COWLITZ COUNTY REQUEST FOR PROPOSALS INMATE HELATH CARE #09-2017 Issued September 13th, 2017 ADDENDUM #2 Issued: October 6th 2017 1
Vendor submitted questions; 1. Do you expect your inmate population to change significantly over the next three years? Our average daily population for each of the last 3 years has been 291, 263 and 282. The population has gone up and down, but not significantly. We are trending this year to be just under 300. There are no indicators that would suggest any kind of significant increase in our inmate population over the next 3 years. 2. Can you please provide a list of county owned, and CCS owned equipment? All equipment is owned by the County. 3. What is the overall average length of stay for inmates? The average length of stay for our inmates is 12 days. 4. What are detention officers roles in the process of assisting or managing medical services? Is a prescreen performed by custody? At present our Custody Staff pre-screen inmates during the intake process. Medical is notified of any alarming medical issues, otherwise the medical sheet is printed out and medical staff review it in a timely manner. As stated in the RFP we would like to have an RN perform the intake screening. Detention staff will standby with some of the inmates who are being triaged, dependent on their classification and institutional behavior. We have an officer accompany medical staff, during med pass, for those areas that are maximum security. 5. Is the two-hour window for screening currently met? I would say for the most part, yes. 6. Do you house ICE detainees? If so, how long is the typical stay, and does ICE provide inspections on an annual basis? We do not hold ICE detainees for more than 48 hours unless local charges have been added. 7. What did the County spend for offsite costs (hospitalization, outpatient, specialty services) for each of the last two years? 2015 $89,277.42 2016 $107,752.27 8. Please describe any services the county expects provider to make available to county staff, ie: flu vaccinations, TB, etc. Currently we receive Flu Vaccinations, TB test, and Hep B for new hires from our current provider. 9. Is the current provider performing any training activities to the county staff? They have offered some training. We have utilized the provider mental health staff for some suicide prevention training. 10. Are you a narcotic free facility? No 11. What was the price paid for medical services to CCS for the past 3 years can you provide a copy of the current contract? 2015 - $721,875.12 2016 737,756.25 medical services and $227,628 mental health services = $965,384.25 annually. 2017 2
$767,266.50 medical services and $227,628 mental health services = annually $994,894.50 12. There are many references to NCCHC, yet no requirement for accreditation. Are you currently accredited, and if so, when is it up for renewal. If not, is that a desire of the county? ACA or others? We are not currently accredited but would like our facility to meet those standards. It may be something we would look at in the future, obviously cost is a factor. Accreditation is not a requirement for this RFP. 13. The RFP states the 2016 average daily population (ADP) was 282. Does this include the juvenile facility? What was the 2016 ADP for the Cowlitz County Jail and the Cowlitz County Juvenile Department Detention Center? That number is for the Cowlitz County Jail only. Juvenile ADP for 2016 was 17 14. What ADP should all proposers utilize in calculating prices (by Jail and Juvenile)? 282 for the Jail and 17 for Juvenile Facility - 15. What do you consider a Mental Health Screening at intake? We have identified a series of questions, which are currently asked by our booking officers during the intake process. Evaluation by a qualified mental health professional would be necessary if any questions identified mental health problems. 16. Do you currently have the equipment on site to do x-ray and ultra sound? The County uses MobilexUSA, a subcontractor of the current provider, to provide onsite diagnostic services as needed. 17. How many hours per week do you currently have a physician or provider? Our staffing matrix currently calls for 2 hours for our Medical Director/Physician, 6 hours for midlevel provider (Somatic), 8 hours for Psychiatric Nurse Practioner and 80 Hours for Mental Health Professionals. 18. How long does a background check take, and will you allow an individual to work while the check is in progress? Our background check is fairly quick, typically within a few days. We do require that new staff attend a 2 hour orientation prior to being on their own. 19. What is method for sick call and is there a co-pay system in place? We have an electronic kite system where most sick calls are initiated. Medical staff have access to this platform. We also allow paper medical kites if access to the kiosk is not available. There is a $10 co-pay for new prescriptions and requests for sick call. 20. Please confirm that sick call shall be conducted seven days a week. Yes 3
21. What hospitals are currently used for off site needs? Typically St. Johns Medical Center in Longview, Washington is the hospital that is utilized. 22. The statistics in exhibit C do not contain any numbers other than ADP. Please provide statistics for 2016 and YTD 2017, separated by Juvenile and Adult facilities, if possible. These stats are not available to us at this time. 23. What is the current process for getting inmates enrolled in Medicaid? Who is enrolling them? We do have a community liaison, who works for Columbia Wellness, and is stationed in the jail to assist inmates with community services. This individual can help enroll inmates in Medicaid, however if an inmate is admitted to the Hospital and hasn t been enrolled in Medicaid the vendor ensures that this is taken care of. This allows the hospital to bill Medicaid rather than the jail. 24. Please confirm that sick call shall be conducted seven days a week. Yes 25. According to the RFP you require stabilization protocol -- are you currently providing this or is this new? Are you asking for a Restoration of Competency program? How many inmates per year have this need? What we are asking for is to ensure inmates are evaluated and then if medication is recommended for stabilization, that they be prescribed the appropriate medication. If the inmate has been prescribed mental health medication on the outside, and hasn t been taking it, that they are reevaluated and stabilized with appropriate medication if necessary. Our goal would be to minimize destructive behavior. 26. What is the current wait time to see the psychiatrist? Typically the Psychiatrist is able to see those on the list each week. 27. What hours are mental health staff on-site? The hours currently expected of mental health staff are specified in an earlier question. We are fairly flexible with how the provider schedules those staff members, however we would like to see some weekend coverage and possibly some staggering schedules to cover some evening time. The MHP employed by the County works Monday through Friday 0800-1700. 28. What has been the County s census for pregnant females each of the past two years? What is the average length of stay for this population? This would be a stat we would need mined by our IT staff, not accessible at this time. 29. What is the history of attempted and completed suicides for the past two years? We have had no successful suicides in the past two years. I do not have the data readily 4
available for the attempted suicides, that would require IT to mine information from our JMS. 30. Are there any collective bargaining agreements in place for current medical or mental health staff? No 31. Are candidates able to begin work pending completion of the background check? Yes, however we would like them to go through a 2 hour orientation class prior to working on the floor by themselves. 32. How many FTEs, by practice are currently on site? Can you provide a current staffing plan? We will provide the hours of current positions. We will not provide the current providers staffing matrix and how they schedule their staff. 1. Medical Director/Physician 2 hours a week 2. Mid-Level Provider (Somatic) 6 hours a week 3. Mid-Level Provider (Psychiatric) 8 hours a week 4. HSA (RN) 40 hours a week 5. Admin Assistant 20 hours a week 6. Registered Nurse 16 hours a week 7. LPN 208 hours a week 8. Mental Health Professional 80 hours a week 33. The statistics in exhibit C do not contain any numbers. Please provide statistics for 2016 and YTD 2017. We do not have any of these stats and would like the proposer to provide us with an example sheet, notating any stats that the proposer would not be able to provide the County if they were chosen as the successful bidder. Essentially these are the stats that the County wishes to have provided throughout the life of the contract and we want to ensure that the provider can deliver. 34. How long is the typical wait to see the dentist or hygienist? Is there a wait list? We do not have an onsite dentist. All dental referrals are taken off-site by custody staff. They are usually able to schedule in a reasonable amount of time. 35. Please describe your Keep On Person (KOP) medication policy, if any. It s a case by case basis, nitro, some creams, and Fixodent are a few of our KOP medications. 5
36. What is the current medical provider policy on narcotics, methadone and suboxone? We typically will follow the P&P of provider and recommendations, however nothing is blanket no. It is approved on a case by case basis with input from Medical Staff, Jail Administration and sometime the court. 37. How much was spent on (1) all medications, (2) HIV medications and (3) psychotropic medications for each of the last two years? ALL MEDS: 10/1/15-9/30/16: $128,726.45 10/1/16-9/30/17: $193,680.54 HIV: 10/1/15-9/30/16: $55,582.23 10/1/16-9/30/17: $74,168.65 PSYCH: 10/1/15-9/30/16: $28,879.47 10/1/16-9/30/17: $46,345.57 38. How are OTC meds provided? OTC medication is provided at med pass. OTC medications are purchased from our pharmaceutical vendor Westwood Pharmacy. 39. What are the times of med pass, and currently how long does med pass take to perform? Med pass times are currently staged at 0800, 1430 and 2100. The afternoon pass takes anywhere from 1-2 hours and the morning and nightshift passes take 2-3 hours each. 40. Are inmates released with a supply of medications? If so, how much and who pays for? Typically they are released with a 7 day supply of medication. The County pays for pharmaceuticals under a separate contract. 41. Which diagnostic/x-ray provider does the County currently use for diagnostic/x-ray services? How often are they on-site? What s the annual cost for diagnostic/x-ray services? MobilexUSA. On average 1-2 times a week. On average about $10,000 a year. 42. Which laboratory provider does the County currently use for lab services? How often are they on-site? What s the annual cost for lab services? Labcorp. We spent $30,024.79 in lab services for 2016. 43. Which medical waste provider does the County currently use? How often are they onsite? What s the annual cost for medical waste services? We use Stericycle for all our hazardous waste disposal. They are site once a week. The County pays for all waste disposal. 2016 - $2,458.09 6
44. What is connectivity like throughout the jail? Currently it is spotty as would be expected in a concrete and rebar environment, however our IT department has looked into installing additional access points to assist with better coverage. 45. What ambulance service is currently used? Most of the time the ambulance service utilized is AMR. 46. What type of health awareness training has been performed in the past 12 months? Our staff go through CPR, Blood Borne Pathogens, suicide prevention training. These trainings are put on by the County. 47. Do you expect the provider do vaccinations, drug screenings of any kind to the county staff? Would like to keep at least the status quo. 48. Are you currently under any type of consent decree or legal stipulation that would impact medical services? No. 49. What is the Juvenile Detention Center average daily population? ADP is 17 50. Will the county provide network and internet access for the implementation of electronic health records? That would be something that would require further discussions with our IT department, however I do not see as much of a hurdle as we have other vendors that we provide network and internet access too. 51. Will the county provide an interface to their JMS for the purposes of providing patient demographic and location data for the EHR? We currently use an in-house JMS system, which allows us to easily provide an interface to a vendor. However we are in the process of switching to Spillman as our JMS. This question would largely depend whether or not the provider already has an interface with Spillman for the EHR. Any cost associated with developing an interface with Spillman would need to be negotiated. 52. Please clarify the requirement in Item 1.10 on p.8 of the RFP that reads: Evaluation by a qualified mental health professional of mental health problems identified, upon intake into the Jail system, within 24 hours. Is it your requirement that a mental health professional will evaluate every inmate identified with any mental health issue within 24 hours? Our requirement would be for any identified mental health issue, whether identified by custody staff or a medical professional, that the MHP s should have eyes on it and make a determination as to the urgency of meeting with these identified individuals. We do use emergency mental health within the community for weekends and evenings in which no mental health staff are on site. 53. On page 21, it says the County will release information identified as being proprietary unless we obtain a court order enjoining that disclosure. Is this the correct reading? Yes, that is correct. That language is standard with all county contracts and abides by the Public Disclosure Laws for the State of Washington. We would not release identified information prior to contacting the vendor and giving them an opportunity to refute the release of the information. 7
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