TO: Holders of Specifications Relating to: RELEASE DATE: June 24, 2015 RFP: # 695 Health Care for Inmates FROM: Mike Westerman, CPPO

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1 CLARK COUNTY Last Updated: August 25, 2015 TO: Holders of Specifications Relating to: RELEASE DATE: June 24, 2015 RFP: # 695 Health Care for Inmates FROM: Mike Westerman, CPPO SUBJECT: Additional Information/Clarifications to Specifications Question 1) Fusion is a partner of General Electric (GE) Healthcare specializing in the implementation of GE Centricity EMR within the Department of Corrections nationwide. As I m sure you are aware, an EMR is no longer an option when it comes to efficient and effective inmate care. GE Centricity has been used in the successful, 100% compliance accreditation of numerous correctional facilities for NCCHC, ACA, AJA and more. I came across your RFP #695 for Medical Services for Inmates and I noticed that vendors are to supply the County with an EMR system. An independent EMR (i.e., one that is not proprietary to Clark County Sheriff s Office s correctional health care vendor) provides numerous benefits to CCSO at the expiration of that given contract, as it simplifies transition, ensures data integrity, and maintains continuity of inmate care between the outgoing and incoming vendors. In addition, since an incumbent vendor's proprietary EMR cannot be transferred over to the new vendor if the client wishes to change medical providers, Fusion's implementation of the GE Centricity EMR provides our clients with more choices and flexibility. Please let me know if you have any time this week or next for a brief phone call and introduction. If there is anyone else with whom I should be in contact with at Clark County Sheriff s Office about this opportunity, an introduction would be greatly appreciated. Answer 1) Question 2) Our RFP requires the electronic medical records to be part of the submittal package and not as a standalone product through a separate vender. You are welcome to contact venders who may apply and partner with them. I was downloading the RFP from the website and noticed there are Attachments C-F, but no A & B. Should there be, or were the additional two documents of the Plan Holders List and Sample Professional Service Contract those attachments? Answer 2) Please note that Attachment A & B are listed in the RFP as the bidders ;. A: Proposal Cover Sheet B: Letter of Interest Question 3) Answer 3) 5 In Part III Proposal Evaluation and Contract Award Section, 2. Evaluation Criteria Scoring, there are 25 points designated for references, but the proposal doesn t state the parameters of the references, e.g. how many or references specification including name, address, phone, etc. If you could let me know these specifications, I could answer this question to meet your specific needs. 1

2 Question 4) Answer 4) Question 5) Answer 5) In Section IIC Proposal Content, under 4. Respondent s Capabilities, the RFP asks us to Provide a list of present clients including Urgent Care Experience, Chronic Care Experience, Emergent Care Experience. Do you want us to state if we provide these three services for each client, or would you rather us detail these services in the scope section? We would like to know how you propose these services to function as well as for whom you provide them. Also, in section IIB, 2. Proposal, the RFP states that it should be limited to 200 pages. Does this page count include the Appendices and Attachments? No, the 200 pages does not include appendices and attachments, however all pertinent information needs to be conveyed within the page allotment. Question 6) Is the expectation that the provider have an RN or similar stationed in receiving, 24/7? Is that the current practice? Answer 6) This is not the current practice refer to page 10 Question 7) Can you provide 2015 average populations; Attachment D only goes to Dec. 2014? Answer 7) The ADP for January June of 2015 is Question 8) Answer 8) Question 9) Answer 9) Question 10) Answer 10) Average number of inmates admitted weekly? Average Monthly Bookings , , ,300 What is the jail management system, and is there an IT contact? Discussions on connectivity and information sharing will begin after the contract has been awarded Who is the current ambulance provider? American Medical Response Question 11) How often is the county interpreter used and how much has been charged to the current provider over the past two years? Answer 11) The average is about 24 contacts a year for this service, average cost ranges from $110- $170 per contact depending upon the time and duration of the service. Question 12) Answer 12) Question 13) Answer 13) How many emergency response kits are there that provider will be responsible for and do the all include an AED, the RFP also indicates that there are only three AEDs on site? The County has 3 AED s in the CCLEC (1) on each Floor and three at the Jail Work Center (JWC) one in each building. The AED s are County owned. The emergency response kits are determined by the provider as part of your proposal. How many protein or nutritional supplements are provided on a monthly average? Varies as it is patient specific. Averages are about one or two a month. Most nutritional needs are addressed by working with our food services unit through diet and not through supplements as a rule.. 2

3 Question 14) Answer 14) Question 15) Answer 15) Question 16) Answer 16) Question 17) Answer 17) Question 18) Answer 18) Question 19) Answer 19) Question 20) Answer 20) What equipment is owned by the current provider? See page #21 and Read section KK). Supplies and Equipment Please provide and name and contact number for the Health Care Authority. Clark County Public Health Please provide the amount of penalties that have been assessed. None for this contract What is the current accreditation status for the (a) jail and (b) juvenile facilities? If accredited is the Jail Work Center part of the accreditation as well and when are the renewals? None of the facilities are currently accredited (Jail, JWC and JDH) The RFP indicates the contractor will be responsible for paying for 1200 urinalysis (UA) drug test per year. What (or who) is the intended use for theses test? Will they be for employment purposes of custody or medical personnel, diagnostic use for medically indicated needs of the inmate patient or another purpose? What is the estimated costs associated with each UA? Is 1200 an accurate number for the amount of yearly testing? UA s are for inmate workers at the main jail and jail work center to detect illegal substances. These tests are not related to employment for corrections staff. Drug testing U/A s cost are $4.70 per test UA tests are accurate. Please provide name and number to contact current Food Service Manager. Food Service is provided by a department within the Sheriff s Office and the contact will be provided to successful proposer. Please provide the most current annual price for this service. What services are you referring to? Refer to county website for public budget information Question 21) How much Inmate Co-Pay has been collected on an annual basis Answer 21) $46, for 2014 Question 22) Answer 22) Question 23) Answer 23) Question 24) Answer 24) Please provide a record of the number of times the Notification of Deficiencies has been invoked, as referenced in item J. None Clarify the intake (preliminary health triage ) vs. receiving screening? The RFP indicates preliminary health triage are to be done to clear for entrance into the facility when requested, it also indicates a Receiving screening will be done immediately. How do the two differ? Health Triage assigns degrees of urgency to determine if a prisoner can be cleared for intake or be referred to emergency medical care prior to acceptance at booking. Receiving screening is a formal process that occurs after an inmate has been accepted from the arresting authority. How are current OB/GYN needs of the inmate patients addressed? By vendor first and referral if required 3

4 Question 25) Answer 25) Question 26) Answer 26) Question 27) Answer 27) Question 28) Answer 28) Question 29) Answer 29) Question 30) Answer 30) Question 31) Answer 31) Question 32) Answer 32) The RFP indicates pharmacy services shall include the availability of methadone typically for pregnant inmates. Is there an existing relationship with a methadone clinic for the collative care of these pregnant inmates? Yes there is one currently and vendor maintains a local contact What EMR system is currently in place? Is it owned by the County? What are the vendor s responsibilities with respect to records transfer, installation, implementation, interfaces, etc.? COREMR is provided by the current vendor and not County owned. Records are the property of the County. Vendor with minimal County IT involvement must handle the transfer, install, implementation and interfaces, etc.. How are dental services currently handled for juveniles? Does the Sheriff s Office or County want dental services to be provided on-site at the JDC Juvenile dental services are primarily coordinated through parental/guardian involvement. However, it is part of the contracted services How are mental health services for the JDC handled? Juvenile mental health services are not part of the existing contract. They are currently handled by separate contract or by facilitating existing services with parent or guardian. Please provide the Sheriff s Office agreement with Washington State s Health Care Authority and/or Clark County Public Health and describe all efforts and processes related to the pursuit of Medicaid coverage for jail residents (both adults and juveniles). PDF is attached. On pg. 13 of the RFP, under M. Scope of Services, the RFP mentions Consent Decree No. C89-460TB (John Doe vs. Clark County) and says this document is included in Appendix B. There is no Appendix B attached. Are any of the facilities under a consent decree and, if so, could you please provide this document? The document is now attached. This is an old decree, HIPAA is more applicable. This is the only decree inforce for the County. Page 13 of the RFP at N. Receiving Screening says trained probation and detention officers conduct medical and mental health intake screenings for juveniles. Would the County like to continue this practice or should vendors alter their staffing matrices to have nursing staff perform this function? The County s Juvenile Department wishes to continue as it is, however you may submit differing staffing options Do pregnant females with a history of opiate use go off-site for methadone treatment? If so, who is the present provider of this service? If not, how is this cohort of patients currently treated on-site? Vendor/Medical provider makes the decision for all outside medical care. We have a local provider who we refer for methadone services if the provider feels it is necessary. Names will be provided to the preferred proposal during the negotiation period. 4

5 Question 33) Who is responsible for paying for UA drug tests over the allotted 1200 Answer 33) The County is fiscally responsible for drug tests over 1,200 per year. Question 34) Answer 34) Question 35) Answer 35) Question 36) Answer 36) Question 37) Answer 37) Question 38) Answer 38) Question 39) Answer 39) Who is responsible for transport of chronic care patients to appropriate facilities beyond release? Who is responsible for making these arrangements? This is a coordinated effort between the medical vendor and the County s discharge planning staff. What dental equipment will be available on-sight and what will need to be purchased? The dental area in the jail was available for inspection during the jail tour. All existing equipment reverts to the County at the end of the contract. Who pays for the registered/licensed dietician mentioned on page 18 under DD Therapeutic Diet Program? If the contractor, should this position be listed on the Staffing Matrix? This is not a budgeted position. The County contracts this position and this is paid by the County Who employs the main jail discharge planners mentioned on pg. 19? If the contractor, how many are needed and must they be included in the Staffing Matrix? These positions are County employees and not part of the staffing matrix. Should bidders submit a written exposure control plan and policy regarding the use of standard precautions with the proposal or can this be established subsequent to contract award? This should be produced subsequent to contract award. Who is responsible for background checks? The Sheriff s Office Question 40) Please explain the following (from #17. on pg. 9): The contractor shall agree to credit the County the full value (salary and fringe benefits) of service hours not provided by classification based on 13 weeks as contained in the staffing plan. Answer 40) This is a staffing credit, hour for hour based on a 13 week quarter. Question 41) Answer 41) Question 42) Answer 42) Question 43) Answer 43) Question 44) Is oral surgery currently performed on-site or are inmates referred out? What is the County s preference? This is left up to the provider. However, past practice suggests that some requiring dental services will be referred off site. Please list all current vacancies. Medical staffing is currently full, except for on mental health coordinator. How many attempted and completed suicides have there been within the last two (2) years? 2013: 3 attempts, 0 completions 2014: refer to the statistics attached to the RFP Please list all lawsuits lodged against the SO/County for the past two (2) years and the nature of each claim. 5

6 Answer 44) Question 45) Answer 45) Question 46) Answer 46) Question 47) Answer 47) Question 48) Answer 48) Question 49) Answer 49) Question 50) Answer 50) Will provide to preferred provider or can be requested through County public disclosure request. Please provide staff turnover rates for the past two years. Per current vendor there have been 30 staff that have left in the last two years. Would the SO/County be amenable to the use of telepsychiatric services, in particular for juveniles? No Please explain why there the transition timetable is only days. If the County anticipates executing the contract in October or November of 2015, with an anticipated start date of February 1, 2015, why wouldn t the transition timetable be considerably longer (at least 60 days)? Our existing contract is current through January 31, We are not funding a transition period. Whoever is awarded the contract may begin planning at any time and the County will work closely with to facilitate a successful, smooth transition, however we will not interrupt existing services nor patient care. When does the County anticipate issuing the final answer to bidders questions? Please keep in mind that out-of-state vendors will have to mail their proposal submissions several days prior to August 31 st. With this in mind and an anticipated contract start of February 1 st, 2016, would the County consider extending the proposal deadline so that bidders have enough time to prepare responses that incorporate the answers to all questions posed The deadline for submitting such questions/clarifications is seven calendar days prior to the due date for proposals. We are making every attempt to respond to all questions within 2-3 working days. We will not extend the proposal deadline Please provide last year s cost to the County for the current medical vendor the County paid $3,053, to the current vendor. What are the educational and licensing requirements for all mental health professionals listed on the Staffing Matrix? County defers to the Washington State Department of Licensing requirements. Question 51) What is the correct amount for inmates pharmacy co-pay - $3.00 or $10.00 Answer 51) Please refer to Attachment G Question 52) Please provide the average number of intakes performed daily at the adult facilty. Answer 52) This averages based on external factors but for 2014 a daily average is 42.6 Question 53) How many medication carts are used during each med pass in the adult facility? Please provide the times of all daily medication passes Answer 53) There is currently one (1) med cart in the Main Jail and three med passes 3 AM 10:45 AM - 3 PM Question 54) Answer 54) Does the CCSO work with the Department of Health to obtain vaccinations for juveniles? No 6

7 Question 55) Answer 55) Question 56) Answer 56) Question 57) Answer 57) Question 58) Answer 58) Question 59) Answer 59) Question 60) Answer 60) Question 61) Answer 61) Question 62) Answer 62) Question 63) Answer 63) Question 64) Answer 64) Please provide the name of the County s medical waste provider. Stericycle. Please provide the name of the language interpretation vendor used by the County Language Line and individual interpreters. Do bidders have to maintain 12 hour nursing shifts or can they propose alternative nursing schedules? No, please provide your best staffing proposal Would the County be willing to accept CPR- and BLS-certification from the American Heart Association in place of certification with the Red Cross? The County has no preference What are the specific duties of the CNA Intake Booking position? C.N.A at intake collects medical screening data and vital statistics and alerts on duty RN to medical concerns identified during this process. Are forced psychotropic medications permitted for the adult facilities? for the juvenile facility? Forced Psychotropic medications are only done by court order and based on current case law. Who does the Contract Monitor report to? The contract monitor is independent and provides the same data to the vendor and the Support Services Commande3r. The existing Contract Monitor is an RN from the County Health Department Does the Contract Monitor use an established objective standard for evaluating the medical vendor s performance (NCCHC, ACA, etc.) or does the Contract Monitor use a standard developed by the SO/County or another entity? If using standards developed by the SO/County or another entity, please provide Primarily NCCHC standards but also industry standards and best practices. What female-specific mental health services are available (group counseling, family planning, etc.)? These will be up to the successful bidder to initiate and maintain. Some services are currently provided on a limited basis currently through reentry, not through the medical provider. Medical does provide limited one on one counseling that is patient specific and should be providing groups per contract. Are inmates with hepatitis C treated on-site? What is the budget for treatment of patients with hepatitis C? Does the SO/County have access to any grants for treatment of this patient cohort? Does the SO/County have a relationship with any local hospitals re: treatment for hepatitis C? Hepatitis C cases are treated on site. This is handled by the medical provider. Refer to Attachment E for numbers. There are no current grants through the County for these services. We would refer to the medical director/provider for referrals. 7

8 Question 65) Are inmates with AIDS treated on-site? What is the budget for treatment of patients with AIDS? Does the SO/County have access to any grants for treatment of this patient cohort? Does the SO-County have a relationship with any local hospitals re: treatment for AIDS? Answer 65) See the answer to question #64 Question 67) Answer 67) Question 68) Answer 68) Does the county currently use Telemed/Telepsych? If yes, who owns the equipment? No What is the average monthly census of the infirmary? There are 6 double bunked cells in this area. Average census for 2014 was not tracked because a construction project moved suicidal inmates into that area for an extensive time. Question 69) What are the current medication pass times for each facility? Answer 69) Please refer to Q&A #53 Question 70) Answer 70) Question 71) Answer 71) Does the county health department provide any service to the jail? (e.g. STD testing, supply of flu vaccines, etc.?) County Health Department provides court-ordered HIV testing both at the jail and also at their on-site clinic when inmates are released. They don't provide STD testing. On occasions, Health Department vaccine outreach staff have offered free vaccines to jail medical administration staff for inmates that would actually be provided by the Washington Department of Health, however, these vaccines are based on State availability and should not be relied upon. What is the current Jail Management System (JMS)? The current system is 20+ years old and is in the process of being replaced. The new vendor is EIS and the program should be up and running by late next year. Question 72) What are the annual statistics for use of the restraint chair? Answer 72) 12 uses in 2014 Question 73) Answer 73) Question 74) Answer 74) What equipment is owned by the county and will remain onsite? (e.g. exam tables, dental equipment, EKG, etc.)? Please review KK of the RFP. In the use of the E-Verify system, would we verify our company and our subcontracting companies, or each potential employee? After the Company or subcontractor enrolls, only new employees after will need to be enrolled. Question 75) What is the role of the CNA in the booking/intake process? Answer 75) Please refer to Q&A #59 Question 76) Answer 76) What are the disciplines and roles of the mental health clinicians? Please refer to current staffing matrix for disciplines. All members work cooperatively on case management issues for inmates with special needs. Mental health team members work routinely with corrections staff managing patient care. How the group is deployed will be for the vendor to manage 8

9 Question 77) Answer 77) Question 78) Answer 78) Question 79) Answer 79) Question 80) Answer 80) Question 81) Answer 81) Question 82) Answer 82) What are the surrounding community agencies with which the jail works? The jail works with many community partners from all areas of our community, Goodwill industries, NAMI, Second Step Housing, VA, Lifeline Connections, faith based community partners, DSHS and many more. Please see our reentry page by accessing under /Sheriff, Jail Services. How many involuntary psychiatric hospitalizations did the County have in 2014, 2015 YTD Involuntary Psychiatric Hospitalization is not tracked by the Sheriff s Office. If a person s criminal charges are adjudicated we refer an individual to the a community designated mental health professional to determine if a person is detainable at the direction of the court or if at the time of release the individual possess a direct threat to themselves. I would estimate this happens about times a year. When an involuntary psychiatric hospitalization occurs, to what hospital are they taken? After a DMHP Evaluation and it is determined they are detainable they are transported to Peace Health SW Hospital here in our community. What percentage is the mental health population out of your total ADP What percentage is your SMI? What are the more common psych drugs used? Refer to attachment E. Medication is patient specific. We primarily use Generics which are standard on most formularies Where do you send incompetent inmates to get restored? Western State Hospital in Tacoma, WA Can you confirm that the number of HIV patients on medications in the last 6 months has quadrupled compared to 2014, and that 2014 has the lowest HIV numbers in the past 3 years The physician s assistant from 2014 kept statistics that added new patients only on HIV Medications from month to month. It did not denote pre-existing patients. In 2015 we had a new physician s assistant who combined old patients on HIV medications with new patients, this gave the impression that HIV patients were increasing. I would refer to 2015 data if you are looking at a monthly average of 4.4 inmates See 2015 stats Question 83) Could you identify all County-owned equipment? In section KK of the Inmate Health Care RFP it states that the contractor is responsible to keep at least three AEDs on site but does not identify if the County or the Contractor owns these items, and does not identify any other equipment owned by the County. Please send us an equipment list, e.g. exam tables, dental equipment, EKG, etc., of County-owned equipment. Answer 83) Please refer to question and answer #35 Question 84) Answer 84) We had talked previously about getting the E-Verify information started to ensure compliance with the RFP. Unfortunately, we have recently reorganized our entities and the entity we are using for these services does not currently have a DUNS Number. Please let me know what our options are to ensure our compliance with the RFP. The County requires E-Verify participation. For specific questions, please contact Homeland Security. 9

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