing, ethical decision making, value-centered leadership, inspection processes March 2005-March 2006 Criminal Justice Executive Development Institute - Fox Valley Technical College Appleton, WI Certificate of Completion Instruction from nationally recognized FBI leaders in topics including Power Politics, Media Relations, Planning, Budgeting and Process Leadership, Labor Management Relations/Personnel Management Issues Wrote and presented research paper on the topic of suicide prevention in the jails Northeast Wisconsin Technical College Green Bay, WI Associate Degree Police Science

199 Instruction in police organization and administration, criminal law, corrections Northeast Wisconsin Technical College Green Bay, WI Associate Degree Marketing Sales/Management Instruction in accounting, staff development, and computer operations, macro/micro economics, macro/micro marketing, principles of sales supervision Kewaunee High School Kewaunee, WI High School Diploma

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201 regulations and legal issues, terrorism prevention, personnel policies, team building, records management, budgeting, fees and revenues, council of governments, inter local agreements, bonds and certificates of obligation, governing Texas counties, tax rates, working with the legislature, etc.

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255 e. Exhibit E Contractor s RFP Response Proposal which is incorporated by reference and considered binding except to the extent these documents conflict with the main body of this Contract or its Exhibits. f. Exhibit F Lane County Jail s Medical Equipment Inventory List 2. Definitions - With the exception of proper nouns, capitalized terms not otherwise defined herein shall have the following meanings. a. Agreement means this contract document, entitled Goods and Services Agreement and ending with the signatures of all parties. b. Services means all of the products, properties and services to be provided by Contractor under this Agreement, as described in Exhibit B. 3. Contractor s Representations and Warranties - Contractor makes the following representations and warranties to County: B. Services: a. Qualified Personnel - Contractor and Contractor s personnel are and will at all times hereunder be fully qualified by all necessary education, training, experience, licensure and certification to perform the Services. b. No Encumbrances - As of the date of execution hereof, there are no claims or suits or proceedings, or threats thereof, seeking to enjoin the execution of the Agreement by Contractor or the effect of which could prevent Contractor from performing or having the authority to perform the Services. c. Free to Contract - Neither the execution of the Agreement nor the performance of the Services will constitute a breach or violation of any other contract, agreement, or law by which Contractor is bound or to which Contractor or any of its personnel who will perform the Services are subject. 1. Services Contractor will provide the services described in Exhibit B, Scope of Services (the Services ) in accordance with the terms and conditions of this Contract Agreement. 2. Key Personnel - Contractor shall assign certain key personnel to perform certain Services, as follows: [NAMES OF KEY PERSONNEL (IF ANY) OR NONE AND WHAT PART OF THE SERVICES THEY WILL PERFORM INSERTED HERE.] NONE. Removal of these key personnel from the specified tasks without the prior approval of County, which may not be unreasonably withheld, constitutes a material breach of the Contract. Page 2

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259 H. Indemnification - Contractor shall indemnify and hold County, and its officers, agents and employees, harmless from and against all claims, actions, liabilities, costs, including attorney fees and other costs of defense, arising out of or in any way related to the Services rendered by Contractor or Contractor s employees, agents, officers, or independent contractors; Contractor s failure to strictly comply with any provision of the Contract or any other actions or failure to act by Contractor and Contractor s employees, agents, officers and Contractors. In the event any such action or claim is brought against County, Contractor shall, if County so elects and upon tender by County, defend the same at Contractor s sole cost and expense, promptly satisfy any judgment adverse to County or to County and Contractor, jointly, and reimburse County for any loss, cost, damage or expense, including attorney fees, suffered or incurred by County. County shall notify Contractor, within a reasonable time, of any claim, threat of claim or legal action subject to the provisions of this Section H. I. Insurance - Contractor shall provide and maintain in force for the duration of this Contract all insurance coverage outlined in Exhibit D Insurance Coverage Required. Each policy required by these provisions must be written as a primary policy, not contributing with or in excess of any coverage which County may carry. As evidence of the insurance coverage required by this Contract, Contractor shall furnish and deliver to County a copy of each policy or a certificate of insurance satisfactory to County prior to commencement of the Work to: Lane County Sheriff s Office, Fiscal Section 125 E. 8 th Avenue Eugene, OR The certificate must specify parties who are Additional Insured, and must include a notice provision regarding cancellations. Insurance coverages required under this Contract must be obtained from insurance companies authorized to do business in the State of Oregon. If Contractor is self-insured under the laws of the State of Oregon, Contractor will provide appropriate declarations of coverage. In the event the statutory limit of liability of a public body for claims arising out of a single accident or occurrence is increased above the combined single limit coverage requirements specified below, County has the right to require Contractor to increase the Contractor s coverage s to the statutory limit for such claims and to increase the aggregate coverage to twice the amount of the statutory limit. The adequacy of all insurance required by these provisions is subject to approval by County s Risk Manager. Failure to maintain any insurance coverage required by this contract is cause for immediate termination of this Contract by County, at County s discretion. If County elects to continue service, Contractor is responsible for interim insurance costs pending return of full service. Page 6

260 1. Commercial General Liability - Contractor shall maintain a broad form commercial general liability insurance policy with coverage of not less than $2,000,000 combined single limit per occurrence, and $4,000,000 as an annual aggregate, for bodily injury, personal injury or property damage. The policy shall have a contractual liability endorsement to cover Contractor s indemnification obligations under the Agreement. The policy shall also contain an endorsement naming County as an additional insured, in a form satisfactory to County, and expressly providing that the interest of County shall not be affected by Contractor s breach of policy provisions. 2. Workers Compensation Insurance - Unless Contractor is exempt, Contractor shall comply with the Oregon Workers Compensation law by qualifying as a carrier-insured employer or as a self-insured employer and shall strictly comply with all other applicable provisions of such law. Contractor shall provide County with such assurances as County may require from time to time that Contractor is in compliance with these Workers Compensation coverage requirements and the Workers Compensation law. 3. Automobile Liability - Contractor shall maintain an automobile liability insurance policy with coverage of not less than $1,000,000 combined single limit per occurrence, with an aggregate of $3,000,000, for bodily injury, personal injury or property damage. The coverage shall include both hired and non-owned auto liability. The policy shall also contain an endorsement naming County as an additional insured, in a form satisfactory to County, and expressly providing that the interest of County shall not be affected by Contractor's breach of policy provisions. 4. Professional Liability - Contractor shall maintain a professional liability insurance policy with coverage limits of not less than $5,000,000, and a deductible of not more than $10,000, to protect Contractor from claims for professional acts, errors or omissions arising from the Work. This policy may be written on a claims made form. The policy shall contain an endorsement entitling County to not less than 60 days prior written notice of any material change, nonrenewal or cancellation of such policy. Contractor shall maintain the professional liability insurance coverage for at least one year after completion of the Work. Insurance kept active Contractor shall not cancel, materially change, or not renew insurance coverages. Contractor shall notify Lane County Fiscal Section, 125 E. 8 th Avenue, Eugene, OR 97401, of any material reduction or exhaustion of aggregate limits. Should any policy be cancelled before final payment to County should Contractor fail to immediately procure other insurance as specified, the County reserves the right to procure such insurance and charge Contractor for the cost thereof. Any insurance bearing any adequacy of performance shall be maintained after completion of the Contract for the full guaranteed period, and should the Contractor fail to immediately procure such insurance as specified, the County reserves the right to procure such insurance and charge the cost to the Contractor. Responsibility for payment of damages Nothing contained in these insurance requirements is to be construed as limiting the extent of the Contractor s responsibility for payment of damages resulting from Contractor s operation under this Contract. Page 7

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262 N. Confidential Information All information disclosed by each party to the other party shall be To be considered Confidential Information under the Contract, information must be clearly marked as confidential information, in a manner that will be obvious immediately upon acces unlesss such information is generally available to the public or marked as non-confidential. Each party will limit its use of Confidential Information to the purpose for which it was disclosed by the other party and will use a reasonable level of care to prevent the intentional or inadvertent misuse, theft or inappropriate disclosure of such information. Contractor understands that all records held by the County are public records and subject to public disclosure unless a statutory exemption applies, and agrees that County shall have no liability for the disclosure of any Confidential Information in response to a public records request where such disclosure is required by court or District Attorney Order, or by County s good faith interpretation of its statutory requirements. Contractor also understands and agrees that the Contract documents and all records of Contractor s fees and charges may not be considered Confidential Information, and are public records for which no exemption to public disclosure applies. O. Compliance with Laws - Contractor Each party shall comply with all applicable Federal, State and local laws, rules, ordinances and regulations at all times and in the performance of this Contracte Services, including all applicable provisions of Lane Manual , attached as Exhibit A. P. Notices - Any notice permitted or required by the Contract shall be deemed effective and given when personally delivered or upon deposit in the United States mail, postage fully prepaid, certified, and with return receipt requested, to the persons and addresses shown below. In addition, if directions for telephonic transmission ( FAX ) are set forth below, notices may be delivered by FAX. Notices sent by certified mail will be deemed effective and delivered three (3) business days after placement in the mail and notices sent by FAX will be deemed effective and delivered when successful transmission is electronically confirmed. Except as expressly provided in this Contract, required notices must be signed by the person designated to receive notices, or that person s designee or attorney. Contractor: Correct Care Solutions, LLC 1283 Murfreesboro Road Suite 500 Murfreesboro, TN Attn: President / CEO With a courtesy copy to the Chief Legal OfficerGeneral Counsel at the same address as listed above. Page 9

263 County: Alternative Programs Lieutenant (Currently Dan Buckwald) Lane County Sheriff s Office Corrections Division 101 W. 5 th Avenue Eugene, Oregon Back-up in the event of Lt. Buckwald s Absence: Security Lieutenant (Currently Steve French) Lane County Sheriff s Office Corrections Division 101 W. 5 th Avenue Eugene, Oregon With a courtesy copy to the Lane County Sheriff s Office Fiscal Section (125 E. 8 th Avenue Eugene, OR 97401). Each party shall notify the other of any change in the name, address or FAX instructions to be used for delivery of notices. Q. Dispute Resolution: 1. Continued Performance - Unless the Contract is terminated, neither party shall suspend performance of its obligation hereunder pending the resolution of a dispute. 2. Negotiation/Mediation - The parties shall attempt to resolve all disputes by negotiation and, if negotiation fails, by mediation. The parties shall share equally in all common costs of mediation. The parties may also mutually agree to other methods to resolve dispute. 3. Litigation/Arbitration - Litigation of a claim that cannot be resolved by negotiation or voluntary mediation shall be initiated by filing a complaint in the Lane County Circuit Court that contains a stipulation to arbitration under ORS The claim and all cross and counter-claims filed in response to the complaint shall be submitted to the Court Arbitration Program set forth in ORS to , Chapter 13 of the Oregon Uniform Trial Court Rules and the Lane County Circuit Court supplemental local rules concerning arbitration. Either party may seek, and shall be entitled to, an order directing the other party to submit to arbitration as provided herein and to judgment for its costs, expenses and attorney fees in obtaining and enforcing the order. In any litigation, the entire text of any order or permit issued by a governmental or regulatory authority, as well as any documents referenced or incorporated therein by reference, shall be admissible for the purpose of contract interpretation. R. Construction of Contract - The parties intend that interpretation of this Contract is not affected by which party drafted it. Other than as modified by agreement, the applicable rules of contract construction and evidence apply. This Contract is governed by and construed in accordance with the laws of the State of Oregon without regard to principles of conflict of laws. Page 10

264 S. Forum - Any litigation between the County and the Contractor that arises from or relates to this Contract must be brought and conducted solely and exclusively within the Lane County Circuit Court; provided, however, if a dispute must be brought in a federal forum, then it must be brought and conducted solely and exclusively within the United States District Court for the District of Oregon, Eugene Division. This section does not constitute a waiver by Lane County of any form of defense or immunity, whether sovereign immunity, governmental immunity or otherwise, from any claim or from the jurisdiction of any court. CONTRACTOR, BY EXECUTION OF THE CONTRACT HEREBY CONSENTS TO THE IN PERSONAM JURISDICTION OF THE COURTS REFERENCED IN THIS SECTION. 1. Litigation Costs / Attorney s Fees - If any suit, action, arbitration or other proceeding is instituted upon this Contract or to enforce creditor s rights or otherwise pursue, defend or litigate issues related to or peculiar to federal bankruptcy law (including, but not limited to, efforts to obtain relief from an automatic stay), or any other controversy arises from this Contract the prevailing party is entitled to recover from the other party and the other party agrees to pay the prevailing party all costs and disbursements allowed by law, excluding attorney s fee, in such suit, action, arbitration or other proceeding, and in any appeal. The award of costs and expenses after trial de novo following arbitration under ORS et seq. is subject to ORS The award of costs and expenses after appeal from a judgment entered after trial de novo will be to the prevailing party designated as such by the appeals court. T. Entire Contract - The Contract embodies the entire agreement of the parties concerning the Services. There are no promises, terms, conditions or obligations other than those contained in this Contract, including the exhibits. The Contract supersedes all prior communications, representations or agreements, either oral or written, between the parties. Any amendment to the Contract must be in writing and signed by both parties. In the event a dispute or controversy arises with regard to this Agreement, this Agreement will supersede all Exhibits attached hereto, including, but not limited to Exhibit E Contractor s RFP Response Proposal. U. Survival - Any duty, liability or obligation of a party which arises under this Contract, including without limitation, obligations with respect to indemnification, shall survive the termination or expiration of this Contract and shall remain legally enforceable until satisfied by performance or payment, or until enforcement is legally precluded by lapse of time. V. No Third-Party Beneficiaries - There are no third-party beneficiaries of this Contract. The parties agree and intend that this Contract is enforceable only by the parties and their duly authorized representatives. In witness whereof, the parties have, through their duly authorized representatives, executed this Agreement on the dates set forth below. Page 11

265 Lane County: Signature: Date: Print: (Name/Title) Contractor: Certification of Signatory: The individual(s) signing on behalf of Contractor certifies and swears under penalty of perjury and warrants to County that: (a) the full legal name and status of Contractor are as set forth in the caption to this Agreement, and (b) s/he is authorized to execute and deliver this Agreement to County on behalf of, and as the act of Contractor. Signature: Date: Print: (Name/Title) Signature: Date: Print: (Name/Title) Page 12

266 EXHIBIT A LANE COUNTY - STANDARD CONTRACT PROVISIONS Lane Manual The following standard public contract clauses must be included expressly or by reference in every contract of the County. (1) Contractor shall make payment promptly, as due, to all persons supplying to such Contractor labor or material for the prosecution of the work provided for in the contract, and shall be responsible for payment to such persons supplying labor or material to any subcontractor. (2) Contractor shall pay promptly all contributions or amounts due to the State Industrial Accident Fund and the State Unemployment Compensation Fund from contractor or any subcontractor in connection with the performance of the contract. (3) Contractor shall not permit any lien or claim to be filed or prosecuted against the County on account of any labor or material furnished, shall assume responsibility for satisfaction of any lien so filed or prosecuted and shall defend against, indemnify and hold the County harmless from any such lien or claim. (4) Contractor and any subcontractor shall pay to the Department of Revenue all sums withheld from employees pursuant to ORS (5) Contractor shall make payment promptly, as due, to any person, co-partnership, association or corporation furnishing medical, surgical, hospital or other needed care and attention, incident to sickness or injury, to the employees of Contractor, of all sums which Contractor agreed to pay or collected or deducted from the wages of employees pursuant to any law, contract or agreement for the purpose of providing payment for such service. (6) With certain exceptions listed below, Contractor shall not require or permit any person to work more than 10 hours in any one day, or 40 hours in any one week except in case of necessity, emergency, or where public policy absolutely requires it, and in such cases Contractor shall pay the person at least time and a half for: (a) All overtime in excess of eight hours a day or 40 hours in any one week when the work week is five consecutive days, Monday through Friday, or (b) All overtime in excess of 10 hours a day or 40 hours in any one week when the work week is four consecutive days, Monday through Friday, and (c) All work performed on the days specified in ORS 279B.020 (1) for non-public improvement contracts or ORS 279C.540 (1) for public improvement contracts. For personal/professional service contracts as designated under ORS 279A.055, instead of (a) and (b) above, Contractor shall pay a laborer at least time and a half for all overtime worked in excess of 40 hours in any one week, except for individuals under these contracts who are excluded under ORS to or under 29 U.S.C. Sections 201 to 209, from receiving overtime. Contractor shall follow all other exceptions, pursuant to ORS 279B.235 (for non-public improvement contracts) and ORS 279C.540 (for public improvement contracts), including contracts involving a collective bargaining agreement, contracts for services, and contracts for fire prevention or suppression. For contracts other than construction or public improvements, this subsection (6) does not apply to contracts for purchase of goods or personal property. Contractor shall give written notice to employees who work on a public contract of the number of hours per day and days per week that the employees may be required to work. This notice must Page 13

267 be given in writing either at the time of hire or before commencement of work on the contract, or must be posted as a notice in a location frequented by employees. (7) Contractor, any subcontractors, and all employers working under the contract are subject employers under the Oregon Workers' Compensation Law and must comply with ORS , unless exempt under ORS (8) Unless otherwise provided by the contract or law, the County has a right to exercise the following remedies for Contractor's failure to perform the scope of work or failure to meet established performance standards: (a) Reduce or withhold payment; (b) Require Contractor to perform, at Contractor's expense, additional work necessary to perform the identified scope of work or meet the established performance standards; or (c) Declare a default, terminating the public contract and seeking damages and other relief available under the terms of the public contract or other applicable law. (9) The contract may be canceled at the election of the County, after the expiration of the cure period provided in the Agreement, for any substantial breach, willful failure or refusal on the part of Contractor to faithfully perform the contract according to its terms. The County may terminate the contract by written order or upon request of Contractor, if the work cannot be completed for reasons beyond the control of either Contractor or the County, or for any reason considered to be in the public interest other than a labor dispute, or by reason of any third party judicial proceeding relating to the work other than one filed in regards to a labor dispute, and when circumstances or conditions are such that it is impracticable within a reasonable time to proceed with a substantial portion of the work (10) If the County does not appropriate funds for the next succeeding fiscal year to continue payments otherwise required by the contract, the contract will terminate at the end of the last fiscal year for which payments have been appropriated. The County will notify Contractor of such non-appropriation not later than 30 days before the beginning of the year within which funds are not appropriated. Upon termination pursuant to this clause, the County will have no further obligation to Contractor for payments beyond the termination date. This provision does not permit the County to terminate the contract in order to provide similar services or goods from a different contractor. (11) Unless otherwise provided by the contract or law, Contractor agrees that the County and its duly authorized representatives may have access to the books, documents, papers, and records of Contractor which are directly pertinent to this Agreement for the purpose of making audits, examinations, excerpts, copies and transcripts. Contractor shall retain and keep accessible such books, documents, papers, and records for a minimum period of six (6) six years after the County makes final payment on this Agreement. Copies of applicable records must be made available upon request, and payment of copy costs is reimbursable by the County. (12) By execution of this contract, Contractor certifies, under penalty of perjury that: (a) To the best of Contractor's knowledge, Contractor is not in violation of any tax laws described in ORS (4), and (b) Contractor has not discriminated against minority, women or small business enterprises or one that is owned or controlled by or that employs a disabled veteran as defined in ORS (13) Contractor shall meet the highest standards prevalent in the industry or business most closely involved in providing the goods or services or personal services covered by this Agreement, except if the County has good cause and the contract provides otherwise. (14) Contractor shall not assign this contract or any payments due hereunder without the proposed assignee being first approved and accepted in writing by County. (15) Contractor shall make all provisions of the contract with the County applicable to any subcontractor performing work under the contract. Page 14

268 (16) The County will not be responsible for any losses or unanticipated costs suffered by Contractor as a result of the contractor's failure to obtain full information in advance in regard to all conditions pertaining to the work. (17) All modifications and amendments to the contract will only be effective only if in writing and executed by both parties. (18) Contractor certifies that Contractor has all necessary licenses, permits, or certificates of registration necessary to perform the contract and further certifies that all subcontractors will likewise have all necessary licenses, permits or certificates before performing any work. The failure of Contractor to have or maintain such licenses, permits, or certificates is grounds for rejection of a bid or immediate termination of the contract. (19) Unless otherwise provided, data produced by the Contractor at the request of the County which originates from this contract constitutes "works for hire" as defined by the U.S. Copyright Act of 1976 and is owned by the County. Data includes, but is not limited to, reports, documents, pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, and/or sound reproductions. Ownership includes the right to copyright, patent, register and the ability to transfer these rights. Data which does not originate from this contract, but which is delivered under the contract, is transferred to the County with a nonexclusive, royalty free, irrevocable license to publish, translate, reproduce, deliver, perform, dispose of, and to authorize others to do so; provided that such license will be limited to the extent which Contractor has a right to grant such a license. Contractor shall exert all reasonable effort to advise the County, at the time of delivery of data furnished under this contract, of all known or potential invasions of privacy contained therein and of any portion of such document which was not produced in the performance of this contract. Contractor shall give the County prompt written notice of any notice or claim of copyright infringement received by Contractor with respect to any data delivered under this contract. The County will have the right to modify or remove any restrictive markings placed upon the data by Contractor. (20) If as a result of this contract, Contractor produces a report, paper, publication, brochure, pamphlet or other document on paper which uses more than a total 500 pages of 8 1/2" by 11" paper, Contractor shall conform to the Lane County Recycled Paper Procurement and Use policy, LM through 2.448, by using recycled paper with at least 25% post-consumer content which meets printing specifications and availability requirements. (21) The Oregon Standard Specifications for Construction adopted by the State of Oregon, and the Manual on Uniform Traffic Control Devices, each as is currently in effect, are applicable to all road construction projects except as modified by the bid documents. (22) As to contracts for lawn and landscape maintenance, Contractor shall salvage, recycle, compost or mulch yard waste material in an approved site, if feasible and cost-effective. (23) When a public contract is awarded to a nonresident bidder and the contract price exceeds $10,000, Contractor shall promptly report to the Department of Revenue on forms to be provided by the department the total contract price, terms of payment, length of contract and such other information as the department may require before the County will make final payment on the contract. (Revised by Order No , Effective ; , ; , ; , ; ; ; , ; , ; , ; , ) Page 15

269 EXHIBIT B SCOPE OF SERVICES A. OBJECTIVES: 1. To deliver quality medical, dental, pharmaceutical and mental health services for the Lane County Corrections Division facility (the Lane County Jail) in accordance with industry standards described below to arrestees and inmates incarcerated in the Lane County Jail and Community Corrections Center. The selected proposer will have the sole authority and responsibility for health care decisions and operation within the Lane County Jail and for inmates housed at the Community Corrections Center. 2. Services will meet all applicable federal, state and local guidelines, laws and regulations and will meet the guidelines and standards as prescribed by the National Commission on Correctional Health Care (NCCHC) (2014), the American Correctional Association (ACA) (January 2014), the Oregon Revised Statutes, including specifically ORS (5), the Oregon State Administrative Code, and the Oregon Jail Standards (6 th ed., August 2014). 3. The selected proposer will be responsible for the provision of health care services to inmates from the commitment of an inmate to the custody of the jail until release of the inmate from custody; provided, however, that Contractor shall not be responsible for the cost of any offsite medical care for injuries incurred by an arrested person prior to incarceration at the Lane County Jail or during an escape or escape attempt, including, but not limited to, medical services provided to any arrested person prior to the person s booking and confinement in the Lane County Jail. In addition, Contractor shall not be responsible for the cost of any medical treatment or health care services necessary to medically stabilize any arrested person presented at intake by an arresting agency with a life threatening injury or illness or in immediate need of emergency medical care.. The program requirements include inmate medical screening, admissions evaluation, triage, sick call, care of medically fragile inmates, pharmacy services, psychiatric screening, suicide risk assessments, mental health services, preparation of Director s Holds and Oregon State Hospital commitment reports and Hearings, medical clearances for intra and inter-agency transfers, work clearances, and the continuing care of identified health problems, detoxification and emergency services. 4. Provide an efficient correctional health care system whereby the arrestees and inmates receive medical treatment that is cost effective, legally defensible and medically necessary, and which does not demonstrate indifference to the health and safety of arrestees and inmates. 5. To operate the Medical Services Program using correction industry-experienced and licensed, certified and professionally trained personnel experienced in providing medical service for corrections facilities, while ensuring security measures are maintained at the highest standards. 6. To operate the Medical Service Program in a cost-effective manner with reporting and accountability to the Lane County Sheriff s Office Command staff. Page 16

270 7. To maintain complete and accurate records of care and to collect and analyze health statistics on a regular basis. 8. To maintain an open and collaborative relationship with Jail Administration, Jail staff and with other services providers. Page 17

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273 6. Contractor shall identify the need, schedule, coordinate and pay for all support diagnostic examinations (but not transportation or security for such diagnostic examinations) for arrestees and inmates inside and outside the Lane County Jail and designated inmate workers housed at the Community Corrections Center (CCC). Contractor shall also provide and pay for all laboratory services, as medically indicated. 7. Contractor shall provide the necessary follow-up for health problems identified by any of the screening tests or laboratory tests. This would include inpatient or outpatient hospitalization, appropriate monitoring and prescription of medications, consultations with specialty physicians, etc.but not the transportation or security required for such hospitalization or offsite services. 8. The system shall include prescription medications and over-the-counter medications. All prescription medications shall be prescribed by a physician, psychiatrist or other authorized, licensed provider and shall be administered by qualified, licensed medical personnel. All controlled substances, syringes, needles and surgical instruments will be stored under security conditions acceptable to the County. 9. The Contractor must provide and pay for a Methadone program accessibility to pregnant addicts. The responsibility for the provision of methadone for the pregnant addicts, as well as all associated screening and counseling will be the responsibility of Lane County Behavioral Health or another partnering County agency. With regard to the aforementioned methadone program, Contractor s responsibility is limited to assisting with necessary referrals and administering of provided medications, should Lane County Behavioral Health or another partnering agency be unavailable to provide required services. 10. The Contractor shall provide identification, testing, counseling, education, care and treatment and follow-up HIV/AIDS and AIDS related conditions. This responsibility shall include the provision of payment for AZT and other AIDS related medications 11. The Contractor shall provide identification, testing, counseling, education, care and treatment and follow-up of MRSA and related conditions. This responsibility shall include the provision of payment for medical care and pharmaceuticals. 12. The Contractor shall be responsible for the handling and disposal of medical and contaminated waste for Lane County Jail, in accordance with state and local regulations. 13. Contractor shall provide a consultation service to the County on any and all aspects of the health care delivery system for the Lane County Jail including evaluations and recommendations concerning new programs, alternate pharmaceutical and other systems, and on any other matter relating to this Contract upon which the County seeks the advice and counsel of the Contractor. 14. The Contractor must maintain accurate financial reports that conform to generally accepted accounting principles which will be available for audit by County and State auditing staff. Contractor must comply with all applicable Federal, State, County and local statutes, rules, and funding criteria governing services, facilities, and operation (available from the Department of Health and Human Services by request). Page 20

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276 4. Contractor will respond and assist with emergency situations occurring within the Lane County Jail area, at the Community Corrections Center (CCC) and the Defendant and Offender Management Center (DOMC), and will provide initial emergency medical care until outside ambulatory services arrive but Contractor shall not be required to provide any emergency medical treatment beyond that reasonably necessary to stabilize the individual. 5. Contractor must provide the minimum of one (1) scheduled round per week for physician and four (4) scheduled rounds per week for the Mid-level medical provider. (Include on proposed applicable staffing plan in Exhibit C). 6. Contractor must provide on-call service on a 24/7 basis for consultation to both medical and correctional department employees for inmate health care, including the authorization of appropriate prescription medications. 7. As permissible by applicable law, coverage by an alternate Physician or a Midlevel provider (Licensed Nurse Practitioner or Physician s Assistant) in the event the assigned Physician is unavailable. Generally speaking, the term for an individual providing alternate coverage shall be no longer the seven (7) (seven) days and shall not occur more thaen four (4) (four) times a year. The assigned Physician will appropriately review activities of the Mid-level Provider. 8. Custody staff will immediately notify on-duty medical staff when an arrestee/inmate has been placed in the restraint chair. On-duty medical staff must immediately notify Medical Director Physician who will advise on-duty medical staff of recommended treatment, as necessary. 9. Contractor must provide maintenance of health/medical records and charting of information, with the ability to share/exchange data. If agreed upon by both Parties, the maintenance of health/medical records and charting of information will be in an electronic system with the ability to share/exchange data. Cost for such a system to be negotiated and agreed upon per a separate Agreement. 10. Contractor shall participate in weekly Medical-Psychiatric meetings with Security Supervisor, Mental Health staff, and Jail Programs representatives to discuss and evaluate inmate mental health status. 11. Contractor must provide and/or coordinate OB/GYN Services. Contractor shall not be required to arrange or bear the cost of any health care services for infants 12. Contractor must provide Lab and X-Ray Services and/or shall coordinate and contract with lab and imaging providers as required [no on-site equipment available]. 13. Provide medical-doctor back-up in primary physician s absence. 14. Contractor will complete physicals on Bureau of Prisons (BOP) Public Law inmates who are housed at the CCC. Page 23

277 a. The physicals will be completed within five (5) days of the inmate being housed at the CCC; Page 24

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280 c. Ears, nose and throat assessment d. Respiratory assessment e. Cardiovascular assessment f. Musculoskeletal assessment g. Gastrointestinal examination h. Genitourinary assessment, including sexually transmitted disease i. Skin assessment j. Mental and emotional status and counseling k. Dental condition assessment l. Intoxication assessment and monitoring m. Assessment, monitoring and discontinuation of arrestee/inmate suicide risk, in the absence of mental health staff 5.4. Contractor must provide OB/GYN Services but shall not be responsible for arranging or bearing the cost of any health care services for infants Contractor must provide Lab and X-Ray Services and shall coordinate with lab and imaging providers as required [no on-site equipment available] Contractor must provide maintenance of health/medical records and charting of information, with the ability to share/exchange data. If agreed upon by both Parties, the maintenance of health/medical records and charting of information will be in an electronic system with the ability to share/exchange data. Cost for such a system to be negotiated and agreed upon per a separate Agreement Contractor nursing staff will complete physicals on Bureau of Prisons (BOP) Public Law inmates who are housed at the CCC within five (5) day of the BOP inmates being housed Evaluate persons placed in the Restrain Chair within fifteen (15) minutes of placement, with follow- up assessments performed every fifteen (15) minutes thereafter in order to review the inmate s ability to breathe properly and assure blood flow is unimpeded by the restraints (except when exigent circumstances are present). Examination and treatment rendered must be documented in the inmate s medical records. E. PHARMACEUTICAL SERVICES MANAGEMENT: Page 27

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283 2. Contractor must provide a dentist to provide all dental services, which will include: a. Consultations; Page 30

284 b. Diagnosis; c. Treatment (no preventative dental care, cosmetic care or any orthodontic care); d. Prescriptions and non-prescription medication; e. Referral to appropriate specialists as required. 3. Contractor dentist shall provide on-site service for five (5) to six (6) hours per week (include on proposed staffing plan in Exhibit C). 4. Contractor must provide maintenance of dental health/medical records and charting of information, with the ability to share/exchange data. If agreed upon by both Parties, the maintenance of health/medical records and charting of information will be in an electronic system with the ability to share/exchange data. Cost for such a system to be negotiated and agreed upon per a separate Agreement. 5. Dental care must be provided by the Contractor under the direction and supervision of a dentist licensed in the State of Oregon. 6. Dental Services must be provided for emergency and medically required dental care for all arrestees/inmates at the Lane County Jail and the designated inmate workers at the Community Corrections Center (CCC) within a reasonable period of time. 7. Dental services must include extractions and basic dental services necessary to relieve pain and preserve salvageable teeth. 8. Emergency dental services must be available on a 24 hour, 7 days a week basis. G. MENTAL HEALTH / PSYCHIATRIC SERVICES: 1. The Contractor must provide licensed, qualified mental health professionals who can perform mental health services to the Lane County Jail s arrestee/inmate population, including: a. Evaluate, identify and treat arrestees/inmates upon acceptance / intake into the Lane County Jail system; b. Provide mental health evaluations of arrestees/inmates that include the following: The arrestee s/inmate s orientation to time, place and person; Observation and description of an inmate s current state of mind, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight and judgment; A risk assessment for harm to self or others, including past suicidal or self-harm attempts; Page 31

285 Past or current mental health treatment and prescribed medications, which includes past or present drug and/or alcohol use and/or treatment; Obtaining signed Releases of Information for medical records. c. Provide psychiatric services requested for inmates housed at the Lane County Jail and the designated inmate workers at the Community Corrections Center (CCC). d. Director s Hold Evaluations, which may be conducted when an arrestee/inmate is going to be released from custody and is otherwise suspected of being a danger to self or others. The evaluation will determine if an arrestee/inmate presents a risk. If a risk exists, Contractor Mental Health staff will: Provide treatment, Conduct a medication evaluation for the arrestee/inmate, Monitor arrestee/inmate, Provide an on-site or off-site referral to a County-approved mental health facility to ensure continuity of care, Provide a Director s Hold, Coordinate with Lane County Jail Security staff for transport to an Oregon State certified and secured mental health facility. e. Fitness to Proceed Evaluations, as requested by the Court or attorneys. When requested Contractor s qualified Mental Health staff will: Arrange and complete the evaluations, Write the necessary reports and provide the reports to the Court, If requested, present their findings to the Court, If the Court finds an arrestee/inmate unfit, coordinate with Oregon State Hospital and Jail Records to oversee the transition of arrestee/inmate to and from Oregon State Hospital, including coordination with Lane County Jail Security staff and/or Lane County Sheriff s Office Transport Section to prepare arrestee/inmate for transport. f. Crisis intervention and management of acute psychiatric episodes. g. Monitoring of the mentally ill psychiatric deterioration in the Jail setting, and referral for psychiatric and other identified mental health services. h. Daily and on-going monitoring/assessment of arrestees/inmates who are in segregated housing for chronically impaired and/or psychiatric issues. i. Respond to arrestee/inmate requests for mental health services and transitional care, including drug and alcohol services. Page 32

286 j. Referrals to appropriate specialist, as required. k. Script writing by mental health or medical staff licensed to do so. l. Post-release referral on a case-by-case basis, in consultation with the Sheriff s Office. 2. Contractor must participate in the development and implementation of mental health care protocols, including counselling services, as necessary. 3. Contractor psychiatrist must be available 24/7 (telephone on-call) for advice and consultation to mental health and/or nursing staff. 4. Contractor must provide psychiatric back-up in primary psychiatrist s absence. 5. Contractor must provide licensed nurses or mental health specialists to provide drug and alcohol screening and observation for withdrawal symptoms. 6. Contractor psychiatrist and all mental health staff must maintain appropriate professional licenses. 7. Face-to-face consultative psychiatric services a minimum of 1-2 hours / twice a week (flexible). (Include on proposed staffing plan in Exhibit C). 8. Contractor psychiatrist should attend quarterly pharmacy meetings to track budget and formulary. 9. Contractor must adherence to formulary approved by the County. 10. Contractor must provide maintenance of mental health/medical records and charting of information, with the ability to share/exchange data. If agreed upon by both Parties, the maintenance of health/medical records and charting of information will be in an electronic system with the ability to share/exchange data. Cost for such a system to be negotiated and agreed upon per a separate Agreement. 11. Contractor shall provide sufficient mental health staff for all necessary mental health services, including the completion of Director s Holds and Fitness to Process Evaluations. 12. Contractor will hire qualified Mental Health Specialists (include on proposed staffing plan in Exhibit C). Mental Health Specialist staff shall: a. See and address all arrestees/inmates who are segregated from the general population for psychiatric reasons, after being placed in that status, a minimum of three (3) times per week. b. Assess, monitor and discontinue arrestee/inmate suicide risk precautionary watches. Page 33

287 c. If mental health specialist staffing is not provided 24 hours/day, seven days/week, provide mental health specialist on-call services 24 hours/day, seven days/week. Oncall staff must be available to report to the Jail facility for emergency services, such as suicide risk assessments, monitoring of inmates in restraint chair, and completion of Director s Holds. d. Provide drug and alcohol screening/observation for withdrawal symptoms. e. Train Contractor s staff on the identification and treatment of inmates who are at risk for suicidal or homicidal acts, and provide annual training to Lane County Jail staff on suicide prevention and other medical and mental health related issues, if requested to do so by the County. f. Examine arrestees/inmates who have been placed in a restraint chair in excess of one (1) hour. 13. Contractor shall coordinate services with medical personnel, Jail Security staff, psychiatrist, Courts, families, Oregon State Hospital, local hospitals, Parole and Probation, Attorneys, and other outside agencies. 14. Contractor, working in conjunction with Jail Security staff, may confine arrestees/inmates based upon risk of physical danger to self or others, where such confinement is supported by a risk assessment evaluations performed by Contractor. 15. Contractor shall coordinate and facilitate weekly Medical-Psychiatric meetings with Jail Security Supervisor, Medical staff, and Jail Programs representatives to discuss and evaluate arrestee/inmate mental health status. 16. Contractor must maintain all appropriate professional licenses. 17. Contractor must possess the certification or authority from the State of Oregon to place a Director s Hold on an arrestee/inmate and to conduct Fitness to Proceed evaluations. 18. Contractor must establish policies and procedures for arrestee/inmate mental health assessments, which will be subject for review by the Alternative Program Lieutenant, of County designee. Detailed policies and procedures must be in place for both the on-site treatment of such arrestees/inmates and for referrals to the mental health preferred provider when medically necessary for continued treatment. 19. Contractor shall monitor and evaluate arrestee/inmate mental health process, which includes preparing all required documentation and forms, including fitness evaluations and unfit-to-proceed evaluations. H. ON-SITE MEDICAL SERVICES, ADDITIONAL INFORMATION: 1. Intake Screening: Page 34

288 a. Contractor s licensed registered nurses or other appropriate qualified personnel must perform an initial intake medical screening on incoming arrestees/inmates upon admission and acceptance to the Lane County Jail for booking and/or housing, in accordance with the established rejection criteria mutually approved by the Contractor and the County. Intake medical screening is a two-step process. The first step is medical clearance, which will be initiated by the Jail staff. In the event the Jail staff initially determines that an individual brought into the Jail to be placed in custody has a questionable or unstable medical condition, Jail staff must immediately notify the Contractor, so that said individual may be medically cleared by Contractor s physician, mid-level professional, registered nurse, or other appropriate qualified medical personnel prior to booking. Any incoming inmate found to be unconscious or appears to be seriously ill or injured must be referred for immediate outside medical attention and not admitted into the Jail. Such individual s admission or return to the Jail system is predicated upon written medical clearance from a local hospital. If the County rejects taking the individual into custody based upon Contractor s initial intake medical screening, the arresting agency will be responsible for transportation and medical clearance prior to being accepted. The Contractor will not be responsible for medical care or treatment of an incoming individual after the County has rejected taking the individual into custody at the Lane County Jail. Contractor is responsible for medical care and treatment of individuals upon completion of the booking process and the physically commitment of the individual into custody of the Jail. Contractor s medical screening will identify those individuals with medical conditions, mental disorders, inmates in need of segregation or close supervision, and those with suicidal tendencies. The second step is the actual medical screening. Contractor is responsible for screening incoming inmates for medical care and treatment once the inmate is booked into the facility. Upon receiving notification from Jail staff that the arrestee/inmate has been booked in, Contractor s licensed nurse or other appropriate medical personnel must perform a medical intake screening on incoming arrestees/inmates upon admission and acceptance prior to Jail housing. Contractor s screening must identify those individuals with medical conditions, mental disorders, inmates in need of segregation or close supervision, and those with suicidal tendencies. b. Contractor is responsible for medically screening incoming arrestees/inmates for medical care and treatment once the individuals are booked into the Jail, 24 hours a day, seven days a week. c. Contractor will have medical staff available on-site 24 hours per day, seven days per week; with physician and psychiatric on-call availability 24/7. (Include on proposed staffing plan in Exhibit C). d. Contractor must provide screening findings recorded on a printed form approved by Lane County Sheriff s Office. e. The screening examination should include, at a minimum, documentation of the following: Page 35

289 2. Observation: Inquiry into current illnesses, health problems, and conditions, including: 1) Any past history of tuberculosis, sexually-transmitted disease, or other infectious or communicable illness, or symptoms - e.g., chronic cough, hemoptysis (spitting up blood), lethargy, weakness, weight loss, loss of appetite, fever, night sweats -suggestive of such illness; 2) Mental health problems including suicidal ideation; 3) Dental problems; 4) Allergies; 5) Medications taken and special health (including dietary) requirements; 6) For women, date of last menstrual period, current gynecological problems, and pregnancy; 7) Use of alcohol and other drugs, including types, methods (including needle sharing), date or time of last use, and problems that may have occurred after ceasing use (e.g., convulsions); 8) Other health problems designated by the responsible physician. a. When completing medical assessments, Contractor must be observant of the following: Behavior, which includes state of consciousness, mental status (including suicidal ideation), appearance, conduct, tremors, and sweating; Body deformities and ease of movement; including any durable equipment or prosthetics; Persistent cough or lethargy; Condition of skin, including scars, tattoos, bruises, lesions, jaundice, rashes, infestations, and needle marks or other indications of drug abuse. b. When clinically indicated, Contractor should be an immediate referral to an appropriate health care service. c. Contractor must make notation of the disposition of the patient, such as immediate referral to an appropriate health care service, approval for placement in the general inmate population with later referral to an appropriate health care service, or approval for placement in the general inmate population. d. Contractor must make documentation of the date and time when referral/placement actually takes place. e. The Contractor shall work in conjunction with the Jail's Classification staff to provide for appropriate inmate placement, such as the following: Page 36

290 Placement in the general inmate population; Placement in the general inmate population and referral to the appropriate health care service at the Jail; Immediate referral to a health care provider when indicated; Referral to an appropriate off-site provider/facility for emergency treatment. f. In order for an inmate to remain detained in the Jail facility, they must have the ability to ambulate on their own, transport self to and from restroom, feed themselves and dress themselves. g. Jail staff will be notified if an inmate refuses any aspect of the intake screening and the inmate will be segregated from the general population. 3. Health Assessments: a. The Contractor must establish policies and procedures for inmate health assessments, which shall be subject to review and comment by the Alternative Programs Lieutenant or designee. b. The Contractor must arrange for a licensed physician, mid-level provider (nurse practitioner, physician s assistant), registered nurse or other approved qualified medical professional to complete health assessments for all inmates housed at the Jail within fourteen (14) days of the inmate s admission to the Jail. If requested, the Contractor will provide health assessments for United States Marshal or other federal agencies in regards to federal inmates housed at the Jail. In addition, the Contractor will provide a complete health assessment (physical) for the Bureau of Prisons inmates housed at the Community Corrections Center within five (5) day of the BOP inmate s admission to the CCC. c. The health assessment should include the following, as appropriate: A review of the intake screening results and the collection of additional data to complete the medical, dental, and mental health histories; Laboratory and/or diagnostic tests to detect communicable diseases, including sexually transmitted diseases and tuberculosis, and other tests as determined by the responsible physician upon consultation with and approval by the local public health authority; Recording of height, weight, pulse, blood pressure, and temperature; A physical examination including comments about mental status; Other tests and examinations as appropriate; A review of the findings of the health assessment and tests, and identification of problems by a physician; Initiation of therapy and immunizations when appropriate; Page 37

291 Oral (dental) history, including instruction in oral hygiene and oral health education; The Contractor will provide physical examinations and medical clearances for all inmate workers. A structured interview in which inquiries are made in the following areas: 1) History of hospitalization and outpatient treatment, 2) Current medications, 3) Suicidal ideation and history of suicidal behavior, 4) Drug usage, 5) Alcohol usage, 6) History of sex offenses, 7) History of expressively violent behavior, 8) History of victimization due to criminal violence, 9) Special education placement and history of cerebral trauma or seizures, 10) Emotional response to incarceration. The health assessment process will also include a tuberculin PPD skin test. d. The form used for the health appraisal must be approved by the facility physician and Lane County Sheriff s Office, and shall be provided by the Contractor. e. Inmates referred for treatment as a result of the health appraisal must be seen the following day unless the provider making the referral orders them to physician sick call on another day. f. Contractor medical staff will evaluate any inmate placed in the restraint chair within 15 minutes of placement and conduct follow-up assessments every 15 minutes thereafter (except when exigent circumstances exist). The evaluation will include a review of the inmate s ability to breathe properly, assure the inmate s blood flow is unimpeded by the restraints, and document the examination and treatment rendered in the inmate s medical record. 4. Inmate Requests for Health Care Services: a. The Contractor will establish policies and procedures for handling and responding to arrestee/inmate requests for health care services. Contractor s policies and procedures shall be subject to review and comment by the Lane County Jail Commander, or designee. b. Arrestees/inmates will have the opportunity to request health care services daily. Arrestees/inmates may request services in writing or be referred by correctional staff. The Contractor care personnel will review the requests and determine the appropriate Page 38

292 course of action to be taken to include immediate intervention or scheduling for nursing sick call or a provider evaluation. c. The Contractor will determine the process to be used for collecting, triaging and responding to arrestee/inmate requests for health care services. Sick call will be held by Contractor personnel a minimum of five (5) days per week. 5. Protocols: a. The Contractor must establish protocols to facilitate the sick call process. The protocols will be appropriate for the level of skill and preparation of the nursing personnel who will carry them out. The protocols will be in compliance with relevant state practice acts and will be approved by the health authority. 6. Segregation Rounds: a. Licensed medical personnel must perform medical assessments on arrestees/inmates who are segregated from the general population (whether for disciplinary, administrative, or protective reasons) to determine the arrestee s/inmate s health status and to ensure access to health care services, a minimum of three (3) times a week, unless the arrestee s/inmate s health condition is severe enough to require additional assessments or monitoring. b. A record of the segregation rounds will be maintained, with clinical encounters noted in the arrestee s/inmate s health record. 7. Medical Rounds: a. Licensed medical personnel must perform medical rounds on inmates who are housed in the intake, segregation and medical unit to monitor health status, distribute medications and to ensure access to health care services, a minimum of three (3) times per day. b. Licensed medical personnel must distribute prescribed medications to the inmates who are housed in the general population Jail units, a minimum of two (2) times per day. c. Licensed medical personnel must monitor blood glucose levels and calculate insulin dosages for diabetic arrestees and inmates, as needed, but no less than a minimum of three (3) times per day. d. Records of medical rounds will be maintained, with clinical encounters noted in the inmate s health record. 8. Women's Preventive Health Care: a. The Contractor will be responsible for the provision of medically necessary health services to the female inmate population to include, at a minimum, the following: Page 39

293 Sexually transmitted disease screening, as indicated; Annual Pap smear testing, as indicated; Mammograms, as determined necessary by medical history or an abnormal breast examination. b. The Contractor must establish policies and procedures specific to the health care of pregnant arrestees/inmates, which will include, at a minimum, the following: Pre-natal care, including regular monitoring by an obstetrician; Provision of appropriate vitamins and dietary needs; Identification and disposition of high-risk pregnancies, including appropriate referrals to off-site providers when medically indicated; Contractor will not be responsible for fetus care or care after birth to the baby, however Contractor must develop an after care plan for the mother prior to delivery; Regardless of personal or professional beliefs, female arrestees/inmates may have a legally protected right to an abortion at the arrestee s/inmate s expense. Contractor should include in their proposal, procedures for dealing with this issue. 9. Infectious Disease: a. The Contractor shall establish policy and procedures for the care and handling of arrestees/inmates diagnosed with infectious disease, chronic illnesses and other special health care needs. b. The Contractor shall provide an infection control program that focuses on surveillance, prevention, treatment and reporting. In addition to procedures generic to "infectious diseases," disease specific programs will be established to include: Tuberculosis, 1) The Contractor will develop a TB surveillance, treatment and monitoring program consistent with community standards. 2) If an arrestee/inmate tests positive for a PPD test, the inmate shall be scheduled for and receive a chest x-ray, with appropriate follow-up and care, including isolation, if required. HIV/AIDS, 1) Voluntary HIV testing and counseling will be available on a confidential case-by-case basis to arrestees/inmates who request testing. 2) Contractor health care staff must evaluate arrestees/inmates identified as having HIV disease. Contractor must ensure that HIV arrestees/inmates Page 40

294 Influenza, have access to infectious disease specialists and HIV medications as determined medically necessary. 1) The Contractor must develop an Influenza response program consisting of surveillance, treatment and monitoring consistent with community standards and established Lane County policy and procedures. 2) Contractor health care staff must evaluate arrestees/inmates identified with contagious upper respiratory infections and cases will be isolated or separated as determined necessary. 3) The Contractor shall provide a designated staff member solely responsible for the infectious control program (positive PPD, TB, hepatitis, etc.) in accordance with the standards established by the National Commission on Correctional Health Care (NCCHC) and the American Correctional Association (ACA). 10. Chronic Illness and Special Needs Inmates: a. The Contractor must establish a plan for the identification, treatment and monitoring of arrestees/inmates with chronic illnesses and special health care needs. Upon identification of an arrestee/inmate with a special health care need Contractor s health care staff must establish a special needs treatment plan to guide the care of the arrestee/inmate with special needs. b. If Contractor s health care staff determines and arrestee/inmate is under the influence of alcohol or drugs, Contractor must inform Lane County Jail staff who are responsible for separating the arrests/inmate from the general population and kept under close observation for a reasonable time period, as indicated by Contractor medical staff. c. Contractor shall provide an in-custody medical detoxification program for drug and/or alcohol addicted arrestees/inmates, which shall be administered only at the Jail. d. Contractor shall provide intermittent monitoring of the detoxification cells located in the Jail to determine the health status of individuals held in this area. Such monitoring shall include, at a minimum, documented vital signs and determination of the level of consciousness at a minimum of three (3) times per day, and every two (2) hours for severe cases. e. Arrestees/inmates with suicidal tendencies may be assigned to quarters that have close observation. Suicide prevention protocols must be developed by Contractor and will be subject to approval by Jail Administration. f. Chemical restraints may be administered without consent when appropriate and approved by Contractor physician to control ongoing violent or destructive behavior Page 41

295 to protect both staff and arrestees/inmates. Observation and documentation by Contractor medical staff shall be consistent with best practices and protocols. 11. Emergency Services: a. Contractor must establish policies and procedures to address emergency situations. The emergency policies must provide for immediate response by Contractor health staff to stabilize the in arrestee/inmate. Emergency services to include first aid and cardiopulmonary resuscitation services will be provided on-site. b. Contractor will establish and maintain contracts with area providers for emergency services. c. Contractor must notify the Lane County Jail shift supervisor of the nature of the incident/illness and the type of transportation requested when an offsite emergency transport is required. d. The Contractor must report emergency transfers to the Jail Commander or designee. 12. Emergency Response Plan: a. The Contractor must establish procedures to address the health aspects of the emergency response plan. The related procedures will be approved by the health authority and the Jail Commander, or designee, and include: Responsibilities of Contractor health care staff; Procedures for triage; Predetermination of the site for care; Numbers and procedures for calling health staff and the community emergency response system (e.g., hospitals, ambulances); Procedures for evacuating patients (within Jail s existing evacuation procedures); Alternate backups for each of the plan s elements. b. Health aspects of the emergency plan will be tested or drilled, as required by NCCHC or ACA standards. These drills will be observed and critiqued in a written report. 13. Medication Management: a. Contractor shall provide a total pharmaceutical system for the Jail, beginning with physicians or licensed practitioners prescribing the medication, filling the prescription, the dispensing of medication, and necessary record keeping. b. Contractor will be responsible for the costs of all required and prescribed medications, including routine and non-urgent medications administered. The system Page 42

296 must include prescription and over the counter medications. medications must be administered by a state licensed individual. All prescription c. All controlled substances, syringes, needles, and surgical instruments will be stored by Contractor under security conditions acceptable to the County. d. Contractor shall establish a medications formulary utilizing primarily generic medications unless otherwise medically indicated. Pharmacological support (the administration and issuance of prescribed medications) must be determined by Contractor s health care staff. Contractor must review any requests for renewal of medication orders; include psychotropic medications, to ensure renewal is medically necessary. The re-evaluation must be documented in the inmate's health record. e. The Contractor has the responsibility to record the administration of medications in a manner and on a form approved by the Jail, to include documentation of the fact that inmates are receiving and ingesting their prescribed medications, and to maintain those records. Documentation is also required when an inmate's ordered medication was not administered, and the reason for non-administration must be noted. Contractor will develop a system for tracking and reporting medication errors. f. The pharmaceutical program must provide consultation 24 hours a day, seven (7) days a week from a registered pharmacist. This program must include an emergency backup pharmacy plan. The pharmaceutical program must also include guidelines for administering medications to those inmates scheduled to be temporarily out of the Jail facility (e.g., for court appearances). g. Medications must be maintained under proper conditions and in a secure area. A log indicating the use of stock medications will be maintained. The Contractor shall provide policies and procedures for the removal and disposal of any and all outdated, unneeded, or surplus medications. h. Medication carts shall be purchased at the beginning of contract and replaced every two (2) years, unless other agreements are made between Contractor and County. 14. Laboratory Services: a. Contractor must ensure the availability of laboratory studies as determined necessary and consistent with NCCHC and ACA standards. Contractor must ensure that routine and emergency laboratory specimens will be processed and written reports will be provided in a timely manner. Contractor s health care staff must review test results. b. Contractor s health care staff must review and sign off on all laboratory, EKG and X- ray results. Contractor must provide a follow up plan of care if indicated. c. Contractor must provide equipment and supplies to perform on-site laboratory testing as required by NCCHC and ACA standards. Page 43

297 15. Radiological Services: a. Contractor must ensure access and pay for all radiological studies, including X-rays, as determined necessary and consistent with NCCHC and ACA standards. b. Contractor must process routine and emergency radiology services and provide written reports in a timely manner. c. Contractor must ensure a board certified or board eligible radiologist interprets all images and test results. 16. Physician Services: a. Contractor must have a physician on-site as needed per applicable standards, as the workload dictates. (Include on proposed staffing plan in Exhibit C). The on-site physician will be responsible for the medical oversight for the Jail medical program. b. Contractor must provide a minimum of one scheduled round by a physician per week. The number of hours a physician will be on-site and the contractual minimum to be provided must be consistent with the applicable staffing plan. If the Contractor chooses, an alternative-staffing plan can be submitted with justification for changes. c. Contractor will ensure that a physician is on-call 24 hours per day, seven (7) days per week for consultation to both medical and correctional department employees. Additionally, Contractor shall establish an appropriate schedule for the utilization of staff and the effective delivery of services, with consideration of the staffing pattern included in the RFP. Contractor must ensure coverage by an alternative physician or mid-level provider in the even the physician is not available. The assigned physician will appropriately review activities of the mid-level provider. 17. Psychiatric Services: a. Contractor must provide psychiatric services requested for inmates housed at the Lane County Jail. b. Contractor s psychiatrist will participate in the development and implementation of mental health care protocols as necessary; will be available 24 hours a day, seven (7) days a week for telephonic advice and consultation to nursing staff. Providing a telephonic offsite referral system would be considered (i.e., Tele-Med, etc.). c. Contractor s psychiatrist will also provide face-to-face consultative psychiatric services a minimum of 1-2 hours / twice a week (flexible). (Include in proposed staffing plan in Exhibit C). Contractor s psychiatrist will make referrals to appropriate specialists as required. d. Contractor s psychiatrist will adhere to formulary approved by the County, with attendance to quarterly pharmacy service meetings to track budget and formulary. Page 44

298 18. Medical Clinic Staffing: a. The Contractor must have a sufficient number of nurses on site at all times. b. The Contractor must have a sufficient number of support staff. c. Hours worked by Contractor employees shall be spent on site at the Jail, except as otherwise agreed to by both parties. d. Contractual employees must comply with all County requirements, including specifically security, when entering and leaving the Jail facility. e. The Contractor must provide County access to records indicating the hours worked by each employee. f. Contractor employees will wear the appropriate uniform and/or identification badge as directed by the Jail when on site. g. Contractor providers and employees are all responsible for maintenance of health/medical records and charting of information with the ability to share/exchange information. If agreed upon by both Parties, the maintenance of health/medical records and charting of information will be in an electronic system with the ability to share/exchange data. Cost for such a system to be negotiated and agreed upon per a separate Agreement. h. Contractor personnel are subject to the security regulations and procedures of the Lane County Jail. i. Contractor personnel are subject to removal from the facility at any time for security reasons as determined by the Jail Commander or designee. 19. Mental Health Services Provided by Contractor: a. The Contractor shall be responsible for providing mental health services to the inmate population, including: Services that include evaluation by a qualified mental health professional of mental health problems identified upon intake into the Lane County Jail system; crisis intervention and management of acute psychiatric episodes; Stabilization of the mentally ill and prevention of psychiatric deterioration in the Jail setting; and referral for psychiatric and other identified mental health services; Services that include the identification, treatment and referral of individuals deemed a danger to self or others; and medication evaluation and monitoring; Post-release referral; consultation with the Sheriff s Office to determine appropriate housing; Page 45

299 Daily monitoring of segregated housing for chronically impaired. b. All inmates, who are segregated from the general population for psychiatric reasons, shall be assessed by Contractor s mental health staff after being placed in that status and must be seen by qualified mental health personnel a minimum of three (3) times per week. c. Confinement of inmates based on risk of physical danger to self or others will be limited to circumstances where such confinement is supported by a risk assessment evaluation. d. The Contractor will be responsible to train their staff on the identification and treatment of arrestees/inmates who are at risk for suicidal and/or homicidal acts. e. Detailed policies and procedures will be in place for both the on-site treatment of such arrestees/inmates and for referrals to the mental health preferred provider when medically necessary for continued treatment. 20. Health Records Management: a. The Contractor must initiate and maintain individual health care records for every arrestee/inmate regarding medical, dental or mental health services as a result of the arrestee/inmate screening process, or for services rendered following assignment to a housing area. b. Arrestees/inmates returning from outside hospital stay or clinic visits are to be seen by a Contractor health care provider. A note regarding this review with reference to in-house follow up must be documented in the inmate medical record. c. Contactor must review and document the results of tuberculin tests. d. Contractor medical staff shall perform reviews, medical examinations, medical summaries or certifications as necessary for intra-system or inter-system transfers, food handling and work clearances. e. Contractor must prepare discharge summaries and send with inmates being transferred to other facilities. f. Contractor must include in all inmate health records, the following information (when available): Intake medical screening form Health appraisal form Physician order/treatment plans Prescribed medications administered or not Page 46

300 Administered, date, time and by whom Complaints of illness or injury Findings, diagnoses, treatments and dispositions Consent and refusal forms Release of information forms Inmate medical request forms Medical grievance forms Laboratory, radiology and diagnostic studies Consultation, emergency room and hospital reports and discharge summaries All contacts with jail health providers. All documentation shall include the date, time, signature and title of each documenter g. Confidentiality of medical records and medical information will be maintained by Contractor personnel. The medical and psychiatric records will be kept separate from the custody record. h. Data necessary for the classification, transport, security and control of inmates will be provided to the appropriate Lane County Jail personnel. Medical records will be made available to Sheriff s Office and County Counsel personnel when required to defend any cause of action by any inmate against the Sheriff and/or County. i. Adherence to applicable informed consent regulations and standards of the local jurisdiction must be maintained. j. Inactive medical records will be maintained in accordance with the laws of the State of Oregon, and NCCHC guidelines. All inactive medical, mental health and dental records remain the property of Lane County. All active or inactive medical, mental health and dental records, including records generated by the Contractor during the length of the Agreement, will remain the property of Lane County. k. Active and inactive medical, mental health or dental records/files must not be removed from the Lane County Jail without expressed permission from the Jail Commander or designee. l. Information concerning any court or legal documents affecting arrestees/inmates and the Contractor must be provided, in writing to the designated Sheriff s Office representative at the Lane County Jail prior to the close of the shift during which the documents were served or received. m. Contractor shall maintain complete and accurate medical and dental records separate from the confinement records of the inmate. In any criminal or civil litigation where Page 47

301 the physical or mental condition of an inmate is at issue, Contractor shall provide the County with access to such records and, upon request, provide copies. n. If an inmate's medical record cannot be located within eight (8) hours of the discovered loss, the Contractor shall verbally notify the Jail Commander or designee and a duplicate record shall be immediately generated. 21. Nutritional Services: a. The Contractor must cooperate with the established food service program to ensure the provision of medically necessary diets. b. The Contractor must provide medically required special diet supplements (e.g., Ensure, electrolyte-stabilizing drink, etc.). 22. Inmate Complaint/Grievance Procedure: a. The Contractor will establish policies and procedures that address the handling of inmate complaints related to health services to include a process for appeals. b. The Contractor will utilize the Jail s current inmate grievance system to track complaints regarding health care services for which Contractor is responsible from receipt to resolution. c. The Contractor shall respond to and answer grievances regarding health care services for which Contractor is responsible within seven days of receipt including weekends and holidays. d. The Contractor will generate and provide to the Jail Commander a monthly report of complaints regarding health care services for which Contractor is responsible received, if requested. The reports should include, at a minimum, inmate name and identification number, date the complaint was received, complaint description, date of response, and a brief description of the resolution. 23. Dental Care: a. Dental care will be provided by the Contractor under the direction and supervision of a dentist licensed in the State of Oregon. b. Dental services will be provided for emergency and medically required dental care for all inmates at the Jail within a reasonable period of time. Nothing herein shall be interpreted as requiring Contractor to provide orthodontic services of any kind, or preventive dental care. c. Services shall include basic dental services necessary to relieve pain, and preserve salvageable teeth. d. The Contractor shall provide a dentist for consultations, diagnosis, treatment and Page 48

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304 J. OFF-SITE REFERRALS: Page 51

305 1. All off-site appointment information is classified. Due to safety and security concerns, the Contractor and the Contractor s representatives are prohibited from releasing arrestee/inmate appointment and related information to anyone other than Lane County Sheriff s Office Security staff and anyone not directly involved with the related community health care provider. a. Contractor will not release any information concerning Contractor or County arranged arrestee/inmate off-site appointment or transports with the arrestee/inmate, the arrestee s/inmate s family, or anyone else. 2. The Contractor will establish policies and procedures for referring inmates to specialty care providers when determined necessary by the Contractor s health care provider. 3. The Contractor will be responsible for establishing a network of providers to meet the health care needs of the inmate population. a. Contractor will inform any off-site provider that the arrestee/inmate appointment information must not be released to anyone. b. Release of the information will result in the re-scheduling of the appointment. 4. The Contractor will contact the appropriate Jail Security Supervisor to coordinate the scheduling and arrange the transport of arrestees/inmates to any off-site appointment. 5. The Contractor will be responsible for determining the medical necessity of off-site medical services and for providing the necessary medical information, as well as billing information, to the off-site provider. 6. The Contractor shall generate and complete an appropriate Medical Transfer Form for arrestees/inmates who require specialty care services. This completed form will accompany the arrestees/inmates during transport from the Jail to a provider for treatment. 7. For each off-site referral, Contractor must obtain a legible consultation or treatment report from the off-site provider to be filed in the inmate's medical record. The Contractor health care staff will review the consultant report and ensure that the report will contain: a. Reason for consult b. Appropriate exam/lab findings c. Diagnosis d. Treatment plan(s) e. Follow-up appointment (if necessary) 8. Contractor must communicate with off-site health care provider any recommendations involving any special procedures or non-routine follow-up care. Page 52

306 9. The Contractor will generate and provide the Jail Commander or designee a monthly summary of specialty care referrals. 10. Considerations will be given to proposers who can show cost savings programs utilizing technologies such as (Tele Med) or similar abilities for tele-conferencing with off-site providers for services (i.e. EKG s, X-rays, and consults with physicians) which could lead to less off-site transfers for services. K. NEW HIRES: 1. The Contractor must ensure that hired personnel engaged by Contractor have sufficient technical expertise, skills and abilities, emotional stability, and motivation to perform the required services in an adult corrections environment. The final selections made by the Contractor will be subject to approval by the Jail Commander or designee, which shall not be unreasonably withheld. 2. Current medical staff shall be provided the opportunity to apply and interview for employment with the Contractor. 3. The Contractor will complete a credentialing process, consistent with community standards for each licensed health care professional. A copy of the application, credentialing verification documents, complete work history, license, and degree will be maintained on file. The Jail Commander or designee will have access to this information upon request. 4. In addition to completing the Contractor work-required background check, Contractor s personnel will be required to pass a background investigation conducted by the Lane County Sheriff s Office as a requisite for initial and/or continued employment. Rejection of any job applicant by the Sheriff s Office will be final. Background investigations will be completed within a reasonable timeframe. 5. Contractor personnel will comply with current and future state, federal, and local laws, regulations, court orders, administrative regulations, administrative directives, and the policies and procedures of the Lane County Jail. 6. Contractor health care personnel will be trained and certified in Basic Life Support- Cardiopulmonary Resuscitation (BLS-CPR) with re-certification provided as required by the regulatory body. L. NEW EMPLOYEE ORIENTATION: 1. The Contractor is responsible for ensuring that new health care employees are provided with an orientation addressing the policies, procedures and practices of the on-site health care program. Orientation regarding other facility operations will be the responsibility of the Lane County Jail staff. M. ONGOING IN-SERVICE TRAINING: Page 53

307 1. The Contractor will provide annual in-service training for qualified health services personnel as required by NCCHC and ACA standards. 2. In-service training hours and subject matter will be consistent with accreditation requirements. N. POSITION DESCRIPTIONS: 1. The Contractor will provide a written position description to each member of the health care staff. 2. The job description will delineate the employee assigned responsibilities and will meet requirements of the American s With Disabilities Act. O. PERFORMANCE APPRAISALS: 1. The Contractor must monitor the performance of health care staff to ensure adequate job performance, in accordance with position descriptions. 2. Contractor Management staff shall properly complete employee evaluations for those employees under their direct supervision, in accordance with applicable state laws. 3. Contractor Management staff shall complete monthly progress reports (or experience trackers) for all health care staff who have less than one (1) year of correctional of health care institutional experience. These progress reports will be forwarded to the Alternative Program Lieutenant each month. P. ADMINISTRATIVE PROCEDURES: 1. The Contractor shall be responsible for ensuring that the on-site health staff reports problems and/or unusual incidents to the Alternative Programs Lieutenant or designee per established policies and procedures. 2. Contractor Management staff shall represent assist the health unit in discussions with local civic groups or visiting officials as mutually agreed upon by the Ccontractor and the Lane County Jail Commander or designee. Q. CONTRACT ADMINISTRATION: 1. The Contractor must have a demonstrated history of providing a system of on-going technical and medical support to on-site personnel. 2. The Contractor must demonstrate the ability to prepare and implement protocols, policies, and procedures that comply with NCCHC and ACA standards and requirements. 3. The Contractor must provide a comprehensive internal quality improvement program, which includes conducting an on-going evaluation of compliance with its policies and Page 54

308 procedures, with monitoring results documented and reported on a quarterly basis to the Jail Commander or designee. 4. The Contractor must compile monthly statistical utilization reports of services provided, which are to be used to create monthly service reports to the Alternative Programs Lieutenant or designee. 5. The Contractor must describe the methods to be used in implementing a management information system for collecting and analyzing trends in the utilization of the medical services provided. 6. The Contractor shall not offer financial rewards to its employees or subcontractors as an incentive to limit care or the availability of care or to use excessive referrals to outside providers. R. STAFFING: 1. The Contractor proposal must include a proposed staffing plan, which should be inserted after the Contractor s Compensation Proposal in Exhibit C. Each position will include a post assignment/title and the hours to be worked. The proposed staffing plan is subject to the approval of the Alternative Programs Lieutenant or designee. 2. The Contractor may choose to accept applications from and interview current medical health staff for existing anticipated positions. Decisions to hire/retain current medical health staff must be approved by the Alternative Programs Lieutenant or designee. 3. The Contractor will reimburse the County the hourly rate for each hour a position included in the Contractor s accepted staffing plan chart (included in Exhibit C) if unfilled during any given month. The County and Contractor may negotiate an effective date from the commencement of the Agreement to afford the Contractor adequate time to hire staff. S. QUALITY MONITORING AND IMPROVEMENT: 1. The Contractor must provide a program for a continuous quality improvement (QI). Weekly and/or monthly meetings can serve this function as long as the meetings are attended by at least the Alternative Programs Lieutenant (or designee) and the Contractor s Health Services Supervisor (or designee). 2. The QI program will be utilized to evaluate the health care provided to the arrestees/inmates, at both on-site and off-site locations, on a continual basis for quality, appropriateness, and continuity of care. 3. The Contractor shall actively seek out opportunities for improvement for problems identified by the Contract monitor or Jail Commander regarding the on-site medical services rendered to arrestees/inmates. Page 55

309 4. In the event resolution cannot be reached during weekly/monthly meetings between the Parties, the matter may be referred to the Contractor s Chief Clinical Officer for the West Region, or designee and the County Legal Counsel for assistance. T. MEDICAL EQUIPMENT AND FURNISHINGS: 1. The Lane County Jail owns the existing medical equipment and office furnishings. A true and accurate copy of the Jail s medical equipment inventory list is attached hereto as Exhibit F. a. Contractor will review the County medical equipment list and compare to Contractor s operational needs. b. Contractor will provide the Alternative Programs Lieutenant or designee with a list of all equipment owned by Contractor that will be brought into the Lane County Jail facility (include in Exhibit G). c. Contractor will be responsible for providing any additional medical equipment or supplies needed to satisfy the conditions of this Contract. The provision of Equipment and Furnishings with a purchase cost of less than $500 will be the responsibility of the Contractor. 2. In the event that additional equipment or furnishings not included in Exhibit F or Exhibit G with a value of $500 or more is required by Contractor during the term of the Contract, a written list of proposed added equipment and justification of need must be forwarded to the Alternative Programs Lieutenant or designee for consideration and processing. a. Any such equipment shall be purchased by the Contractor will be added to their inventory list, and shall remain the property of the Contractor at expiration or termination of Contract. b. County reserved the right to purchase needed equipment, which will be added to the County inventory list, and shall remain the property of the County at expiration or termination of Agreement. c. Additions to each party s inventory list will be documented and signed off by both parties immediately upon receipt of purchased equipment. 3. If the Ccontractor determines that additional equipment will be required prior to start-up, that list must be included as part of the proposal. a. The provision of Equipment and Furnishings with a purchase cost of less than $500 will be the responsibility of the Contractor. Page 56

310 4. Maintenance and replacement of equipment included in Exhibit F as belonging to Lane County Jail will be the responsibility of the County unless the damage was caused by negligence and misuse by Contractor staff. If negligence or misuse was the cause, Contractor will be responsible for repair or replacement. b. Any additional equipment replacement or purchase will be added to the inventory list and will be documented and signed off by both parties immediately upon receipt of purchased equipment 5. Contractor shall furnish and pay for all medically necessary prosthetic devices and appliances and prescription eyeglasses. U. CORPORATE EXPERIENCE: 1. The Contractor will have a minimum of five (5) years of experience in providing health care services for inmates in county jail facilities. 2. The Contractor will have experience in the management of health care programs in facilities of average daily populations between 300 and 700 inmates. 3. The Contractor will have experience in the management of health care programs in facilities operating a similar scope of service. V. ACCREDITATION: 1. The Contractor must provide a health care delivery system that conforms to current National Commission on Correctional Health Care (NCCHC) and American Correctional Association (ACA) standards; and make any necessary changes to its services to maintain compliance with these standards if and when the standards may change. 2. The Contractor is not required to obtain accreditation through NCCHC to provide the services called for in this Contract, but may elect to do so at its own option, with approval from the Jail Commander or designee. If the Contractor applies for accreditation, Contract will be responsible for all associated costs. a. The Contractor s administration will implement the process to provide required documentation to ensure accreditation if required and mandated by the Jail. W. MEDICAL SERVICE EQUIPMENT AND PERIPHERAL SUPPLIES: 1. The Contractor will have full use of the medical equipment owned by the County for their use in carrying out the requirements of these specifications. The Contractor will have the right, at its expense and subject to written authorization from the Alternative Programs Lieutenant and Maintenance Supervisor, to install any new equipment needed for efficient operations. Upon termination or cancellation of the Contract, the Contractor is responsible for the removal of the equipment and/or fixtures, and restoration of all areas to at least their original condition. All equipment and fixtures installed by the Contractor must be removed within a reasonable time, but no later than thirty (30) days after the termination or Page 57

311 cancellation of the Contract; otherwise the equipment will become the property of Lane County. 2. Lane County and the selected Contractor will perform a thorough inventory of all equipment, fixtures, and service wares prior to contract startup date. The parties must furnish and maintain an adequate inventory of the support equipment listed in Exhibit F and Exhibit G - BEFORE SERVICE BEGINS. The inventory lists must be signed off by authorized representatives of each party and both parties shall maintain copies of the lists. Thereafter, each party will maintain receipts that clearly identify any new purchases of such equipment, fixtures, and service wares. At the end of each year of service, the inventory list will be updated with purchases made during the newly completed service year. 3. The Contractor may be required to submit weekly inspection reports to the Alternative Programs Lieutenant or designee, detailing the condition, service performed and service needed on medical equipment. 4. The Contractor must immediately (in no event more than one (1) hour) submit a written report to the Alternative Programs Lieutenant or designee for any accident or, injury, loss of kitchen utensils,caused by medical equipment, and/or supplies o.r kitchen utensils or the loss of any medical equipment or medical supplies. 5. In the event the Contractor purchases any equipment during the term of this Contract, and the Contract is terminated, cancelled, or fails to be renewed, if the said equipment is not fully amortized, the Contractor agrees to sell, and Lane County has the option to purchase said equipment for the purchase price of the equipment minus any amortized amount to date, including any amount eligible for amortization but not yet actually realized. 6. The Contractor must order all medical supplies, resupply and stockage. 7. The Contractor is responsible for the maintenance and repair of all equipment owned or purchased by Contractor (as described in Section T above). The Contractor must clear all vendors subcontracted to come in the Jail to complete repairs with the Alternative Programs Lieutenant. 8. If applicable, the Contactor will purchase any existing medical supplies from the County that can be used for services rendered hereunder at fair market value. X. UTILITIES: 1. Lane County will provide all utilities necessary for the performance of medical service operations. 2. Lane County cannot guarantee an uninterrupted supply of water, steam, electricity, telephone, heat or air conditioning. The Contractor is responsible for the continuous medical services regardless of utility disruption, although the timing of services may be changed to alternatives approved in advance. Page 58

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313 1. Subject to other terms of this Scope of Services, t. The County will provide, at its expense, adequate medical facilities for services rendered at the Lane County Jail. The medical facilities are properly equipped and ready to operate together with heat, refrigeration and utilities services as may be required for the efficient performance of the Contract. These facilities are not to be used by the Contractor for any purpose other than Lane County inmate medical services and for the purpose contained in the Contract, unless prior written approval is obtained from the Alternative Programs Lieutenant or designee. 2. The County will provide basic training to the Contractor personnel in the areas of key control, radio usage, evacuation procedures, fire safety, inmate jail management, the Jail Management System Program, Misconduct Report usage, and lockdown procedures; as they apply to medical and mental health staff. Contractor is responsible for paying wages of Contract personnel while receiving training. 3. The County will provide trash and garbage removal and extermination services at the Jail to maintain sanitation (not responsible for medical or hazardous waste disposal). 4. The County will provide access to accurate and timely information for the number of inmate medical requests from within the facility through the Jail Management System program. This information must be recorded by the Contractor and provided to the Alternative Programs Lieutenant or designee on a monthly basis. 5. The County will provide adequate ingress and egress to all production areas. 6. The County will provide adequate heat, lights, ventilation, and all other utilities. 7. The County will provide radio communication, computers, printers, fax machine and business telephone service to the Contractor for Lane County medical-related business use. Contract may only use the telephone for local service and business-related calls. Additional telephone equipment, faxes, computers, or other equipment, if needed, will be at the Contractor s expense, and must be approved by Lane County. Lane County will provide radio communication equipment that is used in the existing facility for Contractor medical employee use. 8. The Contractor or Contractor personnel must not add any computer program, software or hardware to a County computer without prior approval from the Security Systems Administrator. The Contractor or Contract personnel must not use internet connections for personal reasons. 9. The County will provide general maintenance to the building structure including, but not limited to, the maintenance of water, sewer, ventilation, lighting, air conditioning, refrigeration, duct work, floor coverings, painting and wall and ceiling services. The County s direct maintenance staff does not perform day to day cleaning operations in the medical area. Page 60

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