LUZERNE COUNTY COUNCIL VOTING SESSION November 26, 2019 Council Meeting Room Luzerne County Courthouse 200 N. River Street Wilkes-Barre, PA 18701 6:01PM
6:01PM CALL TO ORDER
PLEDGE OF ALLEGIANCE AND MOMENT OF SILENCE
ROLL CALL
RECOGNITIONS & CEREMONIAL PROCLAMATIONS Retirements: Eric Aigeldinger, Lieutenant, Sheriff William Kimmel, Case Management Specialist, Drug & Alcohol Charles J. Smith, Jr., Corrections Officer, LCCF
ADDITIONS TO/DELETIONS FROM VOTING SESSION AGENDA
ADOPTION OF VOTING SESSION AGENDA
PUBLIC COMMENT ON VOTING SESSION AGENDA ITEMS Each speaker shall have three (3) minutes to address any or all items on the Agenda. Each speaker is asked to submit a Speaker Card before the first speaker is called and to limit individual comments to three (3) minutes. Speakers may not yield or transfer their time to another speaker.
OLD BUSINESS
NEW BUSINESS AGENDA ITEMS – CLERK OF COUNCIL Motion to approve minutes of the November 12, 2019 Voting Session ...... pages 1-3 Motion to approve minutes of the November 18, 2019 Special Voting Session ...... pages 4-5
AGENDA ITEMS – COUNTY MANAGER 1. Motion to adopt resolution to abate delinquent Luzerne County Taxes for the property Located at 125-133 E. Main Street, Newport Township………………………………………………………………………………………………….....…….…pages 6-14 2. Motion to adopt resolution authorizing the County Manager to execute a Lease Agreement between Luzerne County and Kingston Township for premises located at 11 Carverton Road, Trucksville, Pennsylvania, 18708 ...... pages 15-24 3. Motion to adopt resolution authorizing the County Manager to execute a Contract with Wexford Health Sources, Inc. for Inmate Health Care Services……………………………………………………………………………………….…pages 25-173
AGENDA ITEMS – COUNTY COUNCIL 4. Motion to adopt resolution declaring a vacancy on the Luzerne County Board of Elections and Registration……………………………………………….………………..pages 174-175
PUBLIC COMMENT This is an opportunity for members of the public to address the Council on matters not listed on the Agenda, but which must be within the subject matter jurisdiction of the Council. Speakers are requested to submit a Speaker Card before the first speaker is called and to limit individual comments to three (3) minutes. Speakers may not yield or transfer their time to another speaker.
ADJOURNMENT
Luzerne County Council November 12, 2019 Council Meeting Room Luzerne County Courthouse 200 N. River Street Wilkes-Barre, PA 18701
Minutes November 12, 2019 Voting Session
Call to Order The Luzerne County Council convened for a Voting Session in the Council Meeting Room of the Luzerne County Courthouse on Tuesday, November 12, 2019, at 6:01 PM. The meeting was called to order by Vice Chair Jane Walsh Waitkus.
Pledge of Allegiance and Moment of Silence Ms. Waitkus announced the Pledge of Allegiance will be led by Girl Scout Troop 32906.
Roll Call Present Patrick M. Bilbow Harry Haas (via phone) Linda McClosky Houck Rick Morelli Chris Perry Sheila Saidman, Esq. Robert Schnee Stephen A. Urban (arrived at 6:05PM) Matthew Vough Jane Walsh Waitkus
Also Present C. David Pedri, Esq., County Manager Romilda P. Crocamo, Chief County Solicitor Sharon Lawrence, Clerk of Council
Absent Tim McGinley
Luzerne County Council Voting Session November 12, 2019 Page 1 of 3 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 1 of 175
Recognitions/Ceremonial Proclamations Ms. Waitkus read a proclamation for Sam-Son Productions/SSPTV. The Lesante Family, which was presented by Mr. Morelli on Election Night.
Mr. Stephen A. Urban arrived at 6:05 PM
Additions to/Deletions from Voting Session Agenda Motion to remove the Retirement Board Appointment from the agenda: Ms. Houck Second: Mr. Vough Vote: Ten (10) Ayes – Unanimous The Retirement Board Appointment is removed from the agenda.
Adoption of Voting Session Agenda Motion to Adopt: Ms. Houck Second: Mr. Schnee Vote: Ten (10) Ayes – Unanimous The Voting Session Agenda is Adopted (10-0)
Public Comment on Voting Session Agenda Items None
Old Business None
New Business Motion to adopt minutes of the October 22, 2019 Voting Session Motion by: Ms. Saidman Second: Mr. Morelli Vote: Nine (9) Ayes by Mr. Bilbow, Mr. Haas, Ms. Houck, Mr. Morelli, Mr. Perry, Ms. Saidman, Mr. Schnee, Mr. Vough and Ms. Waitkus One (1) Nay by Mr. Stephen A. Urban Motion Passed (9-1) The October 22, 2019 Voting Session Minutes are Adopted
Luzerne County Council Voting Session November 12, 2019 Page 2 of 3 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 2 of 175
Motion to adopt minutes of the October 29, 2019 Special Voting Session Motion by: Ms. Houck Second: Mr. Vough Vote: Nine (9) Ayes by Mr. Bilbow, Mr. Haas, Ms. Houck, Mr. Morelli, Mr. Perry, Ms. Saidman, Mr. Schnee, Mr. Vough and Ms. Waitkus One (1) Nay by Mr. Stephen A. Urban Motion Passed (9-1) The October 29, 2019 Special Voting Session Minutes are Adopted
1. Retirement Board Appointment Removed
Public Comment Anne Davies (Dallas) commented on voting machines and the companies providing them.
Joe McCabe (Exeter) stated West Wyoming received a grant from Mohegan Sun and wanted to know if the lobbyist group that received a payment from the grant was the same lobbyist group retained by the County. Mr. Pedri responded he did not believe the County’s lobbyist group represented West Wyoming and would check on it.
Motion to Adjourn: Mr. Stephen A. Urban Second: Ms. Saidman Vote: Ten (10) Ayes - Unanimous Meeting Adjourned at 6:16 PM
Respectfully Submitted, Sharon Lawrence Clerk of Council
* Audio of this meeting can be found in its entirety on the County Council webpage http://www.luzernecounty.org/county/luzerne-county-council or by contacting the Office of the Clerk of Council at (570) 825-1634 or via email to [email protected]
Luzerne County Council Voting Session November 12, 2019 Page 3 of 3 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 3 of 175
Luzerne County Council November 18, 2019 Council Meeting Room Luzerne County Courthouse 200 N. River Street Wilkes-Barre, PA 18701
Special Voting Session Minutes
Call to Order The Luzerne County Council convened for a Special Voting Session in the Council Meeting Room of the Luzerne County Courthouse on Monday, November 18, 2019, at 5:01 PM. The meeting was called to order by Chair Tim McGinley.
Pledge of Allegiance and Moment of Silence
Roll Call Present Patrick M. Bilbow Linda McClosky Houck Tim McGinley Rick Morelli Chris Perry Sheila Saidman, Esq. Stephen A. Urban (via phone) Matthew Vough Jane Walsh Waitkus
Also Present C. David Pedri, Esq., County Manager Romilda P. Crocamo, Chief County Solicitor Sharon Lawrence, Clerk of Council
Absent Harry Haas Robert Schnee
Luzerne County Council Special Voting Session November 18, 2019 Page 1 of 2 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 4 of 175
Adoption of Special Voting Session Agenda Motion to Adopt: Ms. Waitkus Second: Ms. Saidman Vote: Nine (9) Ayes – Unanimous The Special Voting Session Agenda is Adopted (9-0)
Public Comment on Special Voting Session Agenda Items None
Agenda Item 1. Motion to adopt resolution urging Governor Wolf and the Pennsylvania Department of Corrections to Keep the State Correctional Institute at Retreat Open Motion by: Mr. Bilbow Second: Mr. Stephen A. Urban Roll Call Vote: Nine (9) Yes – Unanimous Motion Passed (9-0) Resolution is Adopted
Public Comment None
Motion to Adjourn: Ms. Houck Second: Mr. Vough Vote: Nine (9) Ayes - Unanimous Meeting Adjourned at 5:04 PM
Respectfully Submitted, Sharon Lawrence Clerk of Council
* Audio of this meeting can be found in its entirety on the County Council webpage http://www.luzernecounty.org/county/luzerne-county-council or by contacting the Office of the Clerk of Council at (570) 825-1634 or via email to [email protected]
Luzerne County Council Special Voting Session November 18, 2019 Page 2 of 2 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 5 of 175
RESOLUTION R-2019- LUZERNE COUNTY COUNCIL
A Resolution of the Luzerne County Council to Abate Delinquent Luzerne County Taxes for the Property Located at 125-133 E. Main Street, Newport Township
WHEREAS, the Home Rule Charter, Section 2.09(B)(2), gives Luzerne County Council the power to levy, establish, alter and/or abolish taxes and assessments except as may be limited by the Charter or applicable law; and
WHEREAS, Newport Township intends to receive via deeds of owner Charles Hayes III, the properties known as 125 -133 E. Main Street, Newport Township; and
WHEREAS, the properties located at 125-133 E. Main Street, Newport Township have been placed with Northeast Revenue Services, LLC for tax sale due to several years of delinquent property taxes; and
WHEREAS, it is Newport Township’s intent to secure funding for the demolition of all of the existing structures on the properties which are in an advanced and deteriorating stage and present a public nuisance to Township residents; and
WHEREAS, Newport Township would ultimately then seek to sell the properties; and
WHEREAS, the Nanticoke Area School District and Newport Township have agreed to abate their delinquent taxes related to the properties in order for Newport Township to take title to the properties as set forth above; and
WHEREAS, the outstanding Luzerne County taxes, penalties and interest on 125-133 E. Main Street, Newport Township (as of October 22, 2019) are:
PIN: 46-K6S2-009-007-000 PIN: 46-K6S2-09A-002-000
2014: $ 740.51 2017: $15.03 2015: $1,162.09 2018: $13.96 2016: $1,089.09 Total: $28.99 2017: $1,057.23 2018: $ 981.56 Total: $5,030.72
WHEREAS, Luzerne County desires to abate the delinquent County taxes, interest and penalties on 125-133 E. Main Street, Newport Township in the amount of $5,059.71 plus any additional interest that has accrued through the effective date of this Resolution subject to the following conditions:
a. Newport Township must acquire the property and demolish any unsafe structures located on the properties within one (1) year of the effective date of this Resolution; and
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 6 of 175
b. {Any additional conditions required by Luzerne County Council? TBD}
NOW, THEREFORE, BE IT RESOLVED, the delinquent Luzerne County taxes, penalties and interest in the amount of $5,059.71 will be abated subject to the terms and conditions set forth above; and
BE IT FURTHER RESOLVED, Newport Township will purchase the 125-133 E. Main Street, Newport Township property free and clear of the Luzerne County taxes from the designated owners.
This Resolution shall become effective six (6) days from adoption.
ADOPTED at a meeting of Luzerne County Council held on ______, 2019.
LUZERNE COUNTY COUNCIL
ROLL CALL VOTE (0-0)
Yes: No:
By: Tim McGinley, Chair
ATTEST: Sharon Lawrence, Clerk to Council
By: C. David Pedri, Esq., County Manager
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 7 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 8 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 9 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 10 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 11 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 12 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 13 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 14 of 175 AGENDA SUBMITTAL TO LUZERNE COUNTY COUNCIL
ITEM TITLE COUNCIL MEETING AGENDA Consider adoption of a Resolution authorizing the DATE NUMBER County Manager to execute a Lease Agreement Voting Session between Luzerne County and Kingston Township November 12, 2019 for premises located at 11 Carverton Road, Trucksville, Pennsylvania, 18708.
Dept: Office of Law Contact: Romilda Crocamo Phone: 570-825-1598
SUMMARY:
Court Administration recommends that Council approve a Resolution [Attachment A] authorizing the County Manager to execute the attached Lease Agreement [Attachment B] with Kingston Township for the property at 11 Carverton Road, Trucksville, Pennsylvania, 18708, to be used as the offices of Magisterial District Court 11-03-09. The Court of Common Pleas is in agreement with the proposed Lease Agreement.
FINANCING:
Luzerne County Court Administration Budget.
DISCUSSION:
The current lease for Magisterial District Court 11-03-09 at 11 Carverton Road, Trucksville, Pennsylvania, 18708 expires on December 31, 2019.
The Lease Agreement allows for an initial term of three (3) years. The County may elect to renew the Lease Agreement, the terms and conditions of which are subject to negotiations. The total rent costs to the County is as follows:
January 1, 2020 through December 31, 2020: $2,455.05 per month January 1, 2021 through December 31, 2021: $2,491.88 per month January 1, 2022 through December 31, 2022: $2,535.48 per month
ALTERNATIVES:
County Council may decline to authorize the County Manager to enter into this Lease Agreement. This is not recommended because the current lease expires on December 31, 2019.
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 15 of 175 Luzerne County Council Agenda Submittal Proposed Lease Agreement – Kingston Township Date: November 12, 2019 – Page 2
ATTACHMENT A: Proposed Resolution
ATTACHMENT B: Lease Agreement
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 16 of 175 RESOLUTION R-2019-_____ LUZERNE COUNTY COUNCIL
A Resolution of the Luzerne County Council Authorizing the County Manager to Execute a Lease Agreement between Luzerne County and Kingston Township for premises located at 11 Carverton Road, Trucksville, Pennsylvania, 18708
WHEREAS, Luzerne County Council has authority to approve of all leases concerning real property; and
WHEREAS, Luzerne County currently leases the premises located at 11 Carverton Road, Trucksville, Pennsylvania, 18708 for use in connection with the operations of Magisterial District Court 11-03-09; and
WHEREAS, the current lease agreement for this property expires on December 31, 2019; and
WHEREAS, the Lease Agreement has an initial term of three (3) years with an option to renew, the terms and conditions of which are subject to negotiations; and
WHEREAS, the monthly rental cost for the total space will range from $2,455.05 (2020) to $2,535.48 (2022); and
WHEREAS, the 11th Judicial District (Court of Common Pleas) concurs and recommends the adoption of the Lease Agreement.
NOW, THEREFORE, BE IT RESOLVED, the Luzerne County Council authorizes the County Manager to execute a Lease Agreement to lease space from Kingston Township for the premises located at 11 Carverton Road, Trucksville, Pennsylvania, 18708.
This Resolution shall become effective six days after adoption.
ROLL CALL VOTE: AYES- NAYS-
ADOPTED at a meeting of Luzerne County Council held on ______, 2019.
LUZERNE COUNTY COUNCIL
By:______Tim McGinley, Chair
ATTEST:______Sharon Lawrence, Clerk of Council
______C. David Pedri, Esq., County Manager
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 17 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 18 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 19 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 20 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 21 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 22 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 23 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 24 of 175 AGENDA SUBMITTAL TO LUZERNE COUNTY COUNCIL
ITEM TITLE COUNCIL MEETING AGENDA Inmate Health Care Services DATE NUMBER November 12, 2019 Dept: Luzerne County Division of Corrections Contact: Mark Rockovich Phone: 570-829-7750
DEPARTMENTAL RECOMMENDATION:
The Division of Corrections makes the recommendation that Council approves a three year contract for Inmate Health Care Services with Wexford Health Sources, Inc., Located at 501 Holiday Drive, Suite 300, Pittsburgh PA. 15220.
SUMMARY: The County had issued an RFP for inmate health care services and has found that Wexford Health Sources Inc., was the most responsible bidder that best serves the requirements of the Luzerne County Division of Corrections. This three year contract with a proposed commencement date of January 1, 2020 and expiration date of December 31, 2023 shall cost $2,829,353 in year one, $2,914,235 in year two and $3,001,662 in year three. The contractor shall provide comprehensive medical services, including medical, dental, mental/behavioral health, pharmacy, and electronic medical records, to offenders at the Luzerne County Division of Corrections.
FINANCING:
This is 100% county financed and is pending approval of County Council.
DISCUSSION:
ALTERNATIVES:
Four companies responded to the counties request regarding inmate health care services. The four companies that submitted responses were: Wellpath (incumbent), Wexford Health Sources, Correctional Behavioral Health, and Correctional Care. After a very thorough review of the written proposals, observation of the in-person presentations and responses of questions asked, the committee believed Wexford is the clear choice to provide inmate health services to Luzerne County.
OTHER AGENCY INVOLVEMENT:
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 25 of 175 RESOLUTION R-2019-_____ LUZERNE COUNTY COUNCIL
A Resolution of the Luzerne County Council Authorizing the County Manager to Execute a Contract with Wexford Health Sources, Inc. for Inmate Health Care Services
WHEREAS, the Luzerne County Manager has the authority to recommend, and Luzerne County Council the authority to approve, the execution of certain contracts pursuant to the Luzerne County Home Rule Charter; and
WHEREAS, after issuance of a Request for Proposals and subsequent provider interviews, the Luzerne County Manager in conjunction with the Luzerne County Division of Corrections have selected Wexford Health Sources, Inc. to provide Inmate Health Care Services; and
WHEREAS, the parties have extensively negotiated a contract relative to inmate health care services; and
WHEREAS, County Council desires to authorize the County Manager to execute the negotiated contract.
NOW, THEREFORE, BE IT RESOLVED, the Luzerne County Council authorizes the County Manager to execute a contract with Wexford Health Sources, Inc., subject to the terms and conditions presented to Council, for the provision of health care services for inmates lodged at the Luzerne County Correctional Facility.
This Resolution shall become effective six days after adoption.
ROLL CALL VOTE: AYES- NAYS-
ADOPTED at a meeting of Luzerne County Council held on ______, 2019.
LUZERNE COUNTY COUNCIL
By:______Tim McGinley, Chair
ATTEST:______Sharon Lawrence, Clerk of Council
______C. David Pedri, Esq. County Manager
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 26 of 175 LUZERNE COUNTY DIVISION OF CORRECTIONS INMATE HEALTH CARE SERVICES CONTRACT
THIS Contract is made between the County of Luzerne of the Commonwealth of Pennsylvania and WEXFORD HEALTH SOURCES, INC., located at 501 HOLIDAY DRIVE, SUITE 300, PITTSBURGH, PA 15220, hereinafter referred to as “Contractor” or “Wexford Health.”
WHEREAS, the County seeks to acquire a medical provider to maximize treatment and care of inmates within the detention facilities, thereby avoiding unnecessary instances involving transportation, utilization of staff, and security risks by such movement; and to insure that the health care program is operated in a humane manner with respect to the inmate's right to constitutional health care. Constitutional care means providing timely access to an appropriate level of medical care and providing the care ordered by a physician (provider) for inmates with serious medical needs. A serious medical need is a condition that would, without intervention, lead to a deterioration of function, pain, death or a public health risk.
WHEREAS, the County seeks to establish a contract between the Contractor and the Luzerne County Division of Corrections that will provide generally for the following: a. Quality health services for inmates at the Luzerne County Division of Corrections facilities b. Development and implementation of a health care plan with clear objectives, policies, and procedures that are compatible with those of the Luzerne County Division of Corrections and with a process for documenting ongoing achievement of contract obligations c. Utilization of appropriate personnel, in accordance with their Scopes of Practice, that are certified and licensed by the appropriate bodies as required by the Commonwealth of Pennsylvania d. Administrative leadership that provides for both cost accountability and responsiveness to the contract administrator (County/Director and or their designee) e. Assurance that Federal, State, local, and NCCHC requirements and standards of health care are met f. Continuing education of County/Director's staff, including suicide prevention offered to all staff
WHEREAS, the Contractor represents that it is in the business of providing items and/or services set forth in certain specifications entitled, "INMATE HEALTH CARE SERVICES"; and
WHEREAS, the Contractor represents that it has carefully studied the specifications and that it is familiar with all requirements and conditions set forth therein; and
Luzerne County Division of Corrections Inmate Health Care Services Contract 1 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 27 of 175 WHEREAS, the Contractor was the most responsible bidder that best serves the requirements of the Luzerne County Division of Corrections for said items and/or services and was awarded the contract to provide the items and/or services set forth in said specifications; and
WHEREAS, the County Executive is authorized to execute contracts on behalf of the County of Luzerne pursuant to Home Rule Charter, Section4.07 (A)(7);
NOW, THEREFORE, intending to be legally bound hereby, the Contractor and the County of Luzerne mutually agree as follows:
I. Terms and Conditions:
I.1 Duties of Contractor. The Contractor shall provide the following services relative to this Contract, as described in detail in Attachments A, B, C, D, and E at the end of this document:
I.1.A. The Contractor shall provide comprehensive medical services, including medical, dental, mental/behavioral health, pharmacy, and electronic medical records, to offenders at the Luzerne County Division of Corrections (LCDOC) as stipulated in the County’s Request for Proposals (RFP): Inmate Health Care Services, attached hereto and incorporated herein as Exhibit A. Contractor shall provide these services according to Contractor’s Proposal Response to RFP: Inmate Health Care Services, attached hereto and incorporated herein as Exhibit B, subject to the terms stated herein. Section II, Scope of Services, provides more specific detail as to level of services under the contract.
I.1.B. The minimum staffing levels for the Contract are set forth in Exhibit C, attached hereto and incorporated by reference. During the term of the Contract, the parties may mutually agree to adjust these staffing levels without amending the Contract, as long as the adjustment does not impact cost and is approved in writing by a person or persons designated by the respective leadership of LCDOC and Wexford of Health Sources, Inc. to approve such changes on their behalf.
I.1.C. Total Costs for each contract period are set forth in Exhibit D, attached hereto and incorporated by reference.
I.1.D. To allow for implementation of services, there shall be a ninety (90)-day grace period for Contractor’s obligation under the Contract to meet the LCDOC Performance Measures; for Contractor’s obligation to minimize backlogs including but not limited to, Sick Call, Screening, Chronic Care, and Dental; for Contractor’s obligation to not exceed a 30% staff turnover ratio; and for
Luzerne County Division of Corrections Inmate Health Care Services Contract 2 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 28 of 175 Contractor’s obligation to implement Telehealth, to the extent specified in Contractor’s proposal.
I.1.E. To allow for implementation of services, the staffing payback penalty requirement shall be waived for the first ninety (90) days of the Contract. This is to allow for implementation of effective recruitment and hiring strategies to fill existing vacant positions and deal with potential transition turnover of staff.
I.1.F. For purposes of staffing paybacks, by mutual written agreement of the parties, a lower level position may temporarily cover for a higher-level position (to be paid at lower position salary rates) when the substantive duties of the higher- level position can be performed by a lower level position on a temporary basis. For example, the parties may mutually agree that an LPN could cover for an RN (if within licensure) or mid‐levels for physicians on a temporary basis. Such agreement shall be on a case by case basis, shall be in writing, and approved by a person or persons designated by the respective leadership of LCDOC and Wexford Health to approve such changes on their behalf. Under all circumstances a higher-level position may temporarily cover for a lower- level position within scope of licensure.
I.1.G. In the event any of the following changes materially affects the cost to Wexford Health of providing health care services, the parties agree to meet to negotiate appropriate compensation: (1) expansion of new or like services, (2) increased requirements due to an LCDOC policy change that impacts services delivery, (3) a request for services that were not specified in the County’s RFP or Contractor’s RFP proposal, (4) advancement in medicine or medical treatment, and (5) changes required by Court order or new legislation. The parties agree to meet and negotiate in good faith within 30 days following the giving of notice to the other party of the change (whether the change is anticipated or implemented). If the parties fail to reach agreement regarding compensation or service requirement changes within the aforesaid 30-day period, then either party may refer this matter to the Commonwealth of Pennsylvania under Clause #14 of the Contract as a dispute. If the matter is not resolved by the Commonwealth to the satisfaction of either party, either party terminate this Contract with 60 days’ notice.
I.1.H. The parties do not intend to create in any other individual entity, inmate or patient, the status of third-party beneficiary, and this Contract shall not be construed as to create such status. The rights, duties and obligations contained in this Contract shall operate only between the parties to this Contract, and shall inure solely to the benefit of such parties. The provisions of this Contract
Luzerne County Division of Corrections Inmate Health Care Services Contract 3 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 29 of 175 are intended only to assist the parties in determining and performing their obligations hereunder. The parties intend and expressly agree that only parties signatory to this Contract shall have any legal or equitable right to seek to enforce this Contract, to seek any remedy arising out of a party’s performance or failure to perform any term or condition of this Contract, or to bring an action for the breach of or for damages or relief under this Contract.
I.1.I. The County agrees to allow the Contractor to invoice the County on a monthly basis. Population reports for each month shall be provided by the County to Contractor and these reports shall be used in calculating the invoice amount subject to the adjustments set forth in the Contract. Contractor’s monthly invoices shall be paid Net 30 days.
I.2 Consideration.
I.2.A. Annual contract compensation includes the furnishing of all professional services, labor, materials, equipment, insurance, licenses, and applicable taxes necessary or proper for the completion of the work. Contractor will manage care, coordinate care, adjudicate claims, complete and submit all Act 22 documents to include coordination of any off-site care providers and potential third-party payment resources, and pay all inmate off-site health care applicable cost, not including Prior to Booking cost, on a monthly basis. Annual compensation shall be in accordance with the schedule shown below.
Total cost of first year contract: $2,829,353
Total cost of second year contract: $2,914,235
Total cost of third year contract: $3,001,662
I.2.B. The Contractor shall be paid 1/12th of the annual cost of contract each month based on the contracted annual cost each year for performing the duties set forth above. This rate shall be inclusive of all services in the Contract subject to the limitations set forth therein. Payment Term will be recorded by the County as Net 30 days. (The County will pay the Contractor within 30 days after the date of receipt of a correct invoice describing work performed reasonable and applicable to the contract.)
I.2.C. The monthly rate shall be subject to the following inmate population adjustment: In the event the actual average daily population (ADP) for the month in the LCDOC prison exceeds 650, the County will pay Contactor an adjustment equal to the difference between the actual ADP and 650 multiplied by $4.09 per diem. In the event the actual ADP in the LCDOC prison is below 650, Contractor will credit the County an adjustment equal to the difference
Luzerne County Division of Corrections Inmate Health Care Services Contract 4 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 30 of 175 between the actual ADP and 650 multiplied by the $4.09 per diem. Any additional compensation or credits for inmate population will be payable/credited to the Contractor/County in the billing period following the billing period during which the population exceeded or was below the inmate cap for that year.
I.2.D. The inmate population shall be determined as of 12:00 a.m. every day of the contract term and the population for all of the days in a billing period (month) divided by the number of days in the billing period (month) shall be the average population for that billing period's computations.
I.3 Term. This contract shall cover a three (3)-year period. It shall commence on January 1, 2020 and shall remain in effect through December 31, 2022. Upon mutual agreement, the contract may be renewed for two (2) additional one-year extensions based upon negotiations of service delivery and costs. For any renewal, the annual payment may be adjusted to account for inflation based on the 12-month percent change in the Department of Labor’s Consumer Price Index- All Urban Consumers, U.S. City Average, Not Seasonally Adjusted, (CPI-U), for Medical or 3% whichever is higher. Changes in the contractual provisions or services to be furnished under the contract may be made only in writing, and must be approved by the County/Director and the agent of the Contractor. Should a decision be made to increase the scope of the contract, the County/Director and the provider will mutually agree, in writing, to an adjusted contract price.
I.4 Access to Records. The Contractor and its subcontractors, if any, shall maintain all books, documents, papers, accounting records, and other evidence pertaining to all costs incurred under this Contract. They shall make such materials available at their respective offices at all reasonable times during this Contract, and for three (3) years from the date of final payment under this Contract, for inspection by the County or its authorized designees. Copies shall be furnished at no cost to the County if requested.
I.5 Assignment; Successors. The Contractor binds its successors and assignees to all the terms and conditions of this Contract. The Contractor shall not assign or subcontract the whole or any part of this Contract without the County’s prior written consent. The Contractor may assign its right to receive payments to such third parties as the Contractor may desire without the prior written consent of the County, provided that the Contractor gives written notice (including evidence of such assignment) to the County thirty (30) days in advance of any payment so assigned. The assignment shall cover all unpaid amounts under this Contract and shall not be made to more than one party.
Luzerne County Division of Corrections Inmate Health Care Services Contract 5 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 31 of 175 I.6 Authority to Bind Contractor. The signatory for the Contractor represents that he/she has been duly authorized to execute this Contract on behalf of the Contractor and has obtained all necessary or applicable approvals to make this Contract fully binding upon the Contractor when his/her signature is affixed, and accepted by the County.
I.7 Changes in Work. The Contractor shall not commence any additional work or change the scope of the work until authorized in writing by the County. The Contractor shall make no claim for additional compensation in the absence of a prior written approval and amendment executed by all signatories hereto. This Contract may only be amended, supplemented or modified by a written document executed in the same manner as this Contract.
I.8 Compliance with Laws.
I.8.A. The Contractor shall comply with all applicable federal, state, and local laws, rules, regulations, and ordinances, and all provisions required thereby to be included herein are hereby incorporated by reference. The enactment or modification of any applicable county, state or federal statute or the promulgation of rules or regulations thereunder after execution of this Contract shall be reviewed by the County and the Contractor to determine whether the provisions of this Contract require formal modification.
I.8.B. The Contractor warrants that the Contractor and its subcontractors, if any, shall obtain and maintain all required permits, licenses, registrations, and approvals, and shall comply with all health, safety, and environmental statutes, rules, or regulations in the performance of work activities for the County.
I.8.C. All permits and licenses required by Federal, State, or local laws, rules and regulations necessary for the implementation of the work undertaken by the Contractor pursuant to the contract shall be secured and paid for by the Contractor. This includes any accreditation or certification costs. It is the responsibility of the Contractor to have and maintain the appropriate certificate(s) valid for work to be performed and valid for the jurisdiction in which the work is to be performed for all persons working on the job for whom a certificate is required.
I.9 Compliance with Standards.
I.9.A. Contractor will provide health care services which meet or exceed the National Commission on Correctional Health Care Standards.
Luzerne County Division of Corrections Inmate Health Care Services Contract 6 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 32 of 175 I.9.B. The Contractor will provide services which comply with all applicable jail standards.
I.10 Confidentiality of County and Contractor Information.
I.10.A. If a competing Vendor or other person seeks review or copies of the Contractor's confidential data, the LCDOC will notify the Contractor of the asserted data of the request. If the Contractor does not want the information disclosed, it agrees to indemnify the LCDOC and hold the LCDOC harmless against all actions or court proceedings that may ensue (including all court costs and attorney's fees), which seek to order the LCDOC to disclose the information. If the Contractor refuses to indemnify and hold the LCDOC harmless, the LCDOC may disclose the information.
I.10.B. Performance of the contract may require the Contractor to have access to and use of documents and data which may be confidential or considered proprietary to the LCDOC or its vendors, or which may otherwise be of such a nature that its dissemination or use, other than in performance of the contract, would be adverse to the interest of the LCDOC or others. Any document or data obtained by the Contractor from the LCDOC in connection with carrying out the services under this contract shall be kept confidential and not provided to any third party unless disclosure is approved in writing by the LCDOC, acting through the Director.
I.10.C. All information related to LCDOC's operations which are designated confidential by LCDOC and made available to the Contractor in order to carry out the contract, or which become available to the Contractor in carrying out the contract, shall be protected by the Contractor from unauthorized use and disclosure through the observance of the same or more effective procedural requirements as are applicable to the LCDOC. Any information deemed confidential shall be provided by the LCDOC to the Contractor in writing. The Contractor shall not be required under the provisions of this paragraph to keep confidential any data or information that is or becomes publicly available, is already rightfully in its possession, is independently developed by it outside the scope of the contract, or is rightfully obtained from third parties.
I.10.D. The County shall have the complete and unlimited right to access any and all information maintained by Contractor which may be needed to ensure compliance with the contract terms and conditions. The Contractor shall make available all records or data requested. Requested information deemed confidential by Contractor shall be labeled Proprietary and Confidential and
Luzerne County Division of Corrections Inmate Health Care Services Contract 7 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 33 of 175 used only for compliance review based upon mutually agreed upon access. Requested information shall not be subject to public disclosure.
I.11 Continuity of Services.
I.11.A. The Contractor recognizes that the service(s) to be performed under this Contract are vital to the County and must be continued without interruption and that, upon Contract expiration, a successor, either the County or another contractor, may continue them. The Contractor agrees to: i. Furnish phase-in training; and ii. Exercise its best efforts and cooperation to effect an orderly and efficient transition to a successor.
I.11.B. The Contractor shall, upon the County’s written notice: i. Furnish phase-in, phase-out services for up to sixty (60) days after this Contract expires; and ii. Negotiate in good faith a plan with a successor to determine the nature and extent of phase-in, phase-out services required. The plan shall specify a training program and a date for transferring responsibilities for each division of work described in the plan, and shall be subject to the County’s approval. The Contractor shall provide sufficient experienced personnel during the phase-in, phase-out period to ensure that the services called for by this Contract are maintained at the required level of proficiency.
I.11.C. The Contractor shall allow as many personnel as practicable to remain on the job to help the successor maintain the continuity and consistency of the services required by this Contract. The Contractor also shall disclose necessary personnel records and allow the successor to conduct on-site interviews with these employees. If selected employees are agreeable to the change, the Contractor shall release them at a mutually agreeable date and negotiate transfer of their earned fringe benefits to the successor.
I.11.D. The Contractor shall be reimbursed for all reasonable phase-in, phase-out costs (i.e., costs incurred within the agreed period after contract expiration that result from phase-in, phase-out operations).
I.12 Contractor Personnel.
I.12.A. The Luzerne County Division of Corrections may request replacement of any Contractor personnel believed unable to carry out the responsibilities of the contract and shall approve all appointments to the positions of Health Services
Luzerne County Division of Corrections Inmate Health Care Services Contract 8 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 34 of 175 Administrator, Director of Nursing, Medical Directors, supervising nurses, and other Contractor personnel. Luzerne County Division of Corrections reserves the right to evaluate all Contractor personnel selected to work at Luzerne County prior to employment of the Contractor. All Contractor personnel will be required to undergo a security/background check by the Luzerne County Division of Corrections.
I.12.B. The Luzerne County Division of Corrections may prohibit entry to any secure facility, or remove there from, a contract employee who does not perform his/her duties in a professional manner and/or is suspected to or has violated facility policy or procedure.
I.12.C. The Luzerne County Division of Corrections reserves the right to search any person, property, or article entering or leaving its facilities.
I.13 Default by County. If the County, sixty (60) days after receipt of written notice, fails to correct or cure any material breach of this Contract, the Contractor may cancel and terminate this Contract and institute measures to collect monies due up to and including the date of termination.
I.14 Disputes.
I.14.A. Should any disputes arise with respect to this Contract, the Contractor and the County agree to act immediately to resolve such disputes. Time is of the essence in the resolution of disputes.
I.14.B. The Contractor agrees that, the existence of a dispute notwithstanding, it will continue without delay to carry out all of its responsibilities under this Contract that are not affected by the dispute. Should the Contractor fail to continue to perform its responsibilities regarding all non-disputed work, without delay, any additional costs incurred by the County or the Contractor as a result of such failure to proceed shall be borne by the Contractor, and the Contractor shall make no claim against the County for such costs.
I.14.C. If the parties are unable to resolve a contract dispute between them after good faith attempts to do so, a dissatisfied party may request the other party to pursue non-binding mediation. If agreed to by both parties, the dissatisfied party shall give written notice to the Mediator and the other party. The notice shall include: (1) a description of the disputed issues, (2) the efforts made to resolve the dispute, and (3) a proposed resolution. The Mediator shall promptly issue a Notice setting out documents and materials to be submitted to the Mediator in order to resolve the dispute; the Notice may also afford the
Luzerne County Division of Corrections Inmate Health Care Services Contract 9 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 35 of 175 parties the opportunity to make presentations and enter into further negotiations. Within thirty (30) business days of the conclusion of the final presentations, the Mediator shall issue a written decision and furnish it to both parties. The Mediator’s decision shall be the final and conclusive administrative decision. Either party may take such other action helpful to resolving the dispute, including submitting the dispute to a Pennsylvania court of competent jurisdiction, which shall be the Court of Common Pleas of Luzerne County, Pennsylvania. If the parties accept the Mediator’s decision, it may be memorialized as a written Amendment to this Contract if appropriate.
I.15 Employment Eligibility Verification. The Contractor swears or affirms under the penalties of perjury that the Contractor does not knowingly employ an unauthorized alien. The Contractor further agrees that:
I.15.A. The Contractor shall enroll in and verify the work eligibility status of all his/her/its newly hired employees through the E-Verify program. The Contractor is not required to participate should the E-Verify program cease to exist. Additionally, the Contractor is not required to participate if the Contractor is self-employed and does not employ any employees.
I.15.B. The Contractor shall not knowingly employ or contract with an unauthorized alien. The Contractor shall not retain an employee or contract with a person that the Contractor subsequently learns is an unauthorized alien.
I.15.C. The Contractor shall require his/her/its subcontractors, who perform work under this Contract, to certify to the Contractor that the subcontractor does not knowingly employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The Contractor agrees to maintain this certification throughout the duration of the term of a contract with a subcontractor.
I.16 Employment Option. If the County determines that it would be in the County’s best interest to hire an employee of the Contractor, the Contractor will release the selected employee from any non-competition agreements that may be in effect. This release will be at a negotiated recruitment fee to the County and all vacancy penalties will be waived for 90 days as contractor recruits and hires replacement.
I.17 Equipment, Space Available, and Bio Hazardous Waste.
I.17.A. The County shall provide space, limited housekeeping, linens, laundering, facility fixtures, utilities, telephone service, and security. All utilities and general structural maintenance of this area shall be the responsibility of the
Luzerne County Division of Corrections Inmate Health Care Services Contract 10 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 36 of 175 County/Director. Special wiring, outlets, or other electrical work reasonably necessary to the operation of the Contractor shall be at the expense of the County. Modifications requiring structural changes shall be at the expense of the Contractor if requested by the contractor and not necessitated by changes in scope of the contract or in compliance with other mandated changes.
I.17.B. For the life of the agreement, the Contractor is responsible for the purchasing of all medical/office equipment less than $1,500.00 necessary to perform inmate health care. The Contractor shall also be responsible for repair or replacement of all medical equipment, (County’s or Contractor’s) used by any Contractor’s staff. In like manner, the County shall be responsible for any direct loss or damage to property or equipment of the Contractor caused by negligence of the Luzerne County Division of Corrections employees.
I.17.C. All current equipment and any equipment purchased by the successful Contractor shall revert to the County upon contract termination in its present condition, reasonable wear and tear accepted.
I.17.D. The disposal of contaminated waste shall be the responsibility of the Contractor. Disposal of these wastes must be in accordance with all Federal, State, and local laws.
I.18 Force Majeure. In the event that either party is unable to perform any of its obligations under this Contract or to enjoy any of its benefits because of natural disaster or decrees of governmental bodies not the fault of the affected party (hereinafter referred to as a “Force Majeure Event”), the party who has been so affected shall immediately or as soon as is reasonably possible under the circumstances give notice to the other party and shall do everything possible to resume performance. Upon receipt of such notice, all obligations under this Contract shall be immediately suspended. If the period of nonperformance exceeds thirty (30) days from the receipt of notice of the Force Majeure Event, the party whose ability to perform has not been so affected may, by giving written notice, terminate this Contract.
I.19 Funding Cancellation. When the Director of the County Budget Agency makes a written determination that funds are not appropriated or otherwise available to support continuation of performance of this Contract, this Contract shall be canceled. A determination by the Director of County Budget Agency that funds are not appropriated or otherwise available to support continuation of performance shall be final and conclusive.
Luzerne County Division of Corrections Inmate Health Care Services Contract 11 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 37 of 175 I.20 Governing Law. This Contract shall be governed, construed, and enforced in accordance with the laws of the State of Pennsylvania, without regard to its conflict of laws rules. Suit, if any, must be brought in the State of Pennsylvania.
I.21 HIPAA Compliance. If this Contract involves services, activities or products subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Contractor covenants that it will appropriately safeguard Protected Health Information (defined in 45 CFR 160.103), and agrees that it is subject to, and shall comply with, the provisions of 45 CFR 164 Subpart E regarding use and disclosure of Protected Health Information.
I.22 Indemnification. The Contractor shall indemnify and hold harmless Luzerne County/Director, and their agents, servants, employees, appointees, officers, administrators, successors or assigns from any and all claims, demands, damages, actions, causes of actions, suits, judgments, or liabilities of any kind or nature whatsoever, asserted or sustained by any person or to any property including but not limited to compensatory, consequential, incidental or punitive, and further including any charges, expenses, attorney's fees or other costs incurred, which arise out of or derive from, in whole or in part, the performance of any services, duties, responsibilities pursuant to the Inmate Health Care Services Agreement. The aforesaid agreement to indemnify and hold harmless shall include the Contractor's agreement to undertake at its own expense the defense of any such action, claims, demands, damages, actions, causes of actions, suits, judgments, or liabilities of any kind or nature whatsoever, brought against Luzerne County/Director and its agents, servants, employees, appointees, officers, administrators, successors or assigns, which claims damaged allegedly resulting from, in whole or in part, the performance of any service, duty or responsibility included in or resulting from the Inmate Health Care Services Agreement. The agreement to indemnify and hold harmless shall not include indemnity for acts or negligence on the part of Luzerne County/Director, and its agents, servants, employees, appointees, officers, administrators, successors or assigns and shall not change the status of the Contractor as an independent contractor nor waive or limit any rights of Luzerne County/Director and its agents, servants, employees, appointees, officers, administrators, successors or assigns.
I.23 Independent Contractor; Workers’ Compensation Insurance. The Contractor is performing as an independent entity under this Contract. No part of this Contract shall be construed to represent the creation of an employment, agency, partnership or joint venture agreement between the parties. Neither party will assume liability for any injury (including death) to any persons, or damage to any property, arising out of the acts or omissions of the agents, employees or subcontractors of the
Luzerne County Division of Corrections Inmate Health Care Services Contract 12 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 38 of 175 other party. The Contractor shall provide all necessary unemployment and workers’ compensation insurance for the Contractor’s employees, and shall provide the County with a Certificate of Insurance evidencing such coverage prior to starting work under this Contract.
I.24 Insurance. The Contractor and their subcontractors (if any) shall secure and keep in force during the term of this Contract the following insurance coverages (as detailed in exhibit A) covering the Contractor for any and all claims of any nature which may in any manner arise out of or result from Contractor’s performance under this Contract.
I.24.A. The Contractor shall provide and maintain the following minimum limits of insurance coverage during the period of performance required under a contract resulting from this Request for Proposal:
I.24.A.(i) Comprehensive General Liability
$1,000,000 Bodily Injury and Property Damage per occurrence and $3,000,000 aggregate for bodily injury and property damage with no annual aggregate on an occurrence form
Comprehensive General Form
Extended Business Liability Endorsement
Products/Completed Operations (to be provided for minimum of 24 months after completion of work)
Broad Form Contractual Liability
Personal Injury Liability
I.24.A.(ii) Comprehensive Automobile Liability
$1,000,000 Combined Single Limits for bodily injury and property damage with no annual aggregate on an occurrence form
Statutory Uninsured Motorist Coverage
Hired and Non-Owned Coverage
Motor Carrier Act Endorsement
I.24.A.(iii) Professional Liability
$1,000,000 per occurrence or claim made, with an annual aggregate of $3,000,000, if claim made insurance is offered by the
Luzerne County Division of Corrections Inmate Health Care Services Contract 13 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 39 of 175 Contractor then a Tail Policy must be purchased to cover the Statutes of Limitations and Statute of Repose for filing of lawsuits in Pennsylvania. The Contractor must provide annual proof of the "tail" policy for the period of the contract and through the Statute of Limitations of the State after the policy termination.
I.24.A.(iv) Worker's Compensation and Employer's Liability
Statutory Coverage for Pennsylvania
Employer's Liability up to $1,000,000
Broad Form All States Endorsement
I.24.B. Prior to commencing work under this contract, the Contractor shall furnish The Luzerne County Division of Corrections with a Certificate of Insurance naming Luzerne County/Director as an additional insured, giving a Ninety, (90), day notice of cancellation, non-renewal, or change in the insurance coverage. Any cancellations or lapses of insurance affecting any jail (or Hospital) facility under contract shall be deemed a material breach.
I.25 Merger & Modification. This Contract constitutes the entire agreement between the parties. No understandings, agreements, or representations, oral or written, not specified within this Contract will be valid provisions of this Contract. This Contract may not be modified, supplemented, or amended, except by written agreement signed by all necessary parties.
I.26 Nondiscrimination. Pursuant to the Pennsylvania Civil Rights Law, and in keeping with the purposes of the federal Civil Rights Act of 1964, the Age Discrimination in Employment Act, and the Americans with Disabilities Act, the Contractor covenants that it shall not discriminate against any employee or applicant for employment relating to this Contract with respect to the hire, tenure, terms, conditions or privileges of employment or any matter directly or indirectly related to employment, because of the employee’s or applicant’s race, color, national origin, religion, sex, age, disability, ancestry, status as a veteran, or any other characteristic protected by federal, state, or local law (“Protected Characteristics”). Contractor certifies compliance with applicable federal laws, regulations, and executive orders prohibiting discrimination based on the Protected Characteristics in the provision of services. Breach of this paragraph may be regarded as a material breach of this Contract, but nothing in this paragraph shall be construed to imply or establish an employment relationship between the County and any applicant or employee of the Contractor or any subcontractor.
Luzerne County Division of Corrections Inmate Health Care Services Contract 14 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 40 of 175 I.27 Notice to Parties. Whenever any notice, statement or other communication is required under this Contract, it shall be sent by first class mail or via an established courier/delivery service to the following addresses, unless otherwise specifically advised.
I.27.A. Notices to the County shall be sent to:
Director Mark Rockovich Luzerne County Division of Corrections 99 Water Street Wilkes-Barre, PA 18711
I.27.B. Notices to the Contractor shall be sent to:
John Froehlich, CFO Wexford Health Sources, Inc. 501 Holiday Drive Suite 300 Pittsburgh, PA 15220
I.28 Order of Precedence; Incorporation by Reference. Any inconsistency or ambiguity in this Contract shall be resolved by giving precedence in the following order: (1) this Contract, (2) RFP: Inmate Health Care Services, (3) Contractor’s response to RFP: Inmate Health Care Services, and (4) attachments prepared by the Contractor. All attachments, and all documents referred to in this paragraph, are hereby incorporated fully by reference.
I.29 Progress Reports. The Contractor shall submit progress reports to the County upon request. The report shall be oral, unless the County, upon receipt of the oral report, should deem it necessary to have it in written form. The progress reports shall serve the purpose of assuring the County that work is progressing in line with the schedule, and that completion can be reasonably assured on the scheduled date.
I.30 Public Information. Neither the Contractor nor the County shall publish any findings based on data obtained from the operation of a contract agreement without the prior consent of the other party, whose written consent shall not be unreasonably withheld. The Contractor will provide the County/Director with any and all requested information pertaining to the contract agreement/operation when requested in writing by the LCDOC or its designee. The information will be submitted in written form.
Luzerne County Division of Corrections Inmate Health Care Services Contract 15 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 41 of 175 I.31 Quality Assurance. A quality assurance program will be ongoing, consisting of regularly scheduled audits of inmate health care services with documentation of deficiencies and plans for correction of deficiencies. The quality assurance plan shall include a provision for program and contract monitoring (peer review) by an "outside" correctional health care consultant on an annual basis, the results of which shall be made available to the Director of Corrections and designated LCDOC staff. The cost will be paid by the Contractor.
I.32 Research. No research projects involving inmates, other than projects limited to the use of information from records compiled in the ordinary delivery of patient care activities, shall be conducted without prior written consent of the County or conducted without prior written consent of the County or its designee. The conditions under which research shall be conducted shall be agreed to by the Contractor and the County or its designee, and shall be governed by written guidelines. In every case, the written informed consent of each inmate who is a subject of a research project shall be obtained prior to the participation of an inmate as a subject.
I.33 Severability. The invalidity of any section, subsection, clause or provision of this Contract shall not affect the validity of the remaining sections, subsections, clauses or provisions of this Contract.
I.34 Subcontracts. Luzerne County Division of Corrections and or its representative must approve, in advance, all subcontracts entered into by the Contractor for the purpose of completing the provisions of this contract. The Contractor will not sell, assign, transfer, nor convey any of its rights except with the written consent of the County or its designee. All contracts for services and or activities subcontracted by the Contractor in order to meet the obligations of this RFP must be entered into and completed within fifteen days of the contract start date. After contract start date no subcontracted services and or activities contracted between Contractor and subcontracted parties may lapse or remain unassigned more than thirty (30) days.
I.35 Termination for Convenience. This Contract may be terminated by the County or the Contractor, for any reason, if one party determines that such termination is in its best interest. Termination of services shall be effected by delivery to the other party of a Termination Notice at least one hundred twenty (120) days prior to the termination effective date. The Contractor shall be compensated for services properly rendered prior to the effective date of termination. The County will not be liable for services performed after the effective date of termination. The Contractor shall be compensated for services herein provided but in no case shall total payment made to the Contractor exceed the original contract price.
Luzerne County Division of Corrections Inmate Health Care Services Contract 16 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 42 of 175 I.36 Termination for Default.
I.36.A. The Luzerne County Division of Corrections may terminate the contract resulting from this Request for Proposal at any time the Contractor fails to carry out its provisions. The County shall give the Contractor notice of such termination with stated reasons for the termination. If, after such notice, the Contractor fails to cure the conditions within the specified time period contained in the notice, it shall be the discretion of the County to order the Contractor to stop work immediately and leave the premises or to reinstate the contract based upon corrective action.
I.36.B. The rights and remedies of the County in this clause are in addition to any other rights and remedies provided by law or equity or under this Contract.
I.37 Third Party Reimbursements.
I.37.A. Contractor will, where possible, seek third party insurance reimbursement for inmate medical services performed by the Contractor or other outside Medical Services. The Contractor will share all documentation received on insurance of third-party claims with the County. The contractor will make every effort and establish operation's procedures to routinely pursue all insurance claims, and other means of subrogation, for medical treatment provided.
The efforts to collect insurance information from the inmates upon booking and the successful performance by the Contractor to seek and collect third party payment for inmate health care services must be demonstrated and reported to Luzerne County Division of Corrections and or its designee on a monthly basis. This responsibility will be closely monitored by the County/Director in order to measure the compliance and success of the Contractor.
I.37.B. Contractor will be required to manage all applicable provisions of the Affordable Care Act of 2010 as it relates to the inmate population and the Commonwealth of Pennsylvania
I.38 Waiver of Rights. No right conferred on either party under this Contract shall be deemed waived, and no breach of this Contract excused, unless such waiver is in writing and signed by the party claimed to have waived such right. Neither the County’s review, approval or acceptance of, nor payment for, the services required under this Contract shall be construed to operate as a waiver of any rights under this Contract or of any cause of action arising out of the performance of this Contract, and the Contractor shall be and remain liable to the County in accordance with applicable
Luzerne County Division of Corrections Inmate Health Care Services Contract 17 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 43 of 175 law for all damages to the County caused by the Contractor’s negligent performance of any of the services furnished under this Contract.
I.39 Work Standards and Failure to Perform.
I.39.A. The Contractor shall execute its responsibilities by following and applying at all times the highest professional and technical guidelines and standards. If the County becomes dissatisfied with the work product of or the working relationship with those individuals assigned to work on this Contract, the County may request in writing the replacement of any or all such individuals, and the Contractor shall grant such request.
I.39.B. The services rendered under this contract will be critical to the mandated responsibilities of the Luzerne County Division of Corrections. Therefore, the Contractor will reimburse the County for all expenses incurred by the Luzerne County Division of Corrections in providing services which are the responsibility of the Contractor. Such expenses shall be reduced from the monthly payment due the Contractor. In the event the agreement is te1minated prior to its expiration, all finished or unfinished documents, studies, correspondence, reports, and other products prepared by or for the contractor under this agreement shall become the exclusive property of the Luzerne County Division of Corrections. Notwithstanding the above, the Contractor shall not be relieved of liability to the County/Director for damage sustained by the County/Director by virtue of any breach of the agreement by the Contractor.
II. Specifications and Contract Requirements
The Contractor will meet the following specifications and program requirements. This listing is not intended to be all inclusive, but serves as a guideline with recommendation for the development of a health care program for the inmate population in the custody of Luzerne County Division of Corrections. This includes the responsibility for providing all primary medical, dental, and mental health services.
Contractor is responsible for providing medical screening, admission evaluation, sick call, special needs care, hospitalization, all off-site service management, ambulance transport, pharmacy services, medical clearances for intra- and inter-agency transfer, meal planning, food handling and work clearances, the continuing care of identified health problems, detoxification, and emergency services.
Luzerne County Division of Corrections Inmate Health Care Services Contract 18 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 44 of 175 The Contractor is expected to provide comprehensive services that are legally defensible and which meet the National Commission on Correctional Health Care and PA. Title 37 Standards for Health Services in Jail facilities.
The Contractor will be responsible for all costs related to inmate health care services including, but not limited to:
Pharmaceutical/medical supplies
Office and medical equipment to include dental, radiographic, emergency, examination room, etc.
Personnel (not including the 13 nurses in the CBA)
Required off-site emergency and non-emergency services (hospital, specialty services, dental, laboratory, radiology)
Prosthesis
Eye care and glasses; the Contractor shall provide/pay all eye care/eye glasses on a referral basis when it is deemed necessary by the Provider for the health and well-being of an inmate.
Forms, office supplies, books;
Sufficient copying equipment to support the contract; and
Contaminated waste disposal.
II.1 Administrative Requirements.
II.1.A. Medical Providers. The Contractor shall provide, at a minimum, the following staff: (1) a singularly designated physician health authority to be known as the "Medical Director;" (2) a Psychiatrist for mental health services and (3) a Dentist for dental services, all tasked with the responsibility of assuring the appropriateness and adequacy of inmate health care.
II.1.A.(i) The Psychiatrist shall be physically present at LCDOC and/or available via tele psychiatry for a minimum of two (2) hours per week. If the psychiatrist practices via tele psychiatry, the psychiatrist will be required to be psychically present at LCDOC a minimum of two (2) hours per month. In addition, the Contractor shall have either (a) a full-time psychiatric Nurse Practitioner on- site, or (b) a full-time Physician Assistant present on site.
II.1.B. The Contractor shall provide a full-time Health Services Administrator (HSA) with the authority to oversee the administrative requirements of health care
Luzerne County Division of Corrections Inmate Health Care Services Contract 19 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 45 of 175 programs, such as recruitment, staffing, data gathering and review, monthly/daily reports of contract services activity as required by Luzerne County Division of Corrections, medical record keeping, and other management and clinical services.
II.1.B.(i) The Health Services Administrator (HSA). The HSA must be a Registered Nurse or a Nurse Practitioner and be competent and able to provide liaison services between (a) the LCDOC's psychology/psychiatry department, (b) the physical health department, and (c) the LCDOC's Director, Intake staff and Correctional Officer Staff. The HSA shall report directly to the Director of LCDOC or the Director's designee.
II.1.B.(ii) Director of Nursing (DON). The DON must be a Registered Nurse and be competent and able to provide appropriate supervision and direction for the Contractors nursing staff.
II.2 Staffing Requirements.
II.2.A. Staffing Plan. The Contractor shall provide the following health care personnel to provide appropriate medical and mental health services as outlined in this contract and, if necessary, those certain emergency services outlined herein. Appropriate relief and vacation scheduling shall be provided for all appropriate positions.
Position MON TUE WED THUR FRI SAT SUN Hrs/WK FTEs Medical Director 3 3 3 9 0.23 PA/NP 8 8 8 8 8 40 1.00 H.S.A. 8 8 8 8 8 40 1.00 Psych RN 8 8 8 8 8 40 1.00 AA/Records Clerk 8 8 8 8 8 40 1.00 Medical Records Clerk 4 4 4 4 4 20 0.50 Director of Nursing 8 8 8 8 8 40 1.00 RN 8 8 16 0.40 Dentist 4 4 8 0.20 Dental Assistant 4 4 8 0.20 Psychiatrist 2 2 0.05 Psychologist 1 1 0.03 LMHP 24 24 24 24 24 8 8 136 3.40 Sub Total 79 69 71 78 71 16 16 400 10.00 EVENING SHIFT RN 8 8 8 8 8 8 8 56 1.40 Sub Total 8 8 8 8 8 8 8 56 1.40 NIGHT SHIFT RN 8 8 8 8 8 8 8 56 1.40 Sub Total 8 8 8 8 8 8 8 56 1.40 GRAND TOTAL 95 85 87 94 87 32 32 512 12.80
Luzerne County Division of Corrections Inmate Health Care Services Contract 20 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 46 of 175 II.2.B. Position Requirements. Contractor staff shall provide the following services as required under the contract.
II.2.B.(i) Medical Physician services must be sufficient to provide the required needs of the day and assure medical evaluation/follow-up within twenty-four, (24), hours of post nursing triage referral, (including weekends and holidays). In addition, twenty-four, (24), hour physician on-call services with availability for consultation and on-site needs system-wide is required.
II.2.B.(ii) Nursing services, must be available to provide for the following:
Medical and Psychiatric Department coverage at all times
Intake screening on all inmates at time of admission
Histories and physicals on all inmates ideally within twenty- four (24) hours but no longer than fourteen (14) days of admission
Medications to be delivered as medically indicated
Sick call triage and follow-up on a daily basis
Appropriate and timely responses to medical needs and emergencies
Physician assistance services
Detoxification of "ambulatory detoxifying patients" that may be appropriately treated inside the prison
II.2.B.(iii) Mental Health Professionals must provide the following:
LCDOC Universal Suicide Risk Assessment
Crisis management
Communicate with LCDOC medical staff and Correctional Officers about high-risk inmates on a daily basis
Conduct daily assessments of all inmates on suicide watch and behavioral watch
Therapeutic services, including but not limited to, inmates requesting services
Assist psychiatrist, physician assistant, and/or nurse practitioner
Luzerne County Division of Corrections Inmate Health Care Services Contract 21 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 47 of 175 Attend weekly department meeting
Seek approval from the psychiatrist for inmate removal from suicide watch
Case management services for inmates active with psychology department
Aftercare planning prior to inmate release from LCDOC to include, but not limited to, securing medical insurance, securing housing, and securing community based psychiatric treatment
II.2.B.(iv) Psychiatrist must provide:
Review and approval of a complete psychiatric evaluation and treatment plan including a DSM-V diagnosis and an appropriate treatment medication management plan
Ongoing monitoring of the medication management plan and any changes that are made in conjunction with the PA or nurse practitioner
Review for denial or approval of a Brief Psychiatric Assessment to assist in aftercare housing and continuity of care with outpatient treatment which may be completed by the PA or nurse practitioner
Final approval for removal of suicide watch
II.2.B.(v) Nurse Practitioner and/or Physician's assistant must provide:
Develop a provisional assessment, DSM-V diagnosis, medication needs and treatment plan to be reviewed and approved by the psychiatrist consistent with the state regulations but no more than seven (7) days
Ongoing medication management monitoring
See inmates on a regularly scheduled basis for psychiatric status at a minimum of one time per month
Ongoing contact with the psychiatrist
Ongoing communication with the MHPs
Attend weekly department meeting
Luzerne County Division of Corrections Inmate Health Care Services Contract 22 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 48 of 175 Seek approval from the psychiatrist for inmate removal from suicide watch
Ensure the inmate is released with enough medication until the scheduled outpatient psychiatric appointment
II.2.B.(vi) HSA must provide:
Liaison services between (a) the LCDOC's psychology/psychiatry department, (b) the physical health department, and (c) the LCDOC's Director, Intake staff and Correctional Officer Staff.
Responsible for identifying high risk inmates including but not limited to, suicidality, high risk substance use detox, medication/treatment noncompliance and organic brain issues
Communicate high risk inmates with nurse practitioner/physician's assistant, MHP, physician and/or psychiatrist through the sharing of medical records and direct communication with the appropriate health care provider
Attend weekly psychiatry/psychology department meeting
II.2.B.(vii) Sufficient clerical support staff must be available to support the medical contract.
II.2.B.(viii) Written job descriptions and post orders to define specific duties and responsibilities for all assignments at each facility must be available at each site.
II.2.B.(ix) Copies of staffing schedules encompassing all health care staff are to be posted in designated areas and submitted to the Director of Corrections and Contract Monitor on a bi-weekly basis, with daily updates regarding changes.
II.2.C. Security Clearance. The Contractor shall provide the name, date of birth, local address, previous employment, social security number, and copy of driver's license for all employment applicants. Prior to County approval for employment, an applicant screening shall be conducted, coordinated with the Luzerne County Division of Corrections, fingerprints and background check may be required. Applicable licenses and/or certificates for all professional staff must be on file with the Luzerne County Division of Corrections prior to employment. In addition, malpractice insurance must be on file for all
Luzerne County Division of Corrections Inmate Health Care Services Contract 23 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 49 of 175 Physicians and Nurse Practitioners/Physician Assistants, Psychiatrist, Dentist and other professional or paraprofessional employees, if applicable.
II.2.D. Orientation. The Contractor shall provide a written plan for orientation and staff development/training appropriate to their health care delivery activity for all health care personnel. This plan must outline the frequency of continuing training for each staff position. LCDOC employees, including inmate suicide monitors, shall be included in all appropriate educational offerings.
II.2.E. Staffing Credit for Vacancy. The Contractor will be required to provide the Director for the actual costs of service hours not provided by any medical staff or contracted medical services position from the initial date of non- service to the date the staff position filled. To avoid the penalty, the open positions may be filled by equally qualified staff on an over time or pool agency basis not to exceed thirty days. Positions vacant for greater than a thirty-day period will be assessed a penalty of 1.5 times the wages/benefit.
II.2.E.(i) Paid-time off hours will count toward the hours required by the contract with the exception that paid-time off hours must be filled by agency, part-time or overtime for RN and CNP positions when leave is for more than 2 consecutive days.
II.2.E.(ii) Contractor shall report hours monthly to the Director.
II.2.E.(iii) There shall be a quarterly reconciliation completed to calculate any staffing credit. Staffing hours will be reconciled on total hours for the quarter by position and adjusted for approved coverage of positions as stipulated in the contract. Contractor shall be paid for approved additional hours provided by positions to meet operational needs.
II.2.E.(iv) If a vacancy remains unfilled in excess of 30 days , contractor has provided adequate coverage, no inordinate backlogs exist, and due diligence is evident in recruiting, Contractor may request waiver of the 1.5 time the wages/benefit penalty.
II.3 Clinical Care, Treatment, and Performance Requirements.
II.3.A. Emergency Medical Services. Provision for twenty-four, (24), hour a day emergency or immediate medical services to include on-site emergencies, transportation, and acute hospital services with one physician and appropriate health care providers.
Luzerne County Division of Corrections Inmate Health Care Services Contract 24 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 50 of 175 II.3.B. Sick Call. In addition to twenty-four, (24), hour a day emergency service coverage, the hours for routine nurse sick call at each site shall be at levels which allow for all inmates needing medical services to be seen as clinically necessary.
II.3.C. Policies and Procedures. Written manual of standardized policies and defined procedures approved by the health care authority and the Luzerne County Division of Corrections must be reviewed at least annually and revised as necessary under direction of health care authority with approval of the Luzerne County Division of Corrections. A copy of all policies in effect must be provided to the Director or Operations.
II.3.D. Laboratory and Radiology. Provision for necessary laboratory and x-ray services. All abnormal laboratory and x- ray results shall be reviewed and signed off by a physician with a follow-up plan of care outlined.
II.3.E. Dental Services. Dental services sufficient to provide for emergency and medically required dental for inmates at the jail within a reasonable period must be available
II.3.F. Close Medical Supervision. Development of special medical program which exists for inmates requiring close medical supervision, chronic and convalescent care needs. This section must include specific guidelines for housing standards of these inmates. Requirements to be included are:
II.3.F.(i) Each inmate assigned this classification must have a written individualized treatment plan.
II.3.F.(ii) Inmates committed under the influence of alcohol or drugs shall have an appropriate course of treatment, including a medically approved and supervised substance \specific detoxification program administered.
II.3.F.(iii) Inmates with suicidal tendencies and those with a history of having seizures, as determined by medical authority, must be assigned to quarters that have close observation.
II.3.F.(iv) Pharmacological support care must be determined by a physician.
II.3.G. Information Sharing. Luzerne County Division of Corrections and medical and mental health staff shall share relevant information including, but not limited to, communicable disease and behavior problems/disorders.
Luzerne County Division of Corrections Inmate Health Care Services Contract 25 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 51 of 175 II.3.H. Female Programming. Define a program for meeting the special needs of the female population, e.g., pregnancy. Exhibit B provides detail of the female special needs program.
II.3.I. Communicable Disease. The Contractor shall be responsible for operation of a Communicable Disease Unit.
II.3.J. Specialty Services. A written plan with specifics for provision of specialty health care services shall be followed.
II.3.K. Medical Clearances. Provision for examinations and medical clearance for all inmate workers, trustees, work release inmates, inmates assigned to work programs outside jail facilities, prior to placement in the assignment. Inmate worker medical clearances must include:
Relevant past medical history, including communicable disease, heart problems, respiratory problems, allergies, back problems
Questions for current signs and symptoms of illness
Current vital signs, including blood pressure, pulse, temperature
General examination for overall physical and mental health, with specific reference to (1) examination for evidence of communicable disease to include, but not to be limited to, skin problems such as rash, wounds, sores, boils, et cetera; and (2) heart and lung examinations
Current test for tuberculosis
Current test for Sexually Transmitted Disease
Completion of trustee clearance form prior to inmate placement in such assignment
II.3.L. Medical and Mental Health Screenings. Documented inmate medical and mental health screening shall be provided within eight (8) hours of arrival at the Luzerne County Division of Corrections (LCDOC) facility must be based on structured inquiry and observation, performed by qualified health care personnel, twenty-four, (24), hours a day, seven, (7) days a week. There will a $100 charge for every screening that exceeds the eight-hour limit.
II.3.L.(i) No unconscious person or a person who cannot be treated at the facility shall be admitted to the jail system. They must be referred immediately for emergency medical attention and their admission or return to the jail systems is predicated upon written medical clearance.
Luzerne County Division of Corrections Inmate Health Care Services Contract 26 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 52 of 175 II.3.L.(ii) Receiving screening findings should be recorded on a printed form approved by the health authority and LCDOC, which shall be provided by the vendor.
II.3.L.(iii) At a minimum, the screening must include inquiry into:
Current illness and health problems including mental, dental, and communicable diseases; this includes documentation of prior or present suicidal ideation.
Medications taken and special health requirements
Use of alcohol and drugs, including types, methods, amounts, frequency, date/time of last use and history of problems related to stoppage
For females, a history of gynecological problems and pregnancies
A list of current health insurance available to inmates
II.3.L.(iv) At a minimum, the screening must include the observation of:
Behavior, including state of consciousness, mental status to include thoughts of prior or present suicidal ideation, appearance, conduct, prior mental health problems, tremors, sweating
Notation of body deformities, trauma, markings, ease of movement
Condition of skin and body orifices, including rashes and infestations, needle marks, or other indications of drug abuse
II.3.L.(v) Inmates must be medically cleared before they are sent to general population.
II.3.L.(vi) All new admissions/screening charts are to be reviewed and signed by the MD/PA/NP within seventy-two (72) hours or sooner if medically necessary.
II.3.M. Health Appraisal. Each inmate shall be given a health appraisal, including a physical examination by qualified health care personnel within ten (10) days after admission to the jail system, based on the criterion listed in the NCCHC. There will a $200 charge for every H&P that exceeds ten days.
Luzerne County Division of Corrections Inmate Health Care Services Contract 27 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 53 of 175 II.3.M.(i) The extent of the health appraisal, including physical examination, is defined by the responsible health authority, however, it will include at a minimum:
Review of intake screening forms
Collection of additional data regarding complete medical, dental, psychiatric, and immunization histories
Appropriate laboratory and diagnostic tests to detect communicable disease (Sexually Transmitted Disease and Tuberculosis)
Recording vital signs (height, weight, pulse, blood pressure, temperature)
Physical examination with comments about mental and dental status. A gynecological assessment must be included for females
Review of physical examination and test results by a physician for problem identification
Initiation of therapy when appropriate
Other tests and examinations as clinically appropriate
II.3.M.(ii) The form used for the health appraisal must be approved by the Luzerne County Division of Corrections
II.3.M.(iii) The Luzerne County Division of Corrections policy and procedure requiring a health appraisal must be contained in the standard operating procedures of the medical section.
II.3.M.(iv) 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.
II.3.N. Housekeeping. Medical staff shall be responsible for all light housekeeping duties in the medical department with the exception of the floors, bathrooms, and showers.
II.3.O. Employee Medical Services. Medical staff shall respond to medical needs of the Luzerne County Division of Corrections staff on duty and document services provided.
Luzerne County Division of Corrections Inmate Health Care Services Contract 28 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 54 of 175 II.3.P. Use of Inmates. Inmates will not be allowed to provide any health care services, including record keeping.
II.3.Q. Inspection Reports. Copies of all inspection reports shall be provided to the Luzerne County Division of Corrections and the Contract Monitor.
II.3.R. Transport Communication. All outside medical consultations/treatment shall be coordinated in advance with the Luzerne County Division of Corrections Transportation Division. No information, (time, date, etc.), is to be given to any inmate or inmate relative/family member prior to being transported.
II.3.S. Return from Hospital. Inmates returning from outside hospital stays, clinic visits, or return from other correctional facilities are to be seen by a qualified medical provider. A note regarding this review with reference to follow-up in-house must be documented in the inmate medical record.
II.3.T. TB Testing. The results of tuberculin tests shall be read and documented on a daily basis.
II.3.U. Medical Clearances. Medical staff shall perform reviews, medical examinations, medical summaries or certifications as are necessary for intra- system transfers, food handling and work clearances which must be completed within twenty-four (24) hours from the time the names are provided.
II.3.V. Transfer Medical Summaries. Medical summaries that meet the requirements of PA Act 84 shall be prepared and sent with inmates being transferred to other correctional facilities other than Luzerne County Division of Corrections
II.3.W. Bio Hazardous Waste. The Contractor shall be responsible for the disposal of all contaminated waste. This material must be removed from within the facility to a secured area and disposed of as required.
II.3.X. Prenatal Care. The Contractor shall be responsible for any cost associated with prenatal, delivery, and postnatal care of pregnant inmates. The Contractor will not be held responsible for cost associated with infant care.
II.3.Y. Offsite Care. Luzerne County Division of Corrections requires the Provider process, adjudicate and pay any applicable cost to provide "off-site" care outside the jail inmate health care services. The Provider shall be responsible for all inmate health care expenses incurred outside of the facility.
Luzerne County Division of Corrections Inmate Health Care Services Contract 29 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 55 of 175 II.3.Z. Food Service Menu. Coordination with the Detentions' Facility Food Services Supervisor to ensure the provision of food service needs which include:
II.3.Z.(i) Menus planned for not less than twenty-eight, (28), days in advance and certified by a nutritionist at the expense of the health service provider.
II.3.Z.(ii) Certified, modified diets available for inmates when ordered by the facility physician.
II.4 Behavioral Health Requirements.
II.4.A. Behavioral Health Staffing. The Psychology Department shall be fully staffed Monday through Sunday with an onsite Mental Health Professional. Specifically:
II.4.A.(i) The Psychology Department shall be staffed seven days a week. The Department shall be staffed on-site with a minimum of three (3) Mental Health Professionals during the Monday through Friday schedule shift, and at least one (1) Mental Health Professional during the Saturday and Sunday shift (the "Weekend Shift").
II.4.A.(ii) For all inmates on behavioral watch or suicide watch with scheduled releases for any purpose, the MHP is mandated to use the LCDOC Suicide Risk Assessment (copy enclosed). Prior to the inmate's release. If the inmate proves to be a danger to self and/or others and meets criteria for psychiatric hospitalization commitment (involuntary-302 or voluntary-201), then the MHP is responsible to be the petitioner for the commitment and to arrange a psychiatric evaluation at an approved crisis center, i.e. Commonwealth Health located at the Wilkes Barre General Hospital. The MHP shall coordinate with LCDOC for the transportation of the inmate via ambulance to the approved crisis center and the LCDOC shall assure proper transport of the inmate by ambulance upon the inmate's release.
II.4.A.(iii) A Pennsylvania-licensed Psychologist on staff to provide monthly supervision to all MHPs, a minimum being one hour per month per MHP. The Psychologist shall also be available five-to- seven days per week via telephone. The Psychologist shall also be physically present onsite at LCDOC at least one time per month
Luzerne County Division of Corrections Inmate Health Care Services Contract 30 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 56 of 175 II.4.B. Mental Health Program. Development of a mental health program procedures and policies, and appropriate mental health staffing. This shall include, but not be limited to the following:
II.4.B.(i) When isolated for psychiatric purposes, inmates shall be examined by a physician or designee within forty-eight, (24), hours after confinement.
II.4.B.(ii) Medical evaluation must support medical confinement of inmates based on risk of physical danger to self or others.
II.4.B.(iii) Medical service must continue to provide follow-up care and treatment during the entire time an inmate is held in medical confinement on at least a three, (3), day per week basis.
II.4.B.(iv) Relating to mental health services, a psychiatrist or his/her medical designee will be responsible to determine when an inmate should be sent or returned to general population with documentation in the medical record regarding these decisions. All inmates referred for mental health evaluation will receive a comprehensive diagnostic examination including a psychosocial history and mental status evaluation. This examination will include an assessment of suicidal risk, potential for violence, and special housing needs, up to and including State Hospitalization.
II.4.B.(v) Psychotropic medication, including injectable, will be used where appropriate. To maximize the effectiveness of pharmacotherapy and to reduce the toxicity and side effects of medication, an intensive program of drug monitoring shall exist. All inmates placed on drug therapy will be seen within one (1) week by the psychiatrist. Precautions to be followed will include:
The psychiatrist will review the inmate's medical record to determine which medications the patient has been receiving prior to prescription of psychotropic medication.
Prior to the prescription of psychotropic medication, inmates will be informed by a member of the mental health staff about the risks of taking such medication, in accordance with applicable standards of care. All female inmates will be so informed by a member of the mental health staff about the risks of taking such medication while pregnant. A pregnancy test will be provided prior to the prescription of psychotropic
Luzerne County Division of Corrections Inmate Health Care Services Contract 31 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 57 of 175 medication to female inmates wishing such a test, if such a test has not already been provided upon intake.
All patients placed on medication will be evaluated for signs of toxicity. Blood pressure will be regularly checked and drug levels monitored where appropriate with documentation of this information to be placed routinely in the inmate's record.
II.4.B.(vi) Substance Abuse services will be offered to those inmates who are referred to the program for mental health problems and, who also have mental health problems and, who also have substance abuse related problems. These services will be provided by mental health professionals and should include case findings, referrals, liaison work, and post release planning. Alcohol withdrawal, Opioid withdrawal, Benzodiazepine withdrawal, any other substance abuse withdrawal must be addressed.
II.5 Pharmacy Services.
II.5.A. Pharmacy Delivery. The Contractor shall provide for pharmaceutical services to assure the availability of prescribed medications within eight, (8), hours of the order of issue being written and provisions for emergency pharmacy services within two (2), hours. Pharmacy services consistent with State and Federal laws and/or regulations, monitored by a licensed qualified pharmacist must be maintained as/if required.
II.5.B. Medication Administration. Recording the administration of medications in a manner and on a form approved by the health care authority to include documentation of the fact that inmates are receiving and ingesting their prescribed medications. Documentation will also be required when an inmate's ordered medication was not administered and the reason given.
II.6 Reporting.
II.6.A. Required Reports. The Contractor shall be responsible to provide a comprehensive annual statistical report that will be forwarded to the Luzerne County Division of Corrections. In addition, monthly and daily statistics will be required by site and in total:
II.6.A.(i) Monthly Statistics: Narrative reports shall be submitted on the fifteenth calendar day of each month to the Director of Corrections and the Contract Monitor with data reflecting the previous month's workload, to include:
Luzerne County Division of Corrections Inmate Health Care Services Contract 32 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 58 of 175 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 Special needs admission, patient days, average length of stay Off-site hospital and Emergency Room admissions and cost Medical specialty consultation referrals and cost Intake medical screening Fourteen, (14), day history and physical assessments Psychiatric evaluations Diagnostic studies Report of third-party reimbursement, pursuit, and recovery Percentage of inmate population dispensed medication and costs Inmates testing positive for venereal disease and TB Inmates testing positive for AIDS or AIDS Antibodies Inmate mortality Number of hours worked by entire medical staff and staffing compliance to contract staffing levels Other data deemed appropriate by the Corrections Director
II.6.A.(ii) Daily Statistics: A narrative report for the previous twenty-four, (24), hours, capturing the following data shall be submitted to the Director upon a daily basis prior to 9:00 a.m. to include: Transfers to offsite hospital emergency departments Communicable disease reporting Suicide data (i.e., attempts and precautions taken) Report of status of inmates in local hospitals and infirmaries Staffing positions unfilled Submit completed medical incident report copies A list of lost medical files History and Physical and Medical Intake Screening status report
II.6.A.(iii) On a scheduled basis, the central administrative staff shall have documented monthly meetings with LCDOC administrators to evaluate statistics, program needs, problems, and coordination between custody and medical personnel.
Luzerne County Division of Corrections Inmate Health Care Services Contract 33 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 59 of 175 II.6.A.(iv) Documentation of health care staff roles in the jail disaster plan. The contract provider for medical services shall, in times of emergency or threat thereof, whether accidental, natural, or caused by man, provide medical assistance to the Luzerne County Division of Corrections to the extent or degree required by LCDOC policies and procedures.
II.7 Electronic Medical Record.
II.7.A. CorEMR. The contractor shall implement the CorEMR system as presented in their technical proposal and detailed in Exhibit B.
II.7.B. Electronic Health Record. An electronic health record consistent with State regulations and community standards of practice shall be maintained on each inmate.
II.7.C. Information Technology Requirements:
II.7.C.(i) The EHR software must interface with LCDOC's inmate management software, providing new bookings, moves, transfers and releases along with other demographic information including pictures. The system must also be able to access all current EHR's or convert all existing electronic records to any proposed system. The Contractor may utilize the current or future versions of the Offender Management System that is currently in place as long as the system meets the State regulations and community standards described in the request.
II.7.C.(ii) EHR system must run terminal services server for medical staff to access and input data via "Remote Desktop" on laptops (via wireless) and PC's in the medical facilities at the jail. Software must be able to run in a terminal service environment.
II.7.C.(iii) The EHR vendor will provide timely patches to provide solutions to any programming issues. The EHR vendor will provide at least a quarterly update with new features added to the software. The EHR vendor will install any required updates and county IT staff will assist to the extent that is reasonable.
II.7.C.(iv) Individual health care records will be initiated and maintained for every inmate regarding medical, dental, or mental health services as a result of the inmate screening process, or for services rendered following assignment to a housing area.
Luzerne County Division of Corrections Inmate Health Care Services Contract 34 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 60 of 175 II.7.C.(v) With the approval of the LCDOC, the Contractor will be responsible for procurement and maintenance of the computer equipment and will provide software system, installation, integration, training, implementation support and ongoing technical support of the EHR system. County IT staff will assist with connectivity issues to the county network to facilitate EHR implementation for the Contractor's IT staff.
II.7.C.(vi) The Contractor shall also cooperate and provide assistance to Luzerne County Division of Corrections in the development and implementation of software "linkage" between local health care providers and the jail EHR system. This is to include the linkage development between Luzerne County inmate EHR system and the Contractor's for future purposes of claims management and billing of off-site and or onsite health care services as may be allowed by law. Any additional future cost associated with EHR Links or changes in the provider network will be the responsibility of the Contractor.
II.7.D. Health Record Content. The inmate health record shall include, but not be limited to: Intake screening form Medical and Mental Health appraisal forms Physician order/treatment plans Prescribed medications administered or not, date, time, and by whom Complaints of illness or injury Complaints of illness or injury Findings, diagnoses, treatments, and dispositions Health service reports Consent and refusal forms Release of information forms Inmate medical request forms Medical grievance forms Signature and title of each documenter Laboratory, radiology, and diagnostic studies Consultation, emergency room and hospital reports and discharge summaries
II.7.E. Medical Record Confidentiality. Confidentiality of medical records will be assured. The medical and psychiatric records will be kept separate from the custody records. Data necessary for the classification, security, and
Luzerne County Division of Corrections Inmate Health Care Services Contract 35 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 61 of 175 control of inmates will be provided to the appropriate Luzerne County Division of Corrections personnel. Medical records will be made available to Luzerne County Division of Corrections personnel when required to defend any caused action by any inmate against the County.
II.7.F. Informed Consent. Adherence to applicable informed consent regulations and standards of the local jurisdiction must be maintained.
II.7.G. Inactive Records. Inactive medical records will be maintained in accordance with the laws of the Commonwealth of Pennsylvania and the American Medical Association. After two (2) years, inactive medical records will be, at the Provider's cost, properly stored so as to remain intact and accessible.
II.7.H. Court and Legal Documents. Information concerning any court or legal documents affecting inmates and the medical contract provider must be provided in writing to the designated representative in the Director's Office prior to the close of the shift of service/receipt.
II.7.I. Lost Records. If an inmate's medical record cannot be located within forty- eight (48) hours of the discovered loss, a duplicate record shall be immediately generated. Any clearance information that cannot be determined shall be repeated. Upon location of the missing record, and after a duplicate file has been created, the two files shall be joined to form one file.
In Witness Whereof, Contractor and the County have, through their duly authorized representatives, entered into this Contract. The parties, having read and understood the foregoing terms of this Contract, do by their respective signatures dated below agree to the terms thereof.
Wexford Health Sources, Inc: Luzerne County Division of Corrections:
______SIGNATURE SIGNATURE
______PRINTED NAME PRINTED NAME
______TITLE TITLE
______DATE DATE
Luzerne County Division of Corrections Inmate Health Care Services Contract 36 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 62 of 175 CONTRACT ATTACHMENT A:
RFP
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 63 of 175 COUNTY OF LUZERNE Luzerne County Division of Corrections Office of Procurement 200 N. River Street Wilkes-Barre, PA 18711-1001
REQUEST FOR PROPOSAL:
INMATE HEALTH CARE SERVICES
RFP Released: May 16, 2019 Deadline for Receipt of Questions: May 27, 2019 Deadline for Receipt of Proposal: June 28, 2019 Vendor Selection/Contract Negotiations: July 29, 2019 Contract Begins: October __, 2019
Questions regarding this RFP should be directed to:
Director Mark Rockovich Luzerne County Division of Corrections 99 Water Street Wilkes-Barre, PA 18711
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 64 of 175 Contents
PART A ...... 3
GENERAL TERMS AND PROVISIONS: ...... 3
SCHEDULE OF PROPOSAL PROCESS ...... 9
PARTB ...... 10
SPECIAL TERMS AND CONDITIONS ...... 10
General Requirements: ...... 10
Scope· ...... 11
Preparation and Submittal of Proposals ...... 14
Bond Requirements: ...... 14
Evaluation of Proposals ...... 15
Method of Award ...... 17
Terms of Contract ...... 1 B
Specifications and Program Requirements ...... 24
PARTC ...... 41
BID PROPOSAL FOR INMATE HEALTH CARE SERVICES ...... 41
STATEMENT OF BUSINESS REFERENCES ...... 49
STATEMENT OF FINANCIAL REFERENCES ...... 50
EXHIBIT A ...... 50
Luzerne County Council Voting Session November 26, 2019 AGENDA Page 65 of 175 LUZERNE COUNTY DIVISION OF CORRECTIONS 99 Water Street Wilkes-Barre, PA 18711
May 15, 2019
SUBJECT: Request for Proposal RFP - PROPOSAL TITLE: Inmate Health Care Services
CLOSING DATE & TIME: June 28, 2019 at 4 p.m. (E.S.T.)
PLACE:
Luzerne County Purchasing Department Penn Place Building 20 North Pennsylvania Ave. Suite 203 Wilkes-Barre, PA 18711
Proposal Conference: The Luzerne County Division of Corrections (LCDC) will host a tour of the facility on June 12, 2019 at 10:30 A.M. Proposers interested in the tour shall provide the names of all individuals that will attend the tour by emailing Kristina. i [email protected].
PART A
GENERAL TERMS AND PROVISIONS:
1. All proposals must be received by the LCDOC via mail or hand delivery, no later than 4:00 p.m. (EST) on June 28, 2019. An original, four (4) copies and one (1) electronic copy of the proposal shall be submitted. All proposals received after the deadline will not be considered. The proposal shall be submitted in a sealed envelope and marked: "INMATE HEALTH CARE SERVICES." All envelopes shall contain the entity or individual's name making the proposal. Luzerne County will select a proposal it deems are in the best interest of the County.
2. Exceptions to specification: Offerors taking exception to any part or section of these specifications shall indicate such exceptions in their document. Failure to indicate any exceptions shall be interpreted as the offeror's intent to fully comply with the specifications as written. Conditional or qualified proposals, unless specifically allowed in the specifications, are subject to rejection in whole or in part.
If our specifications, when included in our Request for Proposal, are not returned with your proposal, and no specific reference is made to them in your proposal, it will be assumed that all
3 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 66 of 175 specifications will be met. When material, sketches, cuts, descriptive literature, vendor's or manufacturer's specifications which accompany the proposal are intended to be a deviation from our specifications; such deviations must be specifically referenced in your proposal response.
3. The responsibility for sending the Proposal to the Luzerne County Division of Corrections on or before the stated time and date will be solely and strictly the responsibility of the Proposer. The County/Director will in no way be responsible for delays caused by the United States Postal Service or a delay caused by any other occurrence, or any other method of delivery. The vendor shall be responsible for reading carefully and understanding completely the requirements in the specifications. Proposals will not be accepted after the time specified for receipt. Such Proposals shall be returned to the Proposer unopened with the notation, "This Proposal was received after the Time Designated for the Receipt and Opening of Proposals".
4. Postponement of Date for Presentation and Opening of Proposals: The County/Director reserves the right to postpone the date for receipts and opening of Proposals and will make a reasonable effort to give at least five (5) calendar days' notice of any such postponement to each prospective Proposer.
5. Time for Consideration: Proposer warrant by virtue of proposing that the prices quoted in their proposal will be good for a period of ninety (90) calendar days from the date of proposal opening unless otherwise stated. Vendors will not be allowed to withdraw or modify their proposals after the opening time and date.
6. Prices: All proposals submitted must show the net proposal price after any and all discounts allowable have been deducted.
7. Proposal Errors: When errors are found in the extension of the proposal prices, the unit price will govern. Proposals having erasures or corrections must be initialed in ink by the Proposer. Each page of the proposal and all attachments submitted shall be identified with the name of the offeror.
8. Proposal Obligation and Disposition: The contents of the proposal and any clarifications thereto submitted by the successful Proposer shall become part of the contractual obligation and incorporated by reference into the ensuing contracts. All proposals become the property of the Luzerne County Division of Corrections and will not be returned to the Proposer.
9. Laws, Statues, and Ordinances: The terms and conditions of the Request for Proposal and the resulting contract or activities based upon the request for Proposal shall be construed in accordance with the laws, statues, and ordinances applicable to Luzerne County. Where State statutes and regulations are referenced, they shall apply to this Request for Proposal and to the resulting contract
10. Manufacturer's Name: Any manufacturers' names, trade names, brand names, information and/or catalog numbers used herein are for purpose of description, reference, and establishing general quality levels. Such references are not intended to be restrictive and products of any manufacturer may be offered if they are approved as equals. The determination as to whether any alternate product or service is or is not equal shall be made by the County/Director and such determination shall be final and binding upon all Proposals.
11. Information and Descriptive Literature: Proposer must furnish all information requested in the
4 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 67 of 175 proposal. If specified, each Proposer must submit cuts, sketches, descriptive literature, and/or complete specifications covering the products/services offered. Reference to literature submitted with any previous proposal will not satisfy this provision. Proposals which do not comply with these requirements will be subject to rejection.
12. Proposal Submittal Costs: Proposers are responsible for all their costs associated with this RFP. LCDOC will not be liable for any costs incurred by the proposer in preparation of a proposal submitted in response to this RFP, in conduct of a presentation, or any other activities related to responding to this RFP.
13. Rejection of Proposals: LCDOC reserves the right at its sole discretion to reject any and all proposals received without penalty and not to issue a contract as a result of this RFP. The LCDOC also reserves the right at its sole discretion to waive minor administrative irregularities contained in any proposal. Failure to comply with any of the terms and conditions of this RFP will result in rejection of a proposal. LCDOC reserves the right to negotiate any and all terms with the successful party.
14. Cancellation and Revisions to the RFP: LCDOC reserves the right to revise the RFP and/or to issue addenda to the RFP. In the event it becomes necessary to revise any part of the RFP, addenda will be provided to all those who received the RFP from LCDOC. LCDOC also reserves the right to cancel or to reissue the RFP in whole or in part, prior to execution of a contract
15. Compliance with Federal Statues, Regulations and/or Rulings Regarding Employment: The Proposer shall comply with all local, state and federal ordinances, laws, and regulations pertaining to the operation specified herein. It shall be the obligation of the Contractor to apply for, pay for, and obtain all permits and licenses as required the various agencies. Contractor shall also comply with the Occupational Safety and Health Act. All material and equipment shall comply with standards promulgated by the American National Standards Institute (ANSI) or with the rules of the Food and Drug Administration under the Safe Medical Devices Act.
16. Proposer Investigations: Before submitting a proposal, each Proposer shall make all investigations and examinations necessary to ascertain all conditions and requirements affecting the full performance of the contract and to verify any representation made by the County/Director that the Proposer will rely upon. No pleas of ignorance of such conditions and requirements resulting from failure to make such investigations and examinations will relieve the successful Proposer from its obligation to comply in every detail with all provisions and requirements of the contract documents or will be accepted as a basis for any claim whatsoever for any monetary consideration on the part of the successful Proposer.
17. Additional Information: All communications, including questions relative to the RFP, shall be directed to Mark Rockovich, Director of Correctional Services, at the address listed above. The e-mail address of Director Rockovich is [email protected]. Should any questions or responses require revisions to the specifications as originally published, such revisions will be by formal amendment only and will be issued by the County/Director. Potential offerors are cautioned that any verbal representations made by Luzerne County/Director personnel or their representatives, which appear to change substantively any portion of the specification, shall not be relied upon unless subsequently ratified by a formal written amendment to this specification.
5 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 68 of 175 18. Contact by proposer or potential proposers to this RFP of any County or current Health Care personnel to gain further information, clarification, or documentation concerning the Luzerne County Division of Corrections RFP is strictly prohibited. Any violation of this requirement may be reason for disqualification by the County/Director or its appointed staff of the Proposer for consideration of the services stated in this RFP.
19. Proprietary Information/Public Disclosure: Materials submitted in response to this RFP shall become the property of the LCDOC. All proposals received shall remain confidential until the contract, if any, resulting from this RFP is signed by the LCDOC and the successful proposer. Thereafter, all proposals shall be deemed public records. All proceedings, records, and other public documents relating to procurement shall be subject to public inspection. Proposers are reminded that while trade secrets and other proprietary information they submit in conjunction with this procurement may not be subject to public disclosure, protections must be claimed by the proposer at the time of submission of its proposal.
Any information in the proposal that the proposer desires to claim as proprietary and exempt from disclosure must be clearly designated, identified and marked "Confidential," on the lower right hand comer of each page submitted to the LCDOC. This is necessary to claim the privilege if any, from disclosure. The proposer shall also mark the cover sheet of the proposal with the following legend, specifying the specific section(s) of his proposal sought to be restricted in accordance with the conditions of the legend: "The data contained in pages_ of the proposal have been submitted in confidence and contain trade secrets and/or privileged or confidential information and such data shall only be disclosed for evaluation purposes, provided that if a contract is awarded to the Proposer as a result of or in connection with the submission of this proposal, the LCDOC shall have the right to use or disclose the data therein to the extent provided in the contract. This restriction does not limit the LCDOC's right to use or disclose data obtained from any source, including the proposer, without restrictions." Further, to protect such data, each page containing such data shall be specifically identified and marked "CONFIDENTIAL".
Proposer must be prepared to defend the reasons why the material should be held confidential. If a competing proposer or other person seeks review or copies of another proposer's confidential data, the LCDOC will notify the owner of the asserted data of the request. If the owner of the asserted data does not want the information disclosed, it must agree to indemnify the LCDOC and hold the LCDOC harmless against all actions or court proceedings that may ensue (including all court costs and attorney's fees), which seek to order the LCDOC to disclose the information. If the owner of the asserted data refuses to indemnify and hold the LCDOC harmless, the LCDOC may disclose the information.
The LCDOC reserves the right to make any proposal, including proprietary information contained therein, available to LCDOC personnel or to other agencies or organizations for the sole purpose of assisting the LCDOC in its evaluation of the proposal. The LCDOC shall require said recipients to protect the confidentiality of any specifically identified proprietary information or privileged business information obtained as a result of their participation in these evaluations.
6 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 69 of 175 Perfmmance of the contract may require the proposer to have access to and use of documents and data which may be confidential or considered proprietary to the LCDOC or its vendors, or which may otherwise be of such a nature that its dissemination or use, other than in performance of the contract, would be adverse to the interest of the LCDOC or others. Any document or data obtained by the proposer from the LCDOC in connection with carrying out the services under this contract shall be kept confidential and not provided to any third party unless disclosure is approved in writing by the LCDOC, acting through the Director.
A charge may be made for copying and shipping any info1mation requested from this RFP. All requests for information should be directed to the Director, Mark Rockovich as stated above.
All information related to LCDOC's operations which are designated confidential by LCDOC and made available to the proposer in order to prepare a proposal or to carry out any resulting contract, or which become available to the proposer in carrying out a contract, shall be protected by the proposer from unauthorized use and disclosure through the observance of the same or more effective procedural requirements as are applicable to the LCDOC. Any information deemed confidential shall be provided by the LCDOC to the proposer in writing. The proposer shall not be required under the provisions of this paragraph to keep confidential any data or information that is or becomes publicly available, is already rightfully in its possession, is independently developed by it outside the scope of the contract, or is rightfully obtained from third parties.
Throughout the term of this RFP process, Proposers must secure written approval from Luzerne County prior to the release of any information related to this RFP or activities associated with it. Prospective vendors must not initiate any publicity related to this RFP process before the selection decision is final and a contract has been awarded. Violations of this stipulation is cause for disqualification. Under no circumstances shall the proposer discuss and/or release information to the media concerning this project without the express written approval of the LCDOC, acting through its Director.
20. It is not mandatory that Proposers tour where services are to be provided but they are urged to familiarize themselves with the scope of the effort required. Those who do not take the opportunity to tour will not be disqualified from proposal on the request.
7 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 70 of 175 21. Specifications are attached.
LUZERNE COUNTY DIVISION OF CORRECTIONS
By ______
Director Mark Rockovich Luzerne County Division of Corrections
22. General Terms and Provisions outlined above are acknowledged. Our quotation is attached.
Signed ______Date ------Company Officer
Company Name
8 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 71 of 175 SCHEDULE OF PROPOSAL PROCESS
The following is a schedule of events concerning the proposal process. This schedule may be subject to change if determined necessary by the County or its appointed staff.
Distribution of RFP May 15, 2019
Tour of Jail Facilities June 12, 2019 at 10:30 a.m.
Letter of Intent to Offer June 14, 2019
Proposal Closing - 4:00 p.m. June 28, 2019
Tentative Oral Presentation (subject on necessity) July 8, 2019
Notification of Intent of Award July 22, 2019
Commence Contract Negotiations July 29, 2019
Contract to be signed by and no later than August 30, 2019
Operational Start Date 12:01 a.m. October , 2019
9 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 72 of 175 PARTB
SPECIAL TERMS AND CONDITIONS
General Requirements:
The purpose of these specifications is to solicit sealed proposals for the provision of health care services, health care personnel, and program support services of the Luzerne County Division of Corrections. The County has separated the services into medical, mental/behavioral health, dental, pharmacy, and electronic medical records. The specifications set forth are for informational purposes and to provide a general description of the requirements. Proposer shall be responsible to submit technical proposal(s) based upon their design that will accomplish the intended purpose as set forth herein.
All questions about the meaning or intent of this Request for Proposal are to be directed, in writing to: Luzerne County Division of Corrections Director Mark Rockovich 99 Water Street Wilkes-Barre, PA 18711 Telephone: 570-829-7750
Interpretations, clarifications and or additional information considered necessary by Luzerne County Division of Corrections in response to such questions will be issued by addendum and mailed or delivered to all parties recorded by Luzerne County Division of Corrections as having received the Request for Proposal. Oral or other interpretations or clarifications will be without legal effect.
A tour of the jail facilities is scheduled for June 12, 2019 at 10:30 A.M. Proposer's will meet at the Luzerne County Division of Corrections, 99 Water Street, Wilkes-Barre PA 18711. The purpose of the tour will be to offer all interested parties the opportunity to see where services are to be provided and familiarize themselves with the scope of the effort required and ask questions about the current health delivery needs. Unofficial responses to verbal questions will be offered; however, any substantive questions will be addressed officially in written response.
ALL INTERESTED PROPOSERS MUST SUBMIT A "LETTER OF INTENT TO OFFER" BY June 14, 2019. FAILURE TO DO SO WILL RESULT IN REJECTION OF THE PROPOSAL.
Any changes made to this Request for Proposal will be shared with all registered Proposers. Any and all changes will be addressed officially in writing.
10 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 73 of 175 1. Scope:
Located on a five acre lot on Water Street, the Luzerne County Prison was completed in the summer of 1870. The building's two wings contained 72 cells - 32 of which were double cells and could accommodate 104 prisoners.
The facility became obsolete by the 1980's. A $12 million expansion and renovation project to the original jail was completed in 1987. Cells were enlarged and a five story tower increased the number of cells to 256. Since that time, the prison became known as the Luzerne County Correctional Facility.
The Ground Floor consists of the Records Department and Booking area, where all admissions and discharges occur. The Kitchen and food supplies, the Commissary and the Laundry are also on this floor. Maintenance Office and Shop and the Mechanical Rooms are here as well.
The First Floor contains the Main Entrance, the Non-Contact Visiting Room, (3) Attorney Visiting Rooms, the Main Control Center, the Library, Education Room, Treatment Offices, Drug and Alcohol Program Offices, Clergy Room and the Offices for the Captains and Deputy Warden. Additionally, the Restrictive Housing Unit (L2), Misconduct Unit (Ll), and Maximum Security Units (Ml and M2) are on this floor along with two outside restrictive recreations areas for segregation inmates. A Kitchen Workers Housing Unit and General Workers Housing Unit exist on this floor.
The Second Floor consists of the Medical Department with two special needs cells, an Examination Room, Dental Office and Pharmacy. Mental Health Offices, Classification, a Control Center, a six cell Behavioral Observation housing unit, and Youthful Offender Unit are also found on this floor. Two more housing units, 2Cl and 2C2 are housing inmates. 2Dl and 2D2 units contain low custody inmates and inmates monitored by the Mental Health due to medication needs. Two ten inmate housing units exist in dayroom areas for specials needs.
The Third Floor holds a Control Center, four Housing Units and two Dayroom Units containing Medium and Maximum classification inmates.
The Fourth Floor entirely houses female inmates. A Control Center and three separate Housing Units 4A (General Population), 4B (Discipline/Segregation/Behavioral Observation), 4C (In House Workers make up this floor).
The Fifth Floor has a Control Center, Housing Unit 5A (Female Housing Unit), a 2- cell Restrictive Housing Unit, Video Conferencing Room, a Multipurpose Room and a Record Storage Room. The floor also has an outdoor yard used for recreating segregation inmates.
Minimal Offenders Unit (MOU)
The MOU consists of 3 blocks with an open housing floorplan. This building is located less than 400 yards from the Luzerne County Correctional Facility. This building can house a maximum of 23 8 inmates. One block houses inmates that are on work release, pre-work release, or supervised release. One block houses protective custody inmates and other block are classified as minimal security inmates.
11 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 74 of 175 A. Philosophy of Administration:
a. Through a proposal process, a qualified health care provider will be selected to provide comprehensive health services to inmates in the custody of the Luzerne County Division of Corrections. The successful Proposer must provide a program that meets the general and unique needs of inmates housed in the Luzerne County Division of Corrections facilities. It is the philosophy of the County/Director to acquire a medical provider to maximize treatment and care of inmates within the detention facilities thereby avoiding unnecessary instances involving transportation, utilization of staff, and security risks by such movement, and to insure that the health care program is operated in a humane manner with respect to the inmate's right to constitutional health care. Constitutional care means providing timely access to an appropriate level of medical care and providing the care ordered by a physician (provider) for inmates with serious medical needs. A serious medical need is a condition that would, without intervention, lead to a deterioration of function, pain, death or a public health risk.
B. Price:
a. To assist with the determination of the proposed contract price, average monthly inmate census of the detention system for the past six-month period has been approximately 650. For purposes of the Proposal, the Proposer should anticipate an inmate population of 650. The price, under all options provided, is to include the furnishing of all professional services, labor, materials, equipment, insurance, licenses, and applicable taxes necessary or proper for the completion of the work. The price should be in accordance with the schedule shown below. The methodology used in determining these prices should be included in the proposal.
b. Vendors will manage care, coordinate care, adjudicate claims, complete and submit all Act 22 documents to include coordination of any off-site care providers and potential third party payment resources, and pay all inmate off-site health care applicable cost, not including Prior to Booking cost, on a monthly basis.
1) Total cost of first year contract: Detailed cost: Luzerne County Division of Corrections (Per Diem cost for inmate health care above a monthly average population of the 650 inmates shall be a credit to the provider and below 650 inmates will be a credit to the LCDOC.)
2) Total cost of second year contract with per diem cost for inmate population above the 650 shall be a credit to the provider and below 650 inmates will be a credit to theLCDOC.
3) Total cost of third year contract with per diem cost for inmate population above the 650 shall be a credit to the provider and below 650 inmates will be a credit to the LCDOC.
12 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 75 of 175 C. Objective of the Request for Proposal (RFP):
1) To provide prospective Proposers data necessary for preparation of proposals.
2) To provide a fair method for objectively analyzing submitted proposals.
3) To result in a contract between the successful Proposer and the Luzerne County Division of Corrections that will provide generally for the following:
a. Quality health services of inmates in the Luzerne County Division of Corrections facilities. b. Development and implementation of a health care plan with clear objectives, policies and procedures that are compatible with those of the Luzerne County Division of Corrections and with a process for documenting ongoing achievement of contract obligations. c. Utilization of appropriate personnel in accordance with their Scope of Practice that are certified and licensed by the appropriate bodies as required in the Commonwealth of Pennsylvania. d. Administration leadership that provides for both cost accountability and responsiveness to the contract administrator, (County/Director and or their designee). e. Assurance that Federal, State, local and NCCHC requirements and standards of health care are met. f. Continuing education of County/Director's staff including suicide prevention offered to all staff
D. Proposer Qualifications:
Proposals shall be considered only from firms who can clearly demonstrate to the County/Director a professional ability to perform the type of work specified within the Request for Proposal. Proposers must be able to demonstrate adequate organization, systems, equipment, and personnel to ensure prompt determination of the evidence of responsibility and ability to perform the contract by the Proposer. The County/Director reserves the right to investigate the financial condition, experience record, personnel, equipment, facilities, and organization of the Proposer. The County/Director shall determine whether the evidence of responsibility and ability to perform is satisfactory, and will make awards only when such evidence is deemed satisfactory. The County/Director reserves the right to reject a proposal when evidence indicates the inability to perform the contract by a Proposer.
13 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 76 of 175 2. Preparation and Submittal of Proposalsl
A. All proposals shall be signed in ink by the authorized principles of the firm.
B. All attachments to the Request for Proposal requiring executing by the Proposer are to be returned with the proposal.
C. Six Proposals, one original, four copies and one electronic are to be returned in a sealed container. The face of the package shall indicate the RFP number, time, and date of public acceptance, and title of proposal.
D. Mark Rockovich must receive proposals no later than 4:00 p.m., June 28, 2019. Requests for extensions of this time and date will not be granted. Firms mailing their proposals should allow for normal mail time to ensure receipt of their proposals prior to the time and date fixed for the acceptance of the proposals. Proposals or unsolicited amendments to proposals, received by the County/Director after the acceptance date will not be considered. Proposals will be publicly opened at the time and date specified.
3. Bond Requirements:
A. Proposal Security Each proposal shall be accompanied by a proposal security made payable to Luzerne County Division of Corrections, pledging that the Proposer will enter into a contract with Luzerne County Division of Corrections on the terms stated in his proposal and will furnish bonds/security as described hereunder.
Should the Proposer refuse to enter into such contract or fail to furnish such bonds/security, when required, the amount of the proposal security shall be forfeited to Luzerne County Division of Corrections as liquidated damages, not as a penalty.
The amount of the proposal security shall be ten thousand dollars ($10,000.00). Security shall be a certified check, cashier's check, treasurer's check, bank draft, or proposal bond issued by a surety company licensed to conduct business in the Commonwealth of Pennsylvania. Bonds shall be written on the surety company's standard form, and the Attorney-in-Fact who affix to the bond a certified and current copy of his Power of Attorney, indicating the monetary limit of such power.
The Luzerne County Division of Corrections will have the right to retain the proposal security of Proposer to whom an award is being considered until either the (a) Contract has been executed and bonds have been furnished, or (b) The specified time has elapsed so that proposal may be withdrawn, or ( c) All proposals have been rejected.
B. Luzerne County Division of Corrections will NOT require a Performance Bond against Performance of a Contract for related to this Proposal.
14 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 77 of 175 4. Evaluation of Proposals
An Evaluation Committee appointed by the Luzerne County Division of Corrections will evaluate all proposals and make a recommendation to the Director of Corrections.
A. Proposer Qualifications
a. Vendors must be organized for the purpose of providing medical, mental health and dental services and must demonstrate experience and proven effectiveness in administering correctional health care programs.
b. Corporate Experience
c. Vendor must detail its overall related work experience which meets the qualifications of RFP, experience in providing correctional health care programs for prisoner/resident populations, and current experience in providing programs and services in facilities that are ACA and/or NCCHC accredited. The proposer must have prior experience with correctional health care contracts with a minimum of five, (5), year's company experience in the direct delivery of health care services in a comparable jail environment.
d. Organization Chart and Information
1. Each Vendor submitting a bid must submit a chart depicting the structure of the Vendor's organization. The organizational chart must also depict the Vendor's parent corporation, any subsidiaries of the Vendor or the Vendor's parent organization, and other significant relationships for the operation of the organization. Any Vendor that is a subdivision of a parent organization must specifically cite the existence of the relationship. Failure to disclose actual corporate structure will be deemed a violation of the RFP
11. If the Vendor is a subsidiary of a parent organization, the Vendor must indicate whether the parent organization will agree to absorb the Vendor's debt.
111. The vendor shall submit resumes of all individuals holding principal positions identified by the organizational chart. For purpose of this requirement, "principal positions" means the Executive Director, the Chief Financial Officer, the Chief Clinical Officer and the Program Officer or equivalent positions.
1v. The Vendor must provide a brief description of current or past services similar to those proposed, indicating success of those services and target population served by the Vendor. Include the number of prisoners/residents served and a brief description of the types of services provided. Include a summary of the Vendor's current and recent history of performances related to correctional health care including all contracts awarded in the past five years along with contact information for the party with whom the vendor has contracted.
v. The Vendor shall indicate capacity to successfully manage proposed services.
15 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 78 of 175 v1. Vendor shall identify the number of employees in the firm, annualized dollars of payroll, and number of years in business.
VIL Vendor shall provide the company's most current Income Statement and Balance Sheet. It is required to be a certified Income Statement and Balance Sheet from the Company/Organization contracting with the Luzerne County Division of Corrections to perform services. It is not to be a parent Company, Group Division or Subsidiary.
v111. The Vendor shall identify facilities that the Vendor serves that are currently accredited and non-accredited. Include the following information:
Ix. List all fines which exceed $10,000 taken together that the vendor has incurred under other contracts for non-performance of duties, in whole or in part, within the last three years.
x. List all contracts on which the Vendor experienced a complete or partial forfeiture of performance or proposal bonds.
x1. List all contracts held in the last ten years by the Vendor, which were not renewed, and any and all reasons for the non-renewal.
xn. Submit the names, business addresses, telephone numbers, and fax numbers of at least three of Vendor's major suppliers and/or sub-vendors within the last five years.
xm. Provide the most recent surveys by NCCHC, ACA or another accreditation agency for three systems of similar size to the LC DOC' s system with which the Vendor has contracted.
XIV. The Vendor shall provide a list of all pending litigation in which the Vendor is a party, all litigation concluded in the past five years, and the outcome, including settlements, of the concluded litigation.
xv. Discuss any corporate reorganization or restructuring involving the Vendor that has occurred within the last three years and discuss how the restructuring will affect the Vendor's ability to provide services proposed. Also disclose the existence of any related entities (sharing corporate structure or principal officers) doing business in the field of correctional health care. The LCDOC reserves the right to terminate the contract, based upon merger or acquisition of the Vendor, during the course of the contract. Include a description of any current or anticipated business or financial obligations, which will coincide with the term of this contract.
e. Corporate Capability
f. Provide financial information evidencing the Vendor's financial stability and ability to start up and manage the program in the time required using the staff, structure and phase-in required in the RFP. Financial stability should be demonstrated through production of complete audited financial statements for the last 3 years.
Luzerne County Council Voting Session November16 26, 2019 AGENDA Page 79 of 175 g. References h. Provide at least three references from customers and subcontractors from operations similar to LCDOC's and include complete contact information for the references.
1. Provide at least three credit references from major suppliers or businesses with which the Vendor has established a line of credit.
J. The proposer must demonstrate sufficient experience to manage this size correctional healthcare operation with knowledge of the special problems of incarceration facilities and provision of health care and proper staffing in such facilities. In addition, soundness of approach and quality of the total program offered will be considered.
5. Method of Award
The Luzerne County Division of Corrections reserves the right to award this contract to the Proposer submitting the proposal that, in the opinion of the County, best serves the requirements of the Luzerne County Division of Corrections. The successful proposal will be determined utilizing criteria outlined in Section 4 Evaluation of Proposals above. The County/Director intends to make a Proposer selection within twenty-five (25), calendar days after the closing date for receipt of proposals. Upon selection, the County/Director will issue a Letter oflntent. Contract negotiations must be completed within thirty (30) calendar days or the County may elect to cancel the original Letter oflntent and issue another Letter oflntent to the next most successful Proposer.
17 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 80 of 175 Proposed Terms of Contract
A. The contract shall cover a three, (3 ), year period. Upon mutual agreement, the contract may be renewed for two (2) additional one-year extensions based upon negotiations of service delivery and costs. Changes in the contractual provisions or services to be furnished under the contract may be made only in writing, and must be approved by the County/Director and the agent of the Provider. Should a decision be made to increase the scope of the contract, the County/Director and the provider will mutually agree, in writing, to an adjusted contract price.
B. Hold Harmless Clause
Proposals shall provide for the firm holding harmless the County/Director and the representatives thereof: INDEMNIFICATION AND HOLD HARMLESS: The successful proposer shall agree to indemnify and hold harmless Luzerne County/Director, and their agents, servants, employees, appointees, officers, administrators, successors or assigns from any and all claims, demands, damages, actions, causes of actions, suits, judgments, or liabilities of any kind or nature whatsoever, asserted or sustained by any person or to any property including but not limited to compensatory, consequential, incidental or punitive, and further including any charges, expenses, attorney's fees or other costs incurred, which arise out of or derive from, in whole or in part, the performance of any services, duties, responsibilities pursuant to the Inmate Health Care Services Agreement. The aforesaid agreement to indemnify and hold harmless shall include the successful proposer's agreement to undertake at its own expense the defense of any such action, claims, demands, damages, actions, causes of actions, suits, judgments, or liabilities of any kind or nature whatsoever, brought against Luzerne County/Director and its agents, servants, employees, appointees, officers, administrators, successors or assigns, which claims damaged allegedly resulting from, in whole or in part, the performance of any service, duty or responsibility included in or resulting from the Inmate Health Care Services Agreement. The agreement to indemnify and hold harmless shall not include indemnity for acts or negligence on the part of Luzerne County/Director, and its agents, servants, employees, appointees, officers, administrators, successors or assigns and shall not change the status of the successful proposer as an independent contractor nor waive or limit any rights of Luzerne County/Director and its agents, servants, employees, appointees, officers, administrators, successors or assigns.
C. Insurance
1) The successful Proposer shall provide and maintain the following minimum limits of insurance coverage during the period of performance required under a contract resulting from this Request for Proposal:
a) Comprehensive General Liability
• $1,000,000 Bodily Injury and Property Damage per occurrence and $3,000,000 aggregate for bodily injury and property damage with no annual aggregate on an occurrence form. • Comprehensive General Form • Extended Business Liability Endorsement • Products/Completed Operations (to be provided for minimum of24
18 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 81 of 175 months after completion of work). • Broad Form Contractual Liability • Personal Injury Liability
b) Comprehensive Automobile Liability
• $1,000,000 Combined Single Limits for bodily injury and property damage with no annual aggregate on an occurrence form. • Statutory Uninsured Motorist Coverage • Hired and Non-Owned Coverage • Motor Carrier Act Endorsement
c) Professional Liability
• $1,000,000 per occurrence or claim made, with an annual aggregate of $3,000,000, if claim made insurance is offered by the Proposer then a Tail Policy must be purchased to cover the Statutes of Limitations and Statute of Repose for filing of lawsuits in Pennsylvania. The proposer must provide annual proof of the "tail" policy for the period of the contract and through the Statute of Limitations of the State after the policy termination.
d) Worker's Compensation and Employer's Liability
• Statutory Coverage for Pennsylvania • Employer's Liability up to $1,000,000 • Broad Form All States Endorsement
2) Prior to commencing work under a resultant contract, the successful Proposer shall furnish The Luzerne County Division of Corrections with a Certificate oflnsurance naming Luzerne County/Director as an additional insured, giving a Ninety, (90), day notice of cancellation, non-renewal, or change in the insurance coverage. Any cancellations or lapses of insurance affecting any jail (or Hospital) facility under contract shall be deemed a material breach.
D. Equal Employment Opportunity
The successful Proposer shall comply with all provisions of Federal, State, and local regulations to ensure that no employees or applicant for employment is discriminated against because of race, religion, color, sex, age, handicap, or national origin.
E. Warranty Against Contingent Fees
The successful Proposer will agree to warrant that no person or selling agency has been employed or retained to solicit this contract upon an agreement of understanding for commission, percentage, brokerage or contingency, except bona fide employees or selling agents maintained by the Proposer for the purpose of securing business.
Luzerne County Council Voting Session November19 26, 2019 AGENDA Page 82 of 175 F. Subcontracts
Luzerne County Division of Corrections and or its representative must approve, in advance, all subcontracts entered into by the Proposer for the purpose of completing the provisions of this contract. The Proposer will not sell, assign, transfer, nor convey any of its rights except with the written consent of the County or its designee. All contracts for services and or activities subcontracted by the Proposer in order to meet the obligations of this RFP must be entered into and completed within fifteen days of the contract start date. After contract start date no subcontracted services and or activities contracted between proposer and subcontracted parties may lapse or remain unassigned more than thirty (30) days.
G. Security of Inmate Health Care Records
Medical and psychiatric records are of a confidential nature. The Proposer will agree to establish those procedures necessary to maintain the confidentiality of health care records as required by law. Also, it should be noted that the Luzerne County Division of Corrections has implement an Electronic Health Records (EHR) system and will require the selected inmate health services provider to provide and utilize a compatible EHR and transfer existing Electronic Health Records to the proposed system. Proposed system must also be able to interface with the current Jail Management System
H. Proposer Personnel
The Luzerne County Division of Corrections may request replacement of any Proposer personnel believed unable to carry out the responsibilities of the contract and shall approve all appointments to the positions of Health Services Administrator, Director of Nursing, medical directors, supervising nurses, and other Proposer personnel. Luzerne County Division of Corrections reserves the right to evaluate all Proposer personnel selected to work at Luzerne County prior to employment of the Proposer. All Proposer personnel will be required to undergo a security/background check by the Luzerne County Division of Corrections.
I. Proposer Cooperation
The successful Proposer shall, at all times, observe and comply with all Federal, State, local, and municipal laws, ordinances, rules, and regulations in any way affecting the contract.
J. Termination
The Luzerne County Division of Corrections may terminate the contract resulting from this Request for Proposal at any time the Proposer fails to carry out its provisions. The County shall give the Proposer notice of such termination with stated reasons for the termination. If, after such notice, the Proposer fails to cure the conditions within the specified time period contained in the notice, it shall be the discretion of the County to order the Proposer to stop work immediately and leave the premises or to reinstate the contract based upon corrective action. Either party may terminate the agreement, without cause, upon giving the other party not less than one hundred twenty (120) day's written notice of termination.
Luzerne County Council Voting Session 20November 26, 2019 AGENDA Page 83 of 175 K. Failure to Perform
The services rendered under this contract will be critical to the mandated responsibilities of the Luzerne County Division of Corrections. Therefore, the Proposer will reimburse the County for all expenses incurred by the Luzerne County Division of Corrections in providing services which are the responsibility of the Proposer. Such expenses shall be reduced from the monthly payment due the Proposer. In the event the agreement is te1minated prior to its expiration, all finished or unfinished documents, studies, correspondence, reports, and other products prepared by or for the contractor under this agreement shall become the exclusive property of the Luzerne County Division of Corrections. Notwithstanding the above, the Proposer shall not be relieved of liability to the County/Director for damage sustained by the County/Director by virtue of any breach of the agreement by the Proposer.
L. Immunity From Liability
The successful Proposer agrees to indemnify and hold harmless the County/Director, their agents, servants and employees from any and all claims, actions, lawsuits, judgments, or liabilities of any kind whatsoever deriving from acts or omissions of the Proposer, its agents or subcontractors.
The Proposer shall carry malpractice insurance with the limits set forth in their proposal, evidenced by additional insured endorsement adding Luzerne County/Director and its officers and employees as additional insured.
M. Payment for Services
Luzerne County/Director shall pay the successful Proposer for provision of designated services during the term of the contract, in the amount of the proposal or the agreed upon sum, which shall be payable in equal monthly payments. Payment Term will be recorded by the County as Net 30 days. (The County will pay the successful Proposer within 30 days after the date of receipt of a correct invoice describing work performed reasonable and applicable to the contract.)
A "per diem" for inmate population above the stated yearly inmate population caps shall be allowed to the provider. Also a per diem credit shall be allowed to the County/Director for inmate population below the stated inmate population caps. The per diem charge allowed per inmate shall be derived from the inmate population cap per each contract year by 650 inmates. The use of a "per diem" figure is intended to establish a basis for pro rating charges/credits payable to the successful Proposer/County/Director in case of fluctuation in the jail population over/under applicable inmate populations in years one through three as outlined below.
Whenever the number of inmates average, per billing period, is in excess of 650, the
21 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 84 of 175 Provider shall be paid at a rate equal to the number by which the average of 650 is exceeded times the per diem rate times the number of days in the affected billing period.
Whenever the number of inmates average, per billing period, falls below 650, the LCDOC shall be paid at a rate equal to the number by which the average is less than 650 multiplied by the per diem rate times the number of days in the affected billing period.
Any additional compensation or credits to the County/Director for inmate population of the Luzerne County Division of Corrections in excess or below the appropriate number of inmate's yearly cap will be payable/credited to the Provider/County in the billing period following the billing period during which the population exceeded or was below the inmate cap for that year.
The inmate population shall be determined as of 12:00 a.m. every day of the contract term and the population for all of the days in a billing period (month) divided by the number of days in the billing period (month) shall be the average population for that billing period's computations.
N. Third Party Reimbursements
Proposer will, where possible, seek third party insurance reimbursement for inmate medical services performed by the Proposer or other outside Medical Services. The Proposer will share all documentation received on insurance of third party claims with the County. The contractor will make every effort and establish operation's procedures to routinely pursue all insurance claims, and other means of subrogation, for medical treatment provided.
The efforts to collect insurance information from the inmates upon booking and the successful performance by the Proposer to seek and collect third party payment for inmate health care services must be demonstrated and reported to Luzerne County Division of Corrections and or its designee on a monthly basis. This responsibility will be closely monitored by the County/Director in order to measure the compliance and success of the proposer. '
Proposer will be required to manage all applicable provisions of the Affordable Care Act of 2010 as it relates to the inmate population and the Commonwealth of Pennsylvania.
0. Obligations of The Luzerne County Division of Corrections
The County shall provide space, limited housekeeping, linens, laundering, facility fixtures, utilities, telephone service, and security. The disposal of contaminated waste shall be the responsibility of the Proposer. Disposal of these wastes must be in accordance with all Federal, State, and local laws.
P. Public Information
Neither the Proposer nor the County shall publish any findings based on data obtained from the operation of a contract agreement without the prior consent of the other party, whose
Luzerne County Council Voting Session November22 26, 2019 AGENDA Page 85 of 175 written consent shall not be unreasonably withheld.
The Proposer will provide the County/Director with any and all requested information pertaining to the contract agreement/operation when requested in writing by the LCDOC or its designee. The information will be submitted in written form.
Q. Research
No research projects involving inmates, other than projects limited to the use of information from records compiled in the ordinary delivery of patient care activities, shall be conducted without prior written consent of the County or conducted without prior written consent of the County or its designee. The conditions under which research shall be conducted shall be agreed to by the Proposer and the County or its designee, and shall be governed by written guidelines. In every case, the written informed consent of each inmate who is a subject of a research project shall be obtained prior to the participation of an inmate as a subject.
R. Compliance with National Commission on Correctional Health Care Standards
Proposer will provide health care services which meet or exceed the National Commission on Correctional Health Care Standards.
S. Compliance with State Minimum Jail Standards
The successful Proposer will provide services which comply with all applicable jail standards.
T. Access to Management Information
The County shall have the complete and unlimited right to access any and all information maintained by Proposer which may be needed to insure compliance with the contract terms and conditions. The Proposer shall make available all records or data requested.
U. Permits and Licenses
All permits and licenses required by Federal, State, or local laws, rules and regulations necessary for the implementation of the work undertaken by the Proposer pursuant to the contract shall be secured and paid for by the Proposer. This includes any accreditation or certification costs. It is the responsibility of the Proposer to have and maintain the appropriate certificate( s) valid for work to be performed and valid for the jurisdiction in which the work is to be performed for all persons working on the job for whom a certificate is required.
V. Equipment and Space Available
For the life of the agreement, the successful proposer is responsible for the purchasing of all medical/office equipment less than $1,500.00 necessary to perform inmate health care. The Proposer shall also be responsible for repair or replacement of all medical equipment, (Director's or Provider's), used by any health care Provider's staff. In like manner, the
Luzerne County Council Voting Session November23 26, 2019 AGENDA Page 86 of 175 Director shall be responsible for any direct loss or damage to property or equipment of the successful Proposer caused by negligence of the Luzerne County Division of Corrections employees.
All current equipment and any equipment purchased by the successful Proposer shall revert to the Director upon contract termination in its present condition, reasonable wear and tear accepted. Equipment may be inspected by the Proposer during the stated Proposers' tour. The existing Medical Section of the Luzerne County Division of Corrections Facilities will be placed at the disposal of the Provider. All utilities and general structural maintenance of this area shall be the responsibility of the County/Director. Special wiring, outlets, or other electrical work reasonably necessary to the operation of the Provider shall be at the expense of the County. Modifications requiring structural changes shall be at the expense of the Provider.
W. Choice of Law and Venue
Any and all disputes arising under the contract shall be governed by the laws and regulations of the Commonwealth of Pennsylvania. Further, all such disputes shall be brought in the Court of Common Pleas of Luzerne County, Pennsylvania.
Specifications and Program Requirements
The successful Proposer will be expected to meet the following specifications and program requirements. This listing is not intended to be all inclusive, but serves as a guideline with recommendation for the development of a health care program for the inmate population in the custody of Luzerne County Division of Corrections. This includes the responsibility for providing all primary medical, dental, and mental health services.
Proposer would be responsible for providing medical screening, admission evaluation, sick call, special needs care, hospitalization, all off-site service management, ambulance transport, pharmacy services, medical clearances for intra- and inter-agency transfer, meal planning, food handling and work clearances, the continuing care of identified health problems, detoxification, and emergency services.
The successful Proposer will be expected to provide comprehensive services that are legally defensible and which meet the National Commission on Correctional Health Care and PA. Title 37 Standards for Health Services in Jail facilities.
A. Administrative Requirements
1) The Proposer shall include, at a minimum, the following staff: (1) a singularly designated physician health authority to be known as the "Medical Director;" (2) a Psychiatrist for mental health services and (3) a Dentist for dental services, all tasked with the responsibility of assuring the appropriateness and adequacy of inmate health care.
The Psychiatrist shall be physically present at LCDOC and/or available via
Luzerne County Council Voting Session November24 26, 2019 AGENDA Page 87 of 175 tele psychiatry for a minimum of two (2) hours per week. If the psychiatrist practices via tele psychiatry, the psychiatrist will be required to be psychically present at LCDOC a minimum of two (2) hours per month. In addition, the Proposer shall have either (a) a full-time psychiatric Nurse Practitioner on-site, or (b) a full-time Physician Assistant present on site.
2) A full-time Health Services Administrator (HSA) with the authority to oversee the administrative requirements of health care programs, such as recruitment, staffing, data gathering and review, monthly/daily reports of contract services activity as required by Luzerne County Division of Corrections, medical record keeping, and other management and clinical services.
The Health Services Administrator (HSA) shall also be the Director of Nursing (DON) for the LCDOC. The HSA must be a Registered Nurse or a Nurse Practitioner and be competent and able to provide liaison services between (a) the LCDOC's psychology/psychiatry department, (b) the physical health department, and (c) the LCDOC's Director, Intake staff and Correctional Officer Staff. The HSA shall report directly to the Director of LCDOC or the Director's designee.
3) Health Care personnel sufficient to provide appropriate medical and mental health services as outlined in this RFP and, as required, services. A detailed staffing schedule shall be required as part of the inmate health care proposal showing, by jail facility, site by shift, all medical, mental health, dental and health care administrative positions indicating work schedules. Appropriate relief and vacation scheduling shall be required and indicated in the staffing plan for all positions.
The Proposer shall have sufficient qualified Health Care personnel to provide appropriate medical and mental health services as outlined in this RFP, and if necessary, those certain emergency services outlined herein. The Psychology Department shall be fully staffed Monday through Sunday with an onsite Mental Health Professional. Specifically: • The Psychology Department shall be staffed seven days a week. The Department shall be staffed on-site with a minimum of three (3) Mental Health Professionals during the Monday through Friday schedule shift, and at least one (1) Mental Health Professional during the Saturday and Sunday shift (the "Weekend Shift"). • For all inmates on behavioral watch or suicide watch with scheduled releases for any purpose, the MHP is mandated to use the LCDOC Suicide Risk Assessment (copy enclosed). Prior to the inmate's release. If the inmate proves to be a danger to self and/or others and meets criteria for psychiatric hospitalization commitment (involuntary-302 or voluntary-201), then the MHP is responsible to be the petitioner for the commitment and to arrange a psychiatric evaluation at an approved crisis center, i.e. Commonwealth Health located at the Wilkes Barre General Hospital. The MHP shall coordinate with LCDOC for the transportation of the inmate via ambulance to the approved crisis center and the LCDOC shall assure proper transport of the inmate by ambulance upon the inmate's release. ·
Luzerne County Council Voting Session 25November 26, 2019 AGENDA Page 88 of 175 • A Pennsylvania licensed Psychologist on staff to provide monthly supervision to all MHPs, a minimum being one hour per month per MHP. The Psychologist shall also be available five-to seven days per week via telephone. The Psychologist shall also be physically present onsite at LCDOC at least one time per month.
4) Copies of clearly defined written agreements or understanding for twenty-four, (24), hour service with hospitals, physicians, ambulance companies, and others involved in providing care to inmates will be provided to and approved by the Luzerne County Division of Corrections. All subcontracts of every nature are subject to the approval of the County/Director.
5) Well defined operational policies and procedures to include, at a minimum, those required by the NCCHC standards, PA title 3 7 and the Luzerne County Division of Corrections policies and procedures necessary to specify the role of medical services in a jail setting and to provide a liaison between the medical and security staff.
6) A comprehensive annual statistical report will be forwarded to the Luzerne County Division of Corrections. In addition, monthly and daily statistics will be required by site and in total:
a) Monthly Statistics
Narrative reports shall be submitted on the fifteenth calendar day of each month to the Director of Corrections and the Contract Monitor with data reflecting the previous month's workload, to include:
• 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 • Special needs admission, patient days, average length of stay • Off-site hospital and Emergency Room admissions and cost • Medical specialty consultation referrals and cost • Intake medical screening • Fourteen, (14), day history and physical assessments • Psychiatric evaluations • Diagnostic studies • Report of third party reimbursement, pursuit, and recovery • Percentage of inmate population dispensed medication and costs • Inmates testing positive for venereal disease and TB • Inmates testing positive for AIDS or AIDS Antibodies • Inmate mortality • Number of hours worked by entire medical staff and staffing
26 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 89 of 175 compliance to contract staffing levels • Other data deemed appropriate by the Corrections Director
b) Daily Statistics
A narrative report for the previous twenty-four, (24), hours, capturing the following data shall be submitted to the Director upon a daily basis prior to 9:00 a.m. to include:
• Transfers to off-site hospital emergency departments • Communicable disease reporting • Suicide data (i.e., attempts and precautions taken) • Report of status of inmates in local hospitals and infirmaries • Staffing positions unfilled • Submit completed medical incident report copies • A list of lost medical files • History and Physical and Medical Intake Screening status report
7) On a scheduled basis, the central administrative staff shall have documented monthly meetings with LCDOC administrators to evaluate statistics, program needs, problems, and coordination between custody and medical personnel.
8) Documentation of health care staff roles in the jail disaster plan. The contract provider for medical services shall, in times of emergency or threat thereof, whether accidental, natural, or caused by man, provide medical assistance to the Luzerne County Division of Corrections to the extent or degree required by LCDOC policies and procedures.
B. Personnel Requirements
1) Staffing Schedule:
a) This Proposal shall include a schedule (also known as a staffing chart) reflecting of the staffing coverage planned for each housing unit and/or facility within the LCDOC reflective of its anticipated week staffing coverage. This shall include the number and type of staff persons assigned for the various shifts on each day, and shall include the wages and the benefit costs the Provider plans to pay for each position. This schedule/staffing chart shall indicate the professional qualifications required to fill each position, the expected use of any "outside" or Medical Doctors and such Doctor's specialties and expected frequency of visits, and the number of "inside" medical professionals and staff (including but not limited to Medical Doctors, Physician Assistants, Registered Nurses, Licensed Practical Nurses, Paramedics, EMTs, Certified Nurse Assistants, etc.) with the expected number of hours. This schedule shall be listed separately from the body of the Proposal and clearly designated as the "Staffing Schedule."
Luzerne County Council Voting Session November27 26, 2019 AGENDA Page 90 of 175 At a minimum, the Staffing Schedule shall include the following: Psychiatrist- The Psychiatrist shall be physically present at LCDOC and/or available via tele psychiatry for a minimum of two (2) hours per week. If the psychiatrist practices via tele psychiatry, the psychiatrist will be required to be psychically present at LCDOC a minimum of two (2) hours per month.
a. Nurse Practitioner- full-time on-site at LCDOC b. Physician Assistant - full-time on-site at LCDOC c. Medical Health Professional - on site at LCDOC; as clearly set forth above.
b) Proposed staffing will be in accordance with positions required to properly, and in a timely manner, as indicated in this proposal and to meet NCCHC Standards and fulfill all necessary inmate health care operations. However, final staffing for the delivery of medical services will be as mutually agreed upon by written contract between the Proposer and the Luzerne County Division of Corrections.
2) Medical Physician services must be sufficient to provide the required needs of the day and assure medical evaluation/follow-up within twenty-four, (24), hours of post nursing triage referral, (including weekends and holidays). In addition, twenty-four, (24), hour physician on-call services with availability for consultation and on-site needs system-wide is required.
3) Nursing services, must be available to provide for the following:
a) Medical and Psychiatric Department coverage at all times. b) Intake screening on all inmates at time of admission. c) Histories and physicals on all inmates ideally within twenty-four (24) hours but no longer than fourteen (14) days of admission. d) Medications to be delivered as medically indicated. e) Sick call triage and follow-up on a daily basis. f) Appropriate and timely responses to medical needs and emergencies. g) Physician assistance services. h) Detoxification of "ambulatory detoxifying patients" that may be appropriately treated inside the prison
This cost should be broken out in the respective pricing sheets.
4) Mental Health Professionals must provide the following: a) LCDOC Universal Suicide Risk Assessment; b) Crisis management; c) Communicate with LCDOC medical staff and Correctional Officers about high-risk inmates on a daily basis; d) Conduct daily assessments of all inmates on suicide watch and behavioral watch;
Luzerne County Council Voting Session November28 26, 2019 AGENDA Page 91 of 175 e) Therapeutic services, including but not limited to, inmates requesting services; f) Assist psychiatrist, physician assistant, and/or nurse practitioner; g) Attend weekly department meeting h) Seek approval from the psychiatrist for inmate removal from suicide watch i) Case management services for inmates active with psychology department j) Aftercare planning prior to inmate release from LCDOC to include, but not limited to, securing medical insurance, securing housing, and securing community based psychiatric treatment.
5) Psychiatrist must provide: a) Review and approval of a complete psychiatric evaluation and treatment plan including a DSM-V diagnosis and an appropriate treatment medication management plan b) Ongoing monitoring of the medication management plan and any changes that are made in conjunction with the PA or nurse practitioner c) Review for denial or approval of a Brief Psychiatric Assessment to assist in aftercare housing and continuity of care with outpatient treatment which may be completed by the PA or nurse practitioner d) Final approval for removal of suicide watch
6) Nurse Practitioner and/or Physician's assistant must provide: a) Develop a provisional assessment, DSM-V diagnosis, medication needs and treatment plan to be reviewed and approved by the psychiatrist consistent with the state regulations but no more than seven (7) day b) Ongoing medication management monitoring c) See inmates on a regularly scheduled basis for psychiatric status at a minimum of one time per month d) Ongoing contact with the psychiatrist e) Ongoing communication with the MHPs f) Attend weekly department meeting g) Seek approval from the psychiatrist for inmate removal from suicide watch h) Ensure the inmate is released with enough medication until the scheduled outpatient psychiatric appointment.
7) HSA must provide: a) Liaison services between (a) the LCDOC's psychology/psychiatry department, (b) the physical health department, and (c) the LCDOC's Director, Intake staff and Correctional Officer Staff. b) Responsible for identifying high risk inmates including but not limited to, suicidality, high risk substance use detox, medication/treatment noncompliance and organic brain issues c) Communicate high risk inmates with nurse practitioner/physician's assistant, MHP, physician and/or psychiatrist through the sharing of medical records and direct communication with the appropriate health care provider d) Attend weekly psychiatry/psychology department meeting
Luzerne County Council Voting Session November29 26, 2019 AGENDA Page 92 of 175 8) Sufficient clerical support staff must be available to support the medical contract.
9) Written job descriptions and post orders to define specific duties and responsibilities for all assignments at each facility must be available at each site.
10) Copies of staffing schedules encompassing all health care staff are to be posted in designated areas and submitted to the Director of Corrections and Contract Monitor on a bi-weekly basis, with daily updates regarding changes.
11) The successful Proposer will be required to provide the Director for the actual costs of service hours not provided by any medical staff or contracted medical services position from the initial date of non-service to the date the staff position filled. To avoid the penalty, the open positions may be filled by equally qualified staff on an over time or pool agency basis not to exceed thirty days. Positions vacant for greater than a thirty day period will be assessed a penalty of 1.5 times the wages/benefit.
12) The successful Proposer shall provide the name, date of birth, local address, previous employment, social security number, and copy of driver's license for all employment applicants. Prior to County approval for employment, an applicant screening shall be conducted, coordinated with the Luzerne County Division of Corrections, fingerprints and background check may be required. Applicable licenses and/or certificates for all professional staff must be on file with the Luzerne County Division of Corrections prior to employment. In addition, malpractice insurance must be on file for all Physicians and Nurse Practitioners/Physician Assistants, Psychiatrist, Dentist and other professional or paraprofessional employees, if applicable.
13) The successful Proposer shall provide a written plan for orientation and staff development/training appropriate to their health care delivery activity for all health care personnel. This plan must outline the frequency of continuing training for each staff position. Luzerne County Director Employees shall be included in all appropriate educational offerings.
14) Provisions for pharmaceutical services to assure the availability of prescribed medications within eight, (8), hours of the order of issue being written and provisions for emergency pharmacy services within two (2), hours. Pharmacy services consistent with State and Federal laws and/or regulations, monitored by a licensed qualified pharmacist must be maintained as/if required.
a) Address the need for access to all appropriate medications (i.e. if an inmate is prescribed Geodon in the community and there is not psychiatric reason to change the medication then LCDOC should have access to the medication and not make changes based on what medications are available to the jail)
15) Recording the administration of medications in a manner and on a form approved by the health care authority to include documentation of the fact that inmates are receiving and ingesting their prescribed medications. Documentation will also be required when an inmate's ordered medication was not administered and the reason given.
Luzerne County Council Voting Session November30 26, 2019 AGENDA Page 93 of 175 16) Dental services sufficient to provide for emergency and medically required dental for inmates at the jail within a reasonable period must be available.
17) Coordination with the Detentions' Facility Food Services Supervisor to ensure the provision of food service needs which include:
a) Menus planned for not less than twenty-eight, (28), days in advance and certified by a nutritionist at the expense of the health service provider.
b) Certified, modified diets available for inmates when ordered by the facility physician.
18) The Luzerne County Division of Corrections may prohibit entry to any secure facility, or remove there from, a contract employee who does not perform his/her duties in a professional manner and/or is suspected to or has violated facility policy or procedure.
19) The Luzerne County Division of Corrections reserves the right to search any person, property, or article entering or leaving its facilities.
C. Care and Treatment Requirements
1) Provision for twenty-four, (24), hour a day emergency or immediate medical services to include on-site emergencies, transportation, and acute hospital services with one physician and appropriate health care providers.
2) In addition to twenty-four, (24), hour a day emergency service coverage, the hours for routine nurse sick call at each site shall be at levels which allow for all inmates needing medical services to be seen as clinically necessary.
3) Written manual of standardized policies and defined procedures approved by the health care authority and the Luzerne County Division of Corrections must be reviewed at least annually and revised as necessary under direction of health care authority with approval of the Luzerne County Division of Corrections. A copy of all policies in effect must be provided to the Director or Operations.
4) Provision for necessary laboratory and x-ray services. All abnormal laboratory and x ray results shall be reviewed and signed off by a physician with a follow-up plan of care outlined.
5) Development of a mental health program procedures and policies, and appropriate mental health staffing. This shall include, but not be limited to the following:
a) When isolated for psychiatric purposes, inmates shall be examined by a physician or designee within forty-eight, (24), hours after confinement.
b) Medical evaluation must support medical confinement of inmates based on risk of physical danger to self or others.
31 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 94 of 175 c) Medical service must continue to provide follow-up care and treatment during the entire time an inmate is held in medical confinement on at least a three, (3), day per week basis.
d) Relating to mental health services, a psychiatrist or his/her medical designee will be responsible to dete1mine when an inmate should be sent or returned to general population with documentation in the medical record regarding these decisions.
e) All inmates referred for mental health evaluation will receive a comprehensive diagnostic examination including a psychosocial history and mental status evaluation. This examination will include an assessment of suicidal risk, potential for violence, and special housing needs.
f) Psychotropic medication, including injectable, will be used where appropriate. To maximize the effectiveness of pharmacotherapy and to reduce the toxicity and side effects of medication, an intensive program of drug monitoring shall exist. All inmates placed on drug therapy will be seen within one (1) week by the psychiatrist. Precautions to be followed will include:
1) The psychiatrist will review the inmate's medical record to determine which medications the patient has been receiving prior to prescription of psychotropic medication.
2) Prior to the prescription of psychotropic medication, inmates will be informed by a member of the mental health staff about the risks of taking such medication, in accordance with applicable standards of care. All female inmates will be so informed by a member of the mental health staff about the risks of taking such medication while pregnant. A pregnancy test will be provided prior to the prescription of psychotropic medication to female inmates wishing such a test, if such a test has not already been provided upon intake.
All patients placed on medication will be evaluated for signs of toxicity. Blood pressure will be regularly checked and drug levels monitored where appropriate with documentation of this information to be placed routinely in the inmate's record.
g) Substance Abuse services will be offered to those inmates who are referred to the program for mental health problems and, who also have mental health problems and, who also have substance abuse related problems. These services will be provided by mental health professionals and should include case findings, referrals, liaison work, and post release planning.
Alcohol withdrawal, Opioid withdrawal, Benzodiazepine withdrawal, any other substance abuse withdrawal must be addressed
6) DRUG AND ALCOHOL DETOXIFICATION PROTOCOLS please see
Luzerne County Council Voting Session November32 26, 2019 AGENDA Page 95 of 175 attachments for suggested detailed drug specific protocol
7) Development of special medical program which exists for inmates requiring close medical supervision, chronic and convalescent care needs. This section must include specific guidelines for housing standards of these inmates. Requirements to be included are: a) Each inmate assigned this classification must have a written individualized treatment plan. b) Inmates committed under the influence of alcohol or drugs shall have an appropriate course of treatment, including a medically approved and supervised substance \specific detoxification program administered. c) Inmates with suicidal tendencies and those with a history of having seizures, as determined by medical authority, must be assigned to quarters that have close observation.
d) Pharmacological support care must be determined by a physician.
8) Luzerne County Division of Corrections and medical and mental health staff shall share relevant information including, but not limited to, communicable disease and behavior pro bl ems/disorders.
9) Define a program for meeting the special needs of the female population, e.g., pregnancy.
10) The successful Proposer shall be responsible for operation of a Communicable Disease Unit.
11) A written plan with specifics for provision of specialty health care services shall be followed.
12) Provision for examinations and medical clearance for all inmate workers, trustees, work release inmates, inmates assigned to work programs outside jail facilities, prior to placement in the assignment. Inmate worker medical clearances must include:
a) Relevant past medical history, including communicable disease, heart problems, respiratory problems, allergies, back problems;
b) Questions for current signs and symptoms of illness;
c) Current vital signs, including blood pressure, pulse, temperature;
d) General examination for overall physical and mental health, with specific reference to (1) examination for evidence of communicable disease to include, but not to be limited to, skin problems such as rash, wounds, sores, boils, et cetera; and (2) heart and lung examinations;
e) Current test for tuberculosis;
f) Current test for Sexually Transmitted Disease;
Luzerne County Council Voting Session November33 26, 2019 AGENDA Page 96 of 175 g) Completion of trustee clearance form prior to inmate placement in such assignment.
13) Documented inmate medical and mental health screening shall be provided within eight (8) hours of arrival at the Luzerne County Division of Corrections (LCDOC) facility must be based on structured inquiry and observation, performed by qualified health care personnel, twenty-four, (24), hours a day, seven, (7) days a week. There will a $100 charge for every screening that exceeds the eight hour limit.
a) No unconscious person or a person who cannot be treated at the facility shall be admitted to the jail system. They must be referred immediately for emergency medical attention and their admission or return to the jail systems is predicated upon written medical clearance.
b) Receiving screening findings should be recorded on a printed form approved by the health authority and LCDOC, and shall be provided by the vendor.
c) At a minimum, the screening must include inquiry into:
1) Current illness and health problems including mental, dental, and communicable diseases; this includes documentation of prior or present suicidal ideation.
2) Medications taken and special health requirements;
3) Use of alcohol and drugs, including types, methods, amounts, frequency, date/time of last use and history of problems related to stoppage;
4) For females, a history of gynecological problems and pregnancies;
5) A list of current health insurance available to inmates.
d) At a minimum, the screening must include the observation of:
1) Behavior, including state of consciousness, mental status to include thoughts of prior or present suicidal ideation, appearance, conduct, prior mental health problems, tremors, sweating;
2) Notation of body deformities, trauma, markings, ease of movement;
3) Condition of skin and body orifices, including rashes and infestations, needle marks, or other indications of drug abuse;
e) Inmates must be medically cleared before they are sent to general population;
f) All new admissions/screening charts are to be reviewed and signed by the
Luzerne County Council Voting Session November34 26, 2019 AGENDA Page 97 of 175 MD/PA/NP within seventy-two, (72), hours or sooner if medically necessary.
14) Each inmate shall be given a health appraisal, including a physical examination by qualified health care personnel within ten (10) days after admission to the jail system, based on the criterion listed in the NCCHC. There will a $200 charge for every H&P that exceeds ten days.
a) The extent of the health appraisal, including physical examination, is defined by the responsible health authority, however, it will include at a mm1mum:
1) Review of intake screening forms;
2) Collection of additional data regarding complete medical, dental, psychiatric, and immunization histories;
3) Appropriate laboratory and diagnostic tests to detect communicable disease (Sexually Transmitted Disease and Tuberculosis);
4) Recording vital signs (height, weight, pulse, blood pressure, temperature);
5) Physical examination with comments about mental and dental status. A gynecological assessment must be included for females;
6) Review of physical examination and test results by a physician for problem identification;
7) Initiation of therapy when appropriate;
8) Other tests and examinations as clinically appropriate.
b) The form used for the health appraisal must be approved by the Luzerne County Division of Corrections
c) The Luzerne County Division of Corrections policy and procedure requiring a health appraisal must be contained in the standard operating procedures of the medical section.
d) 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.
14) Medical staff shall be responsible for all light housekeeping duties in the medical department with the exception of the floors, bathrooms, and showers.
15) Medical staff shall respond to medical needs of the Luzerne County Division of Corrections staff on duty and document services provided.
35 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 98 of 175 16) Inmates will not be allowed to provide any health care services, including record keeping.
17) Copies of all inspection reports shall be provided to the Luzerne County Division of Corrections and the Contract Monitor.
18) All outside medical consultations/treatment shall be coordinated in advance with the Luzerne County Division of Corrections Transportation Division. No information, (time, date, etc.), is to be given to any inmate prior to being transported.
19) The successful Proposer shall be responsible for the disposal of all contaminated waste. This material must be removed from within the facility to a secured area and disposed of as required.
20) The successful Proposer shall be responsible for any cost associated with prenatal, delivery, and postnatal care of pregnant inmates. The Proposer will not be held responsible for cost associated with infant care.
21) Unusual Costs/ Off- Site Health Care
Luzerne County Division of Corrections requires the Provider process, adjudicate and pay any applicable cost to provide "off-site" care outside the jail inmate health care services. The Provider shall be responsible for all inmate health care expenses incurred outside of the facility.
D. Electronic Medical Health Records Requirements
1) An electronic health record consistent with State regulations and community standards of practice shall be maintained on each inmate.
2) Information Technology Requirements: The EHR software must interface with LCDOC's inmate management software, providing new bookings, moves, transfers and releases along with other demographic information including pictures. The system must also be able to access all current EHR' s or convert all existing electronic records to any proposed system. The successful proposer may utilize the current or future versions of the Offender Management System that is currently in place as long as the system meets the State regulations and community standards described in the request.
Describe and demonstrate the effectiveness of the proposed approach to: • Standards • Integration and Interfaces • Results Capturing and Tracking • Document Imaging
Provide a general system diagram. Outline technical specifications of the proposed
Luzerne County Council Voting Session November36 26, 2019 AGENDA Page 99 of 175 system, including database structure, network components and architecture and description of technologies used for implementation including a list of all other software and/or hardware needed to operate the system. Describe the overall EHR proposed system and requirements.
EHR system must run terminal services server for medical staff to access and input data via "Remote Desktop" on laptops (via wireless) and PC's in the medical facilities at the jail. Software must be able to run in a terminal service environment.
The EHR vendor will provide timely patches to provide solutions to any programming issues. The EHR vendor will provide at least a quarterly update with new features added to the software. The EHR vendor will install any required updates and county IT staff will assist to the extent that is reasonable ..
Any costs/charges associated with this system should be listed separate and apart from the cost proposal for inmate health care services. Submitted plans must address such issues as hardware, software, technical support, and ownership at the termination of the contractual period. Please breakout pricing and descriptions regarding: a. Annual licensing fees b. Annual support costs (technical support for software and hardware issues) c. Start-up costs (including installation and training) d. Annual training costs
3) Individual health care records will be initiated and maintained for every inmate regarding medical, dental, or mental health services as a result of the inmate screening process, or for services rendered following assignment to a housing area.
Luzerne County Council Voting Session November37 26, 2019 AGENDA Page 100 of 175 The Facility currently utilizes an electronic health record system (EHR). Proposer's are asked to propose a plan for implementing a comparable EHR with interfaces to existing LCDOC technology and diagnostic services to begin shortly after the contract start date. The successful EHR system will provide comprehensive EHR functionality and interoperability. The system must provide easy and efficient means for medical staff to more effectively manage individual patient treatment. Functionalities will include: Patient Management Capabilities, Computerized Provider Order Entry, flexible Reporting and Querying. Interoperability with current jail management system, conformance to existing and emerging national vocabulary fmmat and reporting, are key objectives. With the approval of the LCDOC, the proposer will be responsible for procurement and maintenance of the computer equipment and will provide software system, installation, integration, training, implementation support and ongoing technical support of the EHR system. County IT staff will assist with connectivity issues to the county network to facilitate EHR implementation for the proposer's IT staff
The successful proposer shall also cooperate and provide assistance to Luzerne County Division of Corrections in the development and implementation of software "linkage" between local health care providers and the jail EHR system. This is to include the linkage development between Luzerne County inmate EHR system and the proposer's for future purposes of claims management and billing of off-site and or onsite health care services as may be allowed by law. Any additional future cost associated with EHR Links or changes in the provider network will be the responsibility of the proposer.
a) Inmates returning from outside hospital stays, clinic visits, or return from other correctional facilities are to be seen by a qualified medical provider. A note regarding this review with reference to follow-up in-house must be documented in the inmate medical record.
b) The results of tuberculin tests shall be read and documented on a daily basis.
c) Medical staff shall perform reviews, medical examinations, medical summaries or certifications as are necessary for intra-system transfers, food handling and work clearances which must be completed within twenty-four (24) hours from the time the names are provided.
d) Medical summaries that meet the requirements of PA Act 84 shall be prepared and sent with inmates being transferred to other correctional facilities other than Luzerne County Division of Corrections.
4) The inmate health record shall include, but not be limited to:
a) Intake screening form;
b) Medical and Mental Health appraisal forms;
c) Physician order/treatment plans;
38 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 101 of 175 d) Prescribed medications administered or not, date, time, and by whom;
e) Complaints of illness or injury;
f) Findings, diagnoses, treatments, and dispositions;
g) Health service reports;
h) Consent and refusal forms;
i) Release of information forms;
j) Inmate medical request forms;
k) Medical grievance forms;
1) Signature and title of each documenter;
m) Laboratory, radiology, and diagnostic studies;
n) Consultation, emergency room and hospital reports and discharge summanes.
5) Confidentiality of medical records will be assured. The medical and psychiatric records will be kept separate from the custody records. Data necessary for the classification, security, and control of inmates will be provided to the appropriate Luzerne County Division of Corrections personnel. Medical records will be made available to Luzerne County Division of Corrections personnel when required to defend any caused action by any inmate against the County.
6) Adherence to applicable informed consent regulations and standards of the local jurisdiction must be maintained.
7) Inactive medical records will be maintained in accordance with the laws of the Commonwealth of Pennsylvania and the American Medical Association. After two (2) years, inactive medical records will be, at the Provider's cost, properly stored so as to remain intact and accessible:
8) Information concerning any court or legal documents affecting inmates and the medical contract provider must be provided in writing to the designated representative in the Director's Office prior to the close of the shift of service/receipt.
9) If an inmate's medical record cannot be located within forty-eight (48) hours of the discovered loss, a duplicate record shall be immediately generated. Any clearance information that cannot be determined shall be repeated. Upon location of the missing record, and after a duplicate file has been created, the two files shall be joined to form one file.
Luzerne County Council Voting Session November39 26, 2019 AGENDA Page 102 of 175 E. Quality/Assurance Requirements
A quality assurance program will be ongoing, consisting of regularly scheduled audits of inmate health care services with documentation of deficiencies and plans for correction of deficiencies. The quality assurance plan shall include a provision for program and contract monitoring (peer review) by an "outside" correctional health care consultant on an annual basis, the results of which shall be made available to the Director of Corrections and designated LCDOC staff. The cost will be paid by the successful Proposer.
F. Financial Requirements
The successful Proposer will be responsible for all costs related to inmate health care services including, but not limited to:
a) Pharmaceutical/medical supplies;
b) Office and medical equipment to include dental, radiographic, emergency,
examination room, etc.;
c) Personnel; (not including the 13 nurses in the CBA)
d) Required off-site emergency and non-emergency services (hospital, specialty
services, dental, laboratory, radiology),
e) Prosthesis;
f) Eye care and glasses;
a. The Proposer shall provide/Pay all eye care/eye glasses on a referral
basis when it is deemed necessary by the Provider for the health and
well-being of an inmate.
g) Forms, office supplies, books;
h) Sufficient copying equipment to support the contract;
i) Contaminated waste disposal.
Luzerne County Council Voting Session November40 26, 2019 AGENDA Page 103 of 175 9. EXCEPTIONS TO PROPOSAL: All proposals must clearly and with specificity detail all deviations to the exact requirements imposed upon the Proposer by the General Terms and Provisions (Part A) and Special Provisions (Part B). Such deviations should be stated upon the Proposal (Part C) of appended thereto. Proposers are hereby advised that Luzerne County Division of Corrections will only consider proposals that meet the specifications and other requirements imposed upon the proposer by this package. In instances where an exception is stated upon the Proposal (Part C), said proposal will be subject to rejection by Luzerne County Division of Corrections in recognition of the fact that said proposal does not meet the exact requirements imposed upon Proposer by the General Terms and Provisions (Part A) and the Special Provisions (Patt B).
10. HEALTH CARE CONTRACT: The successful Proposer must enter into a contract with Luzerne County Division of Corrections, the terms and conditions of which must be acceptable to the County/Director, whether addressed in this Request for Proposal or not. A tentatively selected health care Proposer that fails to meet the contractual terms of the separate needed contract shall be rejected.
PARTC
PROPOSAL FOR INMATE HEALTH CARE SERVICES
Include as part of your bid proposal an overview of your company indicating the background of your general management and staff. Provide insight as to how you propose to begin your service to our facility.
The proposal shall include samples of all forms proposed to be used in the performance of the contract.
The proposal shall include an organization chart identifying specific areas of responsibilities of all staff members supported by job descriptions and qualifications of each staff member.
The Proposer shall include a list of all litigation that the firm is currently involved in and all damages, cost, paid by the Proposer in the last five, (5), years in determined negligence.
We would expect to see reference to prior experience in this field along with documentation of staffing and personnel turnover.
We require a copy of your most recent audited financial Income and Balance Statement from your most recent fiscal year, along with proof of AM.A. certification of your staff and State licensing reports for the past three years.
Please included, as part of the proposal package, a Statement of References Form, (Financial and Business), which must be completed as part of your response.
The proposer understands that this Bid Proposal must be signed in ink, and that an unsigned Bid Proposal will be considered incomplete and subject to rejection by Luzerne County Division of Corrections.
41 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 104 of 175 SUBJECT TO DEVIATIONS STATED BELOW, THE UNDERSIGNED, BY THE SIGNATURE EVIDENCED, REPRESENTS THAT THE PROPOSER ACCEPTS THE TERMS, CONDITIONS, MANDATES, AND OTHER PROVISIONS OF THE FOREGOING GENERAL TERMS AND CONDITIONS AND THE SPECIAL PROVISIONS, SAID DOCUMENTS BEING THE STRICT BASIS UPON WHICH THE SAID PROPOSER MAKES THIS PROPOSAL.
* * * USE BLACK INK ONLY * * *
Luzerne County Council Voting Session November42 26, 2019 AGENDA Page 105 of 175 ALL THE FOLLOWING INFORMATION MUST BE HEREUPON GIVEN FOR THIS PROPOSAL TO BE CONSIDERED BY THE LUZERNE COUNTY DIVISION OF CORRECTIONS
EXCEPTIONS TO PROPOSAL: NOTE - ANY PRESENTATION (BELOW) OR EXCEPTION(S) MAY CAUSE THIS PROPOSAL TO BE REJECTED BY THE LUZERNE COUNTY DIVISION OF CORRECTIONS.
1. The following represents every deviation (itemized by number) to the foregoing General Terms and Provisions (Part A) and the Special Conditions (Part B), upon which this Proposal is based, to wit:
Luzerne County Council Voting Session November43 26, 2019 AGENDA Page 106 of 175 PROPOSAL FORM
Proposal Title: INMATE HEALTH CARE SERVICES Proposal Number: RFP LCDOC-xxxx-xx
By signing this proposal, the undersigned Proposer affirms that said proposal is made without any understanding, agreement, or connection with any other person, fom, or corporation providing a proposal of the same purpose, and that this proposal is in all respects fair and without collusion or fraud. The undersigned understands that this proposal must be signed in ink and that an unsigned proposal will be considered incomplete and subject to rejection by Luzerne County Division of Corrections.
THE UNDERSIGNED, BY THE SIGNATURE EVIDENCED, REPRESENTS THAT THE PROPOSER ACCEPTS THE TERMS, CONDITIONS, MANDATES, AND OTHER PROVISIONS OF THE FOREGOING INSTRUCTION TO THE PROPOSERS AND THE SPECIFICATIONS, SAID DOCUMENTS BEING THE STRICT BASIS UPON WHICH THE SAID PROPOSER MAKES THIS PROPOSAL. ALSO, THE UNDERSIGNED (PROPOSER), BY THE SIGNATURE EVIDENCED, AGREES TO INDEMNIFY AND HOLD HARMLESS LUZERNE COUNTY/DIRECTOR AND ANYONE DIRECTLY OR INDIRECTLY EMPLOYED BY THEM FROM AND AGAINST ALL CLAIMS, DAMAGES, LOSSES, AND EXPENSES (INCLUDING COURT COSTS AND ATTORNEY'S FEES) RESULTING OUT OF ANY ALLEGED INFRINGEMENT OF PATENT RIGHTS OR COPYRIGHTS HELD BY OTHER AS ARISES OUT OF THE PROPOSER'S PERFORMANCE OF ANY CONTRACT AWARDED BY THE COUNTY/DIRECTOR PURSUANT TO THIS PROPOSAL.
Mandatory proposal requirement- Please provide a separate price/cost breakdown, using the line item categories as outlined below, for each of the Three contract periods. The program/cost applied to each of the categories by the proposer's in the development of their price proposals listed below should be based on the cost for that category and that period in conjunction with the assumed inmate population for that period. The sum total of the listed categories cost for each period should equal the total bid cost for that period and for that Option.
Luzerne County Council Voting Session November44 26, 2019 AGENDA Page 107 of 175 COST CATEGORIES FOR EACH CONTRACT PERIOD
TOTAL COST CONTRACT PRICING
Vendors shall provide contract pricing which is inclusive of all costs for all required health care services as described herein, rendered inside and outside the Facilities for each of the following periods for each category listed below. This cost will be the total of all price breakdowns as listed below and should be based on an assumed billable population of 650 in years one, two and three. The price is to include the furnishing of all professional services, labor, materials, equipment, insurance, licenses and applicable taxes necessary for proper performance of the contract services requested. Provide total cost for each year and must include the breakdown for each year as listed below.
A. October 1, 2019-October 31, 2020- $______Total Cost Year 1
B. October 1, 2020 - October 31, 2021 - $______Total Cost Year 2
C. October 1, 2021-October 31, 2022- $______Total Cost Year 3
This total cost for each year will be the total of all price breakdowns as listed below:
Population 650 650 650
Employee Benefits and Salaries $ $ $
Nursing Services $ $ $
Contract Fees $ $ $
Pharmaceutical Services $ $ $
Off-Site Care $ $ $
Lab $ $ $
X-Ray $ $ $
Dialysis $ $ $
All Medical Supplies $ $ $
Malpractice Insurance $ $ $
Administrative Costs $ $ $ (Please indicate what they include)
Fed, State & Local Taxes and Licenses $ $ $
Luzerne County Council Voting Session November45 26, 2019 AGENDA Page 108 of 175 A LA CARTE PRICING
In addition to a total cost basis contract, the Division shall evaluate "a la carte" pricing for individual components that incorporate Inmate Health Care Services. Vendors are encouraged to offer "a la carte" pricing for each component listed. The "a la carte" pricing is to include the furnishing of all professional services, labor, materials, equipment, insurance, licenses and applicable taxes necessary for proper performance of the contract services requested for each component listed. Provide total cost for each year and must include the breakdown for each year as listed below.
A. October 1, 2019-October 1, 2020 - $ ______Total Cost Year 1
B. October 1, 2020-October 1, 2021 - $ ______Total Cost Year 2
C. October 1, 2021-October 1, 2022 - $ ______Total Cost Year 3
I. Nursing Services This total cost for each year will be the total of all price breakdowns as listed below:
Employee Benefits and Salaries $ $ $
All Medical Supplies $ $ $
Administrative Costs $ $ $ (Please indicate what they include)
Contract Fee $ $ $
II. Medical
This total cost for each year will be the total of all price breakdowns as listed below:
Employee Benefits and Salaries $ $ $
All Medical Supplies $ $ $
Administrative Costs $ $ $ (Please indicate what they include)
Contract Fee $ $ $
Luzerne County Council Voting Session November46 26, 2019 AGENDA Page 109 of 175 III. Dental Services
Employee Benefits and Salaries $ $ $
All Medical Supplies $ $ $
Administrative Costs $ $ $ (Please indicate what they include)
Contract Fee $ $ $
IV. Mental Health Services
This total cost for each year will be the total of all price breakdowns as listed below:
Employee Benefits and Salaries $ $ $
All Medical Supplies $ $ $
Administrative Costs $ $ $ (Please indicate what they include)
Contract Fee $ $ $
V. Pharmaceutical Services & Supplies
This total cost for each year will be the total of all price breakdowns as listed below:
Employee Benefits and Salaries $ $ $
All Medical Supplies $ $ $
Administrative Costs $ $ $ (Please indicate what they include)
Contract Fee $ $ $
Any vendors replying to this R.F.P. may submit pricing based on a total cost basis, "a la carte" pricing for individual components and have the option to submit pricing using both methods. Vendors may also submit pricing for any one or combination of "a la carte" components.
Vendors submitting pricing on individual components must include in their proposal a detailed explanation of how their individual component will operate, and coordinate services with a new, or established multidisciplinary team.
Luzerne County Council Voting Session November47 26, 2019 AGENDA Page 110 of 175 SEPARATE CONTRACT PRICING
In addition to a total cost basis contract, the LCDOC shall evaluate separate pricing of an Electronic Health Record System for the Inmate Health Care Services. The pricing is to include the furnishing of all professional services, labor, materials, equipment, insurance, licenses and applicable taxes necessary for proper performance of the contract services requested. Provide total cost for each year and must include the breakdown for each year as listed below.
Comprehensive Electronic Health Records System
This total cost for each year will be the total of all price breakdowns as listed below:
Fiscal Year 2019 2020 2021 _ Initial Installation Cost/Training $_____ $ _____ $ _____
Annual Support Charges (technical support) $______$ _____ $ ______$ Administrative Costs $------$------
(Monthly Charges, Annual licensing fees, Annual training costs, Update Costs, etc.) _ Contract Fee $______$ _____ $ _____
The Proposal is hereby signed as of the date indicated by an official authorized by the Proposer.
Proposer:
By:______(SEAL) Authorized Signature in Black Ink
Print Name
Title
Date
Telephone Number
Luzerne County Council Voting Session November48 26, 2019 AGENDA Page 111 of 175 STATEMENT OF BUSINESS REFERENCES
The following references are provided for your information and are available for contact.
1. Firm Name
Contact
Title
Mailing Address
Phone
2. Firm Name
Contact
Title
Mailing Address
Phone
3. Firm Name
Contact
Title
Mailing Address
Phone
4. Firm Name
Contact
Title
Mailing Address
Phone
Luzerne County Council Voting Session November49 26, 2019 AGENDA Page 112 of 175 STATEMENT OF FINANCIAL REFERENCES
The following references are provided for your information and are available for contact.
1. Firm Name
Contact
Title
Mailing Address
Phone
2. Firm Name
Contact
Title
Mailing Address
Phone
3. Firm Name
Contact
Title
Mailing Address
Phone
4. Firm Name
Contact
Title
Mailing Address
Phone
Luzerne County Council Voting Session November50 26, 2019 AGENDA Page 113 of 175 + I 1111111111111111111 □ STAT •po• 0 Another brand of drug identical in form and content may be dispensed unless checked
All PAN orders will start on day of admission unless otherwise Indicated CHECK boxes and INITIAL desired schedule DRUG DETOXIFICATION START DATE & TIME " D Therapeutic multivitamin 1 tab by mouth twice a day for 5 days then discontinue
START DATE & TIME D Zolpidem (Ambien) 10 mg by mouth at bedtime for 3 days for sleep then discontinue
START DATE & TIME 0 Prochlorperazine (Compazine) 10 mg by mouth TIO for 2 days for nausea and/or vomiting then discontinue PRN D Antacid liquid (Maalox) 30 ml by mouth every four hours PRN indigestion allow 30 min after last medication D Milk of Magnesia 30 ml by mouth at bedtime PAN constipation D Loperimide (lmodlum) 4 mg by mouth INITIAL DOSE; then 2 mg by mouth after each loose bowel movement Max of 16mg per 24hours Choose one D Acetaminophen (Tylenol Extra Strength) 1000 mg by mouth every 4 hours PAN generalized pain Maximum of 3 gm per 24 hours OR D Aspirin Enteric Coated (Ecotrin) 650 mg by mouth every 4 hours PAN generalized pain OR D Ibuprofen (Motrin) 600 mg by mouth every 6 hrs PAN generalized pain OR D Ibuprofen (Motrin) 800 mg by mouth every 8 hrs PAN generalized pain
BENZODIAZEPINES DETOXIFICATION D Clonazepam (Klonopin) 1mg by mouth doses TODAY at (times)
START DATE & TIME □ Clonazepam (Klonopin) 1 mg by mouth three times a day for 2 days □ Clonazepam (Klonopin) 0.5 mg by mouth three times a day for 2 days D Clonazepam (Klonopin) 0.5 mg by mouth two times a day for 1 day 0 Clonazepam (Klonopin) 0.5 mg by in AM for 1 day then discontinue
Complete for telephone orders (orders must be signed within 24 hours)
Ordering Physician
Nurse Signature Date Time
□ PA D NP Signature Date Time
DMD D DO Physician Signature Date • Time Benzo/Cocaine ,Physician Orders 0 ~ 1508-PO-7705!-IMSFAC 08/16 (Rev. 12/16, 10/17) Page l of2 ,_J..."' ~ -~0 i:i.. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 114 of 175 FIRST HOSPITAL + □ STAT
D Another brand of drug identical in form and content may be dispensed unless checked Continued from page 1
All PAN orders will start on day of admission unless otherwise indicated
CHECK boxes and INITIAL desired schedule
COCAINE DETOXIFICATION
Desipramine (Norpramin} 50 mg by mouth at bedtime START DATE & TIME
Amantadine (Symmetrel} 100 mg by mouth __ doses TODAY at (times}
START DATE & TIME Amantadine (Symmetrel) 100 by mouth three times a day for 3 days Amantadine (Symmetrel} 100 mg by mouth twice a day for 1 day Amantadine (Symmetrel) 100 mg by mouth in the morning for 1 day then discontinue
SEIZURE PREVENTION FOR ALCOHOUDRUG WITHDRAWAL
Carbamazepine (Tegretol) 200 mg by mouth __ doses TODAY at (Unies}
Carbamazepine (Tegretol) 200 mg by mouth three times a day for 1 day START DATE & TIME Carbamazepine (Tegretol} 100 mg by mouth three times a day for 1 day Carbamazepine (Tegretol} 100 mg by mouth twice a day for 1 day Carbamazepine (Tegretol} 100 mg by mouth in the morning for 1 day then discontinue
Tegretol blood level on day 3
Complete for telephone orders (orders must be signed within 24 hours)
Ordering Physician
Nurse Signature Date Time
□ PA D NP Signature Date Time
DMD D DO Physician Signature Date Time
·- RN Transcription of Orders Signature Date Time
Benzo/Cocaine Physician Orders I 508-PO-7705HMSFAC 08/16 (Rev. 12/16, 10/17) Page 2 of2 ...l~ "'i:: ·.g
D Another brand of drug identical in form and content may be dispensed unless checked
All PAN orders will start on day of admission unless otherwise indicated CHECK boxes and INITIAL desired schedule DRUG DETOXIFICATION START DATE & TIME
□ Therapeutic multivitamin 1 tab by mouth twice a day for 5 days then discontinue
START DATE & TIME D Zolpidem (Ambien) 10 mg by mouth at bedtime for 3 days for sleep then discontinue
.. START DATE & TIME --,~----- D Prochlorperazine (Compazine) 10 mg by mouth TID for 2 days for nausea and vomiting then discontinue
PRN □ Antacid liquid (Maalox) 30 ml by mouth every four hours PAN indigestion allow 30 min after last medication □ Milk of Magnesia 30 ml by mouth at bedtime PAN constipation D Loperamide (lrnodium) 4 mg by mouth INITIAL DOSE; then 2 mg by mouth after each loose BM Max of 16 mg per day
Choose one D Acetaminophen (Tylenol Extra Strength) 1000mg by mouth every 4 hours PAN generalized pain Maximum of 3 gm per 24 hours OR D Aspirin Enteric Coated (Ecotrin) 650mg by mouth every 4 hours PAN generalized pain OR D Ibuprofen (Motrin) 600 mg by mouth every 6 hrs PAN generalized pain OR D Ibuprofen (Motrin) 800 mg by mouth every B hrs PAN generalized pain
OPIATE DETOXIFICATION Clonidine (Catapres) 0.1 mg by mouth doses TODAY at (times)
START DATE & TIME Clonidine (Catapres) 0.1 mg by mouth three times a day for 3 days Clonidine (Catapres) 0.1 mg by mouth twice a day for 1 day Clonidine (Catapres) 0.1 mg by mouth in the morning for 1 day then discontinue
HOLD CLONIDINE IF DIASTOLIC LESS THAN 90 AND/OR SYSTOLIC IS LESS THAN 60 AND/OR RESPIRATIONS LESS THAN 12 MIN
Complete for telephone orders (orders must be signed within 24 hours)
Ordering Physician
Nurse Signature Date Time
□ PA D NP Signature Date Time
DMD D DO Physician Signature Date Time
4) Opiate 6-Day Low Physician Orders .g 1508-PO-77 I0HMSFAC 08/16 (Rev. 12/16, 08/17) Page 1 of2 ...J E -~~ 1:1.. FIRST LuzerneHOSPITAL County Council Voting Session November 26, 2019 AGENDA Page 116 of 175 +
nsTAT
□ Another brand of drug identical in form and content may be dispensed unless checked Continued from page 1
All PAN orders will start on day of admission unless otherwise indicated
CHECK boxes and INITIAL desired schedule
OPIATE DETOXIFICATION (Abdominal Pain)
Dicyclomine (Bentyl) 10 mg by mouth doses TODAY at (times)
Dicyclomlne (Bentyl) 10 mg by mouth four times a day for 3 days START DATE & TIME Dicyclomine (Bentyl) 10 mg by mouth twice a day for 1 day Dicyclomine (Bentyl) 10 mg by mouth in the morning for 1 day then discontinue
OPIATE DETOXIFICATION (Medication for side effects of withdrawal, pain, muscle spasms, severe leg/back cramps)
Methocarbamol (Robaxin) 500 mg by mouth doses TODAY at (times)
START DATE & TIME Methocarbamol (Robaxin) 500 mg by mouth four times a day for 3 days Methocarbamol (Robaxin) 500 mg by mouth twice a day for 1 day Methocarbamol (Robaxin) 500 mg by mouth in the morning for 1 day then discontinue
SEIZURE PREVENTION FOR ALCOHOUDRUG WITHDRAWAL
Carbamazepine (Tegretol) 200 mg by mouth doses TODAY at (times)
Carbamazepine (Tegretol) 200 mg by mouth three times a day for 1 day START DATE & TIME Carbamazepine (Tegretol) 100 mg by mouth three times a day for 1 day Carbamazepine (Tegretol) 100 mg by mouth twice a day for 1 day Carbamazepine (Tegretol) 100 mg by mouth in the morning for 1 day then discontinue Tegretol blood level on day 3
Complete for telephone orders (orders must be signed within 24 hours)
Ordering Physician
Nurse Signature Date Time
□ PA □ NP Signature Date Time
DMD □ DO Physician Signature Date Time
RN Transcription of Orders Signature Date Time Opiate 6-Day Low Physician Orders 08/17) Page 2 of2 ~ 1508-PO-771 0HMSFAC 08/16 (Rev. 12/16, ,-l.... ij ·.:; &: FIRST LuzerneHOSPITAL County Council Voting Session November 26, 2019 AGENDA Page 117 of 175 + 11111111111111111111 nsTAT •po•
D Another brand of drug Identical In form and content may be dispensed unless checked All PRN orders will start on day of admission unless otherwise Indicated CHECK boxes and INITIAL desired schedule DRUG DETOXIFICATION & TIME □ Thiamine 100 mg by mouth three times a day for 5 days then discontinue START DATE □ Therapeutic multivitamin 1 tab by mouth twice a day for 5 days then discontinue □ Folio Acid 1 mg by mouth dally for 5 days then discontinue
START DATE & TIME
□ Zolpidem (Amblen) 10 mg by mouth at bedtime for 3 days for sleep then discontinue
PRN . , □ Antacid liquid (Maalox) 30 ml by mouth every 4 hours PAN indigestion allow 30 min after last medication. □ Milk of Magnesia 30 ml by mouth at bedtime PRN constipation movement □ loperamide (lmodlum) 4 mg by mouth INITIAL DOSE; then 2 mg by mouth after each loose bowel Maximum of 16 mg per 24 hours
Choose one □ Acetaminophen (Tylenol Extra Strength) 1000 mg by mouth every 4 hours PRN generalized pain Maximum of 3 gm per 24 hours OR □ Aspirin Enteric Coated (Ecotrln) 650 mg by mouth every 4 hours PRN generalized pain OR □ Ibuprofen (Motrln) 600 mg by mouth every 6 hours PAN generalized pain OR □ Ibuprofen (Motrin) 800 mg by mouth every 8 hours PAN generalized pain DETOXIFICATION (ALCOHOL) Chlordiazepoxide (Librium) 10 mg by mouth doses TODAY at (times) PRN Chlordiazepoxide (Librium) 10 mg by mouth every 2 hours PRN alcohol withdrawal and/or agitation. Give for Systolic greater than 140 and/or Dlastolic greater than 90
Chlordiazepoxlde (Librium) 10 mg by mouth four times a day for 3 days START DATE & TIME Chlordlazepoxide (Librium) 10 mg by mouth three times a day for 1 day Chlordlazepoxlde (Librium) 10 mg by mouth twice a day for 1 day Chlordiazepoxlde (Librium) 10 mg In the morning for 1 day then discontinue all Chlordlazepoxlde including PAN DO NOT GIVE LIBRIUM FOR SYSTOLIC LESS THAN 90 AND/OR DIASTOLIC LESS THAN 60
Complete for telephone orders (orders must be signed within 24 hours)
Ordering Physician
Nurse Signature Date Time
□ PA □ NP Signature Date Time
DMD □ DO Physician Signature Date Time Librium 7-day Physician Order i 1508-PO-7703HMSFAC 08/16 (Rev. 12/16, 08/17) Page I of2 ~
i:l Chlordlazepoxide (Librium) 50 mg by mouth four times a day for 3 days START DATE & TIME Chlordiazepoxlde (Librium) 50 mg by mouth three times a day for 1 day Chlordiazepoxlde (Librium) 50 mg by mouth twice a day for 1 day Chlordiazepoxlde (Librium) 25 mg by mouth in the morning for 1 day then discontinue all Chlordiazepoxide Including PRN DO NOT GIVE LIBRIUM FOR SYSTOLIC LESS THAN 90 AND/OR DIASTOLIC LESS THAN 60 .. SEIZURE PREVENTION FOR ALCOHOUDRUG WITHDRAWAL Carbamazeplne (Tegretol) 200 mg by mouth doses TODAY at (times) Carbamazepine (Tegretol) 200 mg by mouth three times a day for 1 day START DATE & TIMS Carbamazeplne (Tegretol) 100 mg by mouth three times a day for 1 day Carbamazeplne (Tegretol) 100 mg by mouth twice a day for 1 day Carbamazepine (Tegretol) 100 mg by mouth in the morning for 1 day then discontinue Tegretol blood level on day 3 Complete for telephone orders (orders must be signed within 24 hours) Ordering Physician Nurse Signature Date Time □ PA □ NP Signature Date Time DMD □ DO Physician Signature Date Time RN Transcription of Orders Signature Date Time Librium 7•day Physician Order 1508-PO-7703HMSFAC 08/16 (Rev. 12/16, 08/17) Page 2 of2 ! =V 'ij ' /:I-, FIRST HOSPITALLuzerne County Council Voting Session November 26, 2019 AGENDA Page 119 of 175 Luzerne County Correctional Facility Suicide As$esmcnt Inmate Name: ------ Yes No Yes No· Suicide precautions ordered at time of admission: YES NO MH staff signature: _____;______.....;Date: _____;.._Time: ______am pm MH staff to complete this area at time of initial assessment for all MH staff to complete at time of Initial assessment for all inmates inmates on suicide precautions: on suicide precautions: Date: Date: Time: Time: Current Issues: Current Issues: Yes No Clinical worse uo cluinge im11rovcd Current ntteinnf Yes No Situational worse nochiinge mp,·oved Suicide Idea Loss gfiob Suk:ide ideutfon nlan; Loss ofsighfficant oth~r Drtiit or alcehol abuse Emnlovment QIQQ.lm:D Dcnrcssipn Edycation nroblems Honcllessness Financial nroblems Imouise control disorder Humiliation Medical issut<.ll Nothimi: makes inmate hannv -- Paii1 Other· -- Thouizlitdisorder Yes No {isk Factors for Incarceration worse Personalitv disorder no ch:tuge lm111·oved Aooears scared ''Nothf111, 1.i•kt• n1e ·h•nnv" IUl~hcdonia Embarrassment Yes No Inicri>erspnal Guilt ~farltuURe!aliouilli!l .11.r Perceived level of risk at this time: Mild Moderate Severe Yes No Protective features Actions: Please check one Anticlnated Futm·~yent .Pets L Start suicide nrecaution - RelirrioH ·cnre o(c}~p~lde11~ 2; Mah\t@1»uililiJ1rnreonutkm Stable rehitionshin Other: 3. Discontinue suicideprccnutio11 MH staff signature: ______Date: ______Time: _____am pm Document all pertinent additional information on intake initial assessment Luzerne County Council Voting Session November 26, 2019 AGENDA Page 120 of 175 Notice to Responders RFPs will be opened in the Luzerne County Purchasing Department. RFP packages may be obtained at the offices of Luzerne Purchase Department in the Penn Place Building, 20 North Pennsylvania Avenue, Wilkes Barre, PA 18711, and on the website at www.luzernecountv.org. Mark Zulkoski is the only contact for this project. Contacting other County Officials, Council Members, or Staff Members as part of this process is not acceptable and is grounds for elimination from consideration. RFPs will be received weekdays between the hours of 9:00 a.m. to 4:00 p.m. only (excluding holidays). Failure to follow these instructions may result in RFP rejection. The attached labels must be affixed to the outside of the mailing envelopes or the RFP will not be accepted. Respondents who use USPS service please note: The Post Office does not deliver mail directly to Penn Place. You should allow additional time for your RFP to be forwarded from the Court House to Penn Place, It is the Responders responsibility to get their RFP packets to the Purchasing Office by the time specified. Luzerne County will not be responsible for late or misdirected mail. By signing the submitting RFP, each bidder shall be deemed to have consented in writing that the RFP may be awarded and shall remain open up to ninety (90) days of the RFP opening. The County of Luzerne is an equal opportunity employer. Luzerne County Manger reserves the right to reject any or all RFPs or any part or items of the RFPs. Luzerne County advertisement published by the order of: C. David Pedri, Esq. County Manager Luzerne County Council Voting Session November 26, 2019 AGENDA Page 121 of 175 ATTENTION: RFPs will be received weekdays between the hours of 9:00 AM to 4:00 PM only (excluding holidays). All RFPs must be delivered by the time stated in the bid packet. All RFPs must be delivered to the: Luzerne County Purchasing Department 20 North Pennsylvania Avenue Suite 203 Wilkes Barre1 Pa 18711 Any questions in regard to the RFP package, please contact Mark Zulkoski at 570-820-6337 Or [email protected]. ATTENTION: YOU MUST PRINT THE BELOW ADDRESS AND RFP INFORMATION AND AFFIX TO THE OUTSIDE OF YOUR RFP ENVELOPE. THE RFP WILL NOT BE ACCEPTED IF THIS INFORMATION IS NOT PROVIDED Luzerne County Purchasing Department Penn Place Building Suite 203 20 N. Pennsylvania Ave Wilkes Barre, PA 18711 All RFP returns must have this label attached with The name and reference number of the RFP to the Outside of the return envelope (UPS, FEDEX, etc.) Or it will be rejected. RFP Name ______Company Name ______Reference# Responders who use USPS Services, PLEASE NOTE: The Post Office does not deliver mail directly to Penn Place. You should allow additional time for your bid to be forwarded from the Court House to Penn Place. It is the Responders responsibility to get their RFP packets to the Purchasing Department by the time specified. LUZERNE COUNTY WILL NOT BE RESPONSIBLE FOR LATE OR MISDIRECTED MAIL Luzerne County Council Voting Session November 26, 2019 AGENDA Page 122 of 175 GENERAL INSTRUCTIONS TO RESPONDENTS 1. Any alterations, erasures, additions to or omissions of required information, or change of specifications or bidding schedule, is done at the risk of the responder and may result in rejection of his/her RFP. In case a responder finds discrepancies or omissions, or is in doubt as to the meaning of the specifications of bidding schedule, he/she should at once notify the Luzerne County Purchasing Department, who will reply to such questions in official supplement and copies will be sent simultaneously to all responders. 2. All responders are responsible to see that their names appear in the Purchasing Department office on the form recording the names of prospective responders, so that the responders are assured of receiving pertinent bulletins which may be issued before the RFP's are opened. 3. All responders must be recognized dealers in the materials specified and qualified to advise in its application of use. The responders at any time requested, must satisfy the County Manager and administrative officers that they have the requisite organization, capital, plant, stock, ability and experience to satisfactorily execute the contract in accordance with the provisions of the contract in which responder is interested. 4. Submitting a proposal when it is intended to sublet the contract is cause for rejection of your RFP, or cancellation of the contract, unless approval is given in writing by Luzerne County prior to the RFP opening. 5. It is agreed by the parties hereto that wherever the word "Purchasing Agent" or the pronoun in place thereof occurs in the articles of agreement of specifications, it is hereby expressly understood that the Purchasing Agent is acting only under the authority of the subject to the approval of the County Manager and administrative officers. 6. In case of error in the extension of prices, the unit price shall govern. 7. The contract will not be awarded to any corporation, firm, or individual who has failed in any former contract with Luzerne County to perform work or delivery of guarantee. 8. It is expressly understood and agreed that the inspection of materials and workmanship by the purchasing or issuing department will in no way lessen the responsibility of the contractor or release him/her from obligations to perform and deliver to the County satisfactory work materials. The contractor agrees to pay the cost of all tests for defective materials and to allow the cost to be deducted from any money due him/her from the County otherwise bondsmen in this case are liable for satisfactory completion of the contract. 9. When the contract has been duly signed and the contract bond covering the same approved, then and not before, the contractor may secure instructions from the purchasing agent pertaining to the procedure of the work or delivery. 10. If more than one RFP is offered by any one party or in the name of his/her clerk, partners or other persons, all such bids may be rejected. However, a party who has quoted prices on materials to a responder is not thereby disqualified from quoting prices on materials to other responders or from submitting a RFP directly for the materials or work. 11. The County Manager and administrative officers reserve the right to reject any and all RFPs or specifications when deemed to the best interest of the County and also to purchase any, part, or none of the materials specified. The Luzerne County Manager may cancel the award at any time before the execution of the contract. 12. All terms, rebates and discounts shall be considered to be offered effective as of the date of payment by County notwithstanding anything to the contrary expressed by the responder in his/her RFP. 13. The County will reject all materials that do not meet the specifications even though the responders list trade names of such materials on the proposal sheet. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 123 of 175 14. The material and equipment shall be delivered to the County of Luzerne, Pennsylvania. All prices quoted shall be f.o.b., Luzerne County Court House, or point of destination within Luzerne County if otherwise specified. 15. The party or parties bidding upon this proposal to whom the award or awards are made may be required to enter into a contract with the County of Luzerne within sixty (60) days of notification by the Purchasing Agent. Failure of bidder to do so, shall result in the cancellation of the award and forfeiture of the bid bond and/or bid deposit which shall become the absolute property of the County of Luzerne. 16. The responder or responders to whom the contract is awarded agree(s) to release the County of Luzerne from all suits or action of any nature or description brought against it for or on account of the use of patents, appliances, products or processes. 17. The County Manager and administrative officers at their discretion, may extend the time for the completion of this contract, if prevented by strikes of employees or by reason of it being impossible to procure the necessary material, equipment, etc. 18. All RFPs must be made on proposal blanks attached to these specifications and made part thereof, and must be enclosed in sealed envelopes/package directed to the Luzerne County Purchasing Department. Attached labels must be placed upon outside of said envelope/package, failure to do so may result in rejection of submitted RFP. 19. Responders must write or print figures in ink or typewritten. 20. A proposal which is incomplete, obscure, conditional or unbalanced or which contains additions not called for or irregularities of any kind or alterations may be rejected. 21. Luzerne County reserves the right for the Luzerne County and/or the Luzerne County Manager and/or their respective designees to perform financial and/or performance audits on any purchase, sale, award, contract or other transactions involving Luzerne County, therefore, any party to a purchase, sale, award, contract or other transaction involving Luzerne County must grant to the Luzerne County Controller and/or the Luzerne County Manager and/or their respective designees reasonable access to any property and/or equipment purchased in whole or in part with Luzerne County funds and must grant reasonable access for review, inspection and reproduction of any and all financial, employment and/or other records of the vendor, contractor, subcontractor or other entity deemed relevant by the Luzerne County Controller and/or Luzerne County Manager. 22. With respect to responders that are permitted to provide certified checks, cashier's checks and/or trust company treasurer's checks in lieu of a bid bond, such checks shall be returned to unsuccessful responders within thirty (30) days following the award of the RFP and will not be cashed. Luzerne County may deposit the check of the successful responder and may retain such funds until the successful responder enters into an agreement with Luzerne County to fulfill the RFP on the terms submitted by that responder. With respect to successful responders that are permitted to provide certified checks, cashier's checks and/or may be cashed and retained by Luzerne County pending the responder's full and faithful performance of the RFP. 23. Luzerne County will NOT accept vendor contracts that include automatic renewal and price escalation clauses. 24. The successful responder must permit the County to make payment to vendor by credit card or debit card without penalty or surcharge. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 124 of 175 Proposal Blanks To the County Manager: I, the undersigned being a duly authorized representative of Submit for your consideration a proposal to supply is shown The price for which (I/we) will supply each item specified on the following pages immediately after the description of the particular article. to (I/we) agree, if awarded the contract for any items shown on the attached specifications, to furnish a enter into a written agreement and to furnish the said items at the price shown, and performance bond (if applicable) with sixty (60) days. Date: ------20------ Signature-typewritten Signature-signed in ink Street City & State Zip Company telephone number Salesman's telephone number Company fax number E mail address Luzerne County Council Voting Session November 26, 2019 AGENDA Page 125 of 175 Responders Signature Form Responder ______ Proposal must be signed here ______Address ------Telephone number ______ Individual Partnership or Corporation The responder certifies that they come under the class checked below: Please insert names: A. Individual owner ------ B. Partnership partners ______ C. Corporation ______Exact name of corporation State incorporated Note: All County proposals under the jurisdiction of Luzerne County Manager and Luzerne County Correctional Facility are furnished in duplicate. One copy of the proposal is to be filled out and submitted with the bid and the remaining copy to be retained for the responder's records. Proposal should be as net prices and shall prevail in the awarding of contracts. Failure of the responders to sign the bid and have the signature of an authorized representative or agent on the proposal in the space provided, will be cause for rejection of the proposal. Signatures must be written in ink. Typed, printed or stamped signatures will not be accepted. It is understood by both the County and responders that all trade names, catalogue numbers or bids "as per sample" offered on this proposal shall meet the specifications, unless the responder states that such trade names, catalogue numbers or samples are not equal to the specified item. Return to Purchasing Department Luzerne County Council Voting Session November 26, 2019 AGENDA Page 126 of 175 Non Collusion Affidavit State of ______ County of ______ ______, being first duly sworn, deposes and says that: 1) She/he is the ______(owner, partner, officer, representative or agent) of the Bidder that had submitted the attached proposal. 2) She/he is fully informed with respect to the preparation and contents of the attached proposal and of all pertinent circumstances respecting such proposal. 3) Such proposal is genuine and is not part of any conspiracy, collusion or deception. 4) Neither the said nor any of its officers, partners, owners, agents, representatives, employees or parties in interest, including the affiant, has in any way collided, conspired, connived or agreed, directly or indirectly with any other responder, firm or person to submit a collusive or sham proposal in connection with the contract for which the attached bid has been submitted or to refrain from proposing in connection with such contract, or has in any manner, directly or indirectly, sought by agreement or collision or communication or conference with any other proposer, firm, or person to fix the price or prices in the attached proposal or of any other responder, or to fix any overhead, profit or cost element for the prices or the proposal price of any responder, or to secure through any collision, conspiracy connivance or unlawful agreement any advantage against any person interested in the proposed contract; and the price or prices quoted in the attached bid are fair and proper and are not tainted by any collusion, conspiracy, connivance or unlawful agreement on the part of the responder or any of its agents, representatives, owners, employees, or parties in interest, including this affiant. 5) The price(s) and amount of this proposal, have been arrived at independently and without consultation, communication or agreement with any other contractor, proposer, or potential proposer. 6) Neither the price(s) nor the amount of this proposal, and neither the approximate price(s) nor the approximate amount of this proposal, have been disclosed to any other firm or person who is a responder/proposer or potential proposer, and they will not be disclosed before proposal opening. 7) No attempt has been made or will be made to induce any firm or person to refrain from submitting a proposal on this contract, or to submit a proposal higher than its proposal, or to submit any intentionally high or non-competitive proposal or other form of complementary proposal. 8) The proposal of my firm is made in good faith and not pursuant to any agreement or discussion with, or inducement from, any firm or person to submit a complementary or other noncompetitive proposal 9) The above representations are material and unimportant, and will be relied on by Luzerne County in awarding the contract(s) for which this proposal is submitted. I understand and my firm understands that any misstatement in this affidavit is and shall be treated as fraudulent concealment from Luzerne County of the true facts relating to the submission of proposals for this contract. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 127 of 175 (Signed) ______ (Name) (Title) Subscribed and sworn to before me this ___day of ___, 20 ___ Name Title My commission expires ______ Luzerne County Council Voting Session November 26, 2019 AGENDA Page 128 of 175 CONTRACT ATTACHMENT B: TABLE OF CONTENTS FROM CONTRACTOR'S REPONSE TO THE RFP Luzerne County Council Voting Session November 26, 2019 AGENDA Page 129 of 175 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections TABLEOFCONTENTS I.REQUIREDFORMS...... 1 II.GENERALTERMSANDPROVISIONS...... 2 III.SPECIALTERMSANDCONDITIONS...... 3 III.A.GENERALREQUIREMENTS...... 3 III.B.SCOPE...... 4 III.B.1.PhilosophyofAdministration...... 4 III.B.2.Price...... 5 III.B.3.ObjectiveoftheRequestforProposals...... 6 III.B.4.ProposerQualifications...... 7 III.C.PREPARATIONANDSUBMITTALOFPROPOSALS...... 8 III.D.BONDREQUIREMENTS...... 9 III.D.1.ProposalSecurity...... 9 III.D.2.PerformanceBond...... 9 III.E.EVALUATIONOFPROPOSALS...... 10 III.E.1.CorporateExperience...... 10 III.E.2.OrganizationChartandInformation...... 14 III.E.2.a.CorporateStructure...... 14 III.E.2.b.AbsorptionofDebt...... 15 III.E.2.c.ManagementResumes...... 15 III.E.2.d.OtherWexfordHealthCorrectionalContracts...... 15 III.E.2.e.ProgramManagementCapacity...... 19 III.E.2.f.CompanyDemographics...... 19 III.E.2.g.IncomeStatementandBalanceSheet...... 19 III.E.2.h.AccreditedFacilities...... 20 III.E.2.i.FinesandPenalties...... 21 III.E.2.j.LossofBond...... 21 III.E.2.k.NonͲRenewedContracts...... 21 III.E.2.l.MajorSuppliers/SubͲVendors...... 21 III.E.2.m.NCCHCorACASurveys...... 22 III.E.2.n.Litigation...... 22 III.E.2.o.CorporateReorganization...... 22 III.E.3.CorporateCapability...... 22 III.E.4.References...... 23 III.E.4.a.ClientReferences...... 23 III.E.4.b.CreditReferences...... 24 III.E.5.DemonstrationofSufficientExperience...... 25 III.F.METHODOFAWARD...... 25 III.G.PROPOSEDTERMSOFCONTRACT...... 26 III.H.SPECIFICATIONSANDPROGRAMREQUIREMENTS...... 27 III.H.1.AdministrativeRequirements(A)...... 27 III.H.1.a.PhysicianHealthAuthorities...... 27 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 130 of 175 ii Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections III.H.1.b.HSAandDON...... 27 III.H.1.c.ProvisionofSufficientPersonnel...... 28 III.H.1.c.i.RecruitmentStrategiesandResources...... 29 III.H.1.c.ii.IdentifyingandHiringtheRightCandidates...... 41 III.H.1.c.iii.WexfordHealth’sPerformanceManagementProcess...... 44 III.H.1.c.iv.RetentionStrategiesandResources...... 47 III.H.1.c.v.OtherCoverageStrategiesandResources...... 54 III.H.1.d.ProviderNetworkDevelopment...... 56 III.H.1.e.PoliciesandProcedures...... 57 III.H.1.f.ReportingandInformationTechnology...... 58 III.H.1.g.RegularLCDOC/WexfordHealthMeetings...... 64 III.H.1.h.DisasterPlanning...... 65 III.H.2.PersonnelRequirements(B)...... 68 III.H.2.a.StaffingSchedule...... 68 III.H.2.b.PhysicianServices...... 69 III.H.2.c.NursingServices...... 69 III.H.2.d.MentalHealthProfessionals...... 69 III.H.2.e.Psychiatrist...... 70 III.H.2.f.NursePractitionerand/orPhysicianAssistant...... 70 III.H.2.g.HealthServicesAdministrator(HSA)...... 71 III.H.2.h.ClericalSupport...... 71 III.H.2.i.JobDescriptionsandPostOrders...... 71 III.H.2.j.DistributionandPostingofStaffingSchedules...... 72 III.H.2.k.HoursNotProvided...... 72 III.H.2.l.ScreeningandEmploymentRequirements...... 73 III.H.2.m.OrientationandStaffTraining/Development...... 73 III.H.2.m.i.TrainingforClinicalStaff...... 74 III.H.2.m.ii.TrainingforLCDOCSecurityStaff...... 79 III.H.2.n.PharmacyServices...... 80 III.H.2.n.i.InternalWexfordHealthPharmacyResources...... 81 III.H.2.o.MedicationAdministration...... 85 III.H.2.p.DentalServices...... 88 III.H.2.q.MenuPlanningandMedicalDiets...... 89 III.H.2.r.RemovalofEmployees...... 90 III.H.2.s.RighttoSearchEmployees...... 90 III.H.3.CareandTreatmentRequirements(C)...... 91 III.H.3.a.EmergencyServices...... 91 III.H.3.b.TriageandSickCall...... 92 III.H.3.c.AnnualReviewofP&Ps...... 95 III.H.3.d.AncillaryServices...... 95 III.H.3.d.i.XͲRay/RadiologyServices...... 96 III.H.3.d.ii.LaboratoryServices...... 97 III.H.3.d.iii.EKGServices...... 98 III.H.3.d.iv.DME,Orthotics,andProsthetics...... 98 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 131 of 175 iii Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections III.H.3.e.MentalHealthProgram...... 99 III.H.3.e.i.WexfordHealth’sMentalHealthExperience...... 100 III.H.3.e.ii.OurModelofMentalHealthCare...... 102 III.H.3.e.iii.TypesofMentalHealthTherapy...... 104 III.H.3.e.iv.CrisisManagement...... 109 III.H.3.e.iv.ASuicidePrevention...... 111 III.H.3.e.v.PsychiatryServices...... 115 III.H.3.e.v.APsychotropicMedication...... 116 III.H.3.e.v.BTelepsychiatry...... 117 III.H.3.e.vi.SubstanceUseDisorder(SUD)Program...... 118 III.H.3.e.vii.TreatmentforCoͲOccurringDisorders...... 123 III.H.3.e.viii.SpecializedMentalHealthTraining...... 125 III.H.3.e.viii.AForMentalHealthStaff...... 125 III.H.3.e.viii.BForCustodyStaff...... 129 III.H.3.e.ix.ReͲEntryServices...... 133 III.H.3.f.SpecialNeedsPatients...... 138 III.H.3.f.i.ChronicCarePatients...... 139 III.H.3.f.ii.DetoxificationProgram...... 140 III.H.3.g.CommunicationRegardingSpecialNeedsPatients...... 142 III.H.3.h.FemalePatients...... 142 III.H.3.i.InfectiousDiseaseProgram...... 144 III.H.3.j.SpecialtyServices...... 146 III.H.3.k.MedicalClearancesforInmates...... 154 III.H.3.l.IntakeScreenings...... 154 III.H.3.m.InitialHealthAppraisal...... 157 III.H.3.n.HousekeepingDuties...... 159 III.H.3.o.CareforLCDOCStaff...... 159 III.H.3.p.InmatesMayNotProvideServices...... 160 III.H.3.q.InspectionReports...... 160 III.H.3.r.CoordinationonOffsiteCare...... 160 III.H.3.s.DisposalofMedicalWaste...... 160 III.H.3.t.CostsforNewbornInfants...... 161 III.H.3.u.UnusualCosts/OffsiteHealthCare...... 161 III.H.4.EHRRequirements(D)...... 164 III.H.4.a.EHRExperienceandResources...... 164 III.H.4.b.EHRInformationTechnologyRequirements...... 166 III.H.4.c.EHRImplementation,Use,andSupport...... 171 III.H.4.c.i.TheCorEMRSolution...... 172 III.H.4.c.ii.EHRTrainingResources...... 177 III.H.4.c.iii.EHRSupport...... 178 III.H.4.d.HealthRecordContentsandDocumentation...... 179 III.H.4.e.ConfidentialityofHealthRecords...... 179 III.H.4.f.InformedConsent...... 180 III.H.4.g.InactiveHealthRecords...... 180 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 132 of 175 iv Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections III.H.4.h.MedicallyRelatedCourtDocuments...... 180 III.H.4.i.MisplacedHealthRecords...... 181 III.H.5.Quality/AssuranceRequirements(E)...... 182 III.H.6.FinancialRequirements(F)...... 190 IV.PROPOSALFORINMATEHEALTHCARESERVICES...... 191 IV.A.OVERVIEWANDBACKGROUNDOFWEXFORDHEALTH...... 192 IV.A.1.ContractManagementModelandLeadershipTeams...... 192 IV.A.1.a.WexfordHealth’sPittsburghͲBasedTeam...... 192 IV.A.1.b.WexfordHealth’sRegionalContractManagementTeam...... 200 IV.A.1.c.WexfordHealth’sSiteͲLevelLeaders...... 202 IV.A.2.Contract/ProgramTransition...... 204 IV.B.SAMPLEFORMSTOBEUSEDFORTHECONTRACT...... 211 IV.C.ORGANIZATIONALCHARTANDJOBDESCRIPTIONS...... 212 IV.C.1.OrganizationalCharts...... 212 IV.C.2.JobDescriptions...... 215 IV.D.LITIGATIONHISTORY...... 216 IV.E.WEXFORDHEALTHEXPERIENCE...... 217 IV.F.AUDITEDFINANCIALREPORTSANDPROVIDERLICENSURE...... 218 IV.F.1.AuditedFinancialReports...... 218 IV.F.2.ProviderLicensure...... 219 IV.G.STATEMENTOFREFERENCESFORMS...... 220 V.PRICENARRATIVE...... 221 VI.PROPOSALEXHIBITS...... 223 TABLEOFPROPOSALEXHIBITS Proposal Exhibit 1: Accredited Wexford Health Facilities ...... 224 Proposal Exhibit 2: Litigation Information ...... 225 Proposal Exhibit 3: Lists of Participating Hospitals and Providers ...... 226 Proposal Exhibit 4: Sample Data Reports ...... 227 Proposal Exhibit 5: Sample Orientation Materials ...... 228 Proposal Exhibit 6: Sample QA Tools ...... 229 Proposal Exhibit 7: Management Resumes ...... 230 Proposal Exhibit 8: Sample Forms ...... 231 Proposal Exhibit 9: Position Descriptions ...... 232 Proposal Exhibit 10: Audited Financial Statements ...... 233 Proposal Exhibit 11: Proof of Licensure for PA Site Medical Directors ...... 234 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 133 of 175 v Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections TABLEOFFIGURES Figure 1: Successes achieved through the Westmoreland County Prison/Wexford Health partnership ...... 12 Figure 2: Wexford Health corporate structure with relation to parent company and affiliate ... 14 Figure 3: Wexford Health’s approach to accreditation involves quality assessment, management, and improvement on multiple levels...... 20 Figure 4: Organizational chart of Wexford Health's 56 experts dedicated to recruitment, benefits, payroll, retention, and reporting ...... 30 Figure 5: Projected total supply and demand for physicians (2014 through 2025) according to a 2016 report from the Association of American Medical Colleges ...... 33 Figure 6: Provider-specific resources and strategies Wexford Health’s Special OPS team uses to identify, recruit, and retain qualified physicians and physician extenders ...... 35 Figure 7: Information and documentation Wexford Health requires for each candidate participating in our credentialing process ...... 44 Figure 8: Major differences between traditional performance review systems and Wexford Health’s cutting-edge new one ...... 45 Figure 9: Verbal and non-verbal cues to be aware of during a coaching session (http://www.lockhart-meyer.co.uk/salon-body-language-tips-that-give-the-right-impression/) ...... 46 Figure 10: Wexford Health's long-term orientation process results in better trained employees ...... 74 Figure 11: CorEMR MedPass eMAR screen ...... 87 Figure 12: CorEMR MedPass medication preparation screen ...... 87 Figure 13: Wexford Health’s mental health programs are responsive to the specific challenges faced by the correctional industry. The programs offer viable, proven solutions based on three main principles...... 102 Figure 14: Member responsibilities for individualized mental health treatment teams ...... 103 Figure 15: Two-Volume Correctional Therapist’s Guide to Group Clinical Interventions ...... 106 Figure 16: Participant Manuals support the weekly group therapy process ...... 108 Figure 17: Process flow for Wexford Health's Vivitrol program for the West Virginia Division of Corrections ...... 122 Figure 18: General system diagram for a CorEMR implementation ...... 167 Figure 19: Patient Chart ...... 173 Figure 20: CorEMR Dashboard ...... 174 Figure 21: Daily Task List ...... 174 Figure 22: Intake/Receiving Screening Form ...... 175 Figure 23: Mental Health Assessment Form ...... 175 Figure 24: CorEMR MedPass eMAR screen ...... 176 Figure 25: CorEMR MedPass medication preparation screen ...... 177 Figure 26: Corporate, regional, and site-level positions responsible for quality management and corrective action plans ...... 183 Figure 27: Components of a standard Wexford Health mortality review ...... 186 Figure 28: Corporate support provided to our health care units by Wexford Health ...... 192 Figure 29: Wexford Health's DEPLOYment process for contract transition and implementation ...... 204 Figure 30: Tasks involved in a standard 30-day DEPLOYment ...... 208 Figure 31: Wexford Health's corporate table of organization ...... 213 Figure 32: Wexford Health's proposed table of organization for the LCP/MOU ...... 214 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 134 of 175 vi CONTRACT ATTACHMENT C: ELECTRONIC HEALTH RECORD NARRATIVE Luzerne County Council Voting Session November 26, 2019 AGENDA Page 135 of 175 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections III.H.4. EHRRequirements(D) Wexford Health believes good charting is not something done primarily for retrospective review of patient care. Patient health records contain vital information that providers use every day. We emphasize thorough documentation as not only a necessary component of good patient care, but also as the best defense against any liability claims, as proper medical records provide correctional administrators with evidence of the patient’s course of treatment. Complete and accurate documentation leads to many positive outcomes, including improved communication among health team members, effective risk management, and the availability of data for statistical purposes. As such, Wexford Health’s maintenance and management of LCDOC inmate health records will conform to American Medical Association, corrections industry, and Luzerne County standards; as well as Commonwealth of Pennsylvania law and Health Insurance Portability and Accountability Act (HIPAA) regulations. III.H.4.a. EHRExperienceandResources For each LCDOC inmate, Wexford Health commits to maintaining an electronic health record (EHR), consistent with State regulations and community standards of practice. We have significant experience and internal resources devoted to EHRs, as discussed in the following narratives. BenefitsofaNonͲProprietaryEHR AfterperformingastrategicanalysisoftheEHRmarketplaceanditsimpactoncorrectionalhealthcare,Wexford HealthhasactivelychosennottointernallydevelopandmaintainaproprietaryEHRsolution.Instead,we activelypartnerwithawidevarietyofthirdpartyEHRvendorstoofferourclientsthebroadestselectionof potentialsolutions. AnEHRthatperfectlyfitsoneclientmaynotevencomeclosetofulfillingtheneedsofadifferentclient.Bynot promotinganinternalsolution,WexfordHealthcanexploretheEHRmarketplaceinanunbiasedfashionand recommendaproductthatprovidesthebestoperationalfitandgreatestvalueforeachclient’sunique situation—withoutbeingundulyinfluencedbyourcompany’sfinancialgain. AproprietaryEHR(onewherethecorrectionalhealthcarecontractorownstheEHR)cannotbetransferredover fromtheincumbentvendortoanewvendorwhenthereisachangeinhealthcarecontractors.Conversely,an independentnonͲproprietaryEHRsolutiongivestheclienttheoptionofcontractingdirectlywiththeEHR vendor—therebyneverhavingtodealwithendͲofͲmedicalͲcontracttransitiontoanewmedicalrecordsystem. SincetheclientcanmaintainanindependentEHRacrossmultiplehealthcarevendors,anonͲproprietarysystem alsoprovidesthefollowingbenefitstotheclientatexpirationofthehealthcarecontract. x Simplifiestransitionofhealthcarevendors,asnonegotiationsarerequiredrelatingtoownershipofEHR dataorfinancialresponsibilityforsoftwarelicenses x Ensuresdataintegrity,asnofiletransfer,import/exportprocess,ordataconversionisrequiredbetweenthe outgoinghealthcarevendor’sEHRandthatoftheincomingvendor x Maintainscontinuityofinmatecare,asthereisnodatadisruptionorlearningcurvetodealwithbetween theoutgoingandincominghealthcarevendors Luzerne County Council Voting Session November 26, 2019 AGENDA Page 136 of 175164 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections ExperiencewithEHRImplementationandUtilization Few correctional health care providers can claim Wexford Health’s depth of WexfordHealthhasexperiencewithallofthe experience with regard to EHRs. followingcorrectionalEHRs: We have addressed a wide variety of x MarketͲleadingcommercialsolutions situations, including fixing other CorEMR vendors’ EHRs that were broken due to poorly executed implementations; NextGenHealthcareInformation starting from ground zero and Systems’NextGen conducting an entire MarquisSoftware’seOMIS™ implementation from selection to GEHealthcareTechnologies’Centricity daily systems management; and consulting with independent entities to x ProprietarysolutionssuchastheUniversityof assist them with selecting the right TexasMedicalBranchcorrectionalEHR EHR for their environment. x Nichesolutions BioReferenceLaboratories’ChartEvolve We have encountered—and overcome— UlrichMedicalConcepts’CorrecTek all of the typical challenges associated with an EHR implementation: from system limitations to staff resistance. In each case, Wexford Health has faced the challenge head on, with an unwavering commitment to ensure the system functions properly, the modules are fully implemented, and all staff members receive adequate training. We will provide the same level of resources and dedication to ensuring the proper, complete, and efficient operation of CorEMR for the LCDOC. InternalEHRResources Wexford Health maintains a full-time internal EHR Department dedicated to supporting our (and our clients’) use of various solutions. Led by Ms. Diana Grover—a 15+-year correctional health care veteran—this team is responsible for all stages of Wexford Health’s EHR process. The team researches and views in-depth demonstrations for any EHR product that we might consider for a client; maintains relationships with most of the correctional EHR companies in the market; and makes recommendations for each of our product choices, based on the unique operational, clinical, and financial needs of each prospective client. The team is also responsible for leading Wexford Health’s EHR project assessments, workflow development, and system implementations, from initial “kick-off” discussions with the client and EHR vendor through implementation and training; to the final “go live” stage. Our EHR team is available to our clients at all times for consultation and problem resolution. Diana is supported by Joe Astorino, Wexford Health’s Director of Information Services, and by Ms. Wanda Melocchi, Wexford Health’s EHR Project Manager. Wanda is not only a Certified Correctional Healthcare Professional, but also a Certified Professional in Electronic Health Records. This nationally recognized designation means that Wanda has master-level knowledge in the planning, implementation, and operation of EHR solutions; especially as they apply to knowledge management, quality improvement, patient safety, and care coordination in the health care environment. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 137 of 175165 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections WANDAMELOCCHI,CPEHR,CCHP EHR&PROJECTMANAGER Withabackgroundinwriting,editing,policycreation,andprojectmanagement,Wanda MelocchipossessestheperfectskillsettoleadWexford’sdayͲtoͲdayEHRfunctions.She hasworkedinhealthcaresince2000,providingherwithakeeninsightintothe terminology,workflows,andresponsibilityscopesvitaltothesuccessofanEHRproject. Wanda’sdesignationasaCertifiedProfessionalinElectronicHealthRecordsisindependent confirmationofherinͲdepthknowledgeofallaspectsofEHRs,includingfunctionality, systemsintegration,workflows,implementation,training,andreporting.Sheiscompetent inmultiplesoftwaresystemsandEHRs,includingMicrosoftWord,Excel,PowerPoint,Access,Outlook,and Publisher;Visio;AdobeAcrobat;CrystalReports;andtheNextGen,GECentricity,CorEMR,CorrecTek,andPearl electronichealthrecords. III.H.4.b. EHRInformationTechnologyRequirements OMSͲ>CorEMRInterface Wexford Health’s proposed EHR software will interface with the LCDOC’s inmate management software. CorEMR already has a one-way interface with GTL’s OMS platform. This enables demographic and other information to be sent from OMS to CorEMR at the time an inmate is booked. If the individual has previously been incarcerated in the LCDOC system, CorEMR will simply add a new booking to the patient’s existing chart. Otherwise, if the individual has not been previously in the LCP, the system will create a new chart. Additionally, the interface transfers location data to CorEMR from OMS when an inmate is housed or when an inmate’s housing unit is changed in the LCDOC system. Finally, CorEMR will classify the inmate as “released” once OMS sends release information to the health care software. Wexford Health has successfully worked on photo integration in CorEMR for multiple implementations and we will work with GTL to import patient photos into the patient's electronic record for the LCDOC. CorEMR photos are predominantly displayed in the patient chart so that staff can ensure accurate patient identification. CorEMRApproachtoaspectsofInmateHealthCare x Industry standards: CorEMR tracks and reports on the data necessary to successfully obtain accreditation through the NCCHC and/or the ACA. The system currently supports many NCCHC- and ACA-compliant correctional health care programs. With regard to IT standards, CorEMR is certified by the Office of the National Coordinator for Health Information Technology (ONC) as a Complete EHR. x Integration and interfaces: CorEMR is well able to interface with other systems. In addition to communicating with inmate management systems, CorEMR can connect with pharmacies (Diamond Pharmacy), laboratories (LabCorp), and radiology (Mobilex) systems. The system currently supports multiple transfer protocols for integration of data, including Health Care Level 7 (HL7), HTML, flat file, and web services. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 138 of 175166 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections For the pharmacy interface, CorEMR will communicate with Diamond through a two-way interface. When CorEMR sends an order to the pharmacy, the pharmacy receives the electronic order in their software system and sends back receipt and/or clarification messages to the patient chart in CorEMR. Changes to the medication made by the pharmacy will be reflected in CorEMR and displayed on the medication log and medication administration record. x Results capturing and tracking: CorEMR captures laboratory results via HL7 messages. When a diagnostic provider posts a test result, an interface transfers the file to CorEMR, where the data appears on designated users’ dashboards for initial review. Through our many implementations of the system, Wexford Health has developed the software to mirror the standard paper-based process used by most facilities. Once appropriate clinicians review the patient’s lab results and act upon them as medically indicated, CorEMR assigns the data to the patient’s chart. At this point, the system automatically adds the chart to the Approval Queue, so a provider(s) can review the lab data and indicate that the process has been completed. Laboratory results can be assigned to the ordering provider or to all providers. x Document imaging: Documents that are received into the facility from outside providers or hospitals via fax or mail will be scanned directly into CorEMR using an approved scanner (one that supports TWAIN drivers). For easier retrieval, the system can also index or categorize scanned documents using a configurable list of document types. Facilities can also use multi-purpose scanner/copiers to scan document and then upload it into the inmate’s chart in CorEMR. GeneralSystemDiagram The following graphic provides a general system diagram for CorEMR. The software is web-based and can be accessed using any standard web browser (Internet Explorer, Firefox, Chrome, etc.). The only requirement for additional software is on those workstations where direct scanning will be performed. Wexford Health will need to install specific drivers on those computers. Figure18:GeneralsystemdiagramforaCorEMRimplementation Luzerne County Council Voting Session November 26, 2019 AGENDA Page 139 of 175167 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections We will work to develop a workflow for inmates that return from outside hospital stays, clinic visits, or return from other correctional facilities. For our other EMR implementations, we have configured a transfer form that requires completion for both outgoing and incoming patient transfers. In some cases, a physician review of the form is required. For these cases, we configure CorEMR to automatically send the form to the provider's approval queue. CorEMR has a detailed PPD workflow built into the system. As inmates are booked into LCDOC, CorEMR automatically creates a task for a PPD plant. After the PPD plant is documented, CorEMR automatically generates at task for a PPD read. On a daily basis, the list of PPD tasks to be completed is reviewed, scheduled, and completed. For new intakes or intra-system transfers, we will configure mandatory forms and/or questions to address food handling and work clearance within 24 hours. The responses to the questions can be triggered to create an alert in the chart that can be emailed to LCDOC personnel. When inmates transfer, a medical transfer summary form will be created along with the necessary tasks to ensure that the appropriate documentation can be generated from CorEMR, printed, and sent with the inmate. Once medical staff receive notification that an inmate is being transferred, site staff enter a task in the chart to ensure that a transfer screening summary is completed. As necessary, the transfer screening summary is printed, emailed, or faxed depending on the transfer requirements. DescriptionandFunctionalityofCorEMR Paperless Patient x InmateChartscanberetrievedbyname,bookingnumber,socialsecuritynumberand Chart otheridentificationidentifiers x TheChartSummaryincludes:currentmedicalproblems,medications,tasksummary, intakeformsummaryandrecentmedicalhistorywithlinkstoeachsection. x NonͲsystemdocumentscanbescannedandstoredintheinmate’schart. x FlowSheetsprovideagraphicalrepresentationofvitalsignsandBloodGlucose,Detox Checks,HungerStrikes,Coumadin,NeurioChecks,NebulizerandRespiratoryChecks. x ChronicCareisalsopartoftheinmate’schart. Scheduler/Tasks x Dailyactivitiesorschedulescanbefilteredbytaskcategory(medical,dental,mental health,etc.),bypriorityandbyhousinglocation. x Taskandappointmentscanbeviewedbyday,week,and/ormonth. x SickCallscanbeinitiateddirectlyfromthescheduleview. Sick Call x ThesystemusesthestandardSOAPEformattoguidetheexaminer(Subjective, Objective,Assessment,PlanandEducation) x Actionsavailableinthemoduleinclude:completinginterview/examforms,scheduling futureappointments,orderinglabwork,orderingmedicationsandmore. x ScanneddocumentscanbestoreddirectlyintotheSOAPEnote. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 140 of 175168 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections Med Pass/Pill Call x MedPasstimesareconfiguredbydayandaMedPasslistisgeneratedaccordingly. x MedPasslistscanbegroupedbyhousinglocationoralphabeticalbylastname x Usingalaptopdevice,MedicationacceptanceorrefusalcanbedocumentedrealͲtime. (thelaptopdoesnotneedtobeattachedtothenetworkduringtheMedPass) x Barcodedevicescanbeusedtoidentifyinmate’susingwristbandsoridentification cards. x Graphical,detailedMARreportscanbeviewedandprintedatanytime x AbilitytodocumentBloodSugarandVitalSignsaspartofMedPass Med Sets x StandardOrdersorNursingProtocolsformedicationscanbeconfiguredforspecific conditions(i.e.,Detoxprotocolsweremultiplemedicationsareorders,SteroidStep downdosages) x Singleorderingformultiplemedications Drug Interaction x DrugtoDrugcheckingcanbecompletedrealtimeduringtheorderingprocess. Checking x DrugtoAllergycheckingisalsocompletedtocheckanyallergiesreportedbythe patienttoanymedicationbeingordered. Staff Activities x NonͲInmateactivitiescanbeenteredintothesystemtoassistwithcommunication betweenmanagementandclinicalstaff. x Activitiescanbemarkedascompletesothattheywillnolongerdisplay. Pharmacy Module x Thisfeaturecontrolsmedicationprescriptions,makesMedPassassignmentsand schedulesmedicationrefills/reͲorders x Formularylistcanbeenteredtocontrolmedicationordering x DifferentFormulariesbasedonholdingagency(i.e.,USMarshall,County,State) x Medicationscanbegroupedbyname,analgesiccategoryandothercategories. Medical Forms x Ouruniqueformscreationtoolallowsuserstocreatecustomizedformstouse throughoutthesystem.Theseformscanbecategorizedasmedical,dentalormental healthandcanbedefinedasIntake,Release,PatientRequests,SubjectiveInterview, PatientHistory,EducationandExamForms(Objective). x FormscanbeconfiguredasProtocolsbasedonaspecificproblemorcondition. x FormscanbeconfiguredwithTriggersthatwillautomaticallycrateactionsinother partsofthesystem,suchasnursetasksorcreatinganactiveproblemforaninmate. x FormscanalsocapturenotͲexaminationinformation,suchasadministrativeand patientconsentforms. x TheFormstoolwillallowforthecreationofCustomFlowSheetsthatcanbeusedto tracktrendsininformation.CustomerFlowsheetswillappearwithotherFlowSheets inthesystem. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 141 of 175169 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections x FormTriggerscanbeusedtopullpertinentinmatemedicalinformationandplaceon releaseortransferforms. Integrations x ThroughintegrationwithJailManagementsystemsfacilitiessavetimereͲentering inmatedemographicinformationintomultiplesystems. x Achartisautomaticallygeneratedforanewinmateandreactivatediftheinmatehas beeninthefacilityinthepast. x HousinginformationisupdatesothatatthetimeofMedPassinmatescaneasilybe located. x TheinmateisreleasedwhenautomaticallywhentheyarereleasedintheJMS x Laboratoryresultsarereceivedandcanbereviewedandattachedtothe inmates/patientschart. x PharmacyordersandconfirmationcanbeelectronicallyexchangedusingHL7orFax Services. x Radiologyresultsarereceivedandcanbereviewedandattachedtothe inmates/patientschart. Reports x PreͲdefinedManagementreportsthatinclude: x MedPassCompliance/nonͲcompliance x Currentinmateswithspecificmedicalproblems x Demographicdistributionofinmatepopulation x ReportTool–allowsforuserͲdefinablereportingforeasyqueryofthedatabaseand simplegenerationofmanagementreports. Data Exchange x CorEMRisabletoexchangedatawithotherEHRsoftwarepackagesusingthefederally developedCCD/CCRformats. Technology x CorEMRisawebͲbasedElectronicMedicalRecordssystemandcanbeaccessedbyany workstationusingonlyawebbrowser.(MicroSoftIE10,FireFoxorChrome) x UtilizesMicroSoftSQLServer2005/2008/2008/2012RandMySQL5.0+. x WilloperateonLinuxandWindowServeroperatingsystems. AccesstoCorEMR CorEMR is a true web-based system. In most cases the server(s) that host the software reside within the facility’s or County’s network. Remote access will be controlled by internal Luzerne County IT staff. Once a user is connected to the network, s/he will be able to access the software using a web browser. This connection can be accomplished via a Virtual Private Luzerne County Council Voting Session November 26, 2019 AGENDA Page 142 of 175170 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections Network (VPN) connection or by opening up traffic through the County’s firewalls. CorEMR supports HTTPs for additional security. Workstations or laptops can be connected to the network via cable or wirelessly. For medication pass purposes, the software has been designed to allow medication administration from a laptop which is not connected to the network; when the user is back in the medical area s/he can re-establish network connectivity and save the med pass results into CorEMR. SoftwareUpdatesandPatches CorEMR provides periodic upgrades for its software. For prior issues, the company may provide ‘patches’ (through hot fixes) as necessary. All such fixes will also be included in the next upgrade version. CorEMR provides at least one major upgrade each year, with smaller versions released in between the major changes. The major version releases typically contain new functionality, while the smaller releases are reserved for fixes to existing functionality. CorEMR will install all releases remotely, with the assistance of Luzerne County IT staff. CorEMRCosts As directed in the RFP, Wexford Health has listed the costs/charges associated with CorEMR separately from the proposed cost of our inmate health care services. The CorEMR pricing describes all of the following items. x Annual licensing fees x Annual support costs (technical support for software and hardware issues) x Start-up costs (including installation and training) x Annual training costs III.H.4.c. EHRImplementation,Use,andSupport Wexford Health will create and maintain an individual health care record for every LCDOC inmate that receives medical, dental, or mental health services, either at the initial screening process or for as services are rendered following the inmate’s assignment to a housing area. WexfordHealthcommitstomeetingtheclinicaloperationtimeframesoutlinedinthissectionoftheRFP,as listedbelow. AqualifiedWexfordHealthmedicalproviderwillseeanyinmatereturningfromanoutsidehospitalstay,clinic visit,orothercorrectionalfacility.Ourproviderwilldocumentthisencounter(includingnotestoinͲhousefollow upcare)intheinmate’shealthrecord. Ourstaffwillreadanddocumenttheresultsoftuberculintestsonadailybasis. Within24hoursofreceivingthenamesofapplicableinmates,ourmedicalstaffwillperformreviews,medical examinations,medicalsummaries,and/orcertificationsasnecessaryforintraͲsystemtransfers,foodhandlingand Luzerne County Council Voting Session November 26, 2019 AGENDA Page 143 of 175171 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections workclearances. Wewillpreparemedicalsummaries(compliantwiththerequirementsofPAAct84)toaccompanyanyinmates beingtransferredtocorrectionalfacilitiesotherthanthoseoftheLCDOC. We understand that the LCDOC currently uses an EHR. We describe CorEMR—Wexford Health’s proposed replacement for the current EHR—below, with technical aspects discussed in the preceding narrative. CorEMR will provide comprehensive functionality and interoperability, providing site-level clinical and LCDOC staff with an easy and efficient way to more effectively manage individual patient treatment. Wexford Health will be responsible for procuring and maintaining computer equipment and software for CorEMR. We agree to install, integrate, train staff on, and provide ongoing technical support for the system. We acknowledge and appreciate that Luzerne County IT staff will assist with any connectivity issues to the County network, to facilitate our implementation of CorEMR. We will support the LCDOC in developing and implementing “linkages” between CorEMR and local health care providers (as technologically and financially feasible). We agree that any additional future costs associated with EHR links or changes in the provider network will be the responsibility of Wexford Health. III.H.4.c.i. TheCorEMRSolution Since early 2011, Wexford Health has utilized the NON- PROPRIETARY VERSION of CorEMR in our statewide contract with the WVDOC; at our contracted jail facilities in Yavapai and Pinal Counties, Arizona; in our Pennsylvania county prison facilities in Erie and Westmoreland; and in Kane County, Illinois. We are also implementing the CorEMR system in our Butler County, Pennsylvania facility. CorEMR was designed specifically for the correctional environment. It includes only those components that will be used in a correctional facility (e.g., appointment scheduling, receiving screenings, medication monitoring and administration, and record retrieval) but none of the free-world modules that some EHRs charge for (e.g., practice management, insurance billing). Wexford Health realizes that many county correctional agencies do not have the extra budget dollars or available IT staff to allocate toward a comprehensive EHR solution. By allowing us to fully implement the CorEMR system, the LCDOC can solve both of those problems, as well as retain sole possession of the EHR, if and when the Department decides to go a different route with health care services. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 144 of 175172 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections The CorEMR system allows multiple users, at different workstations, to access information simultaneously. This allows employees to work with far less redundancy and can provide the LCDOC with extremely accurate health care utilization and cost information. PatientCharts CorEMR can be used as an entirely paperless system. With the system’s scanning and file upload capabilities, Wexford Health and the LCDOC can integrate even hard copy, third-party documents into an inmate’s chart. Users can search for an inmate chart by booking number, name, social security number, or other identifier. The system offers a chart summary or “dashboard” outlining the patient’s current medical problems and medications, a task summary, intake form summary, and recent medical history (e.g., appointments, sick calls, prescriptions, completed forms, flow sheet entries, scanned documents, notes). Each part of the chart summary links to detailed information about the corresponding section of the inmate’s medical record. Figure19:PatientChart CorEMR maintains an active medical problem list for each inmate patient, as well as a complete historical summary of every action recorded in the system for each patient. Flow sheets for vital signs and blood sugar levels can be recorded and logged, and any inmate requests, outside provider visits, lab reports, or any other non-system documents can be scanned and stored in the patient's chart. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 145 of 175173 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections Figure20:CorEMRDashboard Figure21:DailyTaskList MedicalForms With CorEMR, the LCDOC will be able to easily create and modify its own forms. The system contains a proprietary tool that Wexford Health can use to design customized intake, transfer, and other forms to capture clinical and administrative information. The form creation tool can also add “triggers,”, so that when certain information is entered into a chart, a second, related Luzerne County Council Voting Session November 26, 2019 AGENDA Page 146 of 175174 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections action occurs automatically in the EHR. For example, we can set a test result outside of normal range to trigger a flag for the clinician on duty to review that inmate’s chart. Figure22:Intake/ReceivingScreeningForm Figure23:MentalHealthAssessmentForm AppointmentScheduling CorEMR contains an appointment scheduling function to manage onsite and offsite clinician encounters. Users are able to view appointment calendars by day, by week, or by month. Appointments can be sorted by type of clinician (e.g., physician, dentist, nurse, social worker), Luzerne County Council Voting Session November 26, 2019 AGENDA Page 147 of 175175 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections acuity level, inmate housing location, and so forth. The system also allows the user to initiate Sick Call appointments directly from the scheduler function. ElectronicMedicationAdministrationRecord(eMAR) CorEMR’s MedPass electronic medication administration record (eMAR) allows for full integration with any pharmacy, as well as complete medication ordering, check-in, and distribution. The MedPass module can operate with or without network connectivity and—by nature of its design—loads quickly. With a laptop on the medication cart, staff members are able to distribute and record MedPass results with a mouse or a barcode scanner. Resident photos can also be made available in MedPass to enhance patient identification. With MedPass’s multiple reporting tools, administrators are easily able to track medications given, compliance percentages, and medication types administered. The eMAR’s reporting function shows all medications given, including a date and time stamp of the staff member who administered the medication. CorEMR is fully capable to order, deliver, track, search, and generate reports for medications. The MedPass prep list assists staff in preparing medication for distribution in a simple, clear format. Figure24:CorEMRMedPasseMARscreen Medication sets: This feature of MedPass enables users to create and edit medication sets directly from the patient’s chart during sick call visits. The medication set feature allows for an unlimited number of medications, with different start times and dosages. The built-in permissions grid provides protection against unwanted or accidental changes to the medication set. MedPass preparation list: The “prep” list is used to organize medication carts and to review medication distribution planning for the entire day. The list is sortable, and can be filtered both alphabetically and by housing area. The feature-rich screen shows considerable detail about the medications scheduled for any given day. The list is also used by many facilities as a “print to file” option in case the need arises for disaster recovery. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 148 of 175176 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections Figure25:CorEMRMedPassmedicationpreparationscreen Reports From the large amount of information the CorEMR system captures on each inmate, Wexford Health can easily generate monthly management reports for the LCDOC. Examples of reports available from the CorEMR system include, but are not limited to, those listed below. x Medication pass compliance/non-compliance x Current inmates with TB x Active inmates yet to receive 10-day physical/nurse evaluation x Most common medications distributed x Most common clinical problems x Age, gender, and race distributions of inmate population III.H.4.c.ii. EHRTrainingResources Wexford Health has significant successful experience in implementing and using a wide variety of EHR systems. We are experienced not only in installing these solutions; but also in training staff, ensuring proper utilization, and otherwise supporting systems. We do not rely on EHR software vendors for training materials. Our internal EHR Department creates client-specific training materials as well, in both written and electronic media. These pamphlets and videos are role-specific, with different variations designed for nurses, providers, schedulers, and so forth. We deliver training in the classroom environment, as well as providing users with self-study materials. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 149 of 175177 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections Our EHR training will not cease once transition is completed. Wexford Health regularly provides “refresher” training for site-level users, as we bring on new hires and identify those “techno-phobes” who are slower to embrace the electronic systems. As with the initial training, these refresher course take many forms, including classroom training; self-study materials; the creation of a pod of onsite “super-users” to provide more immediate, hands-on assistance; and participation in online user groups, where users at provider practices and correctional facilities across the country share their insight and solutions to common problems. III.H.4.c.iii. EHRSupport Wexford Health and CorEMR will provide multiple levels of technical support for the LCDOC EHR throughout the term of our contract. Level One user help desk support: Wexford Health super users at the LCP will function as the first level of EHR technical support for all users. They will log and Level respond to all issues not directly related to the CorEMR Four Support: software, such as a workstation not having power, an CorEMR inability to connect to the system, or a forgotten password. LevelThreeSupport: WexfordHealthITstaff Level Two user support: Wexford Health super users will also attempt to address issues directly related to the CorEMR software, before escalating these inquiries to a higher LevelTwoSupport: level of support. If the super users are not Sitesuperusers able to resolve the inquiry, they will forward the issue to Support Level Three. LevelOneSupport: Level Three user support: Sitesuperusers Wexford Health will provide subject matter experts to address Level Three support issues, specifically issues that are more complex and/or require a higher level of authorization to resolve. These individuals—consisting of the information technology staff at our corporate office—will provide direct help for CorEMR issues that Level Two support cannot resolve. Level Three staff will update the existing problem description in the application Issues Log and document all efforts they take to resolve the issue. If the Level Three support team is not able to resolve the inquiry or provide a workaround, they will forward the issue to Level Four support. Level Four user support: CorEMR will provide Level Four assistance to Wexford Health’s Level Three support team. CorEMR employees will work with Wexford Health to diagnose and fix any problems that have escalated to this level, or (in response to an immediate or urgent user problem) will develop a workaround solution. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 150 of 175178 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections III.H.4.d. HealthRecordContentsandDocumentation Wexford Health trains our health care staff members to document each health care WexfordHealthmedicalrecordsinclude,at encounter in the appropriate section of the aminimum,thefollowinginformation. Problem-Oriented Medical Record, utilizing appropriate, approved forms. We x MasterProblemList require all documentation to follow the SOAP x Completedintakescreeningform (Subjective, Objective, Assessment, Plan) x Completedhealthappraisalform format. x Allfindings,diagnoses,orders, treatments,anddispositions When making entries using a paper format, all Wexford Health medical professionals write in a x Progressnotes manner that is clearly legible and decipherable x Medicallogsheets to all readers. Any entry into a paper medical x Prescribedmedicationsandtheir record includes the date of entry; the printed administrationlogsheets name of the medical professional making the x entry; and the medical professional’s signature. Resultsoflaboratory,xͲray,andother diagnosticstudies Our clinical staff members establish a x Consentandrefusalforms separate file for each patient at the time of x Releaseofinformationforms his or her receiving screening or upon initiation x Complaintsofillnessorinjury of a health care intervention (medical, dental, or mental health)—whichever occurs first. We x Medicalrequestforms ensure these health records are sufficiently x Medicalgrievanceforms detailed to (a) enable a practitioner to give x Signatureandtitleofprovideroneach continuing care; (b) permit a retrospective document determination of the patient’s condition and x Place,date,andtimeofencounter treatment at the time of examination; and (c) provide information that will enable x Dischargesummaryofhospitalization,ED consulting medical professionals to render trips,andoffsiteprocedures advice on the patient’s care and treatment. x Dischargeplans,asappropriate Wexford Health maintains health records at the x Healthservicereports,e.g.,dental, facility where the patient is housed. psychiatric/mentalhealth,andother After each encounter between a health care consultations provider and a patient, our health care personnel update the patient’s health record by the end of each staff shift. This ensures providers coming onto the next shift are aware of the medical status of any patient treated during the prior shift. We make these entries legibly, in ink, signed and dated by the maker. Licensed nursing staff note orders by a physician, dentist, or psychiatrist and ensure all health care professionals have access to the patient’s health record. III.H.4.e. ConfidentialityofHealthRecords Wexford Health ensures information contained in our inmate health records (including medical, dental, and mental health documentation) is not accessible to inmates or correctional staff. We keep all health records separate and confidential from all persons in custody in accordance with the standards and regulations adopted by the Department of Health and Human Luzerne County Council Voting Session November 26, 2019 AGENDA Page 151 of 175179 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections Services in the HIPAA Privacy and Security Rules. Paper records are securely locked away from heavy traffic areas. For CorEMR, we will utilize appropriate password protections for this electronic data. Upon request—and in accordance with HIPAA—we will immediately give authorized LCDOC personnel access to inmate medical records (primarily in the following cases). x With the informed consent of the patient x When required by law, e.g., the reporting of communicable diseases x When the security of the LCP/MOU or the safety of the individual requires disclosure of such information (and then only to the extent necessary for the protection of the patient and/or the facility) x When necessary for the classification, security, and control of inmates x The defense of a cause of action by any inmate against the County Only authorized Wexford Health personnel perform transcription of medical information and filing of health records. Wexford Health will comply with federal and Pennsylvania rules and policies concerning confidentiality. With the exception of pertinent health care information necessary for an offsite consultation or specialty referral, Wexford Health releases detailed health care information to an outside agency only upon written authorization from the patient. III.H.4.f. InformedConsent As discussed in the preceding narrative, Wexford Health will require all of our staff members to adhere to applicable informed consent regulations and maintain local (Luzerne County) jurisdictional standards. III.H.4.g. InactiveHealthRecords Wexford Health will maintain inactive health records in the CorEMR database in accordance with the laws of the Commonwealth of Pennsylvania and the rules of the American Medical Association. After a record has been inactive for two years, we will seal, properly identify, and archive the file in a designated area with the balance of the inmate’s confinement record, retaining such documents for any applicable legal requirements of the Commonwealth of Pennsylvania. PLEASE NOTE that once we implement CorEMR, the issue of archiving hard copies of inactive records will become minimal, if not non-existent. III.H.4.h. MedicallyRelatedCourtDocuments Wexford Health agrees to provide the designated LCDOC representative with written information on any court/legal documents pertaining to inmates and/or our medical program prior to the close of the shift during which we receive the documents. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 152 of 175180 Solicitation#RFP:LCDOC(2019) InmateHealthCareServices LuzerneCounty(PA)DivisionofCorrections III.H.4.i. MisplacedHealthRecords If an inmate’s health record cannot be located within 48 hours of the discovered loss, Wexford Health’s medical staff will verbally notify appropriate LCDOC staff and arrange for a duplicate record to be immediately generated. We will repeat any medical clearance testing for results that cannot be confirmed. When the missing record is located, we will ensure that the original and duplicate files are joined to form a single file, with the contents marked “original” and “duplicate” as appropriate to help distinguish original from duplicate files. PLEASE NOTE that once we implement CorEMR, the issue of misplaced health records will become minimal, if not non-existent. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 153 of 175181 CONTRACT ATTACHMENT D: PRICING Luzerne County Council Voting Session November 26, 2019 AGENDA Page 154 of 175 Luzerne County Council Voting Session November 26, 2019 AGENDA Page 155 of 175 CONTRACT ATTACHMENT E: SPECIAL PROGRAMS Luzerne County Council Voting Session November 26, 2019 AGENDA Page 156 of 175 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections III.H.3.f. Special Needs Patients A strong case management program not only improves the health of special needs inmates, but also provides the following benefits. Appropriate and effective utilization of offsite specialty services, hospitalizations, and emergency room visits Reduced volume of inmate complaints and grievances, as their essential health needs are met quickly and efficiently Reduced number of legal claims, due to more concise and responsive medical management Improved morale for onsite medical staff, due to frequent interactions with corporate staff that reduce any feelings of isolation within the correctional facility; this also improves staff retention at the facility. Improved relationships between onsite medical and security staff, due to increased patient satisfaction with medical care As discussed below, Wexford Health will develop and implement a “special needs” medical program for inmates requiring close medical supervision and those with chronic and/or convalescent care needs. Each special needs inmate will have a written individualized treatment plan. Inmates committed under the influence of alcohol or drugs will receive an appropriate course of treatment, including a medically approved and supervised detoxification program. Inmates with suicidal tendencies will be assigned to quarters that have close observation. Inmates with a history of seizures will be assigned to quarters that have close observation. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 157 of 175138 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections A physician will determine pharmacological support care for special needs patients. III.H.3.f.i. Chronic Care Patients The prevalence of chronic disease in corrections is higher than in the general population. According to the US Bureau of Justice Statistics9, the percentage of inmates in state prisons with chronic disease was 44%, compared to 31% in the “free world”. Additionally, inmates are about 1.5 times more likely than persons in the general population to have high blood pressure, diabetes, or asthma. These facts contribute to the steadily rising cost of correctional health care. Poorly controlled chronic conditions—especially diabetes mellitus, HIV, hepatitis, and cardiovascular disease— account for a significant amount of onsite encounters, offsite specialty care, and inpatient hospitalizations. Wexford Health believes delivering appropriate, cost-effective correctional health care requires constant attention to the diagnosis and proper treatment of chronic conditions, including but not limited to diabetes, asthma, COPD, epilepsy, cardiovascular disease, HIV/AIDS, hepatitis, TB, cancer, thyroid conditions, obesity, and hypertension. Our “chronic special needs” program also includes patients with conditions including geriatric frailty, physical handicaps, developmental disabilities, terminal illnesses, substance abuse disorders, and psychiatric disorders (depression, anxiety, PTSD, psychosis, suicidal tendencies). Wexford Health Philosophy of a Successful Chronic Care Program If a chronic care program provides treatment based simply on each patient’s current level of control of his or her condition, the program is likely to waste resources or (conversely) provide interventions at a level insufficient to adequately manage the illness. Therefore as part of each chronically ill inmate’s initial health assessment, Wexford Health also measures and analyzes illness‐specific indicators, to establish the patient’s degree of control (poor, fair, or good) over his or her illness. Based on the identified level of control, we determine the frequency of encounters necessary to medically manage the illness; and enroll the inmate in appropriate chronic or specialty care clinics. These clinics provide a recurring means for our clinical staff to evaluate, manage, and educate patients with regard to their conditions, associated risks, and methods for increased wellness and improvement of their overall health and well‐being. To aid our clinical staff in the proper care of these disease states and conditions, we have developed chronic care protocols that meet or exceed industry guidelines. All of these protocols incorporate best practices, prevention strategies, clinical-practice improvement, clinical interventions, and outcomes research. 9 Maruschak, Laura M., Berzofsky, Marcus, PhD, and Unangst, Jennifer. Special Report: Medical Problems of State and Federal Prisoners and Jail Inmates, 2011–12. US Department of Justice, Bureau of Justice Statistics. February 2015, revised October 4, 2016. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 158 of 175139 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections The first step in managing chronic disease is to identify inmates with any of the serious conditions listed above upon admission to the LCP. We detect these individuals at intake, during the screening and health appraisal. For inmates with known or suspected chronic diseases or other special medical needs—such as diabetes, asthma, hypertension, other serious communicable diseases, physical or developmental disability, serious mental illness, or terminal illness—we will note the condition in the patient’s chart in CorEMR and enroll him or her in appropriate chronic care clinic(s). For each inmate assigned to a chronic or specialty care clinic, Wexford Health’s clinical staff creates an individualized, physician-approved treatment plan written to fit the patient’s particular needs. This treatment plan provides the inmate with access to the supportive and rehabilitative services necessary to maintain or improve his or her health. The treatment plan is determined by the needs of the individual, but includes (at minimum) such things as medications, dressing changes, therapeutic diets, physical therapy, type and frequency of laboratory tests, and the frequency of medical follow-up and adjustment of treatment modality. The typical Wexford Health chronic or specialty care treatment plan also contains the following components. Special risks and adjustment needs relevant to the inmate, along with treatment to ameliorate such risks and difficulties during incarceration Direction for health care and LCDOC custody staff regarding their roles in the care and supervision of the chronically ill inmate A written initial evaluation by a licensed physician that includes short- and long-range treatment goals Baseline and monitoring laboratory work as required, along with other diagnostic tests appropriate for the inmate’s disease or condition Regularly scheduled encounters where chronic care clinic participants are seen every 90 days (or as appropriate, according to the patient’s degree of disease control) Regular reviews and updates to the short- and long-range health goals for the inmate, reviewed and co-signed by the attending provider, including the appropriate minimum intervals at which the patient should be seen (minimum of every 90 days) A Wexford Health provider will develop and initiate the chronic or specialty care treatment plan, which we will maintain in the inmate’s chart in CorEMR. We also list any special needs on the master problem list in the chart. III.H.3.f.ii. Detoxification Program Wexford Health will properly manage and detoxify inmates who arrive at the LCP under the influence of alcohol, opiates, or benzodiazepine. We will immediately refer to qualified health care staff any individual who exhibits signs or symptoms of intoxication or Luzerne County Council Voting Session November 26, 2019 AGENDA Page 159 of 175140 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections withdrawal during the intake screening process and use the LCDOC Drug and Alcohol Detoxification Protocols that were provided in the RFP during treatment. Upon identifying an inmate manifesting symptoms of alcohol or drug withdrawal, Wexford Health will immediately notify the on-call provider to receive medication orders. Our staff will segregate such patients, keeping them under constant medical observation and following strict procedures outlined by the onsite or on-call provider and Wexford Health policy. A qualified health care professional will assess the inmate’s risk for progression to more severe levels of intoxication or withdrawal. Based on the guidelines of the American Society for Addictions Medicine, our staff will determine whether to administer detoxification services at the LCP or an offsite health care facility. If an inmate exhibits severe, life-threatening intoxication (overdose), detoxification, or withdrawal symptoms, we will send the patient to a local hospital for assessment, monitoring, and treatment. We will take the same action for any patient we deem to be at risk for progression to more severe levels of intoxication or withdrawal. Wexford Health maintains Policy M-0003 Drug Intoxication/Withdrawal, which describes in detail our medical detoxification program for the management of chemically dependent or intoxicated inmates, and contains procedures, protocols, and forms on the following program components: Identification of inmates in need of detoxification Assessment forms, e.g., Clinical Opiate Withdrawal Scale (COWS), Clinical Institute Withdrawal Assessment- Alcohol revised (CIWA-AR), etc. Comprehensive treatment plans, including appropriate levels of medication and dietary supplements Separation from general population Supervision and monitoring Hospitalization for severe cases Prior to initiating detoxification, a physician or mid-level practitioner will provide the inmate with a full health assessment, including necessary laboratory testing and a review of the patient’s medical history, to ensure that s/he has no major medical disorder (infectious disease, infection, seizure disorder, diabetes) that could affect his or her health during the detoxification process. Wexford Health clinicians and mental health staff will participate collaboratively in the detoxification treatment of the inmate. All detoxification will be administered under medical supervision following County, Commonwealth, and federal laws. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 160 of 175141 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections III.H.3.g. Communication Regarding Special Needs Patients An important aspect to effectively treating special needs patients in the correctional environment is communication. Ongoing communication is vital for accurate classification, treatment planning, and protection of the patient, other inmates, and staff. Wexford Health will (in accordance with all applicable HIPAA regulations) communicate regularly with LCDOC custody and administrative staff regarding chronically ill and other special needs inmates. We will maintain a list of special needs patients at the LCP; and can (upon request) provide the County with statistical reports describing the occurrence of chronic and specialty care clinics. III.H.3.h. Female Patients Female inmates are subject to most of the same illnesses, physical, and mental impairments as males, many times with a greater frequency. For treatment staff at a female correctional facility, sensitivity and awareness of this fact is critical. Beyond this, there are unique requirements necessary to satisfy the health care needs of the female population in custody. At the LCP, Wexford Health’s providers will include OB/GYN-trained health care practitioners qualified to meet the health care needs of female patients across all life years. In addition to the basic health care and specialty services provided to all inmates, we will ensure females receive at a minimum the deliverables listed below. Our intake history will include pregnancy testing, as well as inquiry into menstrual cycle, other pregnancies, gynecological problems, and personal/family history of breast cancer. We will administer lab tests to detect pregnancies and STDs (including syphilis, gonorrhea, and chlamydia), and offer HIV testing for any pregnant inmates. We will provide female preventive health care services in keeping with a designated set of National Guidelines. We will coordinate with custody staff to ensure the availability of adequate sanitary supplies. We will provide information and health education on breast self-examination, pregnancy, contraception, and family planning. We will, to the extent permitted by LCP and community physical and financial resources, provide gynecological services both onsite and offsite. We will provide pregnancy counseling and information in accordance with state laws and regulations. Care for Pregnant Inmates For pregnant inmates, Wexford Health provides safe, timely, and appropriate prenatal care and pregnancy counseling, including specialized obstetrical care services as needed. Our Policy J-114 Care of the Pregnant Inmate ensures all pregnant females receive prenatal, obstetrical, and postpartum care by qualified health care professionals as defined by the American College of Obstetrics and Gynecology. This includes medical examinations, health education on pregnancy, and all needed laboratory and other diagnostic testing. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 161 of 175142 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections We will arrange pre-natal services and regular monitoring for pregnant LCDOC inmates by establishing onsite or offsite OB/GYN specialty clinics, as necessary. Our pre-natal program provides the following care. Routine urine testing for proteins and ketones Monitoring for gestational diabetes Vital signs and weight Assessment of fundal height and heart tone Observation for signs of toxemia Dispensing of pre-natal vitamin supplements Diet and exercise instructions Submitting requests to the Food Services Supervisor for special OB diet Education on the care of infants Identification and disposition of high-risk pregnancies, including appropriate referrals Creation and delivery of a post-partum after-care plan for the mother, developed prior to delivery If we determine that the inmate has a high-risk pregnancy, Wexford Health will identify, and arrange for consultation with, an appropriate high-risk obstetrical provider and hospital (see focus box). Please note we will not be responsible for neonatal or newborn care after the moment of the infant’s recorded birth time. We also provide pregnant inmates with pregnancy counseling and parenting/child care education. We make a practice of partnering with local Departments of Health, family planning clinics, and other appropriate community programs and social service agencies to draw upon those departments’ resources for counseling and education. High‐Risk Pregnancies Wexford Health classifies a pregnancy as high‐risk if the inmate has any of the following conditions: One of these diseases: diabetes, cancer, high blood pressure, kidney disease, or epilepsy Uses or has used alcohol, tobacco, or illegal drugs Is younger than 17 or older than 35 Is pregnant with more than one baby (multiple pregnancy) Has had three or more miscarriages Had preterm labor, preeclampsia or seizures (eclampsia), or gave birth to a baby with a genetic problem, such as Down syndrome, during a past pregnancy Has an infection, such as HIV, hepatitis C, cytomegalovirus (CMV), chickenpox, rubella, toxoplasmosis, and syphilis Is taking certain medicines, such as lithium, phenytoin (such as Dilantin), valproic acid (Depakene), or Luzerne County Council Voting Session November 26, 2019 AGENDA Page 162 of 175143 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections carbamazepine (such as Tegretol) If we determine that an inmate’s pregnancy is high‐risk, Wexford Health will make arrangements for her to be seen by an OB/GYN specialist at Wilkes‐Barre General Hospital, Geisinger Wyoming Valley Medical Center, Geisinger Medical Center (Danville), or other appropriate facility that provides specialized prenatal care and conducts high‐risk pregnancy specific in‐office ultrasounds and lab draws that cannot be done at the LCP. Wexford Health Policy J-115 Pregnancy Counseling addresses the issue of female inmates’ legal entitlement to abortions. We ensure that any pregnant inmate is provided with comprehensive pregnancy counseling—without prejudice—regarding her decision about keeping the child, adoption, or abortion. Wexford Health strives to ensure the counseling is comprehensive, caring, and without bias, to assist the mother in making the most knowledgeable decision regarding her outcome. We accomplish this through detailed educational encounters that allow the mother to fully understand all of her options, and thus make the most informed decision possible. III.H.3.i. Infectious Disease Program Wexford Health will operate a Vital components of Wexford Health’s Communicable Disease Unit for the LCDOC. We establish and maintain a infection control program include the comprehensive infection control following tasks. program at each of the facilities where we Monitoring and management of provide services. Our program stresses the hospital‐acquired infections early identification, prevention, and Pediculosis (body lice) control of infectious diseases. This focus contributes to the overall quality of Sterilization and sanitation practices patient care by reducing the risk of infection. (especially in dental departments) It is also crucial to the safety of inmates and Management of isolation activities staff who live and work in the LCP and Kitchen sanitation (monitored but not MOU. managed by Wexford Health) Our infection control program accomplishes Sanitation inspections the following tasks. Creation and implementation of Monitors the incidence of infectious appropriate policies and procedures and communicable diseases (HIV, TB, Education and training for both HCV, HBV, MRSA, varicella, influenza, Wexford Health and LCDOC staff etc.) and sexually transmitted diseases (gonorrhea, chlamydia, syphilis, herpes, etc.) Prevents the spread of such diseases with strict adherence to the guidelines of the Centers for Disease Control Complies with Occupational Safety and Health Administration (OSHA) regulations Transmits the appropriate reports to the state and county health departments, as well as outside hospitals/health care delivery facilities Reports all subject infections in accordance with applicable laws. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 163 of 175144 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections We will designate an Infection Control Coordinator and establish an Infection Control Committee that meets regularly to provide activity reports to the County. The Coordinator will monitor infectious diseases and report to health departments as required; ensure that the portion of the intake screening relevant to infectious disease is carried out appropriately; monitor that inmates are followed through chronic/communicable disease clinics with consistent diagnostic testing; and ensure that inmates receive treatment consistent with community standards. If we diagnose a communicable disease, Wexford Health will immediately notify the appropriate LCDOC and County personnel. Our staff will follow appropriate isolation protocols and provide treatment as per CDC guidelines. Wexford Health recognizes the importance of educating both health care staff and security staff on the infection control program’s policies and procedures. We will provide continuing education through both the Infection Control Committee and our Infection Control Manual. The Infection Control Manual will provide detailed policies and procedures specifically tailored to meet the needs of the LCDOC. Additionally, Wexford Health will implement proper processes and train all health services staff in the appropriate methods of handling, storing, and disposing of biomedical hazardous wastes. Upon County request, we will also train facility staff and/or inmates in the proper cleanup and handling of biomedical hazardous waste. ADDED VALUE PROGRAM: InDECS: Infectious Disease Program Wexford Health understands the importance of controlling infectious diseases (IDs) in the correctional setting. We apply a multi‐faceted approach to stay up‐to‐date on pertinent issues in the ID field. In fact, industry auditors have recognized our Hepatitis B, Hepatitis C, and HIV chronic care programs for their educational aspect and completeness. We maintain that certain crucial steps must be taken for a complex correctional health care program like Luzerne County’s to be clinically successful, operationally efficient, and cost‐effective with regard to ID, chronic care, and episodic conditions such as scabies. We have formalized these steps into our InDECS—Infectious Disease and Episodic Conditions Specialty—program, described below. The InDECS program involves regular meetings and/or conference calls via telehealth, in which site‐level clinicians communicate directly with Wexford Health’s ACE (Advanced Clinical Expert) physicians, our two corporate pharmacists, and other specialists regarding patients with ID and/or episodic conditions. Discussion topics include, but are not limited to, the subjects listed below. Formulary options for the patient (both pharmaceutical and diagnostic) Methods of determining who is ill and needs specialized care Treatment planning for diagnosed cases Alerts regarding site‐specific issues Necessary clinical and operational follow‐up For any particularly difficult ID or episodic condition issues that may arise, Dr. Neil Fisher—one of Wexford Health’s ACEs and an industry expert on infectious disease—works directly with the site clinicians to resolve the case. The InDECS meetings also serve as opportunities to educate site‐level physicians, mid‐level practitioners, Luzerne County Council Voting Session November 26, 2019 AGENDA Page 164 of 175145 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections DONs, and HSAs, as Dr. Fisher and our other experts present current research, data, and results for the diseases and conditions that are most relevant to the contract. For the Luzerne County contract, Wexford Health will hold regular InDECS calls for our site‐level providers and other clinical staff, at a frequency to be mutually determined. These calls will cover a variety of ID and episodic condition topics to include, but not be limited to, Hepatitis C, HIV, scabies, and newer IDs such as Ebola, H1N1, and the Zika virus. We recognize that the world of infectious disease is evolving. Therefore, Wexford Health will also collaborate with the County to create any new policies and/or protocols necessitated by future outbreaks, impending issues, etc. Our ACEs—and especially Dr. Fisher and the InDECS team—continually augment their already significant ID experience by staying current through resources such as MedPage Today and Medscape. III.H.3.j. Specialty Services Onsite Specialty Care Wexford Health is well aware of the cost and security risks involved in transporting inmates offsite for specialty medical services. Consequently, we will arrange for qualified medical specialists to conduct specialty clinics onsite at the LCP. We base our determination of the types of clinics to develop on two factors: the volume of required services (by specialty) at the site; and the availability of specialists within the community. Specialty and chronic care clinics that we commonly provide onsite for our clients (as appropriate, based on the site-specific situation) include the ones listed below. Wexford Health will also work with LCDOC administration to investigate any new clinics where the volume of need and availability of specialty provider resources would permit us to bring the services onsite. Cardiology (hypertension) Endocrinology (diabetes) General medicine General surgery Infectious disease Liver disease Pulmonology (asthma) Seizures If Wexford Health determines that a low volume of services and/or lack of availability of community specialists render any onsite specialty clinic time- or cost-inefficient, we will work with the County to research and implement alternate arrangements for specialty care. Offsite Specialty Care Wexford Health’s goal is to help the County to avoid inmate transport and offsite security costs. Therefore (as described in the preceding narrative) we will make every effort to Luzerne County Council Voting Session November 26, 2019 AGENDA Page 165 of 175146 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections provide specialty care and consultative services onsite, via telehealth or by arranging for Pennsylvania-licensed specialists to visit the LCP. If services cannot be delivered onsite, Wexford Health will schedule, authorize, and For offsite encounters, Wexford Health requires the coordinate the provision of offsite specialty community provider to supply a written report services as appropriate. In such cases, we will containing, at minimum, the following information. coordinate with LCDOC security and transportation staff; and arrange for the The reason(s) for the offsite consult inmate(s) to be transported to the offsite Appropriate exam and/or lab findings specialty appointment via security van or Diagnosis ambulance. To minimize the impact of offsite The inmate’s discharge plan specialty consults on LCDOC security and Information relating to any necessary follow‐up transportation resources, we will (to the appointments extent under our control) consolidate the scheduling of inmate appointments with community physicians, hospitals, and other health care providers. For each inmate returning from an outside hospital stay or clinic visit, Wexford Health will work with the specialist to create a legible consultation/treatment report in the patient’s medical record. We require the offsite specialty physician to provide copies of all diagnosis, treatment, and treatment plans. Within five days of the consult, our onsite physicians will verbally discuss with the specialist any consult notes and/or recommendations for special procedures or non-routine follow-up care. This information will become part of the inmate’s health record. Additionally, a Wexford Health medical professional will see the inmate in a timely fashion, to discuss the outcome of the visit and to ensure the patient understands any information given to him/her. Wexford Health will make every effort to minimize offsite clinic trips. Our clinical staff will provide routine follow-up care within the LCP to reduce the need for repeat offsite visits. Additionally, a Wexford Health physician or mid-level practitioner will review the results of each outside consult to determine if the inmate requires continued offsite specialty treatment. ADDED VALUE PROGRAM: ECCO (Enhanced Cardiovascular Care) Wexford Health is aware that cardiology accounts for a significant portion of referral requests. To address this specialty’s high utilization, we have designed and are proposing to implement our new ECCO (Enhanced Cardiovascular Care for Offenders) program, described below. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 166 of 175147 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections Components of Wexford Health’s ECCO (Enhanced Cardiovascular Care for Offenders) Program Corporate Medical Director Dr. Tom Lehman, a board‐certified cardiologist Telehealth cardiovascular consults with Dr. Lehman Review by Dr. Lehman of all patients sent offsite for cardiovascular reasons Advanced, one‐on‐one mentoring from Wexford Health's cardiovascular ACEs Specialized cardiovascular reporting via the EHR (once implemented) Potential for onsite cardiovascular imaging services Cardiac telehealth clinics with contract provider specialists Wexford Health brings many cardiovascular resources to the table, including current Corporate Medical Director Dr. Tom Lehman, a board‐certified cardiologist. A practicing physician for more than 30 years, Dr. Lehman has spent the past decade working in correctional health care. He is board‐certified in cardiology as well as internal medicine; with a fellowship in clinical cardiology from the University Hospital Medical Center in Cincinnati, Ohio. As the Cardiac Medical Director at Keesler Air Force Medical Center in Biloxi, Mississippi, he led the hospital’s coronary unit; non‐invasive cardiology laboratory; and pacemaker, coumadin, and coronary step‐down clinics. He has served as medical director—of cardiovascular services, cardiac catheterization lab, and cardiac rehabilitation—for multiple units and labs at various regional medical centers; and has also been a cardiologist in private practice. As our current senior corporate medical director, Dr. Lehman is responsible for the oversight of Wexford Health’s clinical services, including utilization review, case management, clinical protocols, physician development, and peer review. He is also an active member of the Society of Correctional Physicians and the Academy of Correctional Health Professionals. As one of Wexford Health’s ACEs (Advanced Clinical Experts), Dr. Lehman has always been available to consult on complex cases. Now, through the increased access enabled by our ECCO and telehealth programs, he will be able to contribute his expertise to a wide range of LCP inmates’ cardiovascular cases. Educational Program Components The ECCO program also contains educational/mentoring components. Dr. Lehman will share his expertise in cardiology with site‐level providers in multiple ways, as described below. After every Emergency Department (ED) trip, Wexford Health requires our sites to send an MDQA (Medical Director Quality Assurance) form to our corporate office, summarizing the case and the need for offsite emergency services. Under the ECCO program, any MDQA forms involving cardiology services will go directly to Dr. Lehman. Dr. Lehman will review the case of any patient sent offsite for cardiovascular reasons, to ensure the offsite trip was clinically necessary. In any case where he identifies a patient who could have been appropriately treated onsite at the facility, he will use the case as an opportunity to mentor the site physician regarding treatment options. Wexford Health’s ECCO program will proactively educate site providers regarding onsite resources and treatment protocols, helping to prevent unnecessary ED trips for cardiovascular reasons. This, in turn, will save the LCDOC the security and transportation costs associated with unnecessary ED trips. Another additional valuable education resource available through the ECCO program is Dr. Hector Garcia—also a cardiologist. As another of our ACEs, Dr. Garcia applies his 17 years of correctional health care experience to mentoring Wexford physicians. With Dr. Lehman, Dr. Garcia will develop and constantly update Wexford Health’s Luzerne County Council Voting Session November 26, 2019 AGENDA Page 167 of 175148 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections cardiovascular treatment guidelines for the LCP, based on the current recommendations of the American Heart Association, the American College of Cardiology, and other pertinent experts. Along with making themselves available to interpret EKGs, Dr. Lehman and Dr. Garcia will provide site physicians with advanced mentoring on reading EKGs, strengthening site physicians’ skills in this area and enabling these primary care physicians to reach a greater comfort level with interpreting cardiac diagnostic reports. Both physicians will also provide ongoing educational sessions to site clinicians, to ensure they are up‐to‐date on the most current and effective non‐invasive, invasive, diagnostic, and therapeutic methods of caring for heart disease. PLEASE NOTE that Dr. Lehman and Dr. Garcia are not providing direct patient care, but offering clinical opinions— based on their areas of expertise—to Wexford Health’s site Medical Directors. The site Medical Director is the final medical authority at the LCDOC facilities. Program Reporting and Predictive Metrics To identify and track patients with significant cardiovascular issues, Wexford Health will create a special report to be pulled based on certain measurable criteria to be tracked in CorEMR. Based on these data—for example, abnormal vital signs; the presence of coronary artery disease of congestive heart failure; the need for valve replacement surgery or coronary artery bypass grafting (CABG)—we will be able to detect existing (and many prospective) cardiovascular patients. Dr. Lehman and/or Dr. Garcia will review the data in this report to ensure existing cardiac patients are receiving appropriate care; and to proactively help us avoid high‐risk, high‐price cardiac incidents whenever possible. Dr. Lehman will participate on an ongoing basis in the integrated care plans for those patients identified as having the most complex cardiovascular issues. Onsite Cardiovascular Diagnostics As a final component of our ECCO program, Wexford Health will investigate the viability of performing certain cardiovascular imaging services (echocardiograms and vascular ultrasounds) onsite at the LCP. The County will save all of the security and transportation expenses typically associated with having to send the patient to a community hospital for these services PLEASE NOTE that implementation of this program component depends on (a) a sufficient projected volume for such services; and (b) the availability (and willingness to participate) of sufficient clinical and technology resources in the communities around the LCP. Our ACEs, our contract provider specialists, and Wexford Health’s onsite providers will participate in regular telehealth cardiac clinics, as well as in mentoring and patient case presentations. Specialty Care via Telehealth Providing specialized medical care can represent a significant challenge in the correctional environment. Statistics indicate that most correctional agencies currently meet a large portion of inmates’ specialty care needs through offsite transport and the utilization of community providers. Such offsite transport not only creates unnecessary costs, but also increases operational difficulties and public safety risk. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 168 of 175149 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections To further complicate the matter, not only is it becoming increasingly difficult to get specialists to provide inmate care, Oncology but specialists willing to provide such services do so only at great cost to the Endocrin- system. In response to these financial, GI operational, and geographic issues, ology Wexford Health has developed the leading telehealth program in the correctional health care industry: Wexford's our PATH program (Provider Access PATH through TeleHealth). Wound Program Ortho- Care pedics PATH can be utilized for many aspects of medical care, including emergency triage, mental health, wound care, urology, gastroenterology, cardiology, Surgery Psychiatry nephrology, and the treatment of (pre/post) HIV/AIDS and Hepatitis C. Our clients have not only realized substantial reductions in inmate transportation costs; but have also increased the availability of specialty care as a direct result of implementing our PATH technology. Wexford Health advocates the use of telehealth in both the community and correctional settings. In order to stay current with new technology applications and legal aspects, we attend regular telehealth meetings on Capitol Hill in Washington, DC as well as national conferences of such organizations as the Health Information and Management System Society and the American Telemedicine Association (with which we hold a five-year corporate membership). We also use telehealth technology in support of prospective review of health services, administrative meetings (both ours and our clients’), and Continuing Medical Education. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 169 of 175150 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections Wexford Health has delivered multiple presentations on our industry‐leading telehealth program. Recent appearances include the conferences listed below. 2018, January issue of Telemedicine and e‐Health: Telehealth Support of Managed Care for a Correctional System: The Open Architecture Telehealth Model 2016 National Commission of Correctional Health Care: Telehealth: Improving Clinical Outcomes & Reducing the Cost of Correctional Healthcare 2016 Baltimore City Medical Society: Telehealth –The Future Is Now for Correctional Systems 2016 International Center for Northern Governance & Development (ICNGD), University of Saskatchewan‐Government of Ministries of Saskatchewan: Integrated Telehealth for Correctional Systems 2015 National Commission of Correctional Health Care‐Leadership Institute:Telehealth In Corrections 2015 National Commission of Correctional Health Care: A New Generation of Telemedicine for Correctional Systems 2014 American Telemedicine Association Conference: A New Generation of Telemedicine for Correctional Systems Wexford Health Dedicated Telehealth Resources As one of our major focuses, Wexford Health has put multiple resources in place to support our PATH program. We have created a dedicated internal Telehealth Department, led by Medical Director Dr. Tom Lehman; and Vice President of Operations, EHR, & Transition Diana Grover. We go to great lengths to ensure care provided via PATH is equivalent to services provided in person. Tele-providers undergo the same stringent credentialing and peer review processes as do Wexford Health’s onsite clinicians. We maintain a comprehensive Telehealth Manual that addresses all aspects of the program, down to requiring our tele-providers to conduct all encounters from an office or other professional environment, while dressed in appropriate professional clothing. Our tele-providers are not mere specialty consultants, but function as an integral part of Wexford Health’s—and moving forward, the LCDOC’s—clinical treatment teams. These groups conduct regular video- and tele-conferences to ensure we are addressing all areas vital to the patient having a positive outcome: medical, psychological, social, and environmental. Wexford Health Telehealth Physicians: Our ACEs As discussed in the call out box below, Wexford Health maintains full-time “ACE” provider staff in many specialties, to mentor our site-level clinicians and to support our PATH program. Due to our existing business in the state, many of these providers already have their Luzerne County Council Voting Session November 26, 2019 AGENDA Page 170 of 175151 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections Arizona licensure. This will enable Wexford Health to “hit the ground running” at the start of the Luzerne County contract transition. Wexford Health currently has six medical directors on staff, as well as a full‐time National Medical Director whose sole purpose is to mentor our site physicians to help them optimize their efficiency and outcomes in the correctional environment. We will use these ACEs—Advanced Clinical Experts—to provide expert telehealth services in fields including cardiology, rheumatology, internal medicine, geriatrics, nephrology, psychiatry, chronic disease, and the treatment of HIV and Hepatitis. Telehealth End‐User Equipment With LCDOC approval, Wexford Health proposes to purchase, deploy, and maintain basic telehealth peripherals (stethoscope and general exam camera) at the LCP and at our corporate offices—at no cost to the County. This basic telehealth set-up can support the following clinics without the need for additional peripherals. Psychiatry Gastroenterology Cardiology Oncology Internal medicine Neurology consults Dermatology Orthopedics Pulmonology Infectious disease (HIV/Hepatitis C) Urology As we roll-out our PATH program and identify additional opportunities for telehealth, we will add the required associated peripheral equipment that will enable us to provide a wider variety of onsite specialty care. Wexford Health will provide such additional mutually agreed-upon peripheral equipment where the need is justified at an additional cost to the County. Telehealth Network and Security Wexford Health has significant experience in the deployment of telehealth technology and networks. Our experts will identify requirements, obtain the proper approvals from the County, order any necessary lines/equipment, and track the implementation. We will ensure all telehealth equipment is Advanced Encryption Standard (AES) compliant. The AES algorithm is capable of using 128, 192, and 256 bit keys to encrypt and decrypt data in blocks of 128 bits. We do not currently use any type of firewall, since our units have built in AES encryption. Wexford Health’s AES technology not only protects clients, but also supports HIPAA guidelines. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 171 of 175152 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections Telehealth End‐User Training Wexford Health will provide onsite staff at the LCP with end-user training on telehealth equipment and peripherals, using the actual telehealth equipment. We will be responsible for the costs associated with this end-user training. Our telehealth training for appropriate staff will also cover telehealth procedures and telehealth reporting. We will offer special targeted sessions to introduce telehealth to security staff and inmate patients. Telehealth Technical Support Wexford Health maintains internal telehealth and IT teams to focus on the deployment and support of hardware and software for our telehealth programs. This includes program strategy, implementation, training, scheduling, and problem resolution. Additionally, our Telehealth Department will train an onsite Wexford Health staff member at the LCP to serve as the telehealth coordinator. The onsite telehealth coordinator will be responsible for at a minimum for the following tasks. Provide equipment training for current staff and new hires Troubleshoot technical problems onsite and report to the Wexford Health IT department Serve as first-line support for technical problems during the clinic Comprise monthly reports for the LCP, submitting these reports to Wexford Health’s Director of Telehealth Work with our Provider Network department to locate specialty providers for new clinics Set up the necessary peripheral equipment for specialty clinics Integration of Telehealth with Standard Care Delivery Since we will be implementing CorEMR, recording and reporting on care delivered via telehealth will seamlessly integrate with care delivered through face-to-face encounters. Telehealth providers will simply need to log-in to the EHR from their remote location and update patient files in the same manner as onsite providers do. This increases efficiency, as it enables the provider to review the patient’s chart prior to the actual live telehealth encounter (reducing the on-screen time required for examination and diagnosis). In some cases, review of the patient’s chart via remote access to the EHR could remove the need for an actual telehealth encounter. (Please note this assumes the County will allow off-network access to CorEMR.) Additional Uses for Telehealth Infrastructure With County approval, Wexford Health will use the telehealth infrastructure extensively in support of a large variety of clinical services, as outlined below. Education and training: Telehealth infrastructure can be used to provide training for site- level staff without personnel having to leave the facility. Medical staff can attend CEU training, in-services, and clinical meetings while remaining at the site. In addition, the infrastructure can be used to provide Category 1 CME credits to physicians and physician assistants, as well as to nurses and other clinicians. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 172 of 175153 Solicitation # RFP: LCDOC (2019) Inmate Health Care Services Luzerne County (PA) Division of Corrections Collegial Review: In addition to clinic encounters, Wexford Health also uses telehealth equipment during our Collegial ReviewSM process. This enables our clinicians to electronically coordinate with other experts to identify and treat various disease processes. When a physician submits a consult that does not meet the InterQual criteria, our UM physicians will suggest a more effective alternate treatment plan (ATP). If the site physician should appeal the ATP, the UM physician team may examine the patient via telehealth. Other uses: The possibilities for using telehealth equipment are endless. Wexford Health recently used telehealth technology at several client locations to reduce durable medical equipment costs, by having remotely located experts help our site-level staff repair expensive equipment rather than have to replace it. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 173 of 175154 RESOLUTION R-2019-___ LUZERNE COUNTY COUNCIL A Resolution by Luzerne County Council Declaring a Vacancy on the Luzerne County Board of Elections and Registration WHEREAS, pursuant to the Luzerne County Home Rule Charter at section 8.04.B., Luzerne County Council appoints four members to the Board of Elections and Registration; and WHEREAS, pursuant to the Luzerne County Home Rule Charter at section 8.04.C., these four members shall appoint the fifth member by an affirmative vote of at least a majority of their current members with the person appointed serving as the Board’s chair; and WHEREAS, Lewis Wetzel had been appointed to fill the fifth seat on the Board of Elections and Registration and serve as its Chair; and WHEREAS, Attorney Wetzel submitted a letter of resignation regarding his seat on the Luzerne County Board of Elections and Registration; and WHEREAS, when there is a vacancy in the office of the member subject to appointment by the Board of Elections and Registration, a vacancy in this position must be declared by County Council pursuant to Section 11.06 of the Home Rule Charter; and WHEREAS, Section 11.06 of the Luzerne County Home Rule Charter provides that whenever facts or circumstances result in a vacancy as defined in the Charter or applicable law in any County authority, board or commission, County Council shall declare such seat vacant by resolution adopted by an affirmative vote of at least a majority of its current members and announce its intent to fill the seat on the respective board, authority or commission; and WHEREAS, Luzerne County Council desires to declare a vacancy of the Board appointed fifth seat on the Luzerne County Board of Elections and Registration. NOW, THEREFORE, BE IT RESOLVED that Luzerne County Council declares a vacancy on the Luzerne County Board of Elections and Registration due to the resignation of member. This Resolution shall become effective upon adoption. ADOPTED at a meeting of the Luzerne County Council held on ______, 2019. Luzerne County Council Voting Session November 26, 2019 AGENDA Page 174 of 175 LUZERNE COUNTY COUNCIL By: __ Tim McGinley, Chair Attest: Sharon Lawrence Clerk to Council By: __ C. David Pedri, County Manager Luzerne County Council Voting Session November 26, 2019 AGENDA Page 175 of 175