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25H - AGMT - INMATE MEDICAL SRVS
REQUEST FOR COUNCIL ACTION CITY COUNCIL MEETING DATE: SEPTEMBER 2, 2014 TITLE: AGREEMENTS FOR JAIL INMATE MEDICAL SERVICES CITY MANAGER RECOMMENDED ACTION CLERK OF COUNCIL USE ONLY: APPROVED ❑ As Recommended ❑ As Amended ❑ Ordinance on 1" Reading ❑ Ordinance on 2nd Reading ❑ Implementing Resolution ❑ Set Public Hearing For CONTINUED TO FILE NUMBER 1. Authorize the City Manager and Clerk of the Council to execute a three -year agreement, terminating September 30, 2017, with NaphCare, Inc. to provide basic and emergency health care services for Santa Ana Jail inmates, in the amount of $5,971,893, subject to non - substantive changes approved by the City Manager and City Attorney. 2. Authorize the City Manager and Clerk of the Council to execute a one -month agreement, terminating September 30, 2014, with Correctional Managed Care Medical Corporation (CMCMC) in the amount of $139,061 with an contingency not to exceed $56,500 for costs associated with extended liability insurance and employee retention to ensure continuous and compliant medical operations, subject to non - substantive changes approved by the City Manager and City Attorney. DISCUSSION California's Board of State and Community Corrections (BSCC) requires agencies to provide basic and emergency health care services for all incarcerated individuals held within their custody. In addition, the City's federal contracts require that medical services be provided to contract detainees and inmates. On May 29, 2014 the Police Department issued a request for proposals (RFP #14 -034) for inmate medical services. On June 10, 2014 a pre - proposal conference was conducted, and on June 30, 2014 the City received proposals from two firms. NaphCare, Inc. and Correctional Managed Care Medical Corporation (CMCMC) each submitted proposals for consideration. An evaluation committee consisting of representatives from the Santa Ana Jail and the Santa Ana Police Department Fiscal Section reviewed and rated the two proposals. The proposals were evaluated according to Responsiveness to RFP (20 %), Experience of Firm and Personnel (40 %), and Cost of Proposal (40 %), as stated in the RFP. 25H -1 Agreements for Jail Inmate Medical Services September 2, 2014 Page 2 The results of the RFP evaluation are as follows: Vendor Score NaphCare, Inc. 583 CMCMC 491 600 point max 1,940,631 NaphCare was the most responsive, capable and cost effective respondent. The NaphCare proposal enhances efficiencies, modernizes the medical operation and increases preventive care measures, reducing the need for outside or specialized medical care. NaphCare will provide routine and emergency inmate medical services, including but not limited to providing prescription and OTC medications, physical examinations, dental care and psychiatric services. NaphCare will also provide recurring CPR training and Tuberculosis screening for Jail employees. The Police Department proposes to enter into a three -year agreement with NaphCare, Inc. beginning October 1, 2014 and ending September 30, 2017. The agreement includes a base agreement amount of $1,940,631 for each of the three years. A $50,000 annual contingency is included for services not included in the base agreement including, but not limited to, x -rays, dentures, and OB /GYN exams, for a total three -year agreement amount of $5,971,893. The proposed one -month agreement with CMCMC will provide the time necessary for NaphCare to identify the staff and equipment needed for the October 1, 2014 contract start date. This one - month agreement includes a monthly amount of $139,061, and a $56,500 contingency for medical services not included in the base agreement, as well as costs associated with extended insurance and employee retention. The agreement will cover the period of September 1, 2014 through September 30, 2014 and will ensure a smooth transfer and guarantee continuity of services. The October 1, 2014 start date will also allow the Police Department adequate time to complete the background investigations needed for the contract employees that will be working at the Police Department. 25H -2 CMC NaphCare (Per RFP) NaphCare (Negotiated) Year 1 2,112,400 2,033,942 1,940,631 Year 2 2,112,400 2,033,942 1,940,631 Year 3 2.112,400 2,033.942 1,940,631 6,337,200 6,101,826 5,821,893 Contingency 150,000 5,971,893 The proposed one -month agreement with CMCMC will provide the time necessary for NaphCare to identify the staff and equipment needed for the October 1, 2014 contract start date. This one - month agreement includes a monthly amount of $139,061, and a $56,500 contingency for medical services not included in the base agreement, as well as costs associated with extended insurance and employee retention. The agreement will cover the period of September 1, 2014 through September 30, 2014 and will ensure a smooth transfer and guarantee continuity of services. The October 1, 2014 start date will also allow the Police Department adequate time to complete the background investigations needed for the contract employees that will be working at the Police Department. 25H -2 Agreements for Jail Inmate Medical Services September 2, 2014 Page 3 STRATEGIC PLAN ALIGNMENT Approval of this item allows the City to meet Goal #1 Community Safety, Objective #3 (promote fiscal accountability to ensure financial responsibility at all levels of the organization), Strategy A (continuously evaluate and assess fiscal aspect of service delivery to ensure that the Police Department provides programs and services efficiently and effectively). FISCAL IMPACT Funds for these agreements are available in the Jail Operations Contract Services account (no. 01114475 62300). Carlos Rojas Chief of Police, Santa Ana Police Department APPROVED AS TO FUNDS AND ACCOUNT: T (\t\S%Yt % - . l � L Aa Francisco Gutierrez, Executive Director Finance and Management Services Agency 25H -3 25H -4 AGREEMENT FOR THE PROVISION OF INMATE MEDICAL SERVICES BETWEEN CITY OF SANTA ANA, CALIFORNIA AND NAPHCARE, INC. THIS AGREEMENT is made and entered into this 15t day of October, 2014, by and between NaphCare, Inc., an Alabama corporation (hereinafter "Contractor "), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City "). A. The City desires to retain a Contractor having special skill and knowledge in the field of providing basic and emergency inmate medical services. B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. TERM This Agreement is for a three (3) year term and shall commence on October 1, 2014 and terrninate on October 1, 2017, unless terminated earlier in accordance with Section 18, below. Said Agreement may be extended beyond the original term should the parties mutually agree to do so in writing, 2. SCOPE OF SERVICES Contractor shall provide basic and emergency medical services to inmates at the Santa, Ana Jail ( "Jail ") as outlined in sections three (3) and four (4) sections A -F of Contractor's proposal attached hereto and marked as Exhibit "A" and incorporated herein by reference. The proposal outlines the services to be provided by Contractor as part of Contractor's response to RFP No, 14 -034. Contractor's responsibility shall only be applicable to inmates that are physically located and booked into the Jail. Said inmate must be part of the average daily population ( "ADP ") in order for Contractor to maintain any responsibility for basic and emergency medical services. 3. PERSONNEL A. Staffing. Contractor will provide medical, mental health, dental, technical and support personnel necessary for the rendering of health care services to inmates as contemplated herein. The health care staff will be at levels consistent with those identified in Exhibit "B" to 1 25H -5 this Agreement. B. Licensure, Certification and Registration of Personnel. All personnel and contractors provided or made available by Contractor to render services hereunder will be licensed, certified or registered, as appropriate, in their respective areas of expertise pursuant to applicable California law. C. Subcontracting and Delegation. In order to discharge its obligations hereunder, Contractor will engage certain health care providers, such as on -site physicians, as independent contractors rather than as employees, and may engage other persons and entities providing services as subcontractors. As the relationship between Contractor and those health care professionals and providers will be that of independent contractor, Contractor will not be considered or deemed to be engaged in the practice of medicine or other professions practiced by these professionals, and Contractor will not exercise control over the manner or means by which these independent contractors perform their professional duties. Contractor shall, however, remain firlly liable and responsible for the services performed by its independent contractors and subcontractors. 4. COMPENSATION The total annual sum to be expended wader this Agreement for staffing, pharmaceuticals, supplies and other services shall be as below. If during any month of this Agreement the ADP of inmates per day in such month exceeds 440 inmates, the City will pay Contractor the additional per diem below per immate per day as additional compensation, Year One Pricing for Inmate Medical Services: $1,940,631.60 Monthly pricing for Year One: $ 161,719.30 Monthly per diem for ADP exceeding 440: $ 1.25 Pricing for years two and three of the Agreement for Irunate Medical Services shall be determined and increased upon mutual agreement of the parties not to exceed the Consumer Price Index based on the Bureau of Labor Statistics for All Urban Areas, Los Angeles, Orange and Riverside Counties for September of that year In the event the parties agree to extend the contractual term beyond the initial three year term, compensation for any renewal period shall also be determined upon mutual agreement of the parties for an amount not to exceed the Consumer Price Index based on the Bureau of Labor Statistics for All Urban Areas, Los Angeles, Orange and Riverside Counties for September of that year, or as otherwise agreed to by the parties. The following medical services are not included in the inmate medical services listed above and additional compensation shall be due and payable to Contractor in the event those services are rendered by Contractor: A. Repair of dentures, dental plates and partial plates: $ 200.00 per repair B, Mobile X -ray Services: $ 85.00 per study 2 25H -6 C, Ophthalmology Services: $ 150.00 per patient visit D. 013- GYNServices: $ 250,OO per patient visit E. Emergency Psychiatric Crisis: $ 50.00 per patient visit 5. OFF -SITE SERVICES & ON -SITE SPECIALTY SERVICES Contractor shall assist in arranging off -site services for City inmates; however, Contractor shall have no responsibility for costs associated with off-site services provided to City inmates and as outlined in the RFP 14 -034, page 17, shall be responsible for billing the responsible contract agency for all off-site related costs. Contractor hereby understands that the City contracts with the Immigration and Naturalization Services (INS) and the U.S. Marshal Service ( "contracting agencies ") for the housing/detaining of federal inmates. Said contracting agencies are financially responsible for their inmates' approved off -site treatment services. Pursuant to this Agreement, City requires that Contractor assist with scheduling off-site appointments for inmates housed on behalf of the contracting agencies within the Jail. The City shall supply Contractor with relevant classification information regarding the federal inmates of the contracting agencies and Contractor shall bill the contracting agencies directly for off-site services rendered, Contractor acknowledges that the City also provides housing for other non - contracting agency imnates. The non- contracting agencies include the City of Santa Ana and other cities within the area. For off -site services rendered by Contractor on behalf of any non - contracting agency inmate, Contractor shall be reimbursed 100% of all costs of off -site medical services for these initiates by the City. Contractor will bill the City for non - contracting agency inmates for these off-site services as well as services rendered off-site on behalf of City inmates. Contractor shall provide invoices on the I Oth clay of the month following the month service was rendered and the City shall reimburse Contractor within thirty (30) days of receipt of invoice. 6. RECORDS A. Medical Records. Contractor will cause to be maintained a comprehensive, accurate medical record for each inmate who has received health care services, This medical record will be maintained pursuant to applicable laws including but not limited to HIPAA and California privacy laws and will be kept separate from the inmate's confinement record. A summary of the applicable medical record will be available to accompany any immate who is transferred from the Facility to another location for off -site services or who is committed permanently or temporarily to another correctional facility, Medical records will be kept confidential, and Contractor will follow the City's policy with regard to access by inmates and Facility staff to medical records, subject to applicable law regarding confidentiality of such records. No information contained in the medical records will be released by Contractor except as provided by the City's policy, by a court order, or otherwise in accordance with applicable law. Inmate medical records are and will remain the property of the City. B. Electronic Health Record. Contractor will provide its proprietary electronic medical record software system, TeehCar^e (or Contractor's like -kind, updated EHR software 3 25H -7 system which may be referred to by a separate name) for inmate medical record keeping usage in the Jail. Contractor shall maintain ownership of this software and the City shall be entitled to quantitative and select information as required by the City. At the termination or expiration of this Agreement Contractor shall remove Tech Care (or Contr'actor's like -kind, updated -EHR software system which may be referred to by a separate name) system with City maintaining no ownership rights to the software or data included within, with the exception of medical records pertaining to inmates, City shall keep this software and all information pertaining to it confidential at all times during the term of this contract and termination thereof. 7. EXPENDITURE AND REVENUE REPORT No later than sixty (60) days following the end of the initial term, or any subsequent term of this Agreement, Contractor shall submit to City for informational purposes only, an Expenditure and Revenue Report for that period, Such report shall be prepared in accordance with the format that is provided by City. 81 SECURITY A. General, The parties agree that adequate security services are necessary for the safety of the agents, employees and subcontractors of Contractor, as well as for the security of inmates and Jail staff, The City will provide security services satisfactory to Contractor and sufficient to enable Contractor and its personnel to safely provide the medical services called for hereunder. B, Transportation Off -Site. The City will provide security as necessary and appropriate in connection with the transportation of any inmate between the Jail and any other location for off' site services as contemplated herein. 9. OFFICE SPACE AND EQUIPMENT A. Office Space and Support. The City agrees to provide Contractor with office space, facilities, and utilities sufficient to enable Contractor to perform its obligations hereunder. Contractor shall be responsible for all telephone, facsimile lines and computer lines (including installation of new lines or movement of current lines) required for services at the Jail. B. Delivery of Possession. The City will deliver to Contractor on the date of commencement of this Agreement or the date the Agreement is fully executed whichever date is later, possession and control of all office equipment and supplies then in place at the Jail's health care facilities that are City's property. C. Supplies and Egiupment Inventory upon Termination. Medical supply inventories remaining upon termination of this Agreement will become the property of the City. For continuity of care, Contractor will provide no less than a seven day supply of pharmaceutical inventory upon the termination of the Agreement. Office furniture purchased by Contractor during the term of this Agreement will remain the property of the City upon termination of this Agreement. Medical equipment, computers, printers and other office equipment purchased by 51 25H -8 Contractor during the term of this Agreement will remain the property of Contractor upon termination of this Agreement. D. - General Services. The City will provide for each inmate receiving medical services no less than the fall range of services and facilities provided for other inmates at the Jail including, but not limited to, daily housekeeping services, dietary services, personal hygiene supplies and services and linen supplies, The City will provide all necessary building maintenance services. 10. INSPECTIONS AND AUDITS A. City, any authorized representative of City, any authorized representative of the State of California, the Secretary of the United States Department of Health and Harnan Services, the Comptroller General of the United States, or any of their authorized representatives, shall have access to any books, documents and records, including but not limited to medical and client records of Contractor which such person deems pertinent to this Agreement, for the purpose of conducting an audit, evaluation, examination or malting transcripts during the periods of retention set forth in the Records section of Exhibit A to this Agreement. Such persons may at all reasonable times inspect or otherwise evaluate the services provided pursuant to this Agreement, and the premises in which they are provided. B. Contractor shall actively participate and cooperate with any person specified in subparagraph A above in any evaluation or monitoring of the services provided pursuant to this Agreement, and shall provide the above - mentioned persons adequate office space to conduct such evaluation or monitoring. C. Following an audit report, in the event of non - compliance with applicable laws and regulations governing funds provided through this Agreement, City may terminate this Agreement as provided for in the Termination paragraph or direct Contractor to immediately implement appropriate corrective action. A plan of correction shall be submitted to City in writing within thirty (30) days after receiving notice from City. D. Within fourteen (14) days of receipt by Contractor, Contractor shall forward to City a copy of any audit report. Such audit shall include, but not be limited to, management, financial, programmatic or any other type of audit of Contractor's operations, whether or not the cost of such operation or audit is reimbursed, in whole or in part, through this Agreerment. 11. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: A. Comprehensive General hiability Insurance. Contractor shall maintain comprehensive general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against 25H -9 claims arising from bodily and personal injury, including death resulting there from and damage to property, resulting from any act or occurrence arising out of Contractor's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall -be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting there from, and property damage, in the total amotimt of $2,000,000 per occurrence, Said amount may be secured through an excess insurance policy maintained by Contractor. The City hereby permits Contractor to maintain a self-insured retention in excess of $25,000. Contractor shall supply City with a fully executed additional insured endorsement on a form approved, by the City Attorney at the time this Agreement is executed. B, Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Contractor, if Contractor has any employees, is required to be insured against liability for worker's compensation or to undertake self- insurance. Prior to commencing the performance of the work under this Agreement, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. C, Any person providing physician services pursuant to this Agreement shall maintain Professional liability (errors and omissions) insurance against medical malpractice with a combined single limit of not less than $1,000,000 per claim and $3,000,000, in the aggregate, per year. D. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: (i) Contractor shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be famished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. E. If Contractor fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Contractor's right to be paid for its time and materials expended prior to notification of termination. 12. INDEMNIFICATION Contractor agrees to and shall indemnify and hold harmless the City, its officers, agents, employees and representatives from any liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the Contractor or its subcontractors, agents, employees, or other persons acting on 25H -10 their behalf which relates to the services described in section 2 of this Agreement. The Contractor further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party -asserting that personal injury; damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the direct or indirect operations of Contractor. City may make all reasonable decisions with respect to its representation in any legal proceeding. City hereby agrees to indemnify and hold harmless the Contractor, its officers, agents, employees and representatives from any liability for personal injury damages, just compensation, restitution, judicial or equitable relief arising out of any claims directly related to the negligence of the City. 13, CONFIDENTIALITY A. Contractor shall maintain the confidentiality of all records, including billings and any audio and/or video recordings, in accordance with all applicable State and Federal codes and regulations, as they now exist or may hereafter be amended or changed. B. Prior to providing any services pursuant to this Agreement, all employees, subcontractors, and volunteer staff or interns of Contractor shall agree, in writing, with Contractor to maintain the confidentiality of any and all information and records which may be obtained in the course of providing such services. The agreement shall specify that it is effective irrespective of all subsequent terminations of Contractor's employees, subcontractors, volunteers or interns. C. All confidential information furnished by Contractor to City hereunder will be kept confidential by City and shall not, without the prior written consent of Contractor, be disclosed by City, or by its representatives, contractors, or employees in any manner whatsoever, in whole or in part, and shall not be used by City or its representatives, contractors or employees who need to know the Confidential information. 14. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified tinder this Agreement. 15. NOTICE A, Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by facsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Cleric of the City Council City of Santa Ana 20 Civic Center Plaza (M -30) 25H -11 P.O. Box 1988 Santa Ana, CA 92702 -1988 Facsimile (714) 647 -6956 With courtesy copies to: Chief of Police City of Santa Ana Santa Ana Police Department 60 Civic Center Plaza Santa Ana, California 92702 Facsimile (714) 245 -8116 and City Attorney City of Santa Ana 20 Civic Center Plaza (M -29) P.O. Box 1988 Santa Ana, California 92702 Facsimile (714) 647 -6515 To Contractor: James S. McLane Chief Executive Officer NaphCare, Inc. 2090 Columbiana Road, Suite 4000 Birmingham, AL 35215 Facsimile (205) 536 -8404 and NaphCare, Inc. Attn: Legal Department 2090 Columbiana Road, Suite 4000 Birmingham, AL 35215 Facsimile (205) 536 -8404 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by facsimile, communication shall be effective or deemed to have been given twenty -four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For ptuposes of calculating these time frames, weekends, federal, state, City holidays shall be excluded. B. NOTIFICATION OF DEATH — Upon becoming aware of the death of any person receiving services hereunder, Contractor shall immediately, in person or by telephone, notify the 25H -12 on- premises Jail Administrator or his/her designee, the Orange County Coroner, and the Orange County District Attorney. In addition, Contractor shall, within sixteen (16) hours after such death, deliver in person or by facsimile machine, a Written Notification of Death to the above persons. The telephone report and Written Notification of Death shall contain the name of the deceased, the date and time of death, the nature and circumstances of death, and the name(s) of Contractor's officers or employees with knowledge of this matter. Upon request, and to the extent allowable by law, Contractor shall provide the Coroner, District Attorney, Jail Administrator or his designee with a complete copy of the deceased patient's medical record, C. NOTIFICATION OF SPECIAL INCIDENTS — Immediately upon becoming aware of any occurrence of a serious nature which may expose either party to liability or disrupt the services hereunder, Contractor shall verbally notify the on- premises Jail Administrator or his designee. Such occurrences may include but are not limited to accidents, injuries or acts of negligence, or any incident or circumstance which adversely impacts the capacity of Contractor to provide the services hereunder. Such verbal notification shall be followed within twenty -four (24) hours, by written notification to City and the Jail Administrator or his designee. 16. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any teens or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Contractor or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party which is not embodied herein. 17. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer or delegate any interest herein and any such assignment, transfer or delegation shall be considered null and void. However, obligations undertaken by Contractor pursuant to this Agreement may be carried out by subcontracts, provided such subcontracts are approved in writing by City, meet the requirements of this Agreement as they relate to the service or activity under subcontract, and include any provisions that City may reasonably require, No subcontract shall terminate or alter the responsibilities of Contractor to City pursuant to this Agreement. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City, 18. TERMINATION A. This Agreement may be terminated by the City upon thirty (30) days written notice to M 25H -13 the Contractor. Contractor may terminate this Agreement by providing the City with three hundred sixty (3 60) days' prior written notice. B, After receiving any Notice of Termination, Contractor shall continue to provide services and cooperate with City staff until the date of termination in a manner which is consistent with recognized standards of quality patient care and prudent business practice, and obtain immediate clarification from City of any unsettled issues of contract performance during the remaining contract tern. C. The right and remedies of City provided in this Termination paragraph shall not be exclusive, and are in addition to any other rights and remedies provided bylaw or this Agreement, D. City may terminate this Agreement immediately, upon written notice, on the occurrence of any of the following events: i. The loss by Contractor of legal capacity, ii. Cessation of services. iii. Delegation or assignment of Contractor's services operation without written approval by City Of Santa Ana. iv. Neglect by any physician or Iicensed person employed by Contractor of any duty required pursuant to this Agreement. v. The loss of accreditation or any license required by the Licenses and Law paragraph of this Agreement. vi. The continued incapacity of any physician or licensed person to perform duties required pursuant to this Agreement. vii. Unethical conduct or malpractice by any physician or licensed person providing services pursuant to this Agreement; provided, however, City may waive this option if Contractor removes such physician or licensed person from serving anyone pursuant to this Agreement. E. In the event of a material breach of the Agreement by City, Contractor will give City written notice of material breach and thirty (30) days from the date of the notice to cure the material breach. If said breach is not cured within thirty (30) days from the date of the notice, Contractor may terminate the Agreement immediately but will continue to provide services in a manner consistent with recognized standards of quality patient case and prudent business practice for an additional sixty (60) days or any additional time mutually agreed upon by the parties. Contractor will be entitled to be paid pursuant to the rates set forth in this Agreement any additional time worked after termination. Material breach shall be failure to pay for services rendered within sixty (60) days. F. Responsibility for Inmate Health Care. Upon termination of this Agreement, total responsibility for providing health care services to all imnates, including imnates receiving health care services at facilities off-site will be transferred from Contractor to the City or the City's designee and Contractor shall maintain no responsibility for same. 1.0 25H -14 19. NONDISCRIMINATION A. Employment. Contractor shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Contractor affinns that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. B. Services, Benefits and Facilities. Contractor shall not discriminate in the provision of services, the allocation of benefits or the accommodation in facilities on the basis of ethnic group identification, race, color, religion, ancestry, creed, sex, national origin, marital status, age, sexual preference, medical condition or physical or mental disability. For the purpose of this subparagraph B, "discrimination" means denying a client or potential client any service, benefit or accommodation that would be provided to another and includes, but is not limited to, the following: i, Denying a client any service or benefit or availability of a facility. ii. Providing any service or benefit to a client which is different or is provided in a different manner or a different time from that provided to other clients. iii. Restricting a client in any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service or benefit. iv. Treating a client differently from another in satisfying any admission requirement or condition or eligibility requirement or condition, which individuals must meet in order to be provided any service or benefit. V. Assignment of terms or places for the provision of services on the basis of ethnic group identification, race, religion, ancestry, color, creed, sex, marital status, national origin, age, sexual preference, medical condition or physical or mental disability of the clients to be served. C, Persons with Disabilities. Contractor agrees to comply with the provisions of Section 504 of the Rehabilitation Act of 1.973 (29 U.S.C. 794 et seq., as implemented in Title 45 CFR, Section 84.1 et seq.) pertaining to the prohibition of discrimination against qualified persons with disabilities in all programs or activities, and the Americans with Disabilities Act of 1990 (42 U.S,C. 12101 et seq,) as they exist now or may be hereafter amended together with succeeding legislation. D, Retaliation. Neither Contractor nor its employees or agents shall intimidate, coerce or tape adverse action against any person for the purpose of interfering with rights secured by Federal or State laws, or because such person has filed a complaint, certified, assisted or otherwise participated in an investigation, proceeding, hearing or any other activity undertaken to enforce rights secured by Federal or State law. 20. JURISDICTION —VENUE This Agreement has been executed and delivered in the State of California and the 11 25H -15 validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange Comity, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 21. PROFESSIONAL LICENSES A. Contractor and all of its employees and subcontractors providing services pursuant to this Agreement shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. B. Contractor warrants that all Contractor physicians providing services under this Agreement are and will continue to be as long as this Agreement remains in effect, the holders of currently valid unrestricted licenses to practice medicine in the State of California. 22. COMPLIANCE WITH ALL LAWS A. Contractor shall cause all of its activities under this Agreement and all activities at the Santa Ana Detention Facility to be performed in compliance with all applicable federal, state, and local laws, ordinances, and regulations. B. All medical services will meet California Administrative Code (CAC), Title 15 - Minimum Standards for Local Detention Facilities, National Detention Standards of Immigration and Code Enforcement Bureau as well as all other applicable laws, regulations, codes and guidelines relating to health care services and programs in adult detention facilities in the State of California. 23, MISCELLANEOUS PROVISIONS A. Contractor is, and shall at all times be deemed to be, an independent contractor, wholly responsible for the manner in which it performs the services hereunder. Contractor is entirely responsible for compensating staff and consultants employed by Contractor. This Agreement shall not be construed as creating the relationship of employer and employee, or principal and agent, between City and Contractor or any of Contractor's agents, employees or subcontractors. Contractor assumes exclusive responsibility for acts of its employees, agents or subcontractors as they relate to the services provided during the course and scope of their employment. Contractor's employees, agents or subcontractors shall not be entitled to any rights or privileges of City employees, nor be considered in any manner to be City employees. B. Neither party intends that: this Agreement shall create rights hereunder in third parties, including but not limited to any subcontractors or any clients provided services hereunder. 12 25H -16 C. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. D. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: SONIA City Al By: ' Laura, Senior 19 CITY OF SANTA ANA DAVID CAVAZOS City Manager NAPHCARE, INC. Bv: James S. McLane Attorney Chief Executive Officer Tax ID# 5 8- 1 823 464 RECOMMENDED FOR APPROVAL: CARLOSROJAS Chief of Police 13 25H -17 EXHIBIT "A" CONTRACTOR'S PROPOSAL IN RESPONSE TO RFP No, 14 -034 14 25H -18 1FAMM i 1 Inmate Medical Services City of Santa Ana 25H -19 RFP No -'14 -034 i Cover Getter 7 Table of Contents 1. STATEMENT OF QUALIFICATIONS 1 -S 7 2, FIRM AND PERSONNEL EXPERIENCE 5 -i0 i 3. IMPLEMENTATION PLAN 1117 7 4. SCOPE OF SERVICES & SPECIFICATIONS RESPONSE 18.105 7,11 -21 A. Introduction 1R 11 B. Medical Services 18 11-12 C. On -site Medical Services 19 -67 12 -17 1. Treatment Protocols; 19 -20 12 Z. Mlmmum E uiP+iie Tt 20 .12 3, Intake Screening 20 -27 13 4. Initial Health Assessment 27.29 13 5. Non - Emergency Medical Treatment of Inmates 29 -31 13 -14 6. Emergency Medical Treatment of Inmates 32 -33 14 l x 7. Chronic Illness /Infectio€xs disease Protocols 33 -37 15 S. Medication Management 37 -46 M 15 1 Mental Health Services' 47 -51 15 10, Medical Records Management 51-61 15 11. Nutritional Services 62 15 12 Dentai Care 62-65 15 13. Eye Cate 65 15 14, Psych Clinic 55 15 15. First kid Kits 65 _ 1516 15. Inmate Complaint /Grievance Procedure 65 -67 16 17, Exclusions 67 17 D. Off -site Referrals to Preferred Providers 68 -77 _ 17 E. Off -site Preferred Provider Network; 78.83 _ 17.18 F, Medical Services for Immigration Customs Enforcement (ICE) Detainees 84 -86 18 -19 G. Medical Service Provider (Minimum Staffing $7 -92 19-20 H. Qualifications of Stiff 92 -94 20 L Additional Services 9598 20 J. Jail Staff, services 98.99 20 -21 K. Medical Service Provider Required Qualifications 99 21 L. Sole Contractor 99.105 21 M. Equipment and Supplies -1015 21 Inmate Medical Services City of Santa Ana 25H -19 RFP No -'14 -034 i Inmate Medical Services. City of Santa Ana 25H-20 RFR No, 14-034 H � 1 X INTRODUCTION NaphCare has reviewed the RFP In detail and understands the Santa Ana Jail, the nature of its inmate population, and the scope ofservices to be provided as described In the RFP. We are enthusiastic about the program we have proposed, and our proposal addresses the unique needs of the SAJ. All our services will meet andjorexceed the SAJ's requirements, regulatory focal, state and federal standards, Including but not limited to National Standards of Detention, California Titles 15'& 24- Minimum Standards forAdultfacilities, Orange County Health Authority and all other requirements associated with the housing of inmates. our response addresses each requirement outlined in the RFP In order to providethe SA) with a clear understanding of the services we stand ready to offer, Our goal Is to meet and exceed all services requested in the RFP, collaborate with SAJ personnel, end work attentively to ensure the orderly and cost-efficient provision ofscrvices. With a customized approaeh we propose a,proactive healthcare delivery model that is emphasizes compliance, continuity of care, and partnership with the SA}, If the inmate population changes such that the number of non - contracting agency (Santa Ana Arrestees, IAPD, Various Cities, etc.) inmates increases over the amount provided in the 2014 RFP' p8' 11 =16 non contracting agency inmates), the City of Santa Ana agrees to enter negotiations with NaphCare to amend the contract to add a mutually agreeable reimbursement arrangement foron -site costs (Le' Pharmaceuticals, supplies, etc.):, B. MEDICAL SERVICES Napticare understands that the Santa Ana Jail medical services call for properly licensed medical personmel to identify, evaluate, treat and monitor inmate medical' conditions; "inclu€hng the pre - screening of all Incoming inmates to determine medical needs and ability to provide adequate care. NaphCaveIs more than capable of providing these services, and our proposal details comprehensive program ofinmate health care to include: 1. An on-site medical services' program to meet the medical needs of inmate (e.g, initial physical assessments, ongoing evaluation and treatment of medical conditions, stabilization of urgent and emergency medical /psychiatric conditions, discharge planning and medication management; 2. An on -site dental services program to meet the needs of Inmates (e.g. Initial assessment, extractions, examinations and emergency treatment)1 3. Mobile on -site radiology (x-rays) services 4. Ail on -site mental health care delivery program to meet the needs of the inmates; and S. An off -site preferred provider network of hospitals, physicians, and other' ancillary iutsPS to provide medically necessary services to inmates which cannot be provided on -site at $Ai. Inmate Medical; services City of Santa Ana 25H -21 RFP No. 14-014 18 ram indmpenQenrlrWphhcargxi�sq, . C. ON- SITEMEDICALSERVICES 0 As the Medical Services Provider (MSP), NaphCare will provide an on -site program that focuses oncost containment without compromising the quality of services deemed medically necessary, L treatment Protocols NaphCare's program will include techniques and treatment protocols for managing the following list of most prevalent medical conditions or diagnoses, a. Minor lacerations, bruises (suturing,administ rat [on of Tetanus Toxic, etc.) Ii. Respiratntyand chest pain; c, Alteration of consciousness; & Trauma injuries; e, Asthma;: f; Abdominal pain /disorders; g. Cellulites (infection of the skin); h. Joint pain; l: Diabetes and complications j. Aids and related; k. Venous Insufficiency {blood vessel disorder); L Hypertension; m. Drug; psychoses; n. Tuberculosis; o, Pandemic Flu; p. Mli q. Epilepsy; ra Cirrhosis and liver disease NaphCare will deliver treatment protocols in a uniform, standardized manner across' theSAt, Oorwell- coordinated model of healthcare is patient centered and evidence- based, emphasizing prevention, continuity of card, and partnership with the City of Santa Ana, Our nursing services meet and exceed all constitutional and community standards, as well as NCCHC standards, our technologies provide more efficient, accurate, and accountable methods for performing treatment protocols, while maintaining full compliance. bit rsing Protocols We ensure that nurses Who provide clinical services oretromed and do sounder specific guidelines. Nursing assessment protocols are used by nursing staff when providing clinical care; Nurses comply with relevant state practice acts, and conduct data gathering and treatments appropriate to the level of skill, training, and preparation of the nursing personnel who wilIcarrythem out (NCUICJ -E -11, Nursing Assessment Protocols) . we have developed protocols that enable healthcare staff to readily deal with common ailments. This gives the mid -level providers more clinical time to effectively treat offenders with serlous medical conditions. All nursing protocols are approved by our Chlef Mcol cal Officer and are reviewed annually by the Vice President of Operations, Health Services Administrator, and responsible; physician. The protocols are available to the 9A3 in multiple forms —hard copy and electronic. They are also available through NaphCare Online, Documentation of nurses' training in protocol use exists, Including: Inmate Medical Services City of Santa Ana 25H -22 RFP No: i 4.634 19 Evidence that all new nursing staff are trained, • Demonstration of knowledge and skills through competency testing; * Evidence of annual review of skills; and • Evidence of €ralning when new protocols are introduced or revised.- Healthcare staff can access the protocols while treating the patient through TechCcre"". The "Nursing Protocol" tab in TeehC rue'm allows healthcare staff to easily scroll through or alphabetic listing. The protocols ensure that patients are treated in an effective, efficient manner by the nursing staff, and they allow the nursing staff to more easily distinguish m noraliments from emergent medical needs, 2. Minimum Equipment NaphCare will, at a minimum, have equipment, supplies, and treatment protocols in place to provide the following basic clinical assessment studies a. Urloetesting, ls. Blood sugars; c. Electrocardiograms (EKG's) d: Cardiopulmonary resuscitation (CPA) e; Tubertulin PPD testing f, Pregnancy test! rig g. Gram stains h: Hemoccult testing and Hematocrittests I. AED (automatic external defibrillator) (.. tin -site X-ray capabi ty (mofxile)` 3. Intake Screening Napl Care guarantees that all intake screening examinations will be performed by a qualified health professional on all ICE incoming detainees within two (2) hours of initial entry Into the i litq. This screening will Identify those with mental disorders, inmates in need of segregation or close supervision due to medical reasons as well as those individuals with suicidal tendencies. Screening examination will include assessment of suitability for housing and at -a minimum; documentation of the foilawing:' a. Inquiry into current illnesses, health problems, and conditions, including b; Any past history of tuberculosis or other infectious or communicable illness, orsymptoms e.g: chronic cough, hemoptysis {spitting up blood), lethargy, weakness,weight lass, lass of appetite, fever, night sweats - suggestive of illness c. Mental health problems including suicidal ideation d, Dental problems e. Allergies f, Medication taken and special health requirements g. For women, date of last menstrual period, current gynecological problems and pregnancy h, History of cerebral trauma or seizures 1, Use of alcohol and other drugs 3 Behavior, including' state of consciousness k: Body deformities and ease of movement 1. Identification of disabilities rnr Persistent cough or lethargy n. Condition of skin Inmate lvtodicalServices City of Santa Ana 25H -23 RFP No. 14 -034 20 o. Latest l'Pa test p. Any other medical history pertinent to the determination of housing suitability and on- going medical care r{. Recording of height, weight, pulse, blood, pressure and temperature P ROACTIVB INTAKE SCREENING EMIR THE SAJ NaphCare's Proactive Care Model identifies, stabilizes, and monitors all health issues from day one of an Inmate's incarceration. It is important to identify pre - existing; illnesses up- front, so our care model provides the most thorough and aggressive up -front evaluation and assessment in the industry to meet and exceed your heeds in this area. Using our Proactive Carp Model, we identify inmates` medical and mental health Issues as soon as they arrive at the facility. We have seen that this is the most ethical and cost-effective way of del veting correctional medicine. We use quality licensed staff to perform a thorough screening and assessment at intake that allows unto Identify inmates' health needs up-front and alien treat thorn throughout their stay. Experience has shown us thatth is proactive evaluation and Management system provides better healthcare delivery and outcomes. Nap In Care's Proactive SAJ Receiving $crooning Process • SAJ inmate booked In'TechCore'". • SAJ officer screens for Immediate emergency; • If positive, RN assesses & accepts ordenies; • if positive, RN denies, patient sent to hospital; and x • If negative, RN accepts& triage process begins, • All SA) inmates added to TechCare� booking screen for Cqi & tracking purposes; • Inmates with bond are allowed to post bond, and • inmates with no bond and who are high risk are priority in the screening process. • 5AJ inmates are seen bya paramedic — Receiving 5creeni • SAJ inmates are seen by a mental health social worker (MSW) MH Receiving Screen; • RN completes history and physical (H &P) on Inmates, and • Appropriate housing Is assigned, • Paramedic Receiving Screen — always reviewed by RN; • IfMHReceivingScreenispositive - MI-IevaluationIscompleted; • If MH evaluation is positive, Inmates ate placed on MH watch & appropriate housing & are scheduled for psychiatric evaluation; and • If RN H&P is positive, healthcare staff calls provider orschedules, next day visit —severity dependent — Inmate is placed in infirmary or medital housing. Inmate Medical Services City of Santa Ana 25H -24 Rif+ No, 14 -034 21 t NapbCare's proactive intake screening is NCCHCrompl €ant acrd has been written to prioritise care based on need. It assesses the most urgeatissues first and then, Ina systematic way, assesses the Other important areas that will help determine berth the inmate's heed for services and the Urgency of that need. The following list describes each area of assessment: + Urgent Assessments -- Covers vita I signs„ acute health concerns, physical appearance antl behavior, mental instability, substance Intoxication or withdrawal, and suicidal thoughts + General Medical Assessments — Reviews signs of illness or Infection; current, past, and chronic health conditions; review of current medical treatments, and impairments in mobility Mental Health Assessments- Reviews current or past mental health treatment including medicatlons and diagnosis; past psychiatro hospitalizations and suicide attempts; PREA assessment With our E MR system, we will electronicalty flagon inmate's record at intake to identify their status with a different contracting agency, such as US Marshal or ICE. These flags identify where an inmate came from In .order to expedite further medical information In a timely manner and track designations separately for ease of bit ling. Female Assessments —Covers pregnancy issues, any scent deliveries, abortions, miscarriages Substance Use Assessments Reviews use of illegal drugs, abuse of prescription meds, and alcohol use, If indicated by responses, an assessment tool to determine the need for detox is triggered. Other Assessments Reviews dental issues, Insurance coverage, special medical requirements (adaptive devices, diet) Disposition/Treatment Plan — Allows the interviewer to refer to any Indicated services based on the above inforntationin either urgent or routine time frame. Releases are obtained to access outside retards; the medication verification process begins; the inmate is educated on how to access medical and mental health care if needed in the future; and housing recommendations are made. NaphCare's Intake Screen within TechCoreT" assists our quallfied,evaluators to providing the appropriate level of care indicated by thelnmate's responses each and every time. We have built -in guides and alerts that help direct the evaluator through the assessment and lead the evaluator to specific interventions when indicated by the inmate's responses. This ensures proper delivery of the correct care needed for each inmate and reduces human error risks. Below, we have provided several examples of this process: If an SAtinmate responds that they are Having or have recently had suickial thoughts, then the screen alerts the evaluator to immediately take action to ensureinrnate safety, notify security, and alert the mental health supervisor for further intervention. Inmate Medical Services City of Sa m i Are 25H -25 REP No. 14:434 22 If an SW inmate responds thatthey have been using swbstances that pose a riskof dangerous withdrawal symptoms, then the screen outomat(crrfly enters a comprehensive detox assessment tool. This tool assesses the need for detox treatment and automaticaiiyenters the CIWA -Aror COWS protocol if the Inmate meets criteria. The Inmate is then monitored and treated for withdrawal symptoms closely by nursing staff based on the built -In parameters of these nationally recognized and validated assessment and treatment datox protocols. Intake Screening in TechCare m ref I EST, 00VA0 .�pooma■: 5207447 fAnq a" rrench.... YOW Bli31xOP+tf48e =9S sex; Male Nam klem 3 PICTURE a�ya 246A-551-02 ssr+a: ass- si -iras N"AVAnAULE iL4:S Acnve RnMdnynela. 81221100711:46:O AM pule qv, 8)92 120101n:d6:U4 AM io X poet floe 9emsEe appearte be anameft euriraaed, ludmmk. nea. Muperoas whm+e Proactive health Assessment a pion Intake: A beneficial feature of tdaphCare's intake screening process for the 'SAI is that we propose to perform the health assessment upfront, during Intake In order to Identify urgent medical and mental health issues upon an inmate's arrival, please see our response to Section C, 414, Initial health Assessment, for more detolh, Proactive Mental Health, Screening. It Is well known that the mental health population In correctional facilities has and will continue to increase. Inmates with mental health issues can disrupt the facility as well as pose a risk to staff, Other Inmates, and themselves. For this reason it is even more Imperative to have a thorough up -front assessment performed to rapidly and consistently identify acute and chronic mental health issues so that these issues can then be treated and stabilized This Is the most effective way of minimizing negative outcomes and maintaining a more stable inmate population with regard to mental health, nta Ana 25H -26 RAP No. 14-034 23 s 'mow lu poll 11111 Our Mental Health Screening is NCCHC compliant and was created to be proactive in Identifying and prioritizing in mates in need of mental Health services upon Intake. It has built in guides and alerts to assist the evaluator in identifying and addressing mental health symptoms and needs. This screen is focused on gathering more detailed information about current and past psychiatric symptoms and treatment. If an inmate endorses significant mental health symptoms or a strong past history of them, they are referred forthe even more detailed Mental Health Evaluation which is performed by mental health professionals: The f ollowi ng is a description of each section of the screening a nd t he Information it o btai ns. Urgent Assessment —Reviews depressed mood, suicidal thoughts, past suicide attempts„ any recent losses, feelings about current situation, If they feel they have anything positive in their future, and allows the Intervl ewer to comment on tNoIrfeeling of suicide risk based on responses and appearance * Mental Health abuse issues, and psychotic mental health issues ry behaviors, any + General Assessment — Reviews any history of abuse of any kind, in any setting; any convictions for sex orviolent crimes; any History of special education or developmental disabilities; history of head injury or seizures, y DIsposltion/Treatment Plan A[lows the interviewe rto refer to indicated medica10r mentaI health services in either urgent or routine time frames; refer fordetox services If Indicated, begin discharge planning with regard to need far mental health follow up.- We electronically flag an inmate's mad! cal record if his/her responses during the intake screening indicate a need for additional mental health care. All screenings and evaluations Identify inmates with suicidal and homicidal tendencies, as well as acute and chronic behavioral health Issues. As the following scree nshat illustrates, the Mental Health Screening contains prompts to assist the interviewer in taking any indicated actions such as suicide watch, or urgent mental health referral based on the inmate's responses. Inmate Medical Services City of Santa Ana. 25H -27 No, 14 -034 24 Alert in Mental Health Screening Medication Verification. During the Intake Screening, an inmate reports what medications he /she is currently taking, and this Information Is automatically communicated from the site to NaphCare's Pharmacy. Our pharmacydepartment calls the reported dispensing pharmacies 7 days a week toverify prescrlptlons. Medication veriflcation provides Important inmate medical history, which helps the physielin make more informed decision regarding care, This provides a continuum of care from the community to the SAL All inmates enteringintakethat have averif €able proscription arc allowed to remain on this medicatic n until they are evaluated by the physician, NR or PA. Nursmgand Intake staff will not discontinue :a prescription without authorization from the appropriate medical provider. It tsthe duty ofthe clinical provider to continue or discontinue the Medication based onhls /her clinical judgment and physical findings. Tuberculosis Test€ng. It is our policy to administer the tuberc u Im skin test during the intake screening and toschodulea :follow-up appointment, Our T8 screening follows guidelines issued by the American Thoracic Society and the Centers for Disease Control (CDC) for tile management and treatment of Tuberculosis. The TB test Is logged in the EMIR and automatically flagged forfollow -up. A list of inmates requiring aTB read is generated and results of the test can be lead and recorded —this ensures that all inmates receive a TB read Ina timely manner. Our healthcare personnel ensure that inmates are either medically Inmate Medical Services RFP No, 14-034 City of Santa Ana -:25 25H -28 cleared before they are sent to general population or referred to the appropriate healthcare service, Nursing staff can access 7B reads and results electronically, which offers significant advantages such as; 1. Drastically reduces workload,, no paper charts need to be pulled' 1 Generates list of inmates grouped by TB status (positive /negative, administered, read, results, follow-up) 1 Eliminates unnecessary duplication of services for re-admitted inmates 4: Accesses the date the lastTB test was administered, history of services available 5. Reduces costs for staff time and test supplies [rx.T4ffatn �l � Raison Rape Elimination service benefit to You,. Nap[ TS Slain "lust: Screen in Tech CareTm Is A4MYt[ 0546 -a" wPFAVrtIEIi@Lv iWON, wu is a,ca.b, ;gear TM m,rwia TE wmNx�+xL+s raven T &C#asw T ref PREA); In order to comply with PREA standards, and as an added offers a PREA Ong InTechCar°e "" PREA Announcement within Informed Consent ked during the intake ,screening; Has the mmateever been sexuallY abused, sexuaity abused someone else: been convicted of a sex crime, or does the wtervfew feet the inmate maybe at risk of vrctinnization 2 TechCare � automatically sets a PREA flag Based on a positive response to the above question. A daily PREA report is automatically generated from TechCdrem and sent to custody and RaphCare leadership at the site. In addition to this feature, the informed Consent screen, which is -afso part of NaphCare "s intake screening process, describesthe PREA Inmate Medical Services Cny ofSartta Ana 25H -29 RFP No. 14 -434 2# n ir� IVUF � RgA'AP An nouncenient W ensure inmates am aware oft he assistance that is available to them The Informed f Consent form call be read in either English or Spanish. Theseieatures are In place and operational at each of NaphCare's client facllit1es to ensure PREA compliance, intake Screening QuaI4Assurance NaphCore's corporate CQ1 staff monitors the intake screening process to ensure full compliance with NCCNCstandordsl- E -03, J -E -04, AND J -f-05. Tine following proactive QA studies help prevent costly rri smkes, mecucvaf emergencies, and expensive off site CUM Timely Medical and Mental Health Screenings; we provide medical and mental health screenings within 24 hours of an Inmate's admission.; rising 7"echCare' , we audit the initial medical and mental health screenings. T'echCare'searchesrthe database of all active inmates with abed assignment for completed Medical arid Mental Health Screenings. Corporate staff then reviews the screening report Monday through Friday, and any missed screenings are reported to the site Health Services Administrator (HSA) The HSA follows up on all identified inmates, and these inmates receive a Medical and Mental Health Screening within 48 hou rs of site notification, v` Positive Mental Health Screeningsl Per NCCHC standards, any inmate with a positive mental health screening requires a psychiatric evaluation Twice a month, we run a'rechCare'"' report showing all active inmates who had a positi MR d. A physical examination including comments about mental Status with appropriate referral as clinically Indicated, e, Oral (Dental) Screening— ICE detainees only Proactive Health Assessment upon Intake A beneficial feature of NaphCare's intake screening process for the SAJ is that we propose to perform the health assessment up front, during intake. By performing this screening at intake, We can identify urgent medical and mental health issues upon an Inmates arrival. This not only reduces costs for emergency and hospital transportation, but it also reduces the Inmate movement required to provide the 14-day health assessment NophCare exceeds PICCHCstandards by pretforralng the health assessment upon Intake, Additionally, any inmates that have not had a i-lealth Assessment by the 10th day will be flagged in TechCore' far anmedlate failow-up, ensuring compliance with NaphCare's health care personnel will ensure that a the 14-doy requirement. comprehensive health assessment, including a physical examination by an RN or higher, is completed for each Inmate duringthe intake process, and no later than within 14 days of admission to the SAJ. The health assessment record will be reviewed and signed by a physician and entered in the patient's permanent medical record. if there are urgent needs or potential problems 1posIfive screenings, unusual vital sl$ns, etc.) the health assessment will be completed Immediately. The health assessment Includes Inquiries into the follovving. • Vital Signs, • Current Medcatlops/Allergies, • Medical llistW. • TB risk factor and symptoms, • Substance Abuse, • clinical Observations, • Physical Exam (HEENT, Dental, Cardiovascular, Respiratory, Abdominal, Musculoskeletal/Skin) • Pregnancy, • Laboratory Tests Ordered, • Clearances issued, • Treatment Plan, • 1-tousIngAssIgnment, Inmates who are referred forfollow-up will he seen by the appropriate health care professional, and referrals will be documented in TechCaral, Inmates are evaluated based on the medical information obtained during the Intake Screening as to the medical necessity of conducting a health assessment. As with the receiving screening form, the health and physical In rechCarel" is custornizable to meet the needs and requirements of the SAJ; Inmate Medial seffites City of Santa Ana 25H-31 RFP No 14-034 28 Example Health Assessment velivau TEST, DONALD Pnnehtf: 5203497 isnpapea French. ot1u: Sax: Math kare Asian. ususing: 24QA- S5Ta% NNW Sao. -W2555 Status'. ACTM Buwlnruc as 9f2n2QQ! W0 04AM Im asaa w2y2ftla Iftill R9C414aa SStkaa.: tarlDWOd wiiiA C ®Rgtl �eRCmC FIRat6F Sixaean tsvErmed .. 6 CLNtIC Irs OaSEtiVA1I0tIL OF9EPITEECTn: veesoiu Plmac Tl,_ FZG"RE NOT AVd4 @1 "L1 w S. Non - Emergency Medical Treatment of inmates As the SAl's MSP, NaphCare will establish policies and procedures for handling and responding to each inmate request for medical treatment Oka: Sick Call), All policies and procedures will he subject to review and approval by the Fail Administrator or designee, a. Medical sick call requests initiated by inmates will be processed daily. NaphCare will be responsible for obtaining sick call forms from housing location an a daily basis and responding to requests within twenty -four (24) hours of receipt. b. NaplhCaro will coaduct sick call line within the housing units on a daily basis, During this period, medical staff will dispense over-the-counter and prescribed meditations; c, if medical services cannot be provided within inmate housing units, NaphCare will schedule inmates for evaluation and /or treatment in designated medical offices within the facility. d. The on -site primary care physician and/or medical director will deternamethe triage mechanism to be used for each inmate's chief complaint or symptoms, e; NaphCare has established and will implement a system that tracks the non- emergency medical request from initial receipt to final disposition, including date of initial complaint and name and title of health care_providerwho provided treatment. f, NaphCare will maintain a log available to the Jail Administrator on all non - emergency medical requests received: . g. Services requirements included, but are not limited toS Inmate Medical Services City of Santa Ana 25H -32 RFP Na 14 -D34 29 yrsar �epanBcnX 6�41xnFln d +aice. I, Review Inmate Medical Request forms and provide appropriate medical care, ii, Prescribe and dispense approved medications (tablet, liquid and syringe ). ill, Prescribe medical diets iv. Conduct physical examinations. V. Provide firstaid and treat Injuries. Apply, monitor and remove sutures vi Provide weekly dental clinics. vii Provide weekly psychclinIts, when needed:: viii. Provide four (4) hours of annual staff traInmg related to Issues of Infectious d €seases IncludIng universal precautions and proper tra €n1ngfor cleanupan d dIspasaI of blo- hazardous materials. Traih €ng will be subject to approval by the Jail Adminlstra tot 0r designee. ix, M all ntalndetaHed, accurate and confidential med Ica I records, logs and files in accordance with California Department of Corrections and Reh a b that lo ns, Title 15 and the 2011 Nationaf Detention Standards of Immigration and Code Enforcement Bureau X. Review and approvelal lrtiedical policies and procedures. A. Timely and accurate reports to the )all Administrator. x€i App rova16 f off -site medical care by'res pons! ble contracting age ncy of the inmate/detanee. Naph care understands that the majority of inmates cur renttly housed at Santa Ano fall are either I.N.S. or US. Marshall and that these contracting agencies are financiatly responsible for their inmates' approved off -site treri[ment services.. Noph Care agrees to be responsible fur billing the responsible contract agency for off site treatment. For all other Primates (non - contracting agency lnmates), NaphCore shall be reimbursed 100% of all casts of off-site medical services, Nophtare will hlif the Cityof Santa Anu far non - contracti The frequency of sick call is with N CCHCstan d a rds and the facility schedules', and we provide appropriate time for sick call at the SAJ. Timeliness of the response to sick call requests is an important indicator of quality of care and NaphCare meats NCCHC standards for sick call response times. We will operate site - specific sick call throughouttheSAJ Sick call services, in compliance with NCCHC standards, are provided atsufficient' levels to allow the Healthcare staff to give same -liar response to urgent, inmate requests for healthcare services, Nursing sick call is conducted seven days week, and physician sick tail is conducted according to a set schedule agreed upon by NaphCare and the facility. If an inmate's custodystatus precludes attendance at sick call, then ourstaff consults with security staff to make accessto h ealthcare services possible, our healthcare staff follows nursing protocols to facilitate the delivery of sitiCcall services. The assessment protocols are appropriate for the level of skill and preparation of administering nursing personnel. Healthcare staff is trained to effectively triage the Inmate's condition and implement + these established protocols, if the treatment required is outside the nurse's scope of practice orthe established nursing protocols, the inmate Is referred to a midlevel practitioner orthe on -site physician for evaluation and treatment within twenty -four (24) hours. Health services are provided in manner that complies with state and federal privacy mandates within the sco pe,of each facility, Triage Methods We scan all sick call requests Into the TechCtare" system, so the nursing staff can prioritize all requests on every shift and respond in a timely and appropriate manner, Through TechCore, we create a Sick Call Queue that provides a dally work log and makes the sick call process less time-consuming. The system automatically generates a list of inmates who have requested sick call, ensuring that no requests are overlooked, An inmate's multiple sick -call requests are consolidated into one sick call appointment, Within this queue, all sick call requests are subdivided for disposition by the appropriate practitioner. iieferralsk Requests are'triaged and referred elictra"Icullyto the appropriate mid -level clinical I rovider as necessary, which means the referral is completed Immediately without the need" for cumbersome paper logs. Frforitysick calls supersede Routine sick tall requests to efficiently maximize staff time and address the most acute needs quickly, The Importance of categorizing sick call requests is to streamline the process and ensure all requests are documented and addressed.. The nurse .con click on an Inmate's name to select It, and then click o n an a ppoint ment_a nd assign It to the appropriate category. This efficient process makes it easy to respond to requests quickly and ensures that Situ Call Quality Assurance medical staff does not fall behind in processing requests. The clear advantage of using an automated sick call system is that the sequence of the list creates a PRIORITY system based on important factors such as acuity and length of time waiting. Inmate Medical Services City of Santa Ana. Nopi)Cane's corporate C(d staff ranters the sick call process via TechCare' ", Theyensure Martell requests ore documented and reviewed for ur ocy of need and any req uired intervention with or 24 hours, curd that sick cog ellntrs ore conducted or) o thrrelybasr's by licensed niedrcpl staff iii occordorce With NCC-dC Standard g % 25H -34 RFP ttm 14 -034 91 II_£, ytiw Ind�iwnflmyF hagli34cnre c}ieicc. 6, Emergency Medical Treatment of Inmates a. NaphCare has established and will implement policies and procedures for responding to requests by )ail staff to provide emergency medical treatment to Inmates in an efficient and timely manner at all times, b. in the event of an emergency, first aid and cardiopulmonary resuscitation services will be provided on -site as indicated. Medical services staff will provlde on -site emergency intervention for staftin mates'an and visitors when necessary. a NaphCare will provide and have on-site two (2) or more ,Automatic External Defibrillators (AED) and all health care personnel will be certified as park of theannual CPR training. ti, NaphCore will utillzethe preferred provider network for all off-site emergency services Emergency Services NaphCare will work side by side with all SAi personnel to ensure that the health, safety, and welfare of inmates, staff, and visitors are not jeopardized within the confines of the correctional institution during an emergency (NCCKJ -A-08, J -F-08; ACA Emergencies, Emergency Plan, Emergency Response), We take the following steps to ensure that members of our health staff{ are prepared to Implement emergency health services. 1. If contracted, healthcare staff will be available to provide twenty -four (24) hour emergency medical, dental, and/or mental health services to include: Emergency transport of the patient from the facllity; * Emergency contact information will be maintained on -site and will be easily accessible to health care staff, Including emergency vehicle information, The Emergency Contact Numbers will be completed and updated as necessary by the N5A; Use of one (1l or more designated hospital emergency rooms or other appropriate health facilities, Emergency on -calf physicians are available twenty -four (24) hours per day, when the emergency health facility is not located in a nearby community; Security procedures will be reviewed to ensure the immediate transfer of Mmates when appropriate;' The NSA will be notified of all emergency situations; and Emergency evacuation of the inmate from the facility, 1 We secure written agreements with all community hospitals that will provide emergency services to inmates on a twenty -four (24) hour basis; 3. We secure agreements with a local emergency service provider and ambulance services with regards to ensure the emergency transport of inmates. 4. Healthcare staff will docu ment all services provided by outside healthcare services, including emergency services, In the inmate's health record, S. On site emergency first aid and crisis Intervention using emergency medication(s), supplies and medical equipment that are regularly maintained. Inmate Medical. Services City of Santa Ana 25H -35 RFP No. 14 -434 32 5. We provide and document any emergency medical care needed to stabilize any correctro no staff 'm,ember, contract employee, visitor, or volunteer at the facility, . Our healthcare staff provides emergency services to all work release inmates at the most appropriate facility based on the severity of the inmate's condition. 8. Our healthcare staff coordinates with the SAYsworkefs compensation provider regarding treatment, case management, and follow -up services for all inmates Injured while on work release.. Chronic Illness /Infectious Disease Protocols a, NaphCare will establish policy and procedures for the rl h All F' t d, d' lf1 h o ME Vile take a prcla ctive approach to the management of chronic care disease in confer to minimize the development of any urgent or emergent conditions that might require riff -site transportation. care an an ngo anmaes iagnose w we r nic iciness /disease and for inmates diagnosed with an infectious disease subject to the approval of the Jail Administrator. b, NaphCare staff will immediately notify the Jail administratorof designee of any inmate with an infectious disease diagnosis that may require the screening of Inmates (e,g. active T¢, chicken pot, rubella, mumps, etc.). c. NaphCare will ensure policy and procedures adhere toguidelines established by the National Commission on Correctional Care (NCCHC); orange County Health Authority and Tltle 15 and 24 regulationsfor adult facilities, t'1tCiUTfVECHRONICICARE MANAGEMENT" NaphCare provides chronic care in a manner that incorporates principles of case and disease management for complexcases, and promotes maximum progress and healing. Inmates receive timely follow -up, evaluation, treatment, and education about the preventive activities available for these requiring chronic or convalescent care. Our policy ensures all inmates are screened, Identified, and monitored in a manner consistent with national clinical guidelines established for the care and treatment of chronic illnesses. our emphasis on preventive care bedihs at the intake screening, at which time inmates are classified into the appropriate chronic care clinic and schediued for fultow- uptreatment Our extensive staff training, use of Crest practices based on nationally recognized guidelines, and innovative on- shediagngstic testing help us keep chronic care patients in a stable state throughout their incarceration we will schedule and track all chronic care clinic visits within TecirCore'". This data will be available to theSAJ at all times. At a minimum, the database will include the following' • Each inmate enrolled In a chronic care clinic • Each occasion when an enrolled inmate K seen at a chronic care runic • Patient refusals for a chronic care visit Using Techcare, helps ensure that chronic care patients are seen by a provider at least once every inmate Medical Services Itrp: ND. 14 -634 City of Santa Ana 3' 25H -36 w ) 4;6� �iqre� your 1ndgmNd6nY 6vW mmchwo three months: In the Chronic Disease Management section of TechCare ll, the user can a ccess/view Inmates with certain chronic care illnesses. To see a specific chronic illness, simply select a chronic Illness from the drop down fist. The user can view previous notes, labs, and chronic care visits, or complete a chronic care visit, The amount of time until the next visit can also be reviewed from this screen The patient's name turns red when the visit is past due'. lily kS,%ENM1RH r. Tut C<Xm^ARNtaik '„fie..` -`..�1 Y' wt sAead im 19fxW2P4E4:A8:Nr NA.d WNn zamcin79,4Y® Nu ® -- -- AV4Lp.6iAT85�lY (Y9G3394 kgOB- SA1-93 Y__ * -W d*n itYA+Pn13 a,?8�3s6 dwm6a man in BS dagc Hum. [tae ��4..1 ...ftW Ai1GC9 aJmw CBCU 04 tA4'i;- F:SFit (((_�IlI P" -}� N ii- I VVA BakWr•. CN4 (02 70 Fu—"j imt- Il¢sp„a fW.WR3t [um Y tlss34a) by W37 }+xi t IINOrviyr .._... T_, soot d+TT NaYia0i2 oiYa�?9 drA dw is Lewenirzbe dnPa ) daNe� � ? rvpfl 9+psn, tvla�#bsY. �N ' axmiy327x+t'mia bidai9e Na mxbfi¢mpn iN�daia ,N —;�ti4�' �__)idada L— rvurt P9NTl�&d3, E91N�ifi (a:dWim) ODA-Itff 1l '* iaaitl�NC: vnetw�infurmetlun�.Ma My lnbm I-.- ®_yl I„�] Ym$ �.�. . n"Nint PmdI, 3lidr C4981mw �, r�I C��11[ _,-.w— .�.— ,.,:- .'�^[cbadm card NatlhYNrr•.aYkvbr pwYgFde di! .4abi i -Pmt 3Mi ,, 9¢arz [a 6i4 -]t_ �-:: '., 1aesAWS tartmdin(ameYlart rcB awa��¢ Ntltm Wbv :=Ya#:a r7 P?ik YYYiAr6Ak4?N CtGBfl!@d4A} 64 363+!'i { L-]L- . Y9&]tlatie i%6l slab lnfm+wtluiel NU9rMs. G6C _ i@UM =L�Pfik ZEtU rA [Y.�HT$}a. tAI&-EiM11 - - '. ii89daia last NaY nYMamt'Itltl Fl°d H4t¢W iThID �r°IOMf bz . NfaphCare has a proven history of reducing off•slte costs through our proactive, Chronic care system within TechCore". With TechCrareTl, the level and quality of the care within the 5AJ will be improved by scheduling inmates with chronic disease to be seen by a provider before they become acutely JI and require off -site transport or hospitalization, in addition, we greatly reduce liability by identifying this bigh risk population during the Intake process. Collection of Pe r dinent llealtltcaye information Prior to incarceration, many inmates had limited contact with healthcare providers and may lack critical information about their illnesses, Our chronic care program alms to actively monitor, educate, and motivate patients to be responsible forthelrown health maintenance. We have established protocols and practice guidelines to provide guidance on the diagnosis, monitoring, and treatment of common chronic illnesses, our process ensures compliance with standards established for the care and treatment of chronic illnesses, The first opportur[ity, to identify, enroll, and refer an inmate to an advanced level provider is during the receiving screening, If the Inmate's responses during intake indicate that he or she requires additional medical care, then the inmate's medical record is electronically flagged for follow -up. if patient is onpharmacokzgic therapy, continuity will be maintained; If there is a patient whose chronic condition is unstable, hejshe will he seen promptly. In the case where a patients' chronic disease is stable, he/she will he scheduled for a first chronic disease visit in approximately one month. Before the appointment, we collect medical records and current diagnostic test results so an evidencebased treatment plan may becreated. patients enrolled in + chronic care clinics will beseen by a qualified healthcare professional every 90 Mays, or nsore frequently if clinically indicated. Inmate Metrical Services City of Santa ..Ana 25H -37 RrP. No, 14 -034 34 put mdopendot hmlvhwm a Chronic care clinics are built into thalrechCareTMkvstem, which creates consistent documentation and standardizes the provision Of Care. inmates are placed Into the correct chronic care clinic by diagnostic category to ensure proper follow up at their scheduled dates, Terl`;Core° is designed for the classification of Inmates with. chronic diseases and allows the following clinics to be easily scheduled'. Heart Disease, Asthma, Cancer, High Mood Pressure, Diabetes, Hepatitis, SeizurK SexaallyTransmlited Diseases (STD), HIV, and Thyroid, Instantly accessible, 'FechCorel allows medical treatmetitto be monitored and ensures compliance with ACA and NCCHC requirements. Another benefit of the system is the ffalert" feature, which prompts healthcare providers to schedule a follow-up for any missed Inmate screenings. NaphCare has education about chronic diseases available for chronically III inmates, Disease-spedfic infon-nation can be easily selected from a list In TechCore'm and printed to give the Inmate the knowledge to help take care of him or herself. 7echCorel provides a more efficient, effective method DI monitoring the larrintes. We car) ensure that the inmate has been placed in the appropriate chronic care clinic, an appointment has been made with the appropriate provider, blood sugar checks have been initiated, Another mode of Identifying chronic care patients and ensuring their etc, 0 ri from looking ot contioued treatment is through NaphCare's Internal pharmacy team. Z Inn) ate's record in Using I-echCare'O, the pharmacy team analyzes profiles with chronic the computer, care medications, Identifies chronic care patients who may not have been identified yet, and updates the patient medical record, If a patient has been incarcerated for more than 30 days and has been Dyni grookshire, RN, receiving a chronic care medication but has not been flagged as a Reglonai Director of chronic care patient in the medical record system, then the pharmacy Nursing sends out a second request for the patient to he re• assessed. They will enroll patients in need of chronic care in the proper chronic care clinic and make sure they receive the appropriate labs and are seen every 90 clays. This is a quality assurance activity that NaphCare regularly provides as part of our proactive care model. Individual TreatmentPlarns Individual treatment plans are developed by the responsible physician for inmates with special medical conditions rcenildhig close medical supervision, including chronic care. The plan includes, directions to healthcare personnel regarding their roles in the care and sugervisian of the patient Before the treatment plan is implemented, it is approved by a physician. individual treatment plans include, at a minimum:' & Frequency of follow up for medical/mental health evaluation and adjustment of treatment modality; b. Type and frequency of diagnostic testing and therapeutic regimens; and when appropriate, instructions about diet, exercise, adaptation to the correctional environment, medication, etc; c, Reasonable accommodations for persons with diagnosed medical or mental health disabilities, as necessary, med col Services Santa Ana 25H-38 RFV Na. 14 -034 35 Management of Diabetic Immates Diabetes Is one of the most complicated chronic care diseases preventon correctional settings, There are different types of diabetes, different kinds of medication management, and various, ronstant blood glucose testing. This has the potential to be a documentation nightmare, but NaphCare has the solution. We provide electronic devices, (Li feScrrnO ne'Touch`FlexxProfesstonal Blood Glucose Monitoring system) that store previous and current blood sugar levels by using an inmate's Identification number. Electronic glucometers require healthcare professionals to perform control testing and Include a fail safethat prevents inaccurate testing of patients. The nelrouch' Flexx Professional Blood Glucose Monitoring System • Paperless; downloads Information without the need for excessive charting • All information is synced lnto TechCore' In each Innmate's Individual electronic medical record • Photometric technology delivers accurate and precise results. • Absorbent OneTouch Pro Test Strips provide easier handling and application • Unique;off•meter dosing of the test strip minimizes risk of Infection for patents and staff • Removes need to bringmoterto patient • Helps reduce risk of transmission of blood borne pathogens between patients • TechCare"Itroods/graphs the results to demonstrate to the clinician how effectively current and past medications are managing blood sugar. Infection Control Program Our Infection Control program Is modeled after NCCHC standard -9 -01 and ACA Standards for Communicable ❑fseose and Infection CpntrofPrograin, It provides guidelines for the management of, and reduction of unnecessary exposure to, infectious and communicable diseases for SAI Inmates, institution, and healthcare staff. Our program establishes guidelines to enact protection for health of SAI inmates, staff and visitors through maintenance of a clean and orderly health unit. it Is bated on universal precautions recommended by the Centers for Disease Control (CDC], the Occupational Safety and Health Administration (OSHA),the Association 'for Practitioners In Infection Control, and other nationally recognized infection control organizations. Management of AI's Infection, Control Program Our SP. HSA will oversee and implement infection control measures to monitor the incidence of infectious and communicable diseases, ensure proper handling and disposal of biological waste; and provide education to inmates, correctional staff, and clinical staff on control, treatment, and prevention of infection Infection control activities will be monitored by our CQI committee and our SA) infection control program includes written policies, procedures, and practices to Inmate Medical Services City of Santa Ann. 25H -39 kFP No. 14 -034 36 We will hold infection control meetings quarterly, at a milmmurn, and when Infection control Issues requires Immediate or contInuingattention. A licensed healthcare provider Is designated to serve as the infection Control Coordinator. The Infection control committee will consist of the following members: All SAJ infectious disease reporting activities are coordinated through use of Techcare'", inmates diagnosed with Infectious diseases are irmnediately enrolled in the appropriate chronic care clinic, which will provide appropriate referrals,and treatment plans. The inmate's care can then be tracked through the chronic care clinic module in TechCareT" , NaphCare wilt provide automatic incident Reporting to the SA4 IVhen incidents otcuron-site, our 14SA is trained to outomaticollyrepart all incidents to our central office byway of an Autornated Incident Reporting Email Service; OurAutamatedInc(dent Reporting Email Service sends an alert of the SAJ incident to ourcorporate clinical and administrative managers, who review all incidents to ensure tho t appropriate measures are taPen to resolve each 155ve, 8. Medication Management a. NaphCare will provide routine over-the-counter pharmaceutical and routine prescription are for ail inmates. Long-term medication for chronic care, including HIV and psychatroph: medications will be the responsibility of the inmate's contracting agency, if the Inmate population changes such that the number of non-contracting agency (Santa Ana Arresteas, LAPD, Various ClVm�, etc.) Inmates increases overthe population amount provided in the 2014 RFP, pg, 11 (Sixteen (16 non-contracting agency inmates),the Oty of Santa Ana agrees to enter n eSotlatloft With NaphCare to amend the contract to add a mutually agreeable reimbursement arrangement foron-site costs (i.e. Pharmaceuticals, supplies, etc.). Inmate Medical services RFP No. 14-034 City of Santa Ana 37 25H-40 M NAPUCARC'S Its- 11OUSN PIIARNALT SCRVtGES' NaphUre will comply with the -RFP specifications regarding medication management for the SAL Adetailed description of our hr -house pharmacy program is shown on tfigfollowing pages' We will ensure contract compliance In all our pharmaceutical services, and we will strive to give you the finest pharmaceutical services while maximizing your cost-savings potential.. • 25 years of correctional pharmacy experience, • Orunihasln -9 discounts & 'cosisevings extend dIr4cdVtCyou. • Drugardering made sirrple through use ofTechCore '*and out eMARservlces. • Automationstreamspr�s r'lp#don'st ,pharrviaoBstsfrareffdclent ,accurate, complciec €finicalrevieyv.; • Improved communl(atlon between pharmacy healthcare units, allowingfor immediate access to new drug orders and simplified drug formulary management. + Pharntaclst review d €ail -new drug tilers fat ugiscato t ern py, drug loteraicuotisr uilerglus. dosing schedules , and appropriatenoss. therapy... * National contracts with local major pharmacies for emergency back -up services, ensuring 24-hour access to prescription drugs. +, lylt=,dic�titrnsaualdaktls��. Apo] apardpy , ?daysperuraefrr5weeksPpryar. . Most urescricitions free of charRefor NanhCare emoloveesw1ho elect our health insuranceolam NaphCare provides atotal pharmaceutical system for prescription and nor - prescription drugs and all intravenous solutions ordered by our physicians. Appropriate prescription drugs will be ava ila ble to all patients at a l l t I tires. our pharmacists screen all drug orders for completeness and medical Appropriateness;, oversee order preparation, distribution, and control. NaphCare's pharmacy management policies and procedures help to ensure the following. &:mfniroat use of emergency ordering; . Storage & security of drugs, syringes, needles, dispersing Instruments, &. Instruments; * close in onitoring of drug prescribing pihatr€s; Maintenance of SAI patient prof lies at the pharmacy with drug allergies & drug interaction alerts noted: * Control SAllnventoryg * Renew SAJ prescriptions to avoid any interruption or delay in drug d spensms • Develop and utilize quality Improvement tools to monitor psyehotropiedrug usage and poly- pharmacy Issues; All SAI prescriptions wilt be labeled In accordance with applicable state and federal regulations, We wlil provide for electronic submission and prescrlpflons tracking; * Routine reporting of SAf current prescriptions that will expire within five days, unless the prescription was speciflb l as a one-time prescription, and; pruner rltsnosal of all unused drugs. Medication Review NaphCore pharmacists provide a thorough clinical review of drug orders as new prescriptions are electronically sent to the NaphCare Pharmacy. As a value -added service forthe SAI, mmate Medical5ervices City of Santa Ana: 25H -41 RFP Nn. 54 -434 3S NaphcaWs pharmacists review all orders for accuracy. They verify real -time prescriptions for safe dosage, allergies, spe elf led length of time, need ford rug, and duplicatlons. By identifying dupIicatlons „we minimize the number of drugs a patient needs while still ensuriinghigh quality care: Pharma v Crueua Us in—sl Current vital signs, such as blood pressure aril blood glucose levels, are shown on the Pharmacy Queue to alert pharimaclsts of any a bin orrrial vital signs which may preclude, use of the prescribed drug With1n this screen, it fseasy for pharmacists to see when scheduledorap prop date vita I signs hevee not beets taken or properly re corded,Ihey are then able to communicate with healthcare staff so that correct lve action can be taken and negative outcomes Can be prevented, Clinical Pharmacist QuAtyAssuranee Msanagernent Process When inmates firsf enter the M, an Intake Screen is completed to gather important inmate healthcare and mental healthcare info rmat !on upfront taprevent negative outcomes later. During this screaming, we identify any current or needed medications and your Inmates sign a Release of Information (ROI),The RGI allows us to verify medications that patients are receiving in the community, winch ensures continuity of Care and helps stabilize your inmates more quickly. intake Screening information is automatically communicated from the site to NaphCare's pharmacy, and our pharmacy department contacts the reported dispensing pharmacies seven days a week to verify prescriptions; After medications have been verified; medication orders are entered Into Techi:ore's "' eMAR, ensuring that all medication activities are tracked. Inmate medications that NaphCare verifies with the community pharmacy are continued, regardless of whether the medication is a part of our formulary; to ensure continuity of care. Within our eM AR, all providers have the information they need to review and approve orders and snake more informed decisions regarding patient care. At the time that our providers review and approve orders, our Pharmacy Quality Assurance Management Process begins, All of the above activities; which compose our Clinical Pharmacist Quality Assurance Management Process, are completed within 24 hours of an Inmate entering your facility. Finally, when all medications are approved and our pharmacists have reviewed in detail all medication Information, our nurses administer medications to your Inmates Incompliance with NCCHC standards for care and the mannerwhich ' you have :requested. A chart detailing out eMAR Process, is shown In the figure below. Snm,aee Medical Services City of Santa Ana 25H -42 RFP No. 14 -034 39 4" Inmate Mod cal Services. City of San% Ana e e a Y' Fattre process is completed w thin 24 hours, 25H -43 RFP No. 14 -034 40 When a provider reviews and approves orders in TechCcre'4i' eMAR, our Pharmacy Quality Assurance Management Process beglns, A chart outliningthis. process Is shown below. Ousisia. e, APODPA-ta TreamOtnt, S, ia-Ade�basea Guidelms, 4XINODICCam Made& 5:m4dkawri conowme. 6AabManiturkig, %Ad*M lase m. inmate MEdical Services City of Sznta Ana medicatlen is dispensed. 25H-44 EM RFP No. 14-034 41 Electronic Prescription Ordering Prescriptions are electronically communicated directlyfrom our plays €cians to NaphCare's pharmacy and are Immediately recorded on the eMAR. since new orders have been submitted, they are entered Into the Pharmacist's queue, allowing our pharmacists to follow-up with clinical or therapeutic advice foron• site personnel and re, evaluation is documented In your Inmate's health' record. yvul IRNAp Uklll J..Ilhw,� dwl All healthcare staff and pharmacists have access to one central locution for medication Information, Everyone sees the same data without the need to recreate 1llegVe poperfiles or search for records. This saves Amjama #Ycltear�em time and earrunptes the As nurses administer drugs Using out potential far human error eMAR, we match refills with distribution, The result Is that you only pay for whatis used and avoid unnecessary drug casts, on -site staff and our pharmacy department access the same drug list, greatly reducing human error. Automatic Reordering also provides improved tracking of medications, Within ourervtAR, tracking renewalsof maintenance medications is easy. for the SAJ, we will ensure that renewals of maintenance medications are consistent and ongoing so as not to place an inmate's health at risk. Under no circumstances will maintenance medlcationsorkeep -on- person iKOPj medications lapse, Our pharmacists review all orders, verifying prescript€ons for accuracy, safe dosage, allergies, specified length of time, need fordrug, and duplications. Our providers review inmate records for medications near expiration and ensure that -inmates assigned to regular chromic care check -ups have medications renewed on time. Within our eMAR, our pharmacists search for prescrlptions which are nearing expiration and request appropriate refills. All of NaphCare`s pharmaceutical operations comply with NCCHCJ -D -02 Medication Services, which mandates that medication services are clinically appropriate and provided in atimely, safe, and suffic €entmanner, cost Containment initiatives NaphCam's in -house pharmacy ensures maximum pharmaceut €calsav €ngsforyou; since pharmacy services are riot contracted out to a third party, you do not experience middle mart expenses. All prescriptions are charged atouractual acquisition costs (APC) with zero markup. Savings and discountsthat we receive are passed along to you to our base pricing, We always look for opportunities for better or preferential pricing. One of the ways we save you money Is seen In Branded modlcationsi the more generics we purchase, the higher your discounts are on branded medications. Savings and discounts that we receive are passed along to you In our base pricin& Another way our In -house pfarmacists save you money is by reviewing all refills in rechCore"', ensuring Inmate medication compliance within the medication administration record (MAR), and checking to ensure the inmate is active prior to filling, The result is reduced waste and buildup Inmate A9edical Services RFP No, 14-434. city of Santa Ana 42 25H -45 Within TechCorc' ,tine track and trend data on drug use and pricing to determine which drugs are most expensive, An inmate's active status Is always verified before prescriptions are filled. An example of this process in action is seen In the administration of HIV medications at several of our sites. With cur Quality Processes and Systems, we were able to dispense medications In seven day; supplies as opposed to the standard 30 day supply used by other pharmacies: With the high turnoverthat jails see, and with average length of stay less than one month, our seven day dispensing process has significantly reduced costs for our existing clients. In 2012, we transitioned the HRR7 pharmacy services with Diamond to our in -house pharmacy services: With Diamond, HRRi pharmacy expenses between August 2012 and July 2U13 were $7,123.51 per month. With NaphCare, between August 2013 and March 1414, expenses dropped to $1,496.85 per month, roughly a 30% decrease In costs, A listing of additional pharmaceutical cast saving accomplishments which occurred as a result of this transition is shown below. b, Medications will be administered to inmates dally as prescribed, twenty -four (24) hours per day and seven ¢71 days each week by an individual authorized to administer medications by nature of training and licensure as required by law,, Electl'pRIC Medication, Administration Record (oNAR) NaphCare's eMAR is specifically designed for use in correctional facilities, It is included within TechCare.,x and is not 8 separate system. This integration promotes consistency within records of care and does not cost Santa Ana additional money., It is also customizable to meet the unique needs of the 5.Al. We are committed to proactively reducing medication errors. our eMAt ensures : accountability at every level of the medication process, from the entry of the order to the administration to the patient. Inmate records /information can he retrieved using a unique inmate number; and documentation complies with federal and state legal requirements. TechCore' also has a user- fr- iendly interface for accurate documentation that is immediately accessible and can be retrieved easily for reporting and tracking purposes. inmate Medical Serviczs City of Santa Ana 25H -46 RrP No. 14 43 r 4a Fa Also, vital signs, such as blood pressure and blood glucose levels, are shown in our.elvtAR and Pharmacy Queue to alert healthcare staff of abnormal vital signs that may require further attention; The oMAR assists in developing an efficient, structured mod pass process. With our eMAR, medication administration is structured and nurses organize medication-earts in relation to Inmate location, which greatly reduces time needed for medication administration and correctional staff oversight during this process, iechcgre's' eMAR screen ailows nurses operating in your facilities to access all patient Information during medication pass. + TechCorem also generates a Missed Hied Reportthat can be viewed and printed within the eMA function. An additional, significant benefit for you is out ability to generate a Missed Medication Report (see figure (s ) beiow). This report can, be viewed and printed using our eMAR and identifies each patient and the medication missed. Our eMAR thug Administration History Report (see figure (2f below) providess details on why medications were missed. Our report can be pulled at any time and ensures that all inmates with missed medications receive timely follow up from nurses, which ensures no inmate medication need is unmet. Nurses review this report and providefollow -up with SAJ patients who have refused medications to educate them on the importance of taking prescribed medications, (1) eMAR - Missed Medication Report Inmate Medical SeFVjCe$ City of Santa Area 25H -47 RFP No. 14-B4 44 (2) eMAR -Drug Adtmntstratfan History - Reasortsfor Missed Medications - Detail Wit hln TechCareTM; the eMAR features the name of medication, dosage, frequency, date, and time ordered by the MO for each medication to be administe red. In accordance with NCCHCd.p -- 02, NaphCare's medication services are provided as clinically appropriate and In a safe, timely, and sufficient mariner. For your reference, a screenshot of our eMAR is shown in below. NaphCare's eMAR screen lioused to TeehCare'" Inmate Medical Services City of Santa Ana 25H -48 ;: AWA . CNOft G" RFP No. 14.03$ 45 2 s Tether benefits of our eMAR system Include the following- 0 ;Ability to control costs by efficiently reducing the overstocking of tined !cations ■ Formulary drugs are prescriber 's default choice Aulomatically updates Inmate eMARs, ensuring no inmate misses medications, even if there N a change in housing /placement Greater correctional officer awareness and control, less inmate frustration, and safer envlronmenf Reduction of administrative paperwork and improved efficiency * All providers, regardless of discipline have instant access t o o ll patient information • Optimized regulatory compliance Improved patient outcomes and staff satisfaction c. In general, medications will be` administered !it the housing units during scheduled sick call unless medical circumstances or security protocol dictate otherwise: d. Medication will be administered to inmates In accordance with community standards. e: NaphCare will manage an on-site formulary of prescribed and over -the- counter predications. Farmula cy Drugs We adhere to a comprehensive drug formulary to allow medical practitioners and psychiatrists to follow generally accepted clinical practice patterns In their medical management of inmates. This formulary maximizes the use of cost-effective therapy, Aformulary of drugs will be made available, subject to SAl approval, Inclusive of psychiatric drugs and drugs for the treatment of HIV: We will work closely with SAJ custody staff at Intake to review the medical requ[rements of your Inmates; Records of non- formulary requests And responses will be maintained for the term of the contract for trending and analysis purposes. Formulary Management NaphCare will actively participate and assist in maintaining and enforcing drug formulary, . protocols, policies & procedures and will work with the SAI to manage the formulary to control costs and ensure effective clinical care. Clinical experts will share' information regardingthe'best practices" in formulary managernenttechniques based on experience with clients, healthcare organizations, and the State Department of Correction. By programming TerhCore'°' with the approved formulary, we ensure thatinmatemed €cation orders are in strict compliance with approved formulary. To save you money, we always maintain a`rigid formulary but consider tower price alternatives when purchasing medications and when medically appropriate. I, Formulary A detailed listing of our formulary is provided in the Appendix of our proposal, and our pharmaceutical pricing is included in our base pricing, provided under "Required Forms" in Exhibit C. hirnate Medical Services - City cf5anta Ana' 25H -49 ll file in -ilia 46 ��, rncr•a�u«,+Hn a, 9. Mental Health Services a. NaphCare will provide inmatesvrith the necessary mental healthservices. This will Include the assessment and evaluation of mentally ill and suicidal inmates; NAPkt CANE'S MENTAL BEALTH PROGRAM NaphCare will provide a comprehensiveand proact €ve mental health care program for the Santa Ana Jail, NaphCare's mental health program Is built oraa foundation of quality staff that focus on • Proactive identification of persons with behavioral health issues, • Stabilization, • Continued monitoring, • Rapid crisis intervention, • Effective programming, • Constant; clear and effective communication with facility security leadership and staff, and e Collaboration with community mental health providers at discharge. As described throughout our proposed program for the SAE, our goal is to have a very proactive approach to both medical and mental health issues, we strive to identify issues early and Intervene rapidly and consistently, one of the tools that allow us to be successful in reaching this goal is our EMR system, TechC"are�'. Within TechCare -, a patient's entire record (medical and mental hea€thj Is accessible by multiple users at the same time, This provides seamless communication between providers and staff of various specialties. All documentation with regard to patient care is documented within TechCorel, which creates real time, ironclad, complete documentation of all healthcare delivered - - medications, on-and off- site visit&, nursing rounds, interventions, etc. TechCorcm contains not only the current information for this booking of the inmate, but also past bookings as well, for access to past medical and mental health data. Advantages of TechCare'* specific to the Mental Health Program are as follows, • All initial screens have NCCHC and PREA compliance built into tite system with alerts that help direct the evaluator to take action as Indicated by the inmate's responses. They become part of the record and are reviewable for current and future care of the inmate. • Inmates with mental health issues are flagged within the system to alert anyone reviewing their chart to monitorthese issues as well as any other medical issues.. • All mental health Interactions are documented in 7'ecl?Care''5othere is a complete and up-to-date record. « All mental health scheduling (both on and off -site) Is dune inside i`echCorc ", creating an, easily tracked continuum of care through the system. 0 The eMAR function allows a quick, accurate, and real -time review of current and past medications and easytracking of missed coeds, refused coeds, and administered coeds_ inmate Medical Services RFP No, 14.034 City of San taAna 47 ''... 25H -50 Mental flealth Preliminary= creentrtg and Evaluation The NaphCare mental health program begins at intake with the screening processes, defined In Section 4.C.3, Intake Screening. Inmates will be screened for mental Illness at Intake according' toNCCH Cstandrrdd- E- OZReceivfngScreenrng Our method for conducting specific mental health screening and evaluations for newly admitted inmates follows NCCHCstrandord J -E-03, Mental Hearth Screening and evaluation. All of these screens become part of the inmate electronic medical record and are accessible at all times. Mental Health Referral Plait NaphCare will also operate a Mental Health Referral program for Inmates who did not present mental health issues In the initial screens but later develop or endorse them,. NaphCare wilt provide a rapid response to any need for all evaluation or mental health intervention. Inmates will be given Instructions during their receiving screen on how to request mental health services through the Sick Call process. They may also access mental health services by Self- referral through staff. In addition, correctional, medical, or mental health staff may refer an Inmate for services at.any time; if they see a need. Mental health staff will be available for on- call emergencies 24 hours a day, 7 days a week. This includes mental health professionals and a psychiatric provider for after -hour emergencies. We will provide urgent evaluation of mental health crises to address housing; medications, monitoring, or possible outside referral. Once It is determin} d that an inmate needs the highest level of mental health intervention, Le. a psychiatrist, this referral will be made. The inmate will be seen in a timely fashion appropriate for their clinical situation, Psychiatric evaluations will be thorough and per armed in accordance with state, community and NCCIICstandards. Documentation of the assessmentwill su{ port the diagnosis, treatment„ and any confinement necessary for prevention of harm to self or others: NaphCare has a corporate level peer review process that routinely evaluates the quality and consistency of documentation of psychiatrists and inentai health professionals throughout our system. We have extensive policies and procedures in place to deal with mental heath issues, whether they are routine or critical. We will coordinate with facility leadership, when needed, for issues related to housing, monitoring, or other operational concerns. NaphCare operates a robust mental health train ing program for all healthcare and correctional staff, This will focus on many aspects of dealing with mental health inmates including: suicide prevention, mental health crisis interventions, and mental health referrals. Chronic Mental Health Care Inmates with chronic mental health care Issues will be enrolled In the Mental Health Chronic Care Clinic. This meets and/or exceeds NCCHC and ACAstandards formanitoring. Inmates are tracked within the system and this ensures they are seen at a minimum of every 90 days (more' often If clinically indicated). Individualized treatment plans are farmed and implemented. Suicide Pr°eventlan Plan NaphCare uses a Suicide Prevention Plan that Is consistent with NCCHC and ACAstandards at all facilities. Suicide prevention is a key component to any correctional mental health program, bur proactive approach has helped us to achieve a suicide rate that is far below the national average. we work closely with corrections stiff to maintain clear and consistent communication Inmate medical Services. Oily of Santa Aria. 25H -51 II No-14-034 48 in dealing with suicidal Inmates, We have specific policies and procedures in glace with the goal being to reduce the potentialforsuiclde, minimize harm when attempts occur, and to minimize the number of suicide completions. The key components of the plan are as follows: Staff Training — intensive training of all medical, mental health; and correctional staff on: • Signs and symptoms to recognize • Risk Factors • Management of suicidal Inmates • Review of policies and procedures In dealing with suicidal inmates • Ongoing training and annual review of training to keep up to date Screening and Identification of High Risk Inmates • Most suicide attempts occur soon after incarceration, so proactive and thorough assessment through the Receiving and Mental Health Screens is vital and is also the cornerstone of NaphCare's proactive approach, • ,alerts in TechCare °' assist the evaluator In declsion making and notifying corrections and mental health personnel of an inmate In need of urgent services, Referral, Evaluation, Housing o Inmates at risk of suicide are quickly referred to appropriate housing and mental health services. q They will be placed on:Suicide Watch (described below) in appropriate housing located within the facility and will he monitored as clinically indicated based on their level of acuity, o once discharged from watch they remain in the mental health caseload and have regularfollow up until released from custody. « Review of Policies and Procedures a At the onset of the contract we will review current policies and procedures, work with correctional staff and tailor a program that fits the needs of the facility. All pollcles and procedures will be reviewed regularly to keep them up to date, o Staff will be trained forany changes that occur. Effective Communication Clear and consistent communication among all parties — corrections, medical, mental health, and inmates- is vital to the success of the prevention plan,. o Our CQ:I program monitors and provides feedback to ensure success of the plan; Critical Incident Review a Morbidity and Mortality Committee reviews occur both locally and at the corporate level. They analyze and review critical incidents and develop corrective actions plans when necessary. o The committee is made up of clinical, administrative, and legal personnel. o The site receives and implements the action plan and provides feedback to the corporate level. Inmate Medical Services City of Santa Ana 25H -52 REP No. 14.034 449 r x pr x Critical Incident Debriefing —Any staff who have been negatively affected by the self•harni or sulridal act will be provided assistance by trained mental health professionals in a timely manner NaphCare has specific policies and procedures that comply with NCCHC standards for inmates placed on Suicide Watch (SW). TechCore' plays an important role here also for both administrative and clinical staff. There are built in Suld rle Care Plans that assist in tracking, managing, and documenting Inmates on Suicide Watch. Any in mate who has been determined to be a suicide risk wI[I be placed on Suicide Watch and kept under close observation undI removed from this watch by qualified mental health personnel. NaphCare will not use other inmates to substitute for staff in supervising suicidaI Inmates, Continuous Qua]lty I mpruveinertt (CQl) NaphCare is invested In COI, and we have an aggressive CCd program that conducts regular reviews of every site to identify opportunities for improvement and develop corrective action plans. Areas that are frequently reviewed are: • Timeliness of referral for mental health evaluation (MHE} If receiving or mental health screens were positive • Timeliness of referral to higher level mental health professlonals if MHE is positive • Suicide prevention policy compliance Emergency mental health responses r discharge planning Mental flealth Leadership NaphCare takes pride in truly being a partnerto our contracted clients. OurJ'all Operations Team is made up of farmer clinicians who are Involved in the day-to-day processes at our sites. They maintain open communications with their sites -both corrections leadership and ourown on site medical leadership. We are invested in makingsure that all parties involved are satisfied with how the programs are running and that appropriate and high quality care is being delivered. As You will see below, fir. Bonner is both our Medical Director and our Chief Psychiatrist. He maintains activeconimuncaticn with all providers through regularly occurring meetings In order to continuously monitor the status of each site, He is constantly available to any provider who needs clinical input, and works closely with all of our Jail Operations Team V ice P residents to assist with administrative issues as well. NaphCare's Corporate Mental Health Team • Dr. Steven Bonner, Corporate Medical Director and Chief Psychiatrist — Provides clinical support and oversight for all mental health programs and all providers in NaphCare facilities. He serves on multiple corporate level committees including Pharmacy and Therapeutics and Morbidity and Mortality. He is also responsible for psycNatric peer review evaluations. Dr, Bonner is a Telepsychiatryprov €der within our system and in this way provides direct patient care as well as back -up support for our mental health programs. He has been in clinical practice for 15 years. • Marsha Burgess CRNP, Director of Clinical Services — Provides clinical support for all mental health programs and providers in NaphCare facilities. She also works with the NaphCare Inmate Medical Services RFP No, 14 -034 City of Santa Asia so 25H -53 your uWnp tdoM hw&kv. ndlwea pharmacyto help with medication verification processes. she serves on the Morbidity and Mortality committee. She Is responsible for reviewing Receiving Screens and Mental Health Screens to assure delivery of appropriate services in a timelyfashion.Sirewill participate in CC1J activities. She Is a Telepsychiatry p oviderwithin our system and provides direct patient care and back up support for our mental health programs. She has beep a clinical N for 16 years: Tracle Platt RN, Corporate psychiatric RN — Performs reviews of Receiving Screens, Mental Heatth Screens, and Mental Health Evaluations to ensure delivery of appropriate services in a timely fashion. She Is ourhalson between the corporate office and our'on• site Mental Health Directors. Mrs. Platt has great experience in creating training modules and is implementing and updating new mental health training modules for both our employees and correctional staff. she has peen in clinical practice for is years, b. A licensed mental health specialist will he available on -site four (4) hours per week when needed.. c. All health care staff will be properly trained on the symptoms and treatment of the inmates who are at risk or suicidal and/or homicidal acts, Suicide Ptvveartion Training We providesuiclde prevention training to all oil -sRecorrectionaIand Medial staff employees who regularly interactwith initiates. Staff undergoes an 8-hour initial training that includes the following topics; • Signs and symptomxof predisposing factors of potentially suicidal inmates • Risk factors In the, evaluation of suicide potential • Management ofsviddal inmates • Review of institutional procedures regarding suicide prevention We provide annual updates and additional training to keep all staff aware of changes in suicide policies and to update staff on the latest advances in the care of suicidal inmates. d. NaphCare has and will implement detailed policies and procedures for the on -site treatment and handling of these inmates. Policy and procedures will be coordinated with the Jail Administrator or designee: We have provided our complete policy and procedure for Suicide Prevention in the Appendfx: Our policy and procedure complies with NCCHC Standard 1 -C - 05. 1Q, Medical Records Management a. NaphCare acknowledges that the SA) is the sole owner of all inmate medical records. Ownership and Access to EMR Data In the event that leadership decides to switch healthcare vendors, NaphCare provides clients with the option to continue the use of TechCorelm or to transfer electronic records from rechCoreT* to another EMR system. The City of Santa Ana will maintain ownership of ALL EMR DATA throughout and following the contract's end date, upon a Inmate Medical Services RFP No, 14.04 City of Santa Ana 51 25H -54 contract end, we can provide electronic health records to the facility In one of the following three formats: 1. Electronic Bridge; NEpliCare can provide the SAJ or the Incoming provider with access to an electronic bridge for secure data transfer from N a phCare's EMR to another software system selected by the facil Ky. 4 Purchase Ol NaphCare, at its discretion, can provide the SAJ with An EMR Service Agreement that provides usage rights and support for the TechCare'" application even without NaphCare providing comprehensive services, 3. Paper Export: NaphCare can provide a paper-based export of medical records as reques ted. b. NaphCare will be responsVe for the maintenance and retention of a complete, standardized medical record for all Inmates in accordance with p revall Ing medical regulation for confidentially, retention, and access. c. NaphCare has established and Will implement policies and procedures regarding Inmate medical files and access subject to the approval of the Jail Administrator or designee.. Access/Disclosure We understand the Importance of ensuring security and privacy in the protection of inmate records as well as restricting unauthorized user access to these records. TeChCoreTM Controls; access to and within the system at multiple levels (User, Role, Patient and Chart Section / Areasthrough a consistent method of identification and authentication of all users in accordance with the NISI developed, Role Based Accass Control (RBAC),standard. Examples include the following. • if doctors are the only users who are allowedto prescribe medications, then no user Role except for Doctors have access to the Drug Order section of TechCaiv-T", • If policy restricts access to the charts of family members, User X can be restricted completely from their brother's entire chart • Users such as Security Technicians should never view Plil, so their Role can he set to only access the Reports section of TechCare'� The role Administrative Assl5tanis can be granted view only access to TechCare'" for Quality Assurance purposes. d. NaphCare will provide our correctional- specific electronic medical records (EMR) system, TechCarel", at ourtost to satisfy this requirement. TschCore" is compatible with SATs existing Jail management system (ATIMS), e: NaphCare will adhere to HIPAA standards and requirements. NaphCare upholds HIPAA compliance and 15 supported by tool's such as rechCurem" TechCure" maintains centralized, secure storage of Inmate Information with processes and procedures automated to protect data. Inmate Medical Services City o r, S anta An a 25H-55 RrP No. 14-084 52 TECIICARE- ,NAPRCARE'S ELECTRONIC I MEDICAL RECORDS SYSTEM NaphCare's Proactive Care Motel is delivered by Quality People, Quality Processes, and Quality Systemsworkingin unity.An Integral part of this model is NaphCare 's comprehensive electronic medical record (EMRl system, TechCrarvm* Beyond providing electronic medical records „TechCore' Isacorrect( tans- specifir operational system that automates, standardizes, and enforces proactive Inmate care It also connects NaphCare, our on -site staff, and our clients I n a waythatno other system ran, providing on- demand, transparent information and communication regarding healthcare services. TechCarem is currently functional at ALL of NaphCaWs client facilities, and we guarantee that (twill be fully implemented andoperationalon day one of the contract. NaphCare will install the system, preload data, and train all users on TechCare`. We encourage the5ants Ana Jail to contact our referencesto gauge their level of satisfaction and our ability to deliver on our EM implementation timeframes and promises. A Contprehen0ve System Most correctional healthcare providers propose to use an ElMR system. with NaphCare, you receive a more advanced, proven, and comprehensive operating system tailored specifically to the needs of the SAL Electronic records are one of TeChCare'S many features, but there is much more. TechCnre ", is NaphCare's operational system and helps NaphCare to be the best provider of correctional healthcare possible, It tracks the healthcare activities of each inmate upon incarceration, creating standardized treatment processes (with the appropriate documentation) from intake through discharge. it identifies inmates` critical medical needs and ensures timely intervention with appropriate care. TechCara� includes the following components: .. • Electronic Medical Records • Customizable Reports Off -site Medical Scheduling CIwA•Ar Detoxification Tirol Chronic Care Management Crlevance Tracking Quality assurance Screening Tools (Intake, TB, Mental Healthl Dental (Screening, Evaluation) t Mental Health (Screening, Evaluation, Suicide Alerts) F Pharmacy {Electronic Drug orders, Electronic Medication Administration Records) Off -Site Medical Services Tracking Discharge /Re -Entry Support and Documentation • Transfer Support and Documentation for inmates r interface Connections with Ancillary Services :(X -Ray,. Laboratory) &.ATIMSJM5 Medication Administration Record /£Iectro is Medication Administration Record Sick Call Flags * Queues/dashboards (doctor, Nurse, Pharmacy) Alerts Detailed, Compliance Supporting, Lagging inmate Medical - services. City of Santa Ana 25H -56 RFP No 14-034 53 y TechCore° was designed by correctional healthcare professionals, not software developers, and it makes providing excellent care faster, not slower. TechCorew training is also provided by correctional healthcare providers, and this helps to make the daily experience of using TechCore"' easier, Dedicated IT Team TechCare'" is the only proprietary EMR system offered by a correctional healthcare company, While others use third- party software companies that do not understand corrections, TechCare'" Is managed and maintained In -house with our full -time developers and clinically trained support teach. As a result, the SAJ will receive dedicated service and support from curtechnology experts, whose goal Is to understand your site and customize TechCarem to meet your specific needs. We provide instant customizations, fast support, and complete understanding of correctional healthcare; wecommit to never outsourcing this critical puce of your healthcare operation, Tech Care' Advantages forth Santa Ana fall * Fully Customiz able— TechCore" is highly versatile and Maintains nationwide standard levels of interoperability, ensuring continuity of care across other electronic systems, It Is custom- built to meet aI] correctional healthcare accreditation standards and the SATs unique needs. RTIFIfD * a NC Meaningful Vse Certified system —N a ph care is proud to state that TechCerre" nSmunwilaI a achieved certification by the Certification Commiss €on for Health info rmation Tech no logy (CCH€T+C)rt an € NC -ACB, In accordance with the applicable 2011 certif€catle n criteda adopted by the Secretary of Health and Human ServIces. furthermore, we anticipate completion of the 201:4 certification process for TechCore'" by August 21314. • MIPAA Ccermilance- NaphCare upholds HIPAA compliance and Is supported by tools such as rechCare' ". TechCare"" maintains centralized, secure storage of Inmate information with processes and procedures automated to protect data. • Large -Scale Capacity - TechGarelis used to successfully managethousands.of Inmates, €t is more than capable of handling all intakes and medical records that exist at the5Ai and is able to grow as needed. Electronic Teacking of On and tiff Site Appointments -- Techcorel features a robust scheduling system to manage all off site appointments and on site clinics. The system provides Information on any Inmate and their medical services, as well as allows the viewing and printing of medical records for each appointment or medical service provided. 6y tracking off -site care, we can analyze trends to save on future tosts. Inmate Medical Services City at Santa Ana; 25H -57 CONTRAcr AccompusinvENT Clark County realized a 27% reducttgn in off -site casts with thouse of fVaph Care'S prooctiVe care modelin conjunction with the Te(hCom "'system, Clark CnrrrtyDetendo Center, NV RFP No, 14-D34 54 yGUr Sndippenctohl9rvullM1inr�ehcxer, Automatic Scheduling —Once an inmate is registered In Tec,hCarem, the system automatically schedules all medical encounters, including but not limited to, mental health screenings and evaluations, follow -up exams, chronic care clinics, and physician appointments. Medical staff are also kept up-to-date and alerted to any potential health concerns of each Inmate. Contract Monitor Access t oTechcare "' If your site has a Contract Monitor or outside auditing team, this team or the Contract Monitor will have access to off -site referral data during the terse of the agreement in order to monitor:contract compliance. This data is readily available in a web -based format that can he viewed instantly. The Contract Monitor is notified of all inmates who are receiving off -site care,. + 2014 ACA Ready — As an ONC- certified l_MR, TechCare' is fullycompatible with State Health Information Exchanges and State Medicaid systems across the country. We will implement connectivity to these systems for the SAl in order to support greater continuity of care for your Inmates, + Ease of Use— TechCore "' was designed by correctional health clinicians, not software developers.. Itwas developed on the basis of improving care while reducing risk 7'echCore'" makes providing care In correctional institutions faster, more efficient, and more accurate, Proven System — TechCore- has been chosen to manage healthcare services at some of the largest self-op Correctional systems in the country. It was selected by two of the five largest counties in the country — Orange County, California, and Maricopa County, Arizona. Fully Implemented in these self -op correctional systems, 7echCa €er" is more than a technology initiative — it's a proven system, �3 Risk Man at ernant and Quality Assurance TechCorel° provides the highest level ofquality assurance and risk management for your correctional facility. it not only maintaim consistent, iron -clad documentation, but also tracks all healthcare encounters (on -site and off -site) and allows NaphCare to constantly monitor for any irregularities and improve care. Standards and Certifications— TechCare '"meets or exceeds all NCCHC, ACA, and IMQcertification requirements, which will allow the SAl to achieve these certificatidnsas a correctional institution. Our client facilities across the country have used TechCare!" counties$ times to meetthese accreditations, CONTRACT ACCOMPLISHMENT Sujfotk County, Massachusetts ochieved a 100% score during d recent Mossachausei" is DOC Survey in addition to passing a NCCHCaudit in the some your. The use ofTech Cc re"" was a major factor in both assessments. Strict 0ocnmentation— TechCore' has a solid platform for quality charting that ensures detailed logging and documentation without loopholes, thereby supporting chart audit and litigation activities seamlessly and lnstantly. i t r Inmate Medical Services RFP No 14.034 City of Santa Are 55 25H -58 Meaningful Reporting &Tracking —Tech Carew provides centralized storage for data that can be easily aggregated and reported using built -ir search tools. In addition, this data can be used to trackaspects of inmate care, i.e. checking that all inmates with hypertension have completed a chronic care management encounter within the last six months. These activities assure quality of care and provide detailed documentation. Staffing Management — TechCrrre`s built -in tools help our professionals manage staffing requirements and make more efficient decisions to reduce clerical time, increase clinical rare, and Improve the quality of care. Alerts & Dashboards -- 7"echCore "* alerts on -site healthcare professionals and corporate leadership of inmate quality assurance exceptions. Simply put, our system sends warnings to the charge nurse when inmate care parameters are out of bounds.. CONTRACT AcCtf NIPLI SHMENT Pvtarrcopa County, Arizona received ra 2013 recognition from the National, Association of ` Counties for their electronic receiving screening, which was noted to "rapldiy identify patients in need, retrieve past screening information, ruare effectively triage patients in psychlcstric crlsls, and initiate medication verification instantly." TechCure°" is the ENlis system employed by Maricopa County and is the system behind this award. Centralized Care ,TechCoreTM maintains nationwide standard levels of interoperability and provides centralized storagefdr all inmate healthcareactivites. Naphcare interfaces, or connects, TechCofa`�to a numberof different systems that allow the SAJ and our team members to have a full view of an inmate's medical data, Examples of interfaces that NaphCare will setup include thefollowirig. Jail Management Systerm TechCore'" builds upon the existing system of inmate demographic files that are currently maintained by the Jail management: system OlvlSL ATIR Z. We will implement a bi- directional, real time interface with ATIMS to gatherthis information in addition to }letting instantly updated on inmate locations and movement, Inmate Medical. Services, RFP fin. 14.034 City of Santa Ana 56 25H -59 to System: We haves uccessfuIly Interfaced with the follow IngIaboratoryvendors: i3ioReference, i.abCorp and Quest 6lagnostics, In addition to state and local services like thosewhich Santa Ana utilizes: We will create an electronic bridge between the $AI`s lab vendor and TechCare`", allowing an inmate's laboratory results to be viewed Instantly. Having a direct link between the lab vendor and our EMIR allows us to instantly alert the physician of critical lab values through physician dashboards. Pharmaev; NephOre will provide end -to -end medication ordering, management, and administration by interfacing with the SAJ's pharmacy vendor, waving a direct link between the pharmacy vendor and our EIVIR allows for seamless order placement, filling, and distribution without paper or manual processes prone to error. + AddltJOnal Internal Systems: — Dlagmosticm: Integrated access to add -on systems (i.e. radiologyl — Mosk: Sick call request submission and resolution documentation — Food Service: Diets, allergies, etc, communicated automatically Pub csystems:: - Health Information Exchange. iSatherJnmates "free - world" medical history — Hospitals and Off -Site Providers: Maintain documentation for off -site encounters — State Medicaid: Verification and eligibility for off -site encounters Reliability and Support TechCore' is only as goad as the team that backs It NaphCare realizes this and has built a robust IT operations groupthat completely Implements and manages the IT resources needed forthe TechCoreW operational system,,, We place NO repulrements on the 6APs IT resources or personnel while implementing the necessary Infrastructure to run TechCare"", Computers, Servers etc. -NaphCare will provide ail hardware and configuration services at NO additional cost. We have a team of highly trained individuals that are strictly dedicated to installing and supporting jail IT system infrastructure: We will not put additional strain on your IT departmentand will work as a filly dedicated unit toImplem eat these rvers, computers, and networking systems that are needed for fieci Cdrel to run efficiently. 24/7 Support- Naphcare maintains an In- house, 24/7/365 IT Helpdesk Team. if Inmate care is impacted or jobs are made any more difficult, by poor - performing IT resources, we are thereto correct it. To ensure a strong and prompt response to issues, NaphCare guarantees a strict service Level Agreement (SLA) with our response times averaging 15 minutes, no matterthe time of day. No other correctional EM can do this, nor do they have the dedicated ITSUpport needed to keepzhe infrastructure and application at peak performance. We regularly test these scenarios and have seen Tech Core"" perform flawlessly countless times. Redundant System, Always On - TechCore " is designed for correctional facilities and will continue to operate when other Elk Rs cannot, As the following diagram outlines, NaphCare installs redundant servers and redundant network /Internet connections at yourfacility that support an automated follover system. In the event that local resources become unavailable, the application will redirect to servers at mphcare`s corporate dataccnter; Inmate Medical services City of Santa Ana 25H -60 RFP No, 14-034 57 TechC areue " Hybrid - Claud Infrastructure our redundant systems & data backup process, using the cloud, ensures that critical healthcare Information is always available to the Santa Ana JaiL Redundant Setwrs & AIetwor# Data stored ot factilty and NoghCore DoNcenter Real !Time Replicalla n With 2417 Monitoring & Support fraam our iT ex&erls taatr�usttsesktunstTa6larc mFdn'rGd #ion son Ika n &tks5ed "Or times via. oesktop/taptac�a'iabtet, even dt6consectad from the tretm -k: N"lictirs Our Claud Nkatenter do tneauni ON hapheate Cnrparatre, where we ensure Mat yDrican atum lel4rrha #tan at Oil times by way of redum nit '� �n 8nternet ccsnarerttdtts: Orange County, California aatdates NaphCaare "s 7echCoreTM EA4R system m conjunction with NaphCare's Hybrid Cloud solution to ensure they are always up and running. NaphCure will deploy the saline exact, robust system for Santa Anti to make sure medical care is never sacrificed clue to paver, network, or Internet Issues. Inmate Medical Services RrP Na 14.034 City of Santa Ana a$ 25H -61 r a. When Hurricane Ike struck the coast of Texas in 2008, it °hlrsphCare client faculty had to completely mobilize and move off site, The TechC afa' oppllcdtion arrd infrastructure, managed by ✓~iaphCore, remained fullyoperational, All medIcol activities and documentation continued without network. connectivity. Moving to rechCare" NaphCare`s Implementation Team Is experienced in successfully transit oningcorrectional facilities to TechConeTM and has a 100% success rate for complete implementation by -one of the contract, our approach includes two areas of focus: (t) trainingteam members, and (2) pre - loading inmate data. Training NaphCare has a unique approach to training usemon the TechCrlrell system. Ratherthari assigning software developers to train on 'software.' we send Naphcare clinical staff on -site to train on inmate care. This peer to peer approach utilizing RNs, LPNs, and MDs better equips stiff for their primaryjob of caring for inmates while using technology to be more efficient, Ultimately, staff members become more comfortable with the system faster and understand its correct usage as It relates to their particular job. CU NTRAcT AccOm P USH M E NT In Orange County, Colifornia, NophCare placed 9 RNs, 9 LPN,5; carrel 2 Clinical Software Support' stuff an -site, totaling 20004 hours of preparation and go -live training arid support. Training is more than Just a one -time events NapfiCa2e embraces training as an ongoing process. Suring initial training:, we provide the opportunity for select users to advance their understanding of TechCarew to that of a. Super User. AS TechCoreT" experts, Super Users will provide on- going, pees -to- peer training at 5A1 oatlln The process of moving to 7echCoreTM from paper- based records or lit existing EMIR can be overwhelming. To alleviate this concern, NaphCare corporate staff takes the Bill responsibility of loading and verifying all Information InTechCarel Our TechCore"" Implementation Team and our corporate pharmacy team will load the EMIR with the following information • flealth and Physicals • Sick Call and Off S€te:Appointmen s • Medications + Allergies i TB Reads • Problem Lists & Special Needs • Chronic Care Conditions • Scheduler! Diagnostic Testa [nm;;;e edIca IServices RFP No. 14-434 City of -Santa Ana 59 25H -62 i • Lab and Radiology Data • Mental Health Conditions • Substance Abuse • Special Needs finally, to create a'full history of all inmate health data, NaphCare will perforce a Adata dump° from the previous EMIR system into TechCarel. For paper -based facilities, '€NaphCare staff will utilize the document import feature of TechCrare"" and scan in all active inmate Information, nmkft TechCare'"' is our operatlonaIsystem for providing excellent care, so it Is imperative that the system is fully operational by the contracts tart date, Therefore, the timalinef'orthe' migration begins Open contract award The Implementation processes broken down Into these four phases, commencing on the contract start date. CoNTRAGT AccompusHMENT NaphCare succ€ssfulty completed a migration t f sUff'alk. County within seven days, to barge (tart to our planning, processes, and experience, Phased.- Planning; NaphCare will review the medical record system at the SA) in detail and begin planning the process to convert the formersystemtra %chCare'"", NaphCare will initiate plannngwiththeSA !'s1T department on the network that will be assembled by NaphCare, Finally, we will Initiate contact with all outside application vendors that will deed an interface with TechCare'�. Phase 2- Implementation and Migration; NaphCare will begin the process of integrating all pertinent Inmate Information contained in the prior chart system with TechCore' , The Interfaces needed for TechCure' -will be implemented and tested with the respective vendors arid confirmed for correct operation. The network and computer equipment for all sites will be procured and configured in preparation for the deployment phase, Phase 3 —Training and Deployment; All staff members receive job - specific, on- srte,peer- t€a•peer training on the Tech Care'" system. In addition, staff is made aware of guidelines for medical record documentation and confidentiality requirements for the corrections[ and medical environment. The network infrastructure Is Installed and configured at all of the sites and tested for correct operatior€. The rechCare" custom build for the SAJ is deployed to all the necessary servers and workstations as well, and the pro - loaded inmate information is made available within the system. Phase el— Go -Live: NaphCare will have corporate operations staff on site along with technical support for ITavallable at the site for Go -Live. The development and support team at NaphCare will be dedicated to moultoringthe go-live of the application and ensuring _it runs flawlessly, Staff will stay or) site as long as needed to ensure stability and Inmate care is maintained. Proven Solution We believe that technology creates a better environment In which our staff can focus on hands -on Inmate care, rather than charts and paperwork. NaphCare's correctional EMR system does just that by centralizirsg inmate care Into a highly evolved, proven system that is backed by NaphCare operations, development, and support staff, Inmate Medical Services Cia "j of Santa Ana 25H -63 14-034 60 yaw {nd®Pmded . d4o. Orange County Reference Letter The fallowing letter comes from Kim Pearson, Deputy Agency Director for Orange County Correctional Health Services, and speaks to NaphCare's successful Implementation of TechCare'" for Orange County; Innate MedfcalServices City of Santa Ana 25H -64 REP. No, 14-04 61 June 24, 2014 F 6 4 4. 120M.11 Blom 8 Y 4 4: M, NAPHCARE TECUCARETm To Whom It' May Concern- MARK: A. RUPOVATZ DIRECTOR RICHARD StANCHEZ ASSISTANT DIR PGTOR. KIM'PEARSON DEPUTY AGENOY DIRECTOR CORRECTIONALREAL711 SERVICES R4Al(dNCAIIO EMIT: 4rraw. a'" STREEw° aurraxca SANTA ANA, CA 02701 TELEPRDNR:.(7 #4 }654.6404 F ' V14) 654.6505 a•aaAt�c ks��anca yam Implementation of an Electronic health Record (EHR) is a complex and challenging undertaking, The Orange County health Care Agency (11CA) — Correctional Health Services division (CHS) implemented an EHR within the five, adult jails and five juvenile detention facilities earlier this year.1he facilities Collectively house nearly 7540 adults and juveniles on a typical day. With 14 vendors responding to the original RFP, Orange vendor for this project. Their EHR, Tech�Cm, was dove NaphCare holy understands correctional workflow, chail complexity of our "stem, it was critical we find a systenn provided to our patients, and interlace with multiple sysb current housing and custodv status. dlaimostic results. ms elected NaphCare as our chosen ,cifically for correctional settings. A needs. Uiven the size and g us to accurately record all care iding patient demographics, including administration records, and care The implementation process went as smoothly as one could hope! Personally, I have been involved in several ERR implementations in my 30 -year career, and I can confidently state this was the most well - executed and managed implementation i have experienced. The NaphCare team was incredibly accoramodating ranging from flexibility with on -site staff and super -user training sessions. -- to on -site implementation support-- to immediate troubleshooting during the implementation process. Having NaphCare staff on -site during "go live" was invaluable. Their presence provided great energy, decreased staff anxiety, and provided rapid resolution of staff questions/Concerns. We are currently six months into the project, and the support from the NaphCare team has not wavered, They are as responsive today as they have been throughout the entire process. Their commitment to a successful implementation for Orange County has been exceedingly evident. We truly have a partnership with, NaphCare for many years to come. 25H -65 11, Nutritional Services a. NaphCare, wit be responsible for coordinating with the established food service contractor to ensure the provision of medically necessary clin €caldiets, such as the follouving; i. Cardiac diet ii. Diabetic /caloric controlled diet Ilk Gastric soft dlet IV. Pregnancy diet V. High protem /hlghcalcricdlet A Clear liquid diet vii. Restricted protein. sodium and /or potassium diet b. NaphCare`s staff will evaluate the medical special diet list weekly to determine the necessity of the special diets, c. A report consisting of special diets needs will be generated weekly and submitted to the Security Supervisor. d, Coordination and ordering of special diets will be documented in Inmates' medical files, NaphCare's healthcare providers and staff will work with the Sheriff's office to develop optimal diets to meet the specific nutritional needs of inmates. NaphCare understands these medically necessary diets andlor nutritional supplements (e.g. Ensure) will be provided as medically required and will need to be specifically order by a NaphCare prescribing medical provider based on a diagnosis and nutritional need. NaphCare provides a system for managing the nutritional needs' of Inmates and improving continuity of care We have protocols for the prescription of optimal diets, and our physicians willprescr' the fallowing medical diets when necessary. Information o i lama diets is rocorded within ri tchCar&0 and available for reports and review at any time, inmate Diet Information to TechCoti' 13. Dental Care a. Dental clinics will provide dental care Including x-ray for diagnostic purposes and extractions, Dental clinics Will not be required to provide oral surgery, orthodiontic services or devices. b, NaphCare will provide an on-site dental care program which staffs license dental practitioners a minimum of four (a) hours per week; c. The dental clinic will be staffed and operated on a set schedule, d. NaphCare will provide alt supplies (e.g, dental tools, lead covers, etc,) e. Minimum staffing for the dental clinic will consist of a licensed Dentist and one Ji) dental assistant, f. NaphCare wit] provide oral screening by a dentist or certified dental assistant forall new ICE detainees no laterthan fourteen (14) days from the inmate's date of admission. Inmate medica I: Services City of Sonia Ana 25H -66 RFP No. 62 r , DENTALCARE NaphCare's dental program complies with NCCHC and ACA standards by which inmates reeeive dental treatment, not limited to extractions when the health of the Inmate would otherwise be adversely ,affected, Treatments Include any other services deemed necessary bythe contracted dentist. Additionally, we ensure that inmate's serious dental needs are met following NCCHC standards. We provide dental services in accordance with established guidelines for dental evaluation and treatment, An established priority system is used to guide treatment decisions and proper Infection control procedures are utilized fnrall oral treatment procedures. Documentation Is standardized in the health record to better document dental health conditions and treatment in order to enhance communication among health care staff. Y � f The dental program begins with the receiving screening, administered by a health care professional specifically trained bythe contracted dentist The results of this assessment are relayed to the dentist for review and referral, if indicated. At any time during incarceration an inmate can be referred to the dentist. Treatment services provided by the on-site dentist reflect contracted services identified by the SAI The following screenshot shows the Dental Screening form used In 'rerhCarol": Inmate Medical Services RFP Na, 14 -034 City ❑f Santa Ana 63 25H -67 Dental Screening Forni W a will provide emergency and medically required dental care forinmates with an emphasis on relieving pain and attending to urgent or emergent dental needs. Dental services, except for urgent or emergent rare, are provided during regular clinic hours. Emergency dental services are available on a24 hour a day bas[s. We institute periodic performance measurements to ensure that inmates have timely access to dental care. NaphCare provides the following dental services for Inmates: Health Assessment, which includes a Dental Screening and Hygiene Examination Dental assessments for Inmates who request dental services for urgent/emergent needs Eirtergencyand routine dental care Temporary fillings Inmate Medical Servicos AFP No, 1"34 City of Santa Ana 64 25H-68 E • Incision and drainage • Control ofbleeding • Necessary emergency surgery • Clinically indicated extractions • Referral to dental specialist if needed • Medically necessary dental- related prescriptions Ourservices do not limit dental treatment to extractions. We provide an appropriate and timely response to requests for dental services. Dental emergencies are addressed immediately. Inmates with urgent dental needs are seed at the initial sick call, and we currently fulfill all non- emergent dental requests within 2 weeks or less of the initial sick call. We coordinate appropriate off-site referrals for inmates requiring dental care - outside the capabilities of the facility. All dental services are delivered according to proper universal precaution measures and are documented in the ornate's medical record.' We do riot perform cosmetic dental services. $3. Eye. Care a. NaphCarew €II provide eyeexaminatlons and medically necessary treatment. b. NaphCare understands that the majority of inmates currently housed at Santa Ana ]Bit are either I N.S. or U'5. Marshall and that these contracting agencies are financially responsible for their inmates' approved corrective lenses, NaphCare agrees to obtain approval from the responsible contracting agency priorsupplying corrective lens, 14. Psych Clinic a. NaphCare understands that the Santa Ana 4 1 medical services plan requires NaphCare to provide psychiatric services in the form of one it) psych clmicevery week, and we will comply, b. Each clinic will last no less than four (4) hours, unless there are an insufficient number of patients in need of care. c. Psych clinics will provide a range of services including psych evaluations, counseling and prescription of psychotropic medications: 15. First Aid Kits a. NaphCare will provide one (1) basic first aid sit for each housing module; Intake screening areal booking, laundry and transfer hold, b. Contents of the first kits will comply with NCCNCguidelines: c:. NaphCaro will provide- a fig of required contents to the Jail Administrator. d Monthly inspection of the first aid kits will be conducted by Jail staff, 16. Inmate Complaint/Grievance Procedure a, NaphCare will fallow established Jail policies and procedures for processing and responding to inmate complaints and grievances regarding medical treatment. b. NaphCare will abide ay Jail policies and procedure regarding responses to complaints and grievances, within established policy requirements. NaphCare has developed a fully electronic system for tracking complaints from receipt to resolution, and we will ensure this system complies with SAJ policies and procedures. The following chart shows NaphCam's proposed grievance process for the Std, Inmate Medical Services AFP No. 14.034 City of Santa Arta 65 25H -69 S°AJ Grievances are somme,d! directly into TeoltCatr+eaa `a +Grlevaoe Tracking Modubm 8.4ditalliute Grtevauvw Cate «gory.I Gateroryll Gaamgt'nylll Categoryly Healti3coie DOW, Aaams (kattal CHlp lvfedaualCsav $taf'�E,�wlxa3' WCare Urgent lama W Pr4aettve Gore Model Munn RuefoisaFmvided Gr ➢evallm Trackinit k[ixinlu La Iou mto and L'nwmdITAO C,.amannniaat3uux Twwaiya • Teciaiczov?m generates Tinily grievaaxee roaponse Information for Correctkln ill Nt"ff • "1'ezhcbrvTa emaits da Of grlevanae. report to CfaCtanratO t3 operations Ntdlliantilegal da pal Intent review ttla xmpo rtinr prate" Im prove ore, Fit opporkn a Mrs Inmate medical Service; CI ty of Santa Ana 25H -70 gainlatlppmndeaF hunt�9aa�e cheica. wanned uguryV CAtegory Vt Ca'tagoryAll Fee lsspe Nlonhl Dapgoge� Hoald -T.'m 11 GrSumm i$ilitiitpa Iuea Action TakUr; if Appm rtaW Writtwl F•`MPOnm RFP No, 14-434 66 - -J Our T-echCore"I Grievance Tracker provides automated daily mall notifications to multiple key operations and risk management staff, including our General Counsel, This innovative daily alert features ensures that urgent issues receive immediate attention, from the right people. NaphCare's grievance process begins by ensuring that inmates have an open forum to voice their complaints and that no inmate will be denied = accesstothe grievance process, Our personnel are trained to seek resolution to inmate concerns before they escalate Into grievances, Once an Inmate files a grievance, however, a systematic process is triggered that is fully compliant with all relevant NCCHCguldelines. This process is overseen by our Corporate Medical Director and our Genera[ Counsel. Any grievances that we are unable to successfultyaddresswill be escalated to an appeal process. Below isan outline of our grievance process: • Upon entrance into the SAJ, each Inmate receives information about the grievance procedure and how to file a grievance form. • All Naph care personnel are required to attend training regard ing the grievance procedure. • Inmates with special needs (such as impaired vision, hearing problems, language barriers, etc.) who requestspeclal assistance in completing a grievance form receive assistance, • No inmate will be denied access to the grievance process. • Grievance notification alerts are emailedautomaticallyto key staff daily. + Grievances are reviewed and responded to by healthcare staff daily. Ourgrievance process complies with all relevant NCCHC guidelines, -- tiurgrievance process includes electronic tracking of all medical grievances and concerns, along with our healthcare staff's response: : NaphGare personnel receive ongoing corporate support and education pertaining to grievance management. NapfiCare regularly creates and reviews reports of grievances and their disposition to help identify and resolve problem trends, we do this because we view grievances as an instrument for helping us identify ways to continually improve our care and processes. In keeping with this philosophy, NaphCare prepares a corrective action plan for substantiated grievances. This methodical approach to grievance tracking results In ever - improving patient care, 17.. Exctusinns a, NaphCare will be under no obligations to provide or pay for the following types of servlces. I, cosmetic surgery' ii, Sex change surgery III, Elective vasectomy, tubal ligation, hysterectomy and other elective care, which for file purposes of this contract shall mean care which It not provided would not cause the inmate's health to deteriorate or cause definite harm to the inmate's well - being. iv, Care, treatment or surgery determined to he experimental in accordance with accepted medical standard's v. Neonatal or newborn care (prenatal and obstetric•services: Mall he provided when required) vi. Contraceptive devices and medications, Inmate Medical Services RFP No, 14 -034 City of Santa Ana 67 25H -71 D. OFF -SITE REFERRALS TO PREFERRED PROVIDERS 1. NaphCare will determine the medical necessityofall calf - site medical services and abtamapproval from the responsible contract agency. UTILIZATION MANAGEMENT NaphCare takes correctional utilization Management to a new level try reviewing all aff -site services, When off -site care Is required, NaphCare°s utilization team collaborates daily with health services staff and off -site providers to ensure: appropriate usage of healthcare services. Always watchful, NaphCare Is poised to adjust to each clay's demands. We review all cases prospectively; ER visits retrospectively; and hospitallzationseancurrently, ensuring the correct allocation ofoff -site services for our clients NaptiCare's experienced Utilization Management nurses are trained to monitor off -site services allowing them to determine the hest possible outcome for patients, healthcare providers, and correctional facilities. Utilization Management Philosophy ✓ Supportive team approach ✓ Optimum customer service through professional and accurate communication V Decisions based on clinical knowledge, expertise, criteria guidelines NaphCare realizes that high duality care does not have to be expensive; expensive care does not guarantee high quality; and preventive care saves money long-term. Our Utilization Management program follows a simple formule; match intensity of service with severity of Illness, We consider the following factors during the review process: • Medical necessity using Miffirnon criteria • Appropriateness and efflclencyo €medical services, procedures, and facilities on all requests • off -site service delivery -- inpatient and outpatient setting • Length of stay using Mhfi'mancriteria • Maximization of on -site infirmary capabilities • Care consistent with community standards, contractual, or legal mandates • Coordination ofon-siteandiaffsitecare — eliminates duplication of services LIM and Off.-slte Requests information needed to determine approval or deferral of services is available within TechCore' allowing NaphCare's nurses to make reliable and informed decisions in a timely manner. The following screenshat shows an off -site request in TechCare" ". Inmate INedical SGr-v ces RFP No. 1,"34 City of Santa Jana 68 25H -72 Off -site Request In TechCare'" inmate Tracicing through the UM Process We use TachCarrelwto track all off -site requests throughout the Utilization ivtanagamentprocess, On average, NaphCsre "s corporate Utilization Management nursesreview afPaite requests in less than one day, and when appropriate, approve requests. Requests refereed to the physician are reviewed within one business day, The average time frame for approved service schedulingwith community based providers is one day; Emergency cases are Immediately referred off -site and are reviewed retrospectively. For continuity of care, the Health Servlces Admini5tratoror designee svbmits a notifloatlon immediately. Upon return from an emergency room visit, including psychiatric visits, the appropriate Advanced Clinical provider or designated staff will seethe inmate, review the discharge irrformatlan' and treatment recommendations, and issue follow up orders as clinically Indicated. Documentation of ER visits Is tracked and monitored via 1'echCfara* to identify outliers and further ensure continuity of care. At NaphCare, our goal Is to provide inmates with the care they need when they need it; rare is not delayed within our Utiliratlon Management process'. In most cases, NaphCare completes the process —from the time of the Initial request to the scheduling of the appointment —in less than two days; Inmate Medical5ervlces City of Santa Rna 25H -73 RFP Nm 14-034 69 COMMON Utilization Management Key Interactive Components We control oasts by perforuing the fallowing types of revlew: 1. PROSPECTIVER €VIEW - Occursprlor to delivery of Outcomes May Include care and establishes medical necessity, ensuring appropriate and cost- effective care within the correct tirneframe. The following services are V Request for additional reviewed for all requests: information for proper • Hospitalizations -- scheduled inpatient and determination observation V Nurse or physician review • Outpatient surgical or non- surgical ✓ Nurse or physician approval procedures v' Alternate plan of care • Specialty office visits and procedures • Diagnostics,' durable medical equipment and prosthetics • Course of outpatient#reatment—physical therapy, dialysis, chemo, radiation NapfiCare's site Medical Director, designated site staff, Chief Medical officer or designee, and a dedicated utillaatfan nurse review and discuss proposed non -emergent Services to determine the most appropriate and medically sound approach to care. Resulting outcomes and planned courses of action are shared with the site Medical Director or designee and progress notes are documented In TechCcre' ". Prospective review can produce multiple outcomes, all of which are tracked by TechCrxren; In our approach to correctional UR, we do not Use the germ "denial," but rather, discuss the case physician -to- physician and develop alternate plans of care. Our UR process takes less than 24 hours on routine cases when all necessary clinical information is provided. Requestsfor care within 14 days are reviewed and processed the same business day. High Acuity Notifications, NaphCare's Utilization and Case Management team closelyrnonitprs Inmates diagnosed with chronic and complex illness, TechCarev' aids staff In this process by tracking the number of off•slte visits byway of a watch list. Inmate acuity level Is based on the severity of illness and subsequent off-site treatments. when our nurse anticipates that an Inmate's, care will require a wide range of resources, multiple off -site trips, at extended hospitalizations and treatments, a high acuity notification is sent to the Captain and appropriate jail personnel, hlaphCare ensures that high acuity Inmates are closely monitored, which reduces readmission, prolonged length of stay, and repeat surgery, as well as other medical expenses. Pre.Procedure Instructions to, Inmates^ With the goal of educating inmates on scheduled procedures, NaphCare's clinical support staff provides Inmates with medical instructions and information prior to these procedures,Thraugli this process, inmates receive evidence - based answers to clinical questions at the point of care. Informed of their procedures, Inmates are prepared to ask questions and engage in convey Inmate modlcal Services Citytrf Santa 'Ana 25H -74 fly following ourpvficfes we orc able to shorten the length of stray, preserve quality of core, and enhance d{schorge pionninq for return to the f'cactlfty. satlnns with clinical staff regarding course of RFP Na, 14� 34 70 saga �!daPagdanrasaNkmoe Chefoa. treatment. Inmates have the tools necessary to improve treatment prognosis and minimize recidivism through self-care. 2. CONCURRENT REVMW— Bogirui immediately after admission and continues thneughoot hospital stay, ensuring that an appropriate treatment plan, efficient delivery of services, and timely preparation for discharge are established. For health concerns requiring inpatient admission, Utilization Management nurses retrain In daily contact with hospital case managers and the attending physician to ensure that the length of stay is no longer than medically appropriate. Regular communication helps NaphCare develop appropriate discharge plans and maximize on -site infirmary capabilities, 3. RETROSPECTIVE REVIEW— Occurs on all ER trips and for any questions or concerns that may arise regarding the quality and appropriateness of an inmate's care. As part of our quality initiative, our UR nurses and Chief Medical Officer review all emergency'room visits and monitor the site Medical Director's appropriate use of the on -site facilities: Case Matiagienient NaphCare provides Case Managemenand Utilization Review efforts for hospitalized Inmates, We recognize thevalue of on -site nurses in the facilitation of care in the hospltal setting, our nurses are dedicated to and have extensive expertise In the above areas Responsibilitiesfaron -site nurses in the hospital setting'inicude the following..; * Assistance with direct admissions— prevents lengthy & costly emergency room visits • Discharge planning — ensures that all medical needs are met prior to discharge • Increased communication between medical disciplines during complex hospital stays • Esta€ 3fi shmentot collaborative long & short term goals for treatment • Discharge planning —use of formulary drugs • Optimization of infirmary beds — ensures proper assignment& level of care for inmates NaphCare's discharge and release team has the off-site healthcare experlence: needed to best meet Inmates' needs. At the onset of care for each hospitalization, our UM nurses prepare a customized plan. N'aphCare's °nurses are well informed of all available infirmary services and health service units within the priion system, as well as community resources in your rogtori, allowing our personnetto optimize Internal resources while simultaneously minimizing off -site trips. Utilization Management Quality l iitiativ s NaphCare's Utilization Management Depaiimentconducts arnonthly Utilization Management Committee Meeting to identify and implement quality Inititatives such as the readmission review process. Research Is performed and shared with the committee, resulting in Implementation of quality Improvement processes, When necessary, cases are referred back to the Chief Medical Officer for peer review and further recommendations quality improvement. Utilization Management education is an ongoing process throughout the life of the contract. Utilization Management Reports NaphCare has unlimited reporting capabilities based on the data captured in TechCore'. We analyze costs, trends, and provide reports in any format you request. €n addition to providing the above services, inmate Medical Services RFp No. 14 -034 City of Santa Ana. 71 . 25H -75 .yaw' indtiVend hm�i3r.: rn we study statistics that aid you In improving your utilization of off -site care. Our sophisticated reporting capabilities, combined with ourstrong correctional operations experience, creates highly satisfied clients. NaphCare offers: • Daily Hospitalization Report— inc €udingadmissions by diagnosis (DRC) & length of stay • Detailed 'monthly Lit! lizatcrireport— Including detailed time frames for each process of the review a.. Inpatient & outpatient statistical report —by service and location • Specialty servlces—consults; procedures, and diagnostic services • ER trips -by service and location • Utilization Review —by disease classification • Reports of ail catastrophic claims incur red -°any amount greater than $25,000 CENTRALIZED MEDICAL SCHEDULING We will coordinate off -site appointments through the Medical Scheduling Department at our corporate ofCcefortheSAJ. By using the secu re, web-based application, we facilitate the exchange of important healthcare and financial Information between the correctional facility and NaphCare. Casto Ifed Reporting Ability to track inmate healthcare (off -site specialty appointment, by type) Etoptronfel�itddrsyst�tn Ability to view all off -site appointments and on -site clinics ry Inptonf stay s€a�us View and print medical records foroff -site appointments lttforiY atlon backei`forsettirltvto stiiettuletraitspi itat3ast of irirm uss An Organized and Efficient Process Our process for off -site requests ensures seamless preparation and performance of Inmate off -site care. From our central office, our expert Medical Scheduling Department organizes and executes every step of the process with the priority on full communication and cooperation for the most organized, cr st- effrcient, and safe results. Approved requests are sent to the Medical Scheduling Department where they schedule the appointrment, noting such details as inmate insurance and special instructionst Appointments classified as urgent, wlthin 14 bays, or wit bin 30, 60, and 90 days, We understand the issue of and appointment requests are addressed and scheduled within the required time frames, security and transportation The Medical Scheduling department generates and maintains an off -site calendar of appointments that is visible to any atithorized on -site personnel and security officers An example of our Off-site Calendar that 15 used to summarize off -site scheduled appointments is shown here. costs, so we work closely with custody to group and consolidate patient transfers, Inmate Medical. Services RFP NQ. 14-034 City of Santa Ana 72 25H -76 Off -site Calendar An Of Asite Referral form is completed for inmates who require spec €alty care services. This firm accompanies the inmate during transport from the correctional facility to the providerfor treatment: Mach off site referral results In a consultation /treatment report created by the off-site provider, which Is reviewed and filed in the inmate's medical record. in addition to the vast functionality that exists within the calendar and scheduling system, NaphCere has the ability to track and trend all cancelled appointments. Missed or cancelled appointments ire often unavoidable, but they create a drain on facility resources. Our goal is to work wltheach client to minimize cancellations whenever possible. We record every cancelled appointment with the following information so we can track and trend the data to reduce cancellations and ensure new appointments are scheduled. • Inmate naive, Date of Birth, Inmate Number • Original date ofservice • Who cancelled the appointment • Why the appointment was cancelled — inmate released from custody, refused treatment, security issues, provider cancelled, or other reasons Inmate Medical Services. City of Santa Arta 25H -77 RFPNo 14 -4334 73 2. NaphCare will ensure that each off -site referral to a preferred provider results Ina legible consuitation /treatment report in the Inmate's medical record within forty -eight (48) hours of the appointment. MEDICAL, RECORDS DEPARTMENT Our Medical Records Department supports NaphCare's coordination of off -site services for the SAl On behalf of the Jail, we will obtain copies of all diagnosis, treatments, treatment plans,: final medical records, discharge summaryes, and other information related to the off -site referral in a very timely manner. Our Medical Records Department has direct access to many hospital's t:MR systems (where they exist and appropriate access has been grunted) to obtain records Immediately upon completion of service which greatly adds to the continuity of care of the inmates. Responsible ]Poll ow-Up I n dlvid ua is returni ng to the correctional facility fo llow l ng off-site treatment encounters return with documentation of the treatment received, in the form of a discharge summary, consult follow -up or other progress note. A registered nurse evaluates all patients returning from an Inpatient hospital stay prior to place merttInthegeneral population, These lnmates also see anon-site provider as too nas possible to ensure appropriate orders and follow -tip. a When the records are received,they are filed In the inmate's electronic health record in Techcore&' Appropriate personnel can view medical records and print a hard copy for each appointment or medical service provided. As a quality assurance measure, the records also stay on the s €te Medical Director's TechCare` 'Doctor's Queue` until they are reviewed by the ordering physician. This service greatly aids continuity of care and the ease with which services are coordinated, In addition, the timely distribution of hospital reports, discharge summaries, and consult reports ensures complance with program review - requirements. our medical Record Department is also available to assist you in securing medical records for care that Is delivered In the community prior to incarceration. Determining the appropriate course of treatment inside the facility is difficult if current outside medical records are not available. So, NaphCare assumes the responsibility of securing these records for the on -site providers so that appropriate intervention and care can be delivered quickly and efficiently. Securing outside medical records also reduces on -site healthcare costs by ehminatling the need to repeat costly tests that may have been provided prior to incarceration. TechCare "" stores all outside medical record information and ensures all medical records.and documentation are protected. TechCure"I ensures security and HIPAA compliance by utilizing industry standards of security: 3, The report will contain, ata minlmumr a, Reason for consult b. Appropriate exam /lab findings C, Diagnosis d, Discharge Plan e., Follow -up Appointment (If necessary) Inmate Medical services City of Santa Ana 25H -78 RFR No. 14 -034 74 4 a. � 1, pow'IndapvndaiF kevlilrmrm s . a. NaphCare will be responsible for billing the responsible contract agency for off -site treatment, As previnus €y mentioned, NaphCarewiil flag an inmate's electronic medical record upon Intake to Indicate their status with a specific contract agency, Le. ICE, US Marshal, These flags within the system ensure out ability to Identify where an inmate came from in order to expedite further medical information Ina timely manner and track designations separately for ease of billing, Wetrackthese inmates to ensnare appropriate financial liability for off -site medical services Within TechCore' off -site claims are separated based on dassificationides gnation and forwarded to the appropriate entity for payment. We have valuable experience in this form of billing; we perform this service for several of our client ]ail facilities and provide extensive balling services to our Federal Bureau of Prisons clients, Please see Exhibit C under Required Forms for details on cost of billing services. NAPHCARE'S CLAIMS ADJUDICATION SERVICES NapnCare's Claims Department has the V NaphCare's Clai si Departmentaai]udnates latest technology available in the market '" elean claims" within an average of4S hours. ' today, which enables our staff to handle your claims In the most efficient manner. ✓ Average cost savings on re- priced clalma are The accurate and rapid processing of 0% off usual and customary charges; claims is a fundamental part of keeping costs down, and It also maintains our V Promptturnaround time with Pon- posltive relationships with community electronically received claims keyed within 24 providers, hospitals, and specialists. We hours., ensure timely payments, accurate evaluation of claims based on approved services, and payments on claims only for inmates that are eligible at the time of service. Our Director of the Claims Department, Lee Williams, has over 24 years of experience in claims management, including i years with McKesson, where she managed a departmentt hat processed over 400,000 claims per year, WilIlams currently manages NaphCare's claim's department of over 30 employees Dedicated to customers ervice, NaphCare assigns each of our clients a Point of Contact (PQC) who is familiar with their facility, preferred provider network., and unique needs bur clients get fast answers and knowledgeable assistance. Cliti s Processing System Our methods for processing claims and hospital /provider discounts focus' -on listening to clients' needs. We adhere to high standards of accountability and quality that set us apart from the competition, All claims are reviewed for accuracy and proper treatment, as well as correct coding and billing. Claims are acijuditated using the software system McKesson, Managed Care Optimization (h CO), specifically designed for the managed care industry, We pay claims promptly and accurately by applying all applicable payment rules; Through this system, the submitted claims are correctly analyzed for accuracy. MCQ, linked with the EMR system TecahCorer", is the perfect combination to manage inmate eligibility and ensure that only claims on eligible inmates are paid, Information from the client's inmate management system goes through the EMhsystemtoMCO. The integration ofMCO and TechCare'"" Inmate Medical Services City of Santa Ana 25H -79 RrP No. 14-034 7S also allows the flow of information obtained from healthcare claims backto TecbC`ore'". The tin -site clinical team will have real -time access to off -site provider information, which dramatically improves continuity of Care. Claims Administration Our claims examiners work closely with your staff to support your facility. From claims processing to bill payment, our Streamlined administrative services will provide you with valuable benefits. Each claim received bythe claims department is reviewed for accuracy and adherence to community standards, NaphCare assigns an authorization number to each off -slte occurrence that Includes a scenario detAhIng the approved services integrated with service classes and procedural codes.. Only approved services are reimbursed. We review claims to determine that charges are not! n excess of the approprlate Usual and CustcmaryCharges, W also review claims for prior payment to prevent duplicate biIline. In addition, we review for accuracy to Include vaIId dates of service, CPT and IG© -S codes, and bundling and unbundling of codes Any claims that are not valid will be returned to the provider as -a denial and corrected claim will be resubmitted for payment, The following criteria will be used In these revlews; • Eligible Patients • Usual andCwtomaryCharges o Prior Payment •. Accuracy Services thatsupport our clients` efforts to stay current and compliant in dynamic environment Include: Uptinlie productivity for correctional facilities through automated essential operations Identify correct payments for providers • direct contracts with providers • Flexible managed care software that allows for a wide range of date-sensitive feeschodules associated with contracts, Including integrated DRG and APC processing • Referral/authorization component to facilitate case management and utilization management • Eligibility, submission /receipt of electronic claim files, and HIPAAstanrlards • Customer service • Facilitate daily transactions • Allow providers to look up a member's eligibility and check claim status • Provide clients a comprehensive, line -by -line bill audit and analysis, ensuring they are charged a reasonable amount for the appropriate services • Match facility and /or physician bills to itemized statements to identify errors and unbundling of services inmate Medical 5e *Q.5 My of Santa Ana 25H -80 UP No. 14 -034 75 } a r ypurv,d61>&1dev�Y Fea�Vx:o�.24!mcW. REDUCING UFT =SfTC SERVICES FOR THE SAJ one of NaphCaWs cost containment strategies for the $AJ Is to reduce off -site services and transportation. We are experienced and successful In doing so at our client facilities by using our proactive approach to healthcare and organized, comprehensive Utilization Management and Medical Scheduling services. NaphCar cat fidentlyr expects to reduce the S J s cuff -site services by 0%. The fallowing pints outline our services in these areas that will reduce off -site services and program costs. Proactive flare Model NaphCare works to identify important issues early so we can intervene early. At all of our client facilities, the on -site healthcare staff focuses on preventive care, continuously working as a team to prevent unnecessary off -site referrals and emergencies. Our proactive receiving screening identifies all medical and mental health issues up front. Utilization Management Program We offer one of the strongest Utilization Management (UM) programs in the industry. We take correctional UM to a new level by reviewing e 1 off-site services, When off -site cares required, our utilization team collaborates daily with health services staff and off -site providers to ensure appropriate usage of healthcare services, Our EMR and web -based systems play an integral part 'in marvagithe care of any innate needing outside services. Not only do we provide a daily list of all inmates currently hospitalized, but we also detail the clinical course and treatment plan. This data allows us to track and trend stiff -site care in order to find opportunities to reduce costs and bring specialties on-site. f Centralized Medical scheduling Our process for off -site requests ensures seamless preparation and performance of inmate off-site tare. From our central office, our expert Medical Scheduling Department organizes and executes every step of the process with the priority on full communication, and cooperation for the most organized, cost- efficient, and safe results. We understand the issue of security and transportation costs, so we work closely with custody to consolidate patient transfers. �'' fnfirrxrel°tr Care By providing high quality care in on- site infirmaries; we have found that more extensively trained staff can help alleviate emergent medical situations before they ever occur. This process save$ valuable time and resources because of the abliltyto reduce off -site transfers and specialty care_ ✓ On -site Specialty Clinics We seek to provide the maximum level of clinical activity ion -site in order to achieve Increased security and enhanced cast - effective care. With proven negotiation and network development skills, the Network Management Department will supply on -site specialty services as the volume of Inmate healthcare needs merits. Inmate Medical Services. City of Santa Ana 25H -81 RFP No, .14.034 77 E. OFF -SITE PREFERRED PROVIDER NETWORK 1. NaphCare has recruited and will continue to develop a Preferred Provider Network to provide all covered medical treatment and services that cannot be provided on- s'ute. A complete description of our network for the SA) is provided within this section. 1 We have provided written letters of Intent from providers willing to participate In the Preferred Network. We have provided letters of intent from the following providers In the Appendix: Prime Healthcare Managements Garden Grove Hospital Medical Center, Huntington Beach Hospital, and West Anaheim Medical Center Prime Healthcare Services; Physician Services from Garden Grove Hospital medical Center, Huntington Beach Hospital, and West Anaheim medical Center bGMedical Supply, Inc. 3. NaphCarewill ensure that all preferred providers recruited are fully credentialed Please see Section H; #2 for a detailed description of NaphCare's credentialing process. 4, Contracts for the preferred provider network will be between the healthcare provider and NaphCare. 5. To support the delivery of comprehensive health services, the preferred provider network will include the fallowing medical specialty services f proAd errs a, A hospital facility to provide treatment for those inmates requiring medical /.surgical emergency services (e4, inpatient and outpatienthealth care serviees ). ° NAPHCAJUVS HOSPITAL NETWORKSFOR THE SAf NaphCare has conducted substantial research to best understand the referral patterns and key providers used to treat SAJ inmates when they need to go off -site for inpatient, outpatient and emergency care, Going forward, it is NaphCare's position thatSAl inmates are hest served by providing the City of Santa Ana with a choice In network providers, he an option to continue using the current hospitals and doctors who are seeing SAJ Inmates today, ortransitioning inmate core to anew network, of qualified providers eager to embrace correctional care; We're confident that under either framework, the City would see, immediate and substantial improvements operationally, financially, and clinically by utilizing proven, managed care practices tailored specifically for SAJ inmates, all coordinated by NaphCare. This approach enables NaphCare to do what we do best, manage on -site and off-site inmate healthcare while partnering with area providers to do what they do best — treat the patient. In order to provide the City with options related to its selected hospital and physician network partner,soveral months ago NaphCare undertook a systematic approach to identify potential acute care hospitals in Orange County who would he receptive to meetingthe inpatient; outpatient, emergency and ancillary needs of the Santa Ana's inmate population. Area hospitals were evaluated and quantified using the following parameters: Inmate Medical Services City of Santa Ana 25H -82 RFP No, 14.434 78 r r4gl Available scope of services ProxImIty to SAJ • JCAHQ accreditation Level of commitment welcomlng,SAI inmates as a valued patient base Willingness to partner with NaphCare and the City to combine resources to more efficiently manage Inmate care forthe longterm NaphCare's due diligence Involved extensive market research, including multiple in-person meetings with the leadership at selected area hospltaK We feel strongly that this type of hands- on approach is the optimal way to build relationships with our key provider partners and ensure a seamless transition from the current vendor. Such a strong foundation of on-the-ground knowledge enables us to generate ideas to improve Inmate/patient practice patterns that may no longer workas well as they shouK Option I - Integrated Healthcare Holdings, Inc. We are familiar with Integrated Healthcare Holdings, Inc. Western Medkal Center (11RHI) and their -area hospitals that curnentlytreat the Anal-reim inmates from the SAJ, We are equally familiar with the Western Medical, Center secure unit at Western Medical Center-Anahelm, as will as Santa Ana the us a of physicians unde r the di rectio rr of Dr. He rmohinder Gogla, NaphCare is prepared to work closely with Western Medical Center-Santa Ana and Western Medical Center-Anaheim to continue to provide inpatient, outpatient, emergency, and psychiatric care for the Santa Ana inmates. We have established contact with David Platt, CFO of iHHt, and plan to work together should Sonia Ana choose to continue to use the curreft hospital network. Option 2 -Prime Healthcare Services, for, As another option, we are offering an off -site network with Prime Healthcare Services, Inc,, a California -based hospital managemert company that operates Garden Grove Hospital, West Anaheim Medical Center, and Huntington Beach Hospital- Collectively, these Prime Healthcare facilities offerSanta Ana a broad range of Inpatient, outpatient,. emergency, laboratory, and radiology services. NaphCare is entities fastic- about the development of this partnership and we are confident that both NaphCare's and the hospitals' efforts will converge to enhance the Cfty°s off -site and on-site medical services. Prime Healthcare Services operates 26 acute care hospitals In California and five other states. As the largest network of independently contracted physicians In California, Prime Healthcare is dedicated to promoting the patient's overall well-being, Their network provides primary care, ho6pitallst services, Internal medicine, and pediatrics. NaphCare has solidified a strong working relationship with Prime Healthcare Services leadership, including Dan Moral, Corporate Director-of Health Plan Operations; Alan Smith, Regional COOICFO; and Dr. Hassan Alkhouli, Medical Director at West Anaheim Medical center and Chief Medical Officer of physician operations for Prime Healthcare Services, A Letter of intent Is Included In the AppendlX. InmatQ Medical Services City of Santa Ana 25H-83 Rf P No. 14-034 79 oil Carden Grove Hospital Medical Center 2lGARMIN GROW MANIA], it is the position of NaphCare and Prime Healthcare Services that Garden Grove Hospital Is able to serve as a primary access paintforthe Santa Ana inmates, The combined capabllitles; available at Garden Grove Hospital and West Anaheim Medical Center will work together to offer a high level of comprehonMve medical services, in addition, we have secured a commitment that all needed physician specialties will he made available, under the direction of Dr, Hassan Alkhoull, Located approximately four miles from the Santa Ana Jail, Garden Grove Hospital Medical Center Is a 167 bed community hospital that provides a full spectrum of acute care services. The hospital offers inpatient and outpatient services thatInctude maternity care, a wound center, diagnostic imaging, an emergency department, respiratory therapy, and pediatric services, Recently named at "100 Top Hospital" hyThorrson Reuters, Garden Grove Hospital has also been named one of the nation's top performers on key quality measures by The Joint Commission. 22 MILSTANAF]EIM Licensed asa 219 bed acute care hospital, West MEDI CAL CENTER Anaheim Medical Center is dedicated to providing high quality, cost effective healthcare services that include general surgery, emergency services, a psychiatry unit, a comprehensive heart center, and diagnostic imaging. Located on Orange Avenue and Beach Boulevard, West Anaheim Medical Center is approximately 10 miles from the Santa Ana Jail. Recently, West Anaheim Medical Center opened a new Spinal Program with two private surgery rooms, state of the art equipment, and a rehabilitation plan that supports an early return to actfvlty, it is NaphCare's Intent to utilize West Anaheim as an alternate point of care forinpatent and outpatient services. Huntington Beach Hospital 2j 1 1UN-11NMON 111AC3 I Located nine miles from the Sama Ana Jail, Huntington I lostwlr I, Beach Hospital will serve as the primary hospital for Santa Ana imitates In need of psychiatric careand as 0 safety not for Inpatient or outpatient care. Huntington Beach Hospital specializes in behavioral healthcare and provides comprehensive Inpatient, outpatient, and partial hospitalization services, Licensed for 131 beds, Huntington Beach Hospital was recently recognized as one of the notion's Top Performers on Key Quality Measures by The Joint Commission. Huntington Beach Hospital is continually upgrading their facilities and technology in order to provide quality services that include an Emergency Room, a cardiology lab, a wound healing center, a hyperbaric medicine center, and an intensive care unit. NalphCaum and each of these proposed Prime Healthcare facilities valut, the Importance of being sensitive to the cultural differences among the diverse patient populations of SAL Offered at each hospital are interpreters for many languages. specifically, Spanish and Vietnamese translators are available to ensure that the patient and theirfarrilly are fully Informed about their treatment options, Physicians, nursing and support staff at each Prime Healthcare services hospital come from a broad and diverse cultural base, enabling ease of tomMunicanon throughout the patient's medical encounter, NalpfiCare commits to reach out to non-English speaking patients to enhance the overall value of their visit. Inmate Medical Smlces City of Santa Ana 25H-84 RFP No. 14-034 8C b, A psychiatric hospital facility to provide treatment for those Inmates requiring inpatient psychiatric services, NaphCara will use Huntington Beach Hospital, Part of the Prime Healthcare services, Inc, network, to provide off -site psychiatric services. Huntington Beach Hospital Specializes in behavioral healthcare and provides comprehensive Inpatient, outpatient, and partial hospitalization services- A signed letter of Intent from Prime Healthcare Services is located In the Appendix. c. Individual practitioners and /or Group Specialty Physician Practices to provide the following routine outpatient clinics and individual treatment as necessary for the following medical services: 1, Urology I. Gastroenterology h1, Orthopedics iv, ophthalmology /optometry v; Internal Medicine vi, Dermatology YR. Ears /Nose/Throat viii. Allergy ix. 0 bstetri cs /Gy necology x. Psychiatry We have secured a commitment that all needed physician specialties will be made available, underthe direction of Dr. Hassan Alkhoul, Medical Director atWest Anaheim Medical Center and Chief Medical Officer of Physician operations for Pilme Healthcare Services, We have provided a signed letter of Intent for physician services from Dr. Alkhoulf in the Appendix. d, A laboratory providerto provide all necessary routine tests NaphCare will use tabCorp to provide laboratory services to the SA1. We Have created an electronic bridge between LabGorp and TechCorelm that automates the transfer of our current patient demographic information. Through this bridge, TechCcrre' and LabCorp efficiently exchange clinical test order and result information. This provides a permanent record in TeCh CoreTI without the need to print, scan;: and save to the EMtt, The bridge.. ensures accurate and timely reporting of lab results to our providers immediately after testing is cornpleted, allowing an Inmate's laboratory results to be viewed Instantly. Laboratory results are stored in the Inmate's EMR, which saves staff time, since traditional paper files are not needed, and access to the Inmate patlentrs: history can also be compared, This enables Continuity of care and better decision making. Another time saving benefit of this feature is that abnormal results are colored In red, distinguishing between abnormal lout of range) and normal results In an easily recognized form at, The following screenshot shows how lab results can be instantly accessed and viewed by the appropriate medical professional: Inmate Medical Services City of Santa Ana 25H -85 RFP No, 14 -034 81 Another advantage Is that NaphCare has partnered with LabCorp to create ,a menu of lab panels that allow our providers to ordermuItIple disease-specific lab tests as a group; thereby reducing provider time entering tab orders. Also, using "panels,' rather than ordering each test Individually, provides for a significant discount, These panels were developed through s collaboration between our chief Medical Officer, Can -Site Providers, and our team of nurses, Lab services are also available through our hospital network as needed. e. A radiological providerto provide all necessary routine x rays which cannot be accommodated by on -site moblie x -ray services, The hospital networks that NaphCare Is proposing to the SAJ offer radiology services to the inmates. f, A pharmacy provider to provide all proscriptions acid r?on- prescription medications, NaphCare proposes using our In -house pharmacyto provide a][ prescriptions and non- prescription medications for SAJ inmates, In addition to providing medication, NaphCare offers many medication management services, our in -house pharmacy program is described In detall in Section C, #B— Medication Management, A detailed listing of our formulary is provided In the Append by of our proposal, and our phantkaceut €cal pricing Is Included in our base pricing; provided under "Required Fortus" in Exhibit C. g. A durable medical equipment provider to provide all orthotic devices for inmates which are determined medically necessary. Inmate Medical Services City of Santa Ana 25H -86 RFP No. 14-034 &2 4 66i 4h 2i �v� ��i 6!dapond��a hersHhmrcchoicc.. DC Medical Supply lruc. NaphCare has aligned with QC Medica€ Supply to offer durable tried [Cal equipment to the Inmates housed at the Santa Ana )ail. QC Mechcal Supply is certif led as a small business by the tl,S. Small Business Administration under the 8(a) program and with the state of Cal €forma, Whey area Iso MBE cc rtlfi ed with the Southern California Min ority Business Development Cou rtcil. QC Mad Ica I Supply offers the .W a full range of medicai eoulpment and supplies. A Letter of intent is includad1n the Appendix. NETWORlt MANAGEMENT FOR TOE Safi NaphCare's experienced Network Management Department negotiates all rates with off -site providers and hospitals and historically obtains savings over-60% for usual and customary charges, representing a significant reduction in off -Site costs for our clients. Payment terms are.clearly defined In each agreement, so our providers are paid in accordance with contract terms. We treat providers as clients. NaphCare's network management specialists are experienced in many types of provider negotiations such os hospital,; physician, and agreements for providing on -site specialty Clinic sorvltes. We wlII manage the specialty network for the SAi with efficiency„ quality, and cost effectiveness. Features of NaphCare`s Network Management Department Proven and successful history of building comprehensive healthcare networks 37+ years of department experience and strong negotiation strategies Provide afull array of clinical services, evert In rural sections of the country Develop clinically diverse and population appropriate networks * Coordinate contracts to offer continuity of care for inmates • utilize benchmark payment rates, such as current Medicare rates, so that contract pricing may be evaluated for cost - effectiveness across an entire network • Continually evaluate networks and contracts to -ensure competitive pricing and accuracy of providers available • Establish valuable on -site services to decrease security concerns and transportation costs +, offer primary point of contact for correction 0 facilities, hospitals, and providers toenhance communication • Insist on outstanding provIder relations • Contact providers frequently to maintain good working relationships • Listen to community providers concerns and rectify them quickly so that healthcare services are provided In an effective manner • Coordinate security needs with provider needs We want to provide The maximum level of clinical activity on -site In orderto achieve Increased security and enhanced Cost-effective care. With proven negotiation and network development skills, the Network Management Department will supply on site specialty services as the volume of ininate healthcare needs merits. Inmate Medical Services: City of$anta Ana 25H -87 RFP No. 14-0M 83 poor indapam?gnt hanNircnea rka,cn.. F. MEDICAL SERVICES FOR IMMIGRATION CUSTOMS ENFORCEMENT (fCq DETAINEES 1 NaphCare understands that the U.S. Public Health Service, division of immigration Health Services (DINS} acts as the agent and final health authority for ICE inmates on all off - site medical and health-related matters. NaphCare willsuhmlt supporting documentation for non routine, off -site mediral /health services to DINS. 2, NapbCare will release any and all medical Information for ICE detainees to the WHS representatives upon request NaphCare understands that we are responsible for soliciting DIHS approval before proceeding with lion- emergency, off -site medical care including medications and will comply., Tr acIdng ICE Detainees NaphCare is experienced and familiarwith thsstandards related to healthcare for Immigration and customs Enforcement (ICE) detainees. With our EMR system; we electronically flag an inmate's record upon intake to indicate their status with as an ICE detainee. These flags within the system ensure our ability to identify where an Inmate came from in order to expedite further medical information Ina timely manner and track designations separately for ease of billing. VWe trackthese inmates to ensure appropriate financial liability for off -site medical services. WithinTechCore'";off -site claims are separated based on classification /designation and forwarded to the appropriate entity for payment. We have valuable experience in this form of billing; we perform this service for several of out client jail facilities and provide extensive billing services to our federal Bureau of Prisons clients, 3. Ali new arrlvalswill receive a T13 screen ing within 12 hours of intake and using methods in accordance With CDC guidelines. 4, if at any time during the pre-screening pro cess there is an indication of need, or request for mental health services, NaphCare wiil be notified within 24 hours and ensure a full mental health evaluation If a detainee discloses a history of sexual victlmlxation or abuse during a medical or mental health intake screening, whether itoccurred In an restitution setting or In the community, a referral to a qualified, licensed healthcare provider will be made Immediately. Where a detainee has a serious €nedical or mental health condition, or otherwise. requires special or close medical care, NaphCare will complete a Medical /Psychiatric Alert form (IHSC -834) or equivalent, and file the form in the detainee's medical record. Where medical staff furthermore determines the condition to be serious enough to require medical clearance of the detainee prior to transfer or removal, medical staff will also place a medical hold on the detainee using the Medical /Psychiatric Alert form (IHSC -834} orequivalent, which serves to prevent ICE from transferring or removing the detainee without the prior clearance of NaphCare.'rhe .fail Administrator or designee will receive notice of all ICE COMPLIANCE We recognize that your facility is currently operating just above 2008 ICE staindardsr and €star starfing acid programming has been designed to e nsu re that by the and of our transition of the SAJ, you will be operating at 2011 ICE standards. medical/psychiatric-alerts or holds and will notify ICEJER0 of any medical alerts or holds placed on detainee that is to be transferred, Inmate Mad! City of Santa 25H -88 RFP No, 14 -034 EA Sri W fi. Any detal nee referred for mental health treatment will receive a comprehensive evaluation by a licensed mental health provider as clinically necessary no cater than 72 hours after the referrals or sooner if necessary. Nap hCare will develop an overall treatment/managerrrent plan that may include transfer to a mental health facility If the detainees mental illness or developmental disability needs exceed the treatment capability of the faculty. NAPUCARE "5ICE EXPERIENCE Nap hCare is experienced In working with Immigration' and Customs Enforcement (ICE), and we ate confident in cur ability to comply with their standards and requirements for service, Thefollowingfsadescrtptionof NaphCaWs most recent experience working with ICE at our client facilities - the Suffolk County House of Corrections in Massachusetts and the Hampton Roads Regional Jail In Virginia, Suffolk County House of Corrections;(SCUC) Ice InspecUmi Hiiistory August 29,2032 In March 2012, NaphCare completed an emergency takeover of the Suffolk County House of Corrections - (SCHC). A major area of deficiency was the sites ICE audits, which were consistently beingfalled, in August 2412, prior to NaphCare °s presence In the facility, the fallowing ICE deficiencies were noted: • TB reads were not documented after being administered and not read during prescribed tirneframe, resulting in an inability to accurately verify PPD status of newly arrived ICE detainees; • Five out of 28 randomly selected ICE detainee medical charts did not have any documented PPD readings; • Emergency code hag medical contents were expired; medical examination and trauma rooms were tinder stocked with treatment supply essentials; • Absence of documented follow-up progress rates made continuity of care indiscernible; • Tardiness of urgent care (sickcalll, fallowing initial triage process: five out of 28 randomly selected ICE detainee medical charts were identified as not answering detainee sick call requests in .a timely manner (+S days) following Initial triage; and • Tardiness of Chronic Care Clinic follow-up appointments: three out of twenty eight randomly selected ICE detainee medical charts were identified as net receiving follow -up chronic care appointments In a timely manner ( +90 days ). The auditor's report provided additional details on the measures that had been taken by the facility to resolve Issues: • implementation of an all- encompassing electronic medical records system, TeChCore•"', designed for specific use In the correctional environment, TerhCorem Incorporates all aspects of healthcare; including, but not limited to: a comprehensive documentation and tracking system, follow-up, and quality assurance programs; • implementation of stand -alone laptop computers for nursing staff whose Intended purpose is decentralization of facility healthcare. The laptops provided serve as virtual medical units: they are equipped with imaged sick tail, medical records, and medication administration screens, and promote the enhancement of quality healthcare, and • Initial and ongoing staff orientation pertaining to the intricacies associated with the electronic medical system, Tec'hCorel�. Inmate Medical Services City of Santa Ana 25H -89 RFP No, 14 -034 85 `7 y�r 1rv�ePw'danf MwUbmrm choice:. December 12, 2012 - ICG Audit for Suffolk County House of Corrections Just a short time later, In December 2012, the SCHC received high remarks from Marc F. Stern, follDviing an ICE audit. Stern remarked that "Wlthin the limits [the[ examination, [the] quality of are delivered at SCHOC Ds] generally good to very good. Of particular note are involved, knowledgeable, and patient- focused local and corporate leaders, such as the Health Services Administrator, Regional Nurse Administrator, and Corporate Medical Director." February 2013 -ICE Audit for Suffolk County House of Corrections More recently, in February 2013, the SCHC'received additional high remarks from the Director of Compliance, Jeffery 5. Blumberg, following an ICE audit. Blumberg. stated that "it [was] a very positive development that, our medical expert determined that many of the problems identifled in [the[ 2010 recommendation memorandum are no longer present at SCHOC. ' Ilaurgtnn ftaatls Regiirnai jail (flRitj� Ice Inspection kiisturjr December 14,2012 —I CE Audit for HR RJ Shortly after NaphCare took over the contract to provide comprehensive healthcare services forthe HRRJ In 2012, the ICE Office of Detention Oversight performed an audit, which produced no egregious concerns, The Medical Department; which is under Naphiare`s care,; was the only department in the close out conference with no deficient practices and no on -site corrections required. Flue best practices were c€ted by the aualtors€ • NaphCare's two-part intake process: during regular intake hours, for Inmates who our RN deems as having a positive mental health screening; a Mental Health Professional is available to complete an .. Intake evaluation; • Physical exams completed at intake; • Use of an excellent electronic medical record system that is tailored to the corrections environment, • Sick calls delivered from kiosk to the electronic medical record forsick call scheduling; and • Proficiency in operations less than 6 months of the start of the new contract, We encourageyou to contact the ICE audit Inspector, who will provide yoLl with unbiased feedback on our ICE inspection preparedness: Derek T. Anderson I Detention Services Manager U.S. Department of Ho€ LeIand Security Immigration & Customs Enforcement Detention Monitoring Unit, Washington D.C. Pi (757) 4893500, is= 2306 €: Derek.Andemqa@dhg.gov Inmate Medical Services.. RFP Hoe 14-034 City of Santa Ana 86 25H -90 G, MEDICAL SERVICE PROVIDER MINIMUM STAFFING .1,. In accordance with RFP requirements, medical staff will be present 24 hours daily, everyday of the year; Web ave provided two staffing plans for You, and Lath plans have been carefully calculated to ensure compi!ance with ICE, Marshall, CMA and NCCHC rules and regulations, We recognize that your facility is currently operating just above 2008 KE standards, and our staffing and programming has been designed to ensure that by the end of our transition of SAJ, you will W operating at 2011 ICE standards. I n a ddition to ensuring you obtain the compliance needed, our staffing plans and programming ensure maximum quality care and cost savings for you. We offer you a Proactive care Model, In which we spend more time identifying critical issues -up front at intake to prevent more serious outcomes later, The fallowing table shows our RFP Minimum Staffing Matrix: Inmate Medical Services City of Santa Ana . 25H -91 'total € U 17.400 RFF No: 14-Q34 87 in our proposed staffing plan, we exceed RFP minimum staff requirements. Our proposed staffirg matrix is shown here, and additional information on both SAJ RFP Minimum and Proposed Staffing Plans s provided in detail on the following, pages. Totali 151144 a. Physician -One (1) on call 24hours daily. R FIR Min inmuin Staffing Plan, In our RFP Minimum Staffing, we supply you with one physician on call 24 hours, dally. We have appointed this candidate as SAJ Responsible Physician, Proposed Staffing Plan. To support our Proactive' Care Model in operation at SAJ, in addition to ensuring that a physician will be on call 24 hours, daily, we provide you with an on -site physician. With the proposed naffing plan, you have increased mod ical leadership on -site. Corporate Clinical Staffing Support. our corporate clinical staffing support provides an additional layer of medical support and is offered to you with both plans. It. NP —One (1); eight (ii) hours Per day, seven (1) days per week. RFP Minimum Staffing Plan. In accordance with UP requirements, our RFP Minimum Staffing features a NP on -site eight hours per day, seven days per week. Proposed Staffing Plan: Our Proposed Staffing Plan features a NP on-site eight hours per day, five days per week. Inmate Medical Services City of Santa Ana 25H -92 RFF 88 rq tw, Moe c.. RN -Three (3}; twelve (12) hours per day, seven 1711 days per week, (2 Dayshift /1 Nightshift) RFP Minimum Plam In accordance with RFP requirements, our RFP Minimum Staffing features three RNs at 12 hours per day, seven days per week. Of the RNs supplied, two will work days and one will work nights, Proposed Staffing Plan: Statistics show that when higher care Is upfront, the less you have to worry about negative outcomes and litigation. Therefore, our on -site RN coverage exceeds RFP requirements. We propose 2.8 FTE RNs on days and 1;4 FTE RNs on evenings and nights fora combined total of 5.6 fTEs. This translates to 87% more coverage in your facility, That's not alk each shift is managed by Charge RNS, and with improved leadership on -site, you see (getter outcomes, Our Charge RNs on days, evenings, nights, and weekends support our Proactive Care Model by assisting at intake and with sick call At intake, our RNs will not simply perform an ICE screen; they will perform a full population screen; ensuring that all critical needs are addressed sooner rather than later, preventing negative outcomes. All ICE and Intake screens will be completed within 2 hours, guaranteed, We supply psychiatric Reis and /or social workers on days, too. our psychiatric RNs and /or soctai workers will assist with our Emergency Psychiatric Crisis Intervention and Evaluation programming. This service Will support inmates in psychiatric distress and with psychiatric disorders. d. LVN—Four (4); twenty -four hours per day (two each shift), seven (7) days per week. RFP Min }mum Plan: Per RFP requirements, our RFP Minimum Staffing features Four 24/7 LVNs Proposed Staffing Plan: Our proposed staffing exceeds RFP INN medication pass requirements: we supply 2.8 medication pass WNs on days, 2.8 on evenings, and 1.4 on nights for a combined total of 7 FTE medication pass LWNs -- a 75% increase in coverage, Quality System Support: in both our RFP Minimum and Proposed Staffing plans, our EMR system, TechCare' ", produces efficiencies which allow us to re -allot valuable hours to clinical areas of need, Improving care provided and producing the best outcomes for you We are able to use Techcor'e -to continually examine workflow and ensure maximum productivity in the SAT. Ry supplying you r LVNs with laptops on medication carts to access TechCareT` as they conduct medication pass, they are able to view Inmate housing and make tnimudiate medication recordings In real time, When you need to pull reports for ICE audits or CMA or NCCHC certification, TechCare' allows you to do so with ease. e. DOS —Four (4) hours per week. In accordance with RFP requirements, both our RFP Minimum and Proposed staffing plans feature an on -site dentist four hours per week.. f. Dental Assistant —Four (4) hours per week, if necessary. In accordance withilFP recommendations, ourstaffing plan features an on -site dental assistant four hours per week. Inmate Medical Services RFP No. 14-IN City of Santa Ana 89 25H -93 1► yvw {ndepundenP hemNkehreclx. g. Psychiatrist — Four (4) hours per week, If necessary. RFP Minimum Plan; Per RFP requirements, our RFP Minimum Staffing Plan features anon -site Psych €atrlst four hours a week. Proposed Staffing Plan: To support Proactive Mental Healthcare programming m the SAt ,our Proposed Staffing Plan exceeds RFP Psychiatrist requirements. We have staffed the SAl with an an -site psychiatrist at 8 hours perweek, a 10D% increase from RFP recommendations. With an emphnIs:on Identifying ohitical needs at Intake, we stabilise the mental health population quickly, allowing us to reduce detoxification and suicide risksa td improve the overall stability of your incarcerated populatlon. Care is improved, grievances are reduced, and the probability of legal complications is minimised. h. Medical Records Clerk— One (2); forty (40) hours per week, five (S) days per week. Both our RFP Minimum and Proposed Staffing Plans meet the RFP requirement of an on-site Medical Records Clerk at ,10 hours per week, five days per week. Quality System Support In both our RFP Minimum and Proposed Staffing Plans, you are supported by TechC€rreTM. T'echCore offers staffing flexibility and produces additional operational efficiencies by reducing the need for cumbersome administrative labor. The result is that valuable dollars are re- applied to clinical areas of need, which Improves the overall quality of care within the SAL TechCare 'm facilitates this process by creat Ing workload efficlencesas your staff is able to pull real -time reports instantaneously. Your medical recrods division is fully supported by our corporate billing and case management departments. We shift the burden away from you so that on site staff can focus on clinical care. Quality System operational an Clay One, Guaranteed: From paperchart to EMR, Te(hCore` will be fully operational forSAf on day one ofcontraetstart date. As atestamentto its effectiveness as the superior correctional healthcare EMR, in a recent Independent bidding process, TechCdremwas selected above 13 other commonly used systems, including the widely used CorFMR, for use as Orange CountVs EMR system. one (1) physician will be on call twenty -four (Z4) hours daily for phone consultation and or response to the Jail. C A physician will lac available by cell phone and will be required to telephone thejail within thirty (30) minutes of call. fl, A physician will be required to arrive at the jail within two (2) hour's ofa request to respond. RFP Minimum Plan: In accordance with RFP requirements, in our RFP Minimum Staffing, a physician shall be on call 24 hours, daily, for phone consultation or response to)arl. This candidate will be available via cell phone, required to telephone jail within 30 minutes of a call, and arrive at the )ail within two hours of a response request, Proposed Staffing Plann In Our Proposed Staffing Plan, our physician will be: • On -call 24 hours, daily for phone consultation or response toSAJ, • Available via cell phone, Inmate Med Ica I Services city of Santa. Ana 25H -94 RFP him:. 14 -034 94 • Required to telephone tKeSAJ within 30 minutes of call receipt, and 0 Arrive at the SAJ within two hours of a response request. The physician will also be on-site forfour hours each week. Staffing Vacancy Replacement Rather than using agency nurses, NaphCare establishes an extensive pool of highly qualified clinical relief staff that Is pre-credentialed in California, knows the intricacies of SAJ, is familiar with ICE audit procedures and tMA and NCCHC standards for care, has o badge, and is ready to work at a moment's notice, The SAJ will always have appropriately credentialed healthcare staff managing your healthcare operations, which improves, care and minimizesthe likelihood of negative outcomes for SAJ. Corporate Support Team It is Important to note that In addition to each of our proposed staffing plans, you are directly supported by our Corporate Support Tearnal no additional charge. Our Corporate SupportTearn includes highly have been with Naphcare foryears and have extensive correctional healthcare and NCCHC accreditation expertise, This is a valuable serviceffnat cannot be priced. Our Corporate Support Team will partner and work collaboratively with the SAJ to ensure that your staffing and training needs are meths 4 thorough and timely manner. While we are experts in the provision of high - quality correctional healthcare and have developed the Infrastructure needed to Improve care and produce We are deeply invested in efficiencies within the SAJ, we depend an you as our developing a strong and partner in identifying the areas of need unique to $A). transparent relationship with you [mproving,care and Identifying cost-saving measures at your site Is accomplished only through the collaborative because our success is not efforts -of on-site staff In implementing our Proactive Care complete without your expertise Model into SAJs operations, Our partnership Is in facility movement and security. strengthened through the combined efforts of clinical staff working with you r administrative leaders to identify critical areas of needwithin your facility, We listen closely to you and observe SAJ on-site needs, identifying opportunities to maximize staffing efficiencies and Improve services for you. We work with you to understand your needs and become familiar with your facility and the problems that you face so that we can offer the optimal healthcare solutions for those needs, During the SAJ pre-bid conference, our Vice President of Operations, Mr. Larry Gann, listened closely to you to best Identify opportumflos for maximized staffing efficiencies and improved services. M r, Gann'5 experience in corrections, leading our onsite management teams in the care of over,5,000 inmates, has uniquely equipped and allowed him to Identify additional cost savings, operational efficiencies, and care Improvements for your facility, and he will be responsible for leading transition activities for you. He will work closely with you to continually Identify areas of Improvement in the healthcare operations wlthIn the SAJ and will provide position specific peer-to-peer training of your existing healthcare staff, Inmate Mediuil Servfice5 City of Son La Ana 25H-95 RFP No. 14-034 91 2. Responsible physician /health authority; a. NaphCare will appolntone (1) physician as the Responsible physician forthe Santa Ana Jail, The Responsible physician forthtjail will perform all duties and functions of the Responsible Physician asdescribed and referred to In California Department of Corrections and Rehabilitateris, Title,15 Standards and National Commission on Correctional Health Care (NCC<. b, NaphCarewill appoint one (1} phystclan or medical administratoras the Health Authority forthe Santa Ana Jail, The Health Autliorltyforthe jail will perform all duties and functions of the, Health Authority as described and referred to in California Department of Corrocllons and Rehabilitations, Title 1 S Standards,: In accordance with REP requirements, In both our RFP Minimum and Proposed Staffing Plans, we have appointed a medical administrator who will serve as Health Services Administrator at ICE Medical Liaison for the SAL Because our HSA is an RN, you have increased on -site clinical leadership in your facility. in addition to performing all duties and functions of the Health Authority -as described and referred to in California Department of Corrections and Rehabilitations Title 15 Standards, our HSA will be tasked with ensuring ICE audit compliance. Already, we have similar models; established at the Suffolk County House of Corrections and hlampton Roads Regional Jail and have repeatedly received high marks and full ICE audit compliance Details on the results of our successful ICE audits ore described in our Scope of Services and Specifications Response, Section P. o. The physician appointed as the Responsible Physician for the Jail may also be appointed asthe Heath Authority for thejail, RPPMinimum Plan we understand that, per the REP, our physician appointed as Responsible Physician may also serve as Health Authority for SAL However, in our REP Minimum Staffing Plan our Health Services Administrator (HSA) will serve as the SAJ Responsible Health Authority (RHA), Proposed Staffing Plan: In on r Proposed Staffing Plan, our HSA will serve as SA1 RHA and ICE Medical Liaison as added support to ensure that you receive full compliance on all ICE audits, HE QUALIFICATIONS OFSTAFF 1. NaphCare will ensure that medical staff possesses no less than three (3) years of correctional medical experienceas a state licensed medical practitioner. 2, All medical staff will maintain current licensing from the State of California to practice medicine. CREDENTIALING All NaphCare staff providing medical, dental,, prmental health treatmerit wilt meet California state licensure and /or certification requirements, To ensure that our medical professionals have the appropriate licensure and /or credentiaiing to provide the services required, we conduct a thorough interview and credentialing process, which includes the following steps: Inmate Medical Services City of Santa Ana 25H -96 Rr•P No. 14 -034 92 I a. Interviewing candidates at the.SAJ by out health services administrator { HSAj or We ensure that all professional staff, including contract physicians wdrking In the SAJ, has evidence of current ficensure, certification, and /or registration as required by state or federal law on file with NaphCare. We verify our medical professionals` credentials Initially upon hire and again before each individual's license expires. We maintain appropriate records of these credential verifications. These records are maintained by our corporate office and stored securely online; so sites have access to any needed documentation- Comics of all current nursing and physician licenses are also kept on file in the health administrator's office. We make credentialing, profiling, privileges, competency reviews, iteensure, disciplinary and other regulatory data avalfableto the SAJ upon request, NaphCare's SAJ t7t outtathig Proem 5acfat sezau�y z5�aea, ;..; S &Gnaast7'aasai Hackgiuu�i Chetk, �._ 37"1 tknscaaat't�cii tab, Canyai tLd by S'3i4tSCa9�"'S R�vastab� _ Siar+�v9o:.. Inmate Medida services City of Santa Ana 25H -97 RFP No, 14 -034 93 We check for primary source verification with the American Medical Association, National Practitioner Data Rank and the state licensing web site, and credentials all physicians and rnid -level practitioners. We verify licenses,educatlan and any disciplinary actions taken against the potential employee. our nursing and ancillary staff are all credentialed according to their license or certificate' and verified on the corres pond! rig, verification weiasite. Our unique process Far exceeds the competition in organization and saves on -sate staff countless hours in accreditation preparation, our credentialing,files are always available for review, as these riles are malntalned by our corporate Human Resources Department and can be viewed electronically at anytime. Each NaphCare employee has an electronic personnel file that €nclud es a n accreditationspecific il le so that with the cl i ck of a button everything you need loran accreditation audit can be accessed. Credentialing doesn't end when the employee is hired. NaphCare provides ongoing credentlaling services to ensure all healthcare staff maintains proper credentials; NaphiCaWs SAJOi%ottilig Gkedeattiiolh Verfficaticar Proms Ana 25H -98 RFP No -.'14 -034 4 L ADDITIONAL SERVICES 1. All services contained in this section will be called for and paid for on a per-use basis. These services will not be connected to or billed together with any other services In this UP. Please See Exhibit C Attachment, located under Required Forms, for pricing details. 2. NaphCare will provide each of these Services, either internally or via subcontractor, and have detailed our plan for provision of each of these services in our proposal, 3. Repair of dentures, dental plates and partial plates, This service will be available an ark as-needed basis and billed one fiat rate per repair. Naplicare will assume responsibility for repair of dentures, dental plates, and partial plates on an as needed basis, 4 Mobile X-ray services. NaphCare will utilize Mobile Medical Diagnostic Services iMMDS) to provide mobilex-rq services to the 5A1, This service will be available on an as-needed basis and billed one flat rateperstudy. IMMDS is capable of responding to the jail to provide service andcapable of providing X- ray study, technical component, radiologist Interpretation, transcription and delivery on thesame day when necessary. Mobile MWicatt Diagnostic Services (MMOS) NaphCare works extensively with MMDS in other markets and can offerthern as in option to provide portable radiology services. MMDS is -an experienced mobile x-ray provider for correct lo nad facilities. MMDS provides accurate EKG reports rumed[ately following an EKG study, Upon request, one of the MMDS cardiologists will sign and verify the report. We have listed some of the many benefits of MM DS below: Monthly Utilization Reports are completely customizable based on the discretion of the facility: MMDS provides uninterrupted service and will maintain employment of iat least) twice the number of staff required to service Its accounts. MMDS also provides increased medical services that will Improve the current quality of care to the offenders, reduce security risks, and save thousands of dollars in unnecessary transport fees and hospital fao% A valuable feature of MMD!V service is that clients, physicians, and clinicians can log into MMDS' PADS system (Picture Archiving and Communication System) using any computer with an Internet connection to view Images, view reports, schedule exams, and run productivity reports, NaphCare and MMDS have developed an interface between PACS and lrechCaW With the use ofthis interface, MMDS reads and x-ray images are sent directly Into TechCcrrel", which provides greater continuity of care without the risk of studies ever failing through the cracks. Reads areravallable,on average, four to seven minutes from the time the x-ray is taken and staff can instantly retrieve and view the images/reports of their patients. rurnate Medical Services City of Santa Ana 25H-99 RFP No 14-434 95 ®s t~.010a .'. aid. f ovtvd893. ROW M10 R" "W MAWS: MINI 4ov!indel�anda�F hcoid�cmrn cftini[a. 5. Ophthalmologyservlces. This service will be available on an as- needed basis and billed one flat rate per pats eht visit, We have secured a commitment that Ophthalmology services will be made avadaWe, under the direction of Dr, Hassan AlkhouI!, Mod Ica I Director at West Ana helm Medical Center andChlef Medial Officer of Physician Operations for Prime Healthcare services, We have provided a signed letter of T ntent for physician services, to include Ophthalmology, from" Dr, AlkhoullIntheAppendix, 6. 4"YN services, This service will be available on an as- needed basis and billed one flat rate per patient visit. We have secured commitment that OBIGYN services will be made available, under the direction of Dr. Hassan Alkhoula; Medical Director at West Anaheim Medical Center and Chief Medical Officer of Physician Operations for Prime Healthcare Services. We have provided a signed letter of Intent for physician services; to include tdB /GYN, from or. Alkhouli in the Appendix. 7, Emergency Psychiatric Crisis Intervention and Evaluation. This service will be on an as• needed basis for inmate in psychiatric distress; ke, seven: depression (suicidal ideation) ant, psychotic disorders ischizophrenlaa. upon completion of evaluation, a finding and suggested disposrtlon for safe care of the inmate will be provided. Services will be provided with a response time of 30 45 minutes and will be billed one flat rate pervisit. inmate med ical servi ces City of Santa Ana 25H -100 RFP. No. 14-034 96 44k' agate yo., indgwdgnl 4altim Ovwm NaphCare has spoken to psychiatrists: at the nearby correctional fa011tles who are interested in providing emergency psychiatric crisis inte.rventiota and evaluation services for the Santa Ana Jail In the required response time. We plait to use these doctors to meet the City's RFp requirements.: We understand that a mental health crisis can occur during: all hours. Our policies and procedures address emergent situations 24 hours a day; medical staff is trained to assess situations and intervene appropriately, and mental health providers are on -call. Our staffing plan features psychiatrlcfRNs and /or social workers to assist with this service. iulental Health crisis management will also boa component of ongoing tra I hing provided by the NaphCare mental health team for SAJ securitystaff. While the RFp minimum requirement states that such services should be billed one flat rate per visit, since our staffing includes psychiatric RNs andforsoc!Wworkers, this expense is drastically reduced for you. NaphCare's mental health staff and emergency, on -call providers will give an immediate evaluation during a psychiatric crisis to address housing placement, monitoring medications, and any possible referral to an outside mental health facility. Inmates placed In a mental health protective status are only released following a thorough evaluation by a mental health professional. NaphCare also offers telemedicine services to the 8A1 for on -call mental health needs. Telemediclne is a highly successful method for delivering treatment within our other client facilities, especially when paired with our EMR system, TechCore � ". When used in conjunction with telemedicine, providers have real -time access to Inmate medical records, With this capability, providers can review records, order medications, order tests or procedures; review previous labs, view results of diagnostic testing, and can document such encounters within Tech Care" Our corporatetelemedlclne programming heightens the quality of on -site services and, through increased health intemalonsandtreatment discussions, . improves communic- -itlon between providers and patients. When emergencies arise after hours, telemedicine is an effective method for emergency response, Our corporate location has two telemedicine facilities where providers can meet face -to -face with patients or otherstaff members, across the country, Units supplied on-site are modular in design and are completely implemented and supported by our IT Support team NO additional cost. Audio and video is clear and consistent usingtl a latest high- deftmtion equipment available. This solution allows for patients to be seen in the most timely manner possible while maintain compliance and the highest level of patient care. Dr, Steven Bonner, NaphCare's Corporate Medical Director, Is a psychiatrist and telehealth provider in our system. He has personal knowledge and experience with the use and applications of a telemedicine program. We offer his personal experience to describe the usefulness and efficiencies of NaphCare's telemedicine health program; Inmate Medical Services City of Sarkta Ana 25H -101 RPp Na 14-034 97 rho � lnn�n TechCore- generates many reports that are sent to focal and corporate levels. (receive these reports and noticed one morning that one site had seen a significant increase In the need for psychdptricservices over weekend. 1 was able to rapldlyco municate with them to assess the need. Our local staff then worked with corrections to coordinate a trine can venlent for them to have offenders seen via telehealth. The nurses were locohy able 'to triage and prioritize the offenders and make sure that those in the most need of evaluation were seen fast. All l had to do was simply walk dawn the hall to our telehealth office, log In to TechCoreim and begin seeing offenders. Because of the sophistication and ease of use of TechCare'" i wars able to lostontly access each offenders entire nedicalrecord in real tune.. ,perform evaluo Hers, and address clinical needs in this way, our team was able to handle 0 srtua €ion that could have resulted In a backlog at the local site, and in sigrulyicont wait tunes for these offenders. AlaphC'are strives to be very proactive: For me, this experience is a prime example of how this is accomplished within our system. it is possible because of competent and well trained personnel locally, the use of telehealth, and the sophistication and easy use of Techcare. Using these toalss, we are able to reduce waft times and address medical issues in a rapid and prioritized manner. This results in decreased risk of escalating symptoms and worsening of conditions. When you address medical problems in a proactive approach, the number of issues that reach the level of need for off- -site care is reduced significantly. This results not only in better duality core forth offender, but also to sovings to the state with regard to officer man hours, overtime man hours, transportation and fueicosts. Dr. Steven Bonner, NaphCare Corporate Werdicai Director B. Billing services for off-site emergency medical care. Suchbiliing Services will include acomplete accounting of all services performed In addition to a detailed report of the cost of such services. Please see Exhibit C under Required Forms for details on cast of billing services. Also, see our scope of Services and Specifications Response, Section ft, tl4 for a description of our Claims Adjudlcatian Services. I, JArt, STAFF SURV10ES 1. NaphCare will provide baseline tuberculosis testing to all Santa Ana Jail personnel every six months and imrnedlately after any exposure incident, Base Hne skin test wl11 provided via the tatantoux tectinIque: intradermaI injection of 0. 1 mtof purified protein derivative (PP D) contalnmg five IS tuberculin units. 2. NaphCarewill provide three (3) Injection hepatitis imm on] zatlon series to all Santa Ana Jail personnel (unless already Clone) Immunization series will be Recombivax HB' mmnufactu red by Merck, Sharpe & Dohma or as stated by the most current regulations. NaphCare will provide a blood test to all immunized employees three (3) years after initial immunization and shall administer booster to those employees that have diminished immunity. 3. NapfiCare will maintain accurate and detailed records at all employees' immunization and baseline history. Inmate Medical Services. RFP No. 14 -034 City of Santa Ana -98 25H -102 ai t 4. NaphCare will provide four (4) hours of annual trainIngto Santa Ana Jail personnel, Training will consist of two (2) hours of blood- borne pathogens training and two (2) hours of tuberculosis awareness training in accordance with State mandate, K. MEDICAL SERVICE. PROVIDER REQUIRED QUALIFICATIONS NaphCare, Inc, meets all the required qualifications stated In the €tFP for a medical services provider, 1, NaphCare was organized forthe purpose ofprovidinge ntracteolhealthcareservices. Z. NaphCare has 25 years" experience providing correctional healthcare services with proven effectiveness. I NaphCare has prior experience providing healthcare services to correctional facilities of similar size. bur Current Clients List and Contract Accomplishments are included in the Appendix: 4. NaphCare satisfactorily meets ail requirements of this RFP. It is ourgoal'to not only 'meet the requirements of the RFP, but to also go above and beyond to provide a new level of quality correctional care for the SAL L. SOLE CONTRACTOR NaphCare understands that should a contract be executed as a result of this R €p, It will be with a single contractor. NaphCare will be responsible for all of our business issues including, but not limited to, subcontractor affairs, salaries, licensing, training; administration and management, bookkeeping and benefits. CORPORATE SUPPORT SERVICES FOR THE SAJ We are proud of our company culture and ability to connect with our clients on a personal level, and it is our mission to continue our history of personalized service for the SAJ, Care is not reserved simply for the patients entrusted to u5, but also to our partners, the, clients. We- care for our clients by providing efficient services to reduce their casts, communicating regularly about our services, listening to the client, providing accountability through continuous quality studies and reporting, and working with integrity at all times. Our corporate support services take the administrative burden off the on -site staff; so they can focus solely on inmate patient care Our centralized support programs will give the SAJ direct communication, swift decision making, and consistent leadership in the administrative and medical services we ,provide. In turn, the on site heaRlicare staff is able to focus solely on delivering quality health care without distractions. centralized Medical Scheduling Department: This department will coordinate and schedule off -site appointments for SAJ Inmates. The Medical Scheduling Department generates and maintains an off site calendar of appointments that is visible to any authorized ran -site personnel and security officers. Prior to the appointment, Inmate Medical Services City of Santa Ana 25H -103 NophC'are offers support services that shift the burden from you to us. With No hCare, our corporate Office works for our sites, not the other way around. RFPNo 14a034 99 they also communicate all patient preparation and transportation information required through the Utiliiat€un Management module of TechCorel. Utili¢ationMimagement, All off -site appointments and information required for SAJ inmate transport Is managed through the Utilisation iv%anagement module of Tech Cora- by our professional medical schedulers. Once the appointment is complete, our professk malsgatherthe healthcare consultant results, attach the results to the inmate health record, and at a minimum, notify the Charge Nurse and the Physician who requested the consult, e Medical Records: Department: Our Medical Records Department will support NaphOare's coordination ofieff•sheservlcesfortheSAf. On behalf of the facility, we obtain copies of ail diagnosis, treatments, treatment plans, final medical records, discharge stimmarles, and other Information related to the off- site referral In a very timely, manner. Contract Compliance and Man "s storing: We continuously monitors statistical reporting available through Tech' ore'"', as well as staffing reports, to ensure complete contract compliance. Reports are viewed on a daily, monthly,: and annual basis. We maintain close contact with the Facility Administration so as to provide continuous updates on contract compliance. staffing Schedules: We prepare staffing schedules and integrate them through our payroll system: The system contains a central database of information, Including employee skills, certifications, availability, preferences, seniorlty, and Cost. Legal Department. R medical records specialist handles all medical record requests on behalf of the facility, The Legal Department also manages all inmate grievances with clinical oversight from our Chief Medical Off Iter. t.icensing /Credenflalms and Recruiting. Recruiting, credentialing, and annual re -credential mp of all healthcare staff is done through the Corporate Human Resources Department, The Corporate Recruiter places advertisements and filters resumesforppen positions as requested by the facility. The Corporate HR; Department assists the facility administrative staff in scheduling and conducting interviews and provides all new hire Information, All licensing, credentialing and personnel file information is available for the facility to view 05 a file through rechiore"?. CingoingTra €ninW our operatlonsTeatn provides orientation and tramYngto all healthcare staff. With ongoing training, our correctional health care experts keep you updated on current trends and topics Import-ant to your facility. Our health education and training services include continuing education, which NaphCare provides annually by offering hundreds of CEU hours, enough to bring each employee's licensure upto date NaphCare provides for employee's CEU's� through on Site, online training.. This anode of training reduces costs and makes better use of staff time, for it eliminates the need for unnecessary travel and associated expenses. NaphCare also provides, pertinent monthly in- service education programs based on Issues identified by our Continuous Quality Improvement (CCII) program. Budgeting Services; We review all budget informationwIth the facility administrators each month. Lists of all supplies, pharmaceuticals, and over-the-counter meifications are maintained by the corporate office and sent to the administrators weekly to allow fortaetter control of expenditures. z Inmate medical Services Alp No. 14.034 City of Santa Ana 100 25H -104 Wtl lcala MGnitgYm Su rsrt our SAJ heaIthcareprogram is supported by our clin €cal team In addition to corporate office person net Administrative meet]ngsare conducted ona consistent basis, and committees will be fully integrated to ensure program obligations and targets are met: We understand the correct! setting is a unique environment, seas your heaIthcare;partner, we will establish and maintain an ongoing positive relationship with institutional staff. The HSA; and any appropriate NaphCare staff, will participate In quarterly meetings with the Institutional Authority and any designated institutional staff In order to Identify, clarify, anticipate, and resolve Issues relevant to Inmate health careservices. our staff will also meet monthly to order to receive current information on all aspects of the SAi's healthcare program to promote continued success. Administrative meetings will be established as part of our partnership, to include, but not be limited to: SAaJ Administration /On ske HSA Meetings Medical Administrative Committee i Continuous Quality, Improvement Committee 4 Infection Control Committee The following are examples of medicaland monitoringsupportthat NaphCare provides to'our clients and will provide to the SAJ; MedicationVerlRcation: NaphCare' s Pharmacy ' is responsible for all prescription reorders and medication verification for all inmates upon admission to the facility. our Pharmacy staff is ava €lable 24 hours a day 7 days a week for medication verification.. Infectious Disease Monitoring; Our Corporate Infectious Disease staff conducts monthly studies on the infectious diseases within the facilities. All infectious diseases are tracked through TechC'areTM and reported to the facilities, thereby allowing the corporate staff and facility administration to determine any increases or trending within the facilities and any additional actions needed. Quality Assurance: NaphCare conducts ongoing studies of the quality of care provided and assists the facility with process and outcome studies needed to achieve accreditation. Studies are conducted by the corporate office on a daily basis to ensure that Inmates are receiving Immediate screening and appropriate care NaphCare °s Pharmacy staff also conducts ongoing studies of all prescribed medications and moo €tors all prescription orders to ensure proper dosage, avoid duplication, transcription errors, and drug interactions. Ttaeh�p TechCarel Is only as good as the IT infrastructure on which it runs. NaphCare "realizes this and has built robust IF Operations group to match the efforts of our software development group We place Nil requirements on your facility's IT resources or personnel while implementing the backbone infrastructure needed forTechCare�, Inmate Medical 5ervlce5 City of Santa Ana' 25H -105 RFP No 14 -434 1€ir y4ue gidepuilaalvl iwpllficnis 4� +piR. CONTINUING EDUCATION PROGRAM NaphCare wants to invest in our employees:. We recognize the value of educated and well - informed healthcare professionals, and we avant our employees to reach their full potential with NaphCare. Therefore, we provide our qualified healthcare professionals with comprehensive, correctionouspeciffc education that complies with NCCHC and RCA education standardsfor certification. The advantages and benefits of ongoing education and training are countless, and they impact bath our employees and our clients: v' Enhances of care to inmates ✓ Expands our healthcare employees' base of knowledge Meets organizational standards such as NCCHC, ACA, OSHA, AND JCAHO ✓ Spotlights current trends and issues inthefieldof correctional healthcare Reinforces the value of our healthcare staff Our Initial healthcare training and ongoing on-site and national In -service education focuses on specific clinical issues, professional ethical standards, and topics relevant to corrections. NaphCare's full immersion[ in the field enables us to Beep a finger on the pulse of correctional healthcare. Our seasoned clinical directors and administrators have experience as instructors and sneakers in training and educational curriculum for the correctional healthcare Industry, They will ensure focused, relevant, and current training opportunities for our healthcare professionals. Orti to Training with the Essential Learningm blanagementSystern NaphCare provides training and education; In several farms: written material, formal classroom training, hands-on training, and web -based training via Essential [earning„", We utilize the Essential LearningT" software program to provide confinuing education training to healthcare staff. Through this program, licensed employees have access to Continuing Education Units (CEU). NaphCare -has the ability to create and build training courses, curriculum, and hold on -line training classes through the Essential Learning'"" training program Managers can even assign specific training courses for their employees on an as- needed basis and receive email notifications as to the completion status of scheduled training for their staff members. Training Convenlence: The Essential LearningT"' system is a convenient mode of training for employees because each healthcare staff member receives log -in access to the website to complete specific education modules. Therefore, they can complete training anywhere, at the time most convenient for them. Inmate Medical Services AFP Na, 14 -034 City of Santa Ana 102 25H -106 a 44kh4JW� YMrkOaP dotd hwllh.,. chim Easy-to -Use Reports: Essential Learning'' also allows for easytracking and reporting oftraining completion All assignments are tracked through the Essential Learning'• training program, The program generates reminders and reports for NaphCare's corporate managers, as well as site- level managers, regarding completion and examination scores. Essential Learning'" provides reports that can be sent by e-mail to management personnel fureasy tracking, accountability and review of personnel training. Other keyfeatures of the Essential Learn €ng� system Include the following: 906+ hours ofonlhie, interactive courses —NOT iournat, research and newsletter articles Educational technologists using adult learning principles and research to develop courses Curricu la a nd accreditation crosswalks to help you select courses and develop your training plan ! Substarl Val Investment in course development State -of- the -art learning management systems The hest library in the industry— course customization to meet client needs V Automated annual training—saves staff time Flexible testing, surveys and course evaluations for live and online classes Completion certificates for continuing education Integrated authoring tool AND free course development services—create yourown courses +' Staff Competencies - assign and track I/ Live class schedulin& certificates and registration—with automated Waiting list Essential Learning'" courses can be especially valuable to-organizations, that are accredited by national organizations or have staff training requirements from state regulatory agencies such as: • American Correctional Association (ACA) Accreditation Standards • Accreditation Association forAmbulatory Healthcare (AAAHC) • CARF I§ehavtorai Health Standards • CAR FChild and Youth standards • CARF Employment and Community Services Standards • COA Standards for Health and Human Agencies • EAGLE ACCreciltetionPrinciples • Joint Commission Ambulatory Care Standards • Joint Commisslon Behavioral Health Standards National Alliance of Direct Support Professionals Office of Head Start Training Standards Continuing Education Units (CFO) our health education and training services include continuing education, which NaphCare provides annually by offering hundreds of CEU honors, enough to bring each employee's llcensure Lip to date, NaphCare pays for employee's CELI's;througfion -site, online training. This mode of training reduces costs and makes better use of staff time, for it eliminates the need for unnecessary travel and associated expenses. NaphCare also provides pertinent monthly in- service education programs based on issues identified by our Continuous Quality Improvement lCQlj program. High Professional Standards The tralning we provide rneets the recommendations and guidelines mandated by Federal, State, and local guidelines (OSHA, JCAHO, NCCHC, andACA ). As an added service, all employees receive monthly, quarterly, and annual education and training assignments as reminders, These reminders ensure compliance with Inmate Medical Services City of Santa Ana 25H -107 € IFF N 14 -034 103 ��r Ind�endant heohixuv ahoi4e. education and training requirements. 1cb� specific education programs are also assigned to job categories lei arderto maximize each employee's training experience, CORR CTIONS- i3AUDTRAINJNG In addition to in- service education programs and online tra €nErtg. Essential Learning"" also offers the Corrections OnlineTryining Collaborative (COTC). The COTC is a cooperative venture of the leading associations serving the correctional, industry and currently Includes the ACA fAmerican <Correctional Associatoni , American Jail Association (AJA),American Probation and Parole Association (APPA), and the Natlonaf Major Gang Task Farce {NMGTF).The associations joined together to bring high quality, cost- effective staff training solutions to the corrections field, Essential Learning," allows our clients to expand learning opportunitles for staff white reducing costs fair, • Pre - service and in- service training • Compliance with legislation, • AGAaccreditation profess Iona Ilicensing, and' ACAre- certification Agency - specific traInIng ANNUAL TRAINING REQUI REl4tENT5 The fallowing chart lists the annual training that is required by our policies. Several Items on NaphCare "s Healthcare Staff Orientation ( Competency Checklist (included in the Append x) are annual requirements as welL management is required to attend NGCHC Conferences at least once per year. Inmate Medical Svwites Glty of Santa An a 25H -108 14 -634 104 Y J -D -02 Training on non- formulary All staff medication J_p -06 Dental training and oral for intake staff by Dental Provider screening tra ining J -E -11 Training an nursing, protocols Ail staff NaphGare,provides training for correctional officers according to the standards set by NCCHC. Our policy for training correctional officers establishes a systematic method for training correctional staff regarding health- related Issues. Training for all correctional staff that interact with Inmates on topics relating to healthcare, as appropriate to their duties, will he provided (NCCHCStandard, J -C -04, AC4 Standard, Training and Staff Development), This training will be coordinated with the SAi for custodial and civilian staff, to include, at a m€nitnuml • Administration of First Aid • Emergency Intervention — recognizing needforemergency intervention lnlife-threatening situations (Le., heart attack, withdrawal) • Chronic Disease Awareness— recognizing chronic illness and adverse reactions to medications • Sulcide Prevention • Cardiopulmonary resuscitation fCPR) • tutodical Confidentiality and Patient Privacy • Infectious and Communicable Disease Education • Mental Illness Suicide Prevention Tralalo Atopicof particular Importance, we provide suicide preventiontrainingto all an-site correctional and medical staff employees who regularly interact with inmates Staff will undergo an g hourinitial training; Training topics include the following; • Signs and symptoms of predisposing factors of potentially suicidal offenders • Risk factors in the evaluation otsu icide potential • Management of suicidal offenders • Review ofinstitutlonalprocedures regarding suicide prevention We provide annual updates and additional training to keep all staff aware of changes in suicide policies and to update staff on the latest advances in the care of suicidal offenders. Collaboration among medical, mental health, and correctional staff is imperative in successful suicide prevention, M. EQUIPMENT AND SUPPLIES NaphCare Will purchase, own and maintain all medical equipment and consumable supplies. NaphCare will ensure thatadequate supplies of pharmaceuticals and consumable medical supplies are maintained at all times. Inmate Medical Services City of Santa Ana 25H -109 RFP No, 14-034 105 i r-) 25H-110 EXHIBIT "B" Total FTEs 16100 15 25H -111 Health Services Administrator / ICE Medical Liaison 8.000 8,000 8.000 8.000 8.000 40 1.000 Administrative Assistant/ Medical Records Clerk 8.000 8.000 8.000 8.000 8.000 40 Medical Director/Physician (On-call 24/7) 4.000 1 4 0,100 PA/NP 8.000 8.000 8,000 8.000 8.000 40 1.000 RN Charge - Intake/Sick call 8.000 8,000 8.000 8.000 8.000 8.000 8,000 56 1.400 LVN - Med Pass 16.000 16,000 16,000 16,000 16.000 16.000 16.D00 112 2.800 Psychiatrist 4.000 4.000 8 0, 0.200 Psych RN / Soclai Worker 8.000 8.000 8.000 8.000 8,000 8.000 8.000 56 1.400 Dentist 4.000 4 0.100 Dental Assistant 4,000 4 0.100 i 0! xa RN Char - Intake/Sick call 8.000 8.000 8,000 8.000 8.000 8,000 8.000 56 1.400 LVN - Mod Pass 16.000 16,000 16,000 16,000 16.000 16.000 16.000 112 2.800 `.?,vm�htShl A RN Charge - Intake /Sick call 8.000 8.000 8,000 8.000 8.000 8,000 EO00 56 1.400 LVN - Med Pass 8.000 8,000 8.000 moo 8.000 8,000 8o00 56 1.400 Total FTEs 16100 15 25H -111 AGREEMENT FOR THE PROVISION OF INMATE MEDICAL SERVICES BETWEEN CITY OF SANTA ANA AND CORRECTIONAL MANAGED CARE MEDICAL CORPORATION THIS AGREEMENT is made and entered into this Ist day of September, 2014 by and between CORRECTIONAL MANAGED CARE MEDICAL CORPORATION, a California corporation (hereinafter "Contractor "), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City "). RECITALS A. The City desires to retain a Contractor having special skill and knowledge in the field of providing basic and emergency inmate medical services. B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional company in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: TERM This Agreement shall commence on September 1, 2014 and terminate on September 30, 2014, unless terminated earlier in accordance with Section 15, below. 2. SCOPE OF SERVICES Contractor shall provide basic and emergency medical services to inmates at the Santa Ana Jail as outlined in Contractor's letter proposal attached hereto and marked as Exhibit "A" and incorporated herein by reference. The proposal letter outlines the services previously agreed upon by Contractor as part of Contractor's response to RFP 07 -062 and previously provided to the City from 2007 to 2014. 25H -112 3. COMPENSATION a, The Total Annual Sum to be expended under this Agreement for staffing, pharmaceuticals, supplies and other services shall be abase amount of $139,061 with an additional contingency not to exceed $56,500 for costs associated with extended liability insurance and employee retention to ensure continuous and compliant medical operations, for a total agreement amount of $195,561. b. Invoices shall be paid monthly by the 30al day of each month, after receipt of a complete invoice. Payment for Additional / Chargeback Services shall be made within thirty (3 D) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City, c. City shall not reimburse Contractor for services provided beyond the expiration and /or termination of this Agreement, except as may otherwise be provided under this Agreement, or specifically agreed upon in a subsequent Agreement. 4. INDEPENDENT CONTRACTOR Contractor is, and shall at all times be deemed to be, an independent contractor, wholly responsible for the manner in which it performs the services hereunder, Contractor is entirely responsible for compensating staff and consultants employed by Contractor. This Agreement shall not be construed as creating the relationship of employer and employee, or principal and agent, between City and Contractor or any of Contractor's agents, employees or subcontractors. Contractor assumes exclusive responsibility for acts of its employees, agents or subcontractors as they relate to the services provided during the course and scope of their employment. Contractor's employees, agents or subcontractors shall not be entitled to any rights or privileges of City employees, nor be considered in any manner to be City employees. 5. EXPENDITURE AND REVENUE REPORT No later than sixty (60) days following the end of the initial term, or any subsequent term of this Agreement, Contractor shall submit to City for informational purposes only, an Expenditure and Revenue Report for that period. Such report shall be prepared in accordance with the format that is provided by City, 6. FACILITIES PAYMENTS AND SERVICES City shall compensate Contractor and Contractor agrees to provide the services, staffing any equipment and supplies, and reports in accordance with Exhibit A to this Agreement. Contractor shall operate continuously throughout the term of this Agreement with at least the required number and type of staff which meet applicable City, State and Federal requirements, and which are necessary for the provision of services hereunder. 25H -113 7. INSPECTIONS AND AUDITS a. City, any authorized representative of City, any authorized representative of the State of California, the Secretary of the United States Department of Health and Human Services, the Comptroller General of the United States, or any of their authorized representatives, shall have access to any books, documents and records, including but not limited to medical and client records of Contractor which such person deem pertinent to this Agreement, for the purpose of conducting an audit, evaluation, examination or making transcripts during the periods of retention set forth in the Records section of Exhibit A to this Agreement. Such persons may at all reasonable times inspect or otherwise evaluate the services provided pursuant to this Agreement, and the premises in which they are provided. b. Contractor shall actively participate and cooperate with any person specified in subparagraph A above in any evaluation or monitoring of the services provided pursuant to this Agreement, and shall provide the above - mentioned persons adequate office space to conduct such evaluation or monitoring, C. Following an audit report, in the event of non - compliance with applicable laws and regulations governing funds provided through this Agreement, City may terminate this Agreement as provided for in the Termination paragraph or direct Contractor to immediately implement appropriate corrective action. A plan of correction shall be submitted to City in writing within thirty (30) days after receiving notice from City. d. Within fourteen (14) days of receipt by Contractor, Contractor shall forward to City a copy of any audit report. Such audit shall include, but not be limited to, management, financial, programmatic or any other type of audit of Contractor's operations, whether or not the cost of such operation or audit is reimbursed, in whole or in part, through this Agreement. 8. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Comprehensive General Liability Insurance. Contractor shall maintain comprehensive general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting there from and damage to property, resulting from any act or occurrence arising out of Contractor's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting there from, and property damage, in the total amount of $2,000,000 per occurrence. Contractor shall supply City with a fully executed additional insured endorsement on a form approved by the City Attorney at the time this Agreement is executed. 25H -114 b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Contractor, if Contractor has any employees, is required to be insured against liability for worker's compensation or to undertake self - insurance. Prior to commencing the performance of the work lender this Agreement, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. c. Any person providing Physician Services pursuant to this Agreement shall maintain Professional liability (errors and omissions) insurance against medical malpractice with a combined single limit of not less than $1,000,000 per claim and $3,000,000, in the aggregate, per year. d. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: (i) Contractor shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement, (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. c. If Contractor fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City, 9. INDEMNIFICATION Contractor agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, Contractors, special counsel, and representatives from any liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the Contractor or its subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement. The Contractor farther agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the direct or indirect operations of Contractor. City may make all reasonable decisions with respect to its representation in any legal proceeding. 25H -115 10. CONFIDENTIALITY a. Contractor shall maintain the confidentiality of all records, including billings and any audio and /or video recordings, in accordance with all applicable State and Federal codes and regulations, as they now exist or may hereafter be amended or changed. b. Prior to providing any services pursuant to this Agreement, all employees, subcontractors, and volunteer staff or interns of Contractor shall agree, in writing, with Contractor to maintain the confidentiality of any and all information and records which may be obtained in the course of providing such services. The agreement shall specify that it is effective irrespective of all subsequent terminations of Contractor's employees, subcontractors, volunteers or interns. c. All confidential information furnished by Contractor to City hereunder will be kept confidential by City and shall not, without the prior written consent of Contractor, be disclosed by City, or by its representatives, contractors, or employees in any manner whatsoever, in whole or in part, and shall not be used by City or its representatives, contractors or employees who need to know the Confidential information, 11. CONFLICT OF INTEREST CLAUSE Contractor covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NOTICE a. Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Cleric of the City Council City of Santa Ana 20 Civic Center Plaza (M -30) P.O. Box 1988 Santa Ana, CA 92702 -1988 Facsimile (714) 647 -6956 25H -116 With courtesy copies to: and City of Santa Ana Santa Ana Jail 60 Civic Center Plaza Santa Ana, California 92702 Facsimile (714) 245 -8116 City Attorney City of Santa Ana 20 Civic Center Plaza (M -29) P.O. Box 1988 Santa Ana, California 92702 Facsimile (714) 647 -6515 To Contractor: Correctional Managed Care Medical Corporation 4211 E. La Palma Avenue Anaheim, California 92807 Facsimile (714) 528 -5801 Attn: Harmohinder S. Gogia, M.D. A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefaesimile, communication shall be effective or deemed to have been given twenty -four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, stake, County or City holidays shall be excluded. b. NOTIFICATION OF DEATH — Upon becoming aware of the death of any person receiving services hereunder, Contractor shall immediately, in person or by telephone, notify the on- premises Jail Administrator or his designee, the Orange County Coroner, and the Orange County District Attorney. In addition, Contractor shall, within sixteen (16) hours after such death, deliver in person or by facsimile machine, a Written Notification of Death to the above persons. The telephone report and Written Notification of Death shall contain the name of the deceased, the date and time of death, the nature and cirewnstances of death, and the name(s) of Contractor's officers or employees with knowledge of this matter. Upon request, and to the extent allowable by law, Contractor shall provide the Coroner, District Attorney, Jail Administrator or his designee with a complete copy of the deceased patient's medical record. c. NO'T'IFICATION OF SPECIAL INCIDENTS — Immediately upon becoming aware of any occurrence of a serious nature which may expose either party to liability or disrupt the services hereunder, Contractor shall verbally notify the on- premises Jail Administrator or hi ,s 25H -117 designee, Such occurrences may include but are not limited to accidents, injuries or acts of negligence, or any incident or circumstance which adversely impacts the capacity of Contractor to provide the services hereunder. Such verbal notification shall be followed within twenty -four (24) hours, by written notification to City and the Jail Administrator or his designee, 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Contractor nor the City, Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 14, ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer or delegate any interest herein and any such assignment, transfer or delegation shall be considered null and void. However, obligations undertaken by Contractor pursuant to this Agreement may be carried out by subcontracts, provided such subcontracts are approved in writing by City, meet the requirements of this Agreement as they relate to the service or activity under subcontract, and include any provisions that City may reasonably require. No subcontract shall terminate or alter the responsibilities of Contractor to City pursuant to this Agreement. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 15. TERMINATION a. This Agreement may be terminated by the City without cause, by giving thirty (30) days written notice of termination, b. After receiving any Notice of Termination, Contractor shall continue to provide services and cooperate with City staff until the date of termination in a manner which is consistent with recognized standards of quality patient care and prudent business practice, and obtain immediate clarification from City of any unsettled issues of contract performance during the remaining contract term. c. The right and remedies of City provided in this Termination paragraph shall not be exclusive, and are in addition to any other rights and remedies provided by law or this Agreement. 25H -118 d. City may terminate tbis Agreement immediately, upon written notice, on the occurrence of any of the following events: 1. The loss by Contractor of legal capacity. 2. Cessation of services 3. Delegation or assignment of Contractor's services operation without written approval by City Of Santa Ana 4. Neglect by any physician or licensed person employed, by Contractor of any duty required pursuant to this Agreement 5. The loss of accreditation or any license required by the Licenses and Law paragraph of this Agreement 6. The continued incapacity of any physician or licensed person to perform duties required pursuant to this Agreement 7. Unethical conduct or malpractice by any physician or licensed person providing services pursuant to this Agreement; provided, however, City may waive this option if Contractor removes such physician or licensed person from serving anyone pursuant to this Agreement. 16. NONDISCRIMINATION a. Employment. Contractor shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. b. Services, Benefits and Facilities. Contractor shall not discriminate in the provision of services, the allocation of benefits or the accommodation in facilities on the basis of ethnic group identification, race, color, religion, ancestry, creed, sex, national origin, marital status, age, sexual preference, medical condition or physical or mental disability. For the purpose of this subparagraph B, "discrimination" means denying a client or potential client any service, benefit or accommodation that would be provided to another and includes, but is not limited to, the following: 1. Denying a client any service or benefit or availability of a facility. 2. Providing any service or benefit to a client which is different or is provided in a different manner or a different time from that provided to other clients. 3. Restricting a client in any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service or benefit, 4. Treating a client differently from another in satisfying any admission requirement or condition or eligibility requirement or condition, which individuals must meet in order to be provided any service or benefit. 5. Assigmnent of terms or places for the provision of services on the basis of ethnic group identification, race, religion, ancestry, color, creed, sex, marital status, national 25H -119 origin, age, sexual preference, medical condition or physical or mental disability of the clients to be served. c. Persons with Disabilities — Contractor agrees to comply with the provisions of Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794 et seq., as implemented in Title 45 CFR, Section 84.1 et seq.) pertaining to the prohibition of discrimination against qualified persons with disabilities in all programs or activities, and the Americans with Disabilities Act of 1990 (42 U.S.C, 12101 et seq.) as they exist now or maybe hereafter amended together with succeeding legislation, d. Retaliation — Neither Contractor nor its employees or agents shall intimidate, coerce or take adverse action against any person for the purpose of interfering with rights secured by Federal or State laws, or because such person has filed a complaint, certified, assisted or otherwise participated in an investigation, proceeding, hearing or any other activity undertaken to enforce rights secured by Federal or State law. 17. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties farther agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. PROFESSIONAL LICENSES a. Contractor and all of its employees and subcontractors providing services pursuant to this Agreement shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa, Ana and all other govermnental agencies. Contractor shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. b. Contractor warrants that all Contractor physicians providing services under this Agreement are and will continue to be as long as this Agreement remains in effect, the holders of currently valid unrestricted licenses to practice medicine in the State of California. 19. COMPLAINCE WITH ALL LAWS a. Contractor shall cause all of its activities render this Agreement and all activities at the Santa Ana Detention. Facility to be performed in compliance with all applicable federal, state, and local laws, ordinances, and regulations. b. All medical services will meet California Administrative Code (CAC), Title 15 - Minimum Standards for Local Detention Facilities, National Detention Standards of Immigration 25H -120 and Code Enforcement Bureau as well as all other applicable laws, regulations, codes and guidelines relating to health care services and programs in adult detention facilities in the State of California. 20. MISCELLANEOUS PROVISIONS a. Neither party intends that this Agreement shall create rights hereunder in third parties, including but not limited to any subcontractors or any clients provided services hereunder. b. Each undersigned represents and warrants that its signature herein below has the power, authority mud right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. c. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement, IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: MARIA D. HUIZAR Clerk of the Council APPROVED AS TO FORM: ALHO City Senior Assistant qty Attorney RECOMMENDED FOR APPROVAL: CARLOSROJAS Chief of Police CITY OF SANTA ANA DAVID CAVAZOS City Manager CORRECTIONAL MANAGED CARE M Tax ID# t0 25H -121 (Name) (Title) EXHIBIT A 11 25H -122 1*14r111,30 r� 11 25H -123 11. MEDICAL SERVICES CMCMC's proposal for the Jail is based on a contract start date of September 1, 2007 and an imitate population of 480. We understand that the term of this contract will be for three (J) years with a maximum of two (2), one (1) year extensions. CMC'MC will comply with all CAC Title 15 guldeluaes including, but not limited to, the following; > individualized treatment plans > Vermin control 9 Care of pregnant and lactating women > Management of Communicable diseases. > Decision making related to special -need himates la Direct orders > Use of restraints > Standardized procedures > Continuity of care > inmates in segregation > Safety Ceti services > health promotion and disease prevention In addition to meeting the above Title 15 requirements, CM.CMC Will be responsible for Identifying, evaluating, treating arnd.'mnnhoring a.11 i,rrmate medical conditions, including applying, monitoring and removing sutures, The following details the services that CMCMC will be providing to the City. Cilq orsona Aoa fait -12- Proposal for tauraw KAoal SaVins 1 1 25H -124 A. RECEIVING SCREENING CMCMC recognizes that the completion acid review of the iartake screening form is a crideal health encouitter. Not only does this process initiate the health record for the inmate and begin to orVurlze on -going health ogee, but also more importantly, it is intended to serve the preventive health function of protecting the confined population from infectious diseases through astute medical evaluation, The intake screening form is completed by the Detention Officers and includes the following: A, inquiry into: 1. Nast history of illnesses and medical conditions, 2, Known allergies, 3, Cmrsatt illness and health problorns, 4•. Communicable diseases (i,ncha&.g sexually transmitted disessos), 5, Alcohol/drug abuse history (method /types, as well as date and time of last usage), turd problems related to stoppage, 6. Medications currently being taken and other special health requirements, 7, Dental status, 8. Chronic health problems (including behaviorat medicine), 9. Dietary restrictions, and 10. History of, and current possibility of:', suicido risk. H. Observation of: 1. State of consciousness, 2. Mental status (including suicidal ideation), 3, Appearance, City of'saoifi AnD hit] Proom) for Irnnato M odioul Sar im aPP# 07 -062 25H -125 4,. Conduct including tremors and/or sweating, S. Bodily deformities and case of movement, and 6, Condition of skin and body orifices including signs of trauana, bruising, lesions, jaundim, rashes, infestations, needle marks, and/or other signs of drug usage. C. Explanations of procedures for accessing health care services, D, Classification into one of the following categories: 1. Immediate emergency treatment needed, 2. Referral to an appropriate health care service, or 3. Assignment to the general population. If the Detention Officar believes that an inmate requires immediate medical attention or is identified as having an existing medical condition, the medical department will be notified. A licensed nurse will then respond to the intake area to triage the inmate and provide treatment, and /or roferoal to the appropriate provider, as indicated. Inmates requiring ©tnorgonoy medical care, that cannot be provided, on -wite, will be transferred to either the Qrango County Sail or Western Medical Center, Santa Ana's emergency room for evaluation and treatment, The intalce screening process is critical to insure that the medical Ilability to the, City of Santa Ana is at a .minimum, CMCIvIC's medical staff Works well with the Detention staff to insure that this process i,5 suecessfal, All screening forcers will be roviewed by the NP and, if indicated, referred to the appropriate provider for evaluation and treatment. CMCMC will make recommendations regardJ.ng :housing and handling requirements and will provide Follow -up care as indicated. All lmnate encounters will bo dooummted and placed in the himate's medical record.. City Qf Santa Ann Jail 114. Proposal for Inmate Medloi l Sorvioms RPP& 07.062 25H -126 B, TUBERCULOSIS SCREENING All inmates will be screened for tuberculosis (TB) within four (4) days of admission into the fail. The nursing staff will begin by interviewing the Inmate to determine his /her reactivity to the tuberculin. skin test (TST), Inmates who do not have a verifiable positive test .result history will have the TST administered at this time, according to the Mantoux method, with readings taken in 48 to 72 hours, Immune compromised inmates wilt be anergy tested at the time of the skin test to minimize the risl< of a false negative result, Positive TST results will trigger a more extensive examination, to determine the hlcelihood of active disease, Individuals considered positive reactors (by history or skin test) would receive a chest x -ray. The physician, regardless of the shin test result, will examine HIV positive or possible positive, individuals whose oba,5t x-rays are abnormal or whose symptolms are suggestive of active tuberculosis. Sputum stains and cultures will be performed on those individuals suspected of being positive for active tuborordosls. White cultures are pending, the imaate will be ]'roused in respiratory isolation. Coaiirmod cases of TB will be reported to the proper authorides inoluding the Jail Administrator and the Orange County UeparUnant of Public Health. inmates with inactive tuberculosis will be given future TB testing instructions and education. Soreening results will be placed in the inmate's madioat reeerd and reviewed and approved by the pbysiciari or NP during the health appraisal. C. HEALTH APPRAISAL All inmates will receive a comprehensive medical history and physical examination within fourteen (14) days after admission. The history and exarn will be performed by qualified and trained 'health professionals (if City of sanftl Mobil 45- Pmponl fol hunoto Modiul Aervlagx Rr.P# 07 -062 25H -127 not a physician or NP, the results will be reviewed and initialed by the physician). The history and examination will include the following; A. Review of the receiving screening form. B, Review of any available medical records. C. Review of TB testing results. D, Completion of the medical, dental, and mental health histories, The history will include gender specific inquiries regarding menstrual cycle and unusual bleeding, the current, use of contraceptive medications, the presence of an IUD, breast masses and nipple discharge, possible pregnancy for females, and penile discharge for.male inmates. E. Physical exam,irnatlon.s inoluding laboratory and /or diagnostic tests to detect communicable disease (e.g., sexually transmitted diseases), Additiotral taste, such as urinalysis and/or blood work, will be ordered as determinod by the examiner. Examinations for females will inolude a pregnancy test, and, if indicated, leap smear and GC cultures, HIV tests will be completed when indicated and as consented to by the Innxate. F, Complete vision and hearing screenings, U. Completion of a dental scrmning. K Mental Health screening (including suicidal ideation). 1. Laboratory and other diagnostic test results. J. Cunent diagnosis orders and course of treatment. K. Reforrals for follow,,up and specialty care, L. Recoinmandations regarding 'housing, job assignment, and program participation, All recommendations will be communicated, in writing, to the detention staff. Cliy OeSanla Ann Jail 4611 Proposel I'or Inmuo Medical Services R.Pro 07.062 25H -128 M, Iaitlatioa of treatmeru, if indicated, All health appraisals will be docutnonted thoroughly and farms will be placed in the inmate's medical record, Please see the following page for a diagrammatic depiction of the Receiving Soreordug, TB testing, and Health Appraisal Process, D. DAT..LY TRIAGE OF MEDICAL REQUESTS Daily triaging of medical xequests is designed to ensure that inmates have the ability to request medical attention on a daily basis. 'Phis funotlon also improves the delivery of health care services by ensuring that medical problems are prioritized and handled in a vnedicalty appropriate and timely manner. All inmates (including those in segregation) will be able to raquest medical services by utilizing the exi�stin.g written request form (desoribed in the following section). R aquests will be gathered, reviewed acid triaged by the nursing staff ,seven (7) days a week, including holidays. Emergencies will be evaluated and treated innnediately. Other xequesta will be prioritized and referred to the appropriate; p'rovIder as Indicated, Completed request forms will be placed in the inmate's medical record. The objectives of sick call are several: (1) to meet the day-to-day needs of the inmate, (2) to provide care which minimizos the ,potential for exacerbation or complications, (3) to maximize the level of services provided on-site, and (4) to provide patios( education, City oN',anla Am Jail 17- Pmposn! For Inmate Medical 9orvims I Mt 07 -062 25H -129 The Registered Nurse (RN) and /or NP a minimum of live to six (5 -6) days a week, including holidays, will conduct sick call The sick call process begins when the inmate completes the Modical/Dontal Request Vorrn. Completed request forms will be delivered to the medical department on a daily basis. Each request will be date stamped, reviewed, and handled in one of the following three ways: (1) as part of daily triaging completed by the LVN, (2) scheduled to see the RN for further evaluation, or (3) scheduled to the appropriate provider for evaluation and treatment. All inmates requesting medical services will-be seen within 24 to 48 hours and all urgent and emergent sick calls will be soon immediately. inrnates who cannot attend sick call due to custody status will have sick call services provided in their cell or module, All sick call encounters will be documented in the medical rocord. Please see the fotl.owing page for a flow chart describing the sick call process. K PHARMACY SERVICES Pharmacy services will be provided in accordance with CAC 'Title 15 grudolines, and all applicable federal and state codes and regulations, CMCIAC shall be responsible to provide routine over - the - counter medications and routine proscription care for all inmates. Long - term medication for chronic taro, incinding HIV and psyehotropic medications, shall be the responsibility of the inmate's contracting agency, City ofSod&Aw Jai .lg„ NOp0081 far lmmto m4onl ,Savion RFrlt 07-062 25H -130 Sick Call Process Category 1: Minor health problems which appear not to poso a threat to life, thnb, vision or hearing aad, whiah no treatable With fast aid er over- the<nunter medtoatlon. This oategory also Includes individuals beingmonhored forblood.pressure,, blood sager, wound hcaling, etc, Category 11, A signfficantheaRl, problom which needs physician attaatlon, but which can be safely rlalayad until the next N151physlcian sick call Category 'Cllr A specific health problem Which demands prompt Inedloat auntioa to prevent further Compromise. Inmates submits sink call request Sick call request reviewed and triaged by nursin.. staff L>r Tk'ITN 'Created during —a Categnry f daily triage (F Category f'l 'tjth """""""""'"""' 8cheduledfornext NP/physician sick ll Gacalll (V 111 H � - Tnanatc treated �"�"^ hnmedlataly by Category Crl aunrouriate medical staff Tnmato evaluated and bR .lurnate referred to troatment comp:loted spaoialist or hospital for Miser care as aptaropriar 25H -131 Inmate receives medical clearance to return to the goneral All Information will be incorporatod late the intnato's health record Qualified, nursing personnel, daring regularly scheduled pill call rounds will administer medications in the modulos, 'Medications will not be administered without a prescription £xeta the physician, dentist, qualified mental health staff, and/or NP. Medical reoord documentation will imiude the recording of administration of medications, the fact that inmates are receiving and ingesting their medications, and the reason an inmate's ordered medication was not given, if indicated. Pharmaceuticals will ecnixnne to be provided by Correot Rx Pharmacy Services W-A Baxkwood Court Zinthioum, MD 21Q90 In order to receive competitive pricing with tho phimnacoutioals CMCMC has contracted with Correct itx.Pharmaey based out of Linthiouin, M'D. Prescriptions will be prepared off sito and dativored to the medical department on a regulax Monday- Satuxday schedule, excluding holidays, CNICMC will maintain a sapply of STAT medications to help ensure that inmatos needing high -risk medications do not experience a lapse in treatmoizt. CorrectRx will provide all medications in bulls unit dose packages. Medications may be given In tablet, liquid or syringe forna. Administering of syringe medications will be conducted in the medical exam areas only, Medications will then be administered by qualifled nursing personnel as ordered by the physician au&T other health care providers (Le. dentist, NP, Psychiatrist, etc). In most cases medications will be administered in liquid form to decreasc the cbance of mus ter "cheoklug" medications. City orSanai Ant fall MpoRd ru hlmntu Ma&al Sarvices RFP@ 47.062 25H -132 All .medications and supplies will be secured, accessible only to designated staff, and administored solely by nursing personnel unless directed otherwisu by the proscribing physician. Prompt collection of expired non- oontrollod medications, unused a medication remaining after an inmate leaves the Jail, as well as timely disposal of all Class 11, 111, P/, and V medications will be monitored by the NP and the pharmacist, A licensed pharmacist will perform quarterly pharmacy audits to onsuro contract compliance, compliance with CAC Title 15 guidelines and state and federal regulations. G MEDICAL DIETS As mandated by CAC title 15, CMCMC's responsible physician will review and approve all diet .manuals to ensure that they incorporate the four (4) basic food groups (based on die Manual of clinical Diotetics and Manual of the Americau Dietetic Association) and accommodate special, therapeutic diets, the medical staff may, upon request due to religious and/or ,personal pxofereneo, advise inmates who are on restricted diets on how to moot theft nuuitional needs while incarcerated. (Non-medically restricted diets must have the approval of the Santa Ana City Jail's Administration), Tho ,physician and /or other qualified p'rovid'ers will proscribe modioai diets, as indicated. The Mood services department will lro notified„ io . writing, when a rnodical diet has been ozdered. Please see (page 21) for the Nutritional Guidelines Food Guide Pyraraid.. City of data An Jail _y2- Proposal for➢nnate Medical SsMws al'IV 07.062 25H -133 M EMERGENCY SERVICES Emergency services, lncluding first aid and the treatment of injuries, will be provided on -site, whenever possible. Care will be initiated, and /or supported, by the physician, the dentist, and nursing staff: The physician will be available 24 Hours a day, seven (7) days a. week, CMCMC's medical staff will provide emergency treatment for Detention Officers who are injured or become ill while on the job. 'treatment will consist of stabilization and referral to the individual's physician or local emergency room. First response medical care will also be provided to all visitors, ('4 a Naatn Anw Iiit n -232 PMrua11 N)r Nmae N1e1110A1 uervia Si RFP9 07 -062 25H -134 I. H®5PITAL TRANSITERS If an inmate requires a level of care that cannot be provided oxi -site, CMCMC will, in coordination with Jail 'Detention Staff, arrange for transfer to Western Medical Center, Santa Ana's emergency department for evaluation and treatment. J. DENTAL SERVICES Dental services will meet all standards set by the .American Dental, Association, the Centers for Disease Control and Prevention, and Occupational Safety and Health Administration. On -site dental services wore established at the Jait effective September 1, 1998, CMCMC contracts with Helen Ninh, DDS and Maria. Mayo, DDS for the provision of the denial services detailed below, Dr. Ninh k the lead dentist and her business address is 48 Sunset Circle, Westminster, California, 92683. Please see ffifiJIUM for a copy of Dr, Ninh's and Dr. Nlayo's Curriculum Vitae, lurnates will receive, a dental screening and instruction on basic hygiene during the hoalth apptaisal. Identified problems will be referred to the dentist for evaluation and treatment, On -site dental clinies will be held once per week for a minimum of four (4) 'hours per clinic (depending on the number on iamoto8 schodiiied to see the dentist), Requests for dental services will be made available through the si.cic call process ( ' ), Requests will be triaged and prioritized a000rdittg to acuity. All inmates needing dental care will be seen by the dentist within three (S) weeks of stibmission ofrequest, Uy of Vaiuu Am, Jdu ..25_ PoDpo t P+r Wilatc N10(ical SOMOM UPI 07062 25H -136 Dental services will include, but not be limited tot > .Extractions X'Pays > Temporary fillings D Tooth cleaning and gum care > 24 hour emergency soMoos CMCMC understands that we will not be responsible for petlodontal, ondodontics, oral surgery, and the provision of orthodontic appliances, Please see the section entitled III, Additional Services (12MEWA for information regarding the repair of dentures, don tal plates and partial plates. K. MENTAL E'ALTH SERVICES All mental health policies and procedusos will meet CAC Title l.5 guidelines, the legal and ethical guidelines of mental health ,professional organizations, and federal, state, and county laws and regulations. CMCMC will continue to irtilizo the services of'Ravinder P. Singh, MD., Fox the provision of mental health servi.oes..Dr.. Singh has heart providing these services since January 1997. Her 'business address is 1405 N. College Ave., Sto, G, Santa Ana, California, 92706. Please sae for a copy of Dr. Singh's Curriculum Vitae. Mental health sorvloos will include: ' �' �Y. g�:�i6.kd'SEa „wrr„�:u�;anemtwii va er��tan: Initial identifroation of inraatos with mental health care needs will take place during the receiving screening process, Inquiries into past and pt•esent mental health problems, as well as stucidal ideation will be made, City of, aWa Ana Jell -26- PrOPOW Ibr fwwh Radiml sorvlcoa xrrm 07462 25H -137 hirnates needing further treatment will be referred to the mental health staff for evaluation said treatment If the uvmata is currently receiving, or has received treatment from art outside agency, the agency will be contacted and the necessary mental health information will be requested, Inmates i.dentilied as suicidal will immediately be evaluated and treated, as needed (please sae section below entitled Emergency crisis, intervention and suicide prevention services). I�egrtin� /rton�e r,„�t servi. c,i Inmates 'pan make a routine request for non - emergency mental health services by use of the sick call request process ( Detention Officers can also refer Inmates for evaluation and assistance, Routine requests will be triaged and scheduled for the next available mental health clinic, Mental health clinics will be held twice a month for a minimum of four (4) hours per clinic (depending on the number of inmates scheduled for each clinic). r p'iS�a,Prewim dreteawmninpg,a si .ail�„p.�"„mrg„t�ar e v p„��,i Requests for emorgency mental health services can be made by Detention Officers and /or 'inmates 24 hours a day, seven. (7) days a meek, A mam.bor o£ the medical staff will i mmodiately respond to all emergency regw qu, CMCMC contracts with College Hospital Costa Mesa (CH M) for the provision of crisis intervention and mental health support services, Please see REWS&W for CHCNI vendor Information, Mental health support Services include; > Licensed racintal, health professionals trained in emergency psychiatric crisis intervention and evaluation, City a' Sama Ann Jal l _27- Prohoenl be Imnflo Medical Seavlcos RM 07,062 25H -138 S 24 hour, 7 days a week availability, l4^ Response time to the Santa Ana Jail. will be 30.45 minutes. ➢ .Licensed staff vAll provide crisis intervention and evaluation of inmates demonstrating behaviors and/or symptoms related to psychiatric distress, i.e., severe depression and psychotic episodes A The CHCM Mobile Response Team wilt continue to provide evaluation of persons for 5150 Hold when appropriate and facilitate transfer of clients to designated psychiatric facility. This service will continue to be operated in compliance with Orange Cotuity Health Care Agency policies and procedures outdred in the Mobile Psyohiahlo Assossnvmt Team Standards of Practice, If a Pedoral Hold inmate is found to be acutely mentally disturbed, as welt as a danger to self and/or others, and/or gravely disabled, ho will be transferred to an inpatient psychiatric facility by the contracting agency. Suicide prevention services will include asses meat (as outlined above), intervention, and treatinant'by members of the mental health and medical staff, The scope of intervention sorvlees will include close observation, suicide watch, arnotgency medications, and therapeutic restraints. Aonro pia a use of nqvehotroDie wedie io is: The psychiatrist and /or the physician will prescribe psychotropic medications for the sole purpose of treatment of mental and emotional disorders. Medications will be administered on a voluntary basis unless the psychiatrist declares an emergoncy situation. With the exception of emergency situations, the psychiatrist will provide patient education at rite time the medication is prescribed, The psychiatrist Cary of Soma Ann fell 418 - ?ropasel r01`111[Ilnfe Medical Servleou RYN 07.062 25H -139 will explain to the inmate In simple language the anticipated, risks and beneitts of taidng the medication, The inmate will then sign the infotmed Consent Form acknowledging an understanding of this information, Psychotropic medications will be ordered for no more titan M days Without a face- tom£ace evaluation by the psychiatrist, L. DETOXIFICATION CMCMC will be responsible for the proper disposition and care of inmates undergoing detoxification :from drugs and /or alcohol, inmates will be individually evaluated as to the need for medically supported dotoxifleation nfoatmoiit during the receiving screening process. `i'he medioal staff` will evaluate all inmates upon admission into and, when notified, prior to leaving the detoxification cell. Once admitted to the dotoxi:fication cell, a nurse will check on the inmattc at a mialawra of once every six (G) hours, Inmates, who, according to existing standardized procedures, appow to need acute medioal attention will be transferred to an appropriate setting for treatment. M. JAIL STAFF SERVICES t. Sta�g,•ar eel t'itt CMCMC will provide baseline tuberculosis testing to all rail personnel evoty six. ((a) months and immediatoly after any exposure incident. Testing will be via the two (2) step Mantoux technique; intradermal injection of 0,1 nil of purified protein derivative (PPD) containing five (S) tuberculin units. M1 of swa Ana Jail .129> Proposal The tarlwa Me111od Sol -viou KI-N 07,062 25H -140 CMCMC will offer the three (3) step hepatitis B vaccinations to all Tail personnol, The immunization series will be Rocornblvax HB' matnrfactured by Merck, Sharpe &e Dohme or as stated by the most current regulations. Antibody testing to evaluate seroconvorsion and appropriate booster injections, if indicted, will be provided after three (3) years, Documentation regarding administering of tests, lab rosults and signed consent forms will be forwarded to the Jail Administrator for inclusion into existing personnel Gies, 3,Tralging for ei -, g e CMCMC currently provides the Detention Officers with a minimum of five (5) two (2) hour sessions on :Blood borne :pathogens, TD, Universal Precautions, and other topics as doomed necessary by the Tail and by CMCMC. N, LABORATORY SERVICES CMCMC will continue to utilize guest Diagnostic located in Santa Ana for the provision of laboratory services. All routine and rron�cultlred test results will be returned to the medical department within 24 hours. Results will be reviewed upon, receipt, STAT results will be phoned into the medical department with the written report to follow, All SCAT results will be communicated to the NP and /or physician upon receipt. Test results along with documentation of review and plan o'C action will be placed in the medical record, City oMnntn Mn Jail .gp., prgpml 6r.111nate Nled cal ,Yarviu n Krilq 01/1062 25H -141 Laboratory logbooks will be maintained to ensure timely oollection and reporting, of'results. Logbooks will also be used to evaluate the utilization of services. 0. MEDICAL RE, CORDS CMCMC will maintain all medical records in accordance with, CAC Title 15 guidelines, and all other applicable codes and regulations, A complete medical record will be Initiated for each inmate. CMCMC requires accurate and timely reporting from all rnembers of its medical staff and enforces policies requiring thorough documentation of all patient sucotaners (inoWding mental healtb encounters). Each record will include, but not be limited to, a problem list, progress notes, receiving screening, health assessment forms, record of medication administration, and diagnostic test reports. Medical records wih accompany the inmate to on -site health care ancounters and will be secured separately from confinement records. A transfer summary form and copies of pertinent medical. records will acoompany inmates transferred to other correctional facilities, as welt as to cfT' -site medical appointments and /or hospital transfers, Copies of medical records generated off-site will be requgatod for inclusion in tho irunate °s medical. file. CMCMC acknowledges that all medical records are the property of tb.e City and will be maintained by CMCNLC only while its contract is in fbroe. All records will be kept confidential, but will be acewsible to authorized medical personnel (including dental and mental health). files City d8antfl Ana fail I- Normal fur Inmata Medlwa $0"lws UPI 97462 25H -142 will also be made available to other authorized individuals, as required by law. CMCMC will maintain inactive health records ror a minimum of seven (7) years and will follow established procedures for archival storage, A 'FOLIC" AND PROCEDURE CMCMC will coutlrtuo to adharo to the procedure manuals already in existence at the Jail. These manuals comply with all CAC Title 15 guidelines and have been reviewed and approved by the .Tall Administrator and the Orange County Public Health Department. CMCMC maintained a 100% compliance for the 2007 O,C, Public health Department audit, All manuals will be reviewed and updated, on ao annual basis, All updates and revisions will be reviewed and spiptoved by the Jail Adaninistrator, prior to implementation. Q. IVIEETINGS AND REPORI'S CMCNIC's Chief Operating Officer meets regularly through forntal and informal meetings with the Jail "s. Administration, CIVCCMC's ability to meet quickly has developed prompt problem solving and. pro- active dialog to insure issues are .rewlvod quickly before they become probleam The medical start will meet on a monthly basis and minutes will be .kept on rile as well as distributed to all employees. CMCMC will also be available to attend Jail and/or City meetings as requested, City of Santa Ana ,fail .32. Proposal for Inmate Medical Servlans RVV9 07.06'2, 25H -143 To ensure timely and accurate reporting of events, a. oomprehensive Statistical and Activity Report will be provided to the Jai'i Administrator and/or designee on a monthly basis. This report will inohAQ, but not be limited to, statistical workload data on; > Sick call visits ➢ Health appraisals > Dental visits Mental health clinics ➢ Laboratory services > Prescribed medications > Medical diets > Additional services & QUALITY ASSURANCE PROGRAMS Within CMCMC, quality assurance and utilization management are viewed, as codependent activities that are driven by the same purpose, This purpose being to provide a systematic vehicle for the review, evaluation, remediatioa, arid monitoring of medically necessary care in a way that provides all inmates with equal access to cost ot'feati've medical care, that, meet or exceed, community staffdxds, Quality Assurance (QA) inwbanisms shall orroontpass all aspects of medical care including, but not timitod to, diagnostic studies, treatment modalities, appropriate health resccace utilization, medical record aeotuacy and oonfidentiality, and an assessment of the pationt's perception oC quality of care, The QA Committee will be responsible for developing and implementing QA mechanisms. The Chief Operating Officer for CMCMC. has the City ofSamn Ana Jail „gg.. Proposal for Ca nMe M'edlaal SaMods RVP# 07.062 25H -144 responsibility to ensure that the Committee addresses and accomplishes the program goals. S. RESPONDING TO COA111LA.II' TS AND INQUIRIES CMCMC will investigate all inmate-related inquiries, writs, and complaints in accordanco with the Jail's policy and procedures. The Chief" Operating Officer will investigate each complaint, develop a response and, if indicated, a recommended course of corrective action. This rccemmendasion and the rationale behind it will be provided, in writing, to all concerned parties, If the inmate disputes the outcome of an investigation, CMCMC will I mplement recommendations made by the Jail Administrator or his /her designee, CivlcmC's staff will also testify in court concerning writs of habeas coq us flied by iumatos, as r'egtured by subpoena. M EQIIIFMI!aNTa FURNISHINGS, AND SUPPLIES CIVICMC understands that the City will be responsible for providing food, linen, and other maintena rice services to the inmates horsed at the Sall. CMCMC h4athor understands thus wo will continue to be responsible for all other offico wad routine, pharmaceuticals, .medical supplies, forirus, instruments, uniforms, tools, and eciuipment needed to provide medical and dental services, MY or SantaNiu Sall �34- Notmal Cor 61714te Mndlatd 8e¢vices PRO 071062 25H -145 M. AraTIONAL SERVICES The following services will be scheduled and paid for on a per -use ba.sis• These services will not be connected, or billed together with any other services in this proposal. A. REPAID OF DENTURES, DENTAL PLATES, PARTIAL PLATES CMCMC will utilize the services of Crlidewell Laboratories located in Newport Beach, California, for all repairs of dentures, dental plates and partial plates. Di, RAIDYCDI,OGY SERVICES CMCMC will, if at all possible, perform all routine radiology services on- site at, the Jail. On site services will include chest x -rays to rule out TB and x-rays to rule out routine'fi•aotwcs. Theso servioos will continue to be provided through Diagnostic Lab X•R.ay, All x -rays will be taican by a registered techn, Man and read by a liconsed Radiologist. Emergency radiology services or services that cannot be provided, on-site will be provided by Western Medical Center, Samia, Arta. Reports will be delivered to the medical department within 24 hours, Upon receipt, all STAT results will be communicated to the on -Gall physician/'NP, All results will be reviewed aid placed in the medical record. Documentation will znciucle both the review and pl�m of action, if indicated. C. OPHTHALMOLOGY SE RVdC PS CMCMC has obtained the services of Margaret Taw, MD. and Triet Nguyen, M•D„ for the provision or emergency ophthalmology servicea, City oPSauta Affa Jail -35 •• l(opoml a)e POmab M'adlgal SeNICM RPP4 07.06'11 25H -146 i.e., foreign objects, possible orbital fractures, ate, Dr. Taw's business address is 3956 W. Hall Road, 4206, Anaheim, California, 92804 and Dr, Nguyen's address is 9286 13olsa Ave., Westminster, CA 92683, Please see 11UMM for a copy of Dr, T'aw's and Dr. Nguyen's Curriculum Vitae. D. OBSTETRICS AND GYNECOLOGY SERVICES CM.CMC will continue to utilize the services of Joseph Khan, M.D. and Nandi Wijesinge, MD., for the provision of obstetrics and gynecology services for the Jail, Dr, Khan has been providing these services since January 1998. His business address is 1629 W, 17" St., Ste. C, Santa Ana, California, 92706. Dr. Wijesingo has been providing services since April 2005. His business address is 1211 W, La Palma Ave., Suite 101, Anaheitat, CA 92801, Please see lffle . : for a copy of Dr, Kabn's and Dr. Wljesirl Curriculum Vitae. F. &i"MERGENCY PSYCHIATRIC CRISIS INTERVENTION CMCMC currently contracts wiflr Collego Hospital Costa Mesa ('or the provision of emmgencypsychiatric crisis intervention and evaluation. The mental health support team will be utilized as needed for inmates in psychiatric distros6, i,e„ severe depression (suicidal ideation) and psychotic d,isorder9 (sehlzophrenia). C11CM provides a complete evaluation with findings and suggested disposition for safe care of the innates, Their services are provided with a 30 -45 minute response time. 'They also provide the evaluation for 5150 holds for the local artmmes. Please see % ,M For a copy of their venclor information. City or9anh AAra Jill •36- Proposal tbrbnat'n Muallcal Smpm RFFI! 07.462 25H -147 C. BILLING SERVICES CMCMC currently provides billing services, through our claiins adjudication system, for the City of Santa Ana. This service extends to the billing of off-site emergency medical care. CMCMC currently processes claims for both. Hospital and Physicians providers, CMCMC includes a complete accounting of ail services that includes the following; A Complete claims report; report includes name of patient, date of service, provider of service and amount billed and amount to be paid, > Copy of each claim paid, b* lavo ice for the monthly administrative fee. > 'Mo Chief pperatbtg Officer reviews all hospital and provider olauns to insure that the City pays for only what they are responsible far and all other clairns are directed to the appropriate law enfoterment agency, G OFF-SITE MEDICAL SERVICES CMCMC, in•eoajunotion with westerai Medical Center, Anaheim, contracts with the U.S. Marshal Service. for the provision of out-patient specialty services sud hospitalization, CMCMC coordinates all out- patient services and monitors all in- patient services to insure that appropriate utilization of taro is accomplished and the patient returns, timely, to the jail. City V sama Ana lull .37. Proposal Ir Inmale Medlen( SON1=5 RCP# 07 -062 25H -148 IV. PERSONNEL SERVICES A, EQUAL EMPLOYMENT OPPORTUNITIES CMCMC promotes a drug free work place and is an equal opportunity employor. We do not discriminate on the basis of age, sex, race, color, religion, sexual preference, and national origin or handicap status, & PRE - T+Ji0r1PT.C9'iCi"dT:ENT PROCESS CMCMC believes that to most effectively interact with inmates and provide them with quality care; all stiff must be capable of clear thinking, exercising good judgment and quick decision-making and have adequate experience in the delivery of correctional medical services (all potential employees valll have at least three (3) years health care experience). CMCMC also believes that it is imperative that staff members serve as healthy, stable role models and exhibit sound. professional judgment. Therefore, once CMC.MC has identified a potential employee, tho pre - ornployment process will begin. This process includes reference checks, verification of l.iimasing and credential ug, C. T.' PC: ENSUTiJE/ CP; T3 .TIFICSI'TOladTdEQUIREME NTS All CMCMC personnel are mqui'red to powoss licenses, eet-ti£ioatious and qualifications appropriate to their positions, Credentials are verified with the issuing institution before employment, or contracting, and are re- verified annually in conjunction with regular performance reviews and contract renewals. CMCMC personnol. are also required to meet minimum criteria for their job doscripdon and participate in initial and ongoing training programs, City d8ado Amifall _fig_ I?rapml for tnmala Mod al $rrvio" RGP9 97.062 25H -149 A ORIENTATION OF NEW PERSONNEL All new employees will. be required to complete a two (2) wcalc orientation program, In. addition to data and materiala regarding their employment with CMCMC, the New Employee Orientation Program will provide employees with information on the business eorrnnitmerlt to the City as well as knowledge about the unique operating guidelines within the Jail, We also worts with the Jail so that all CMCMC employees receive an orientation to the Jail's security practices, said policies and procedures including the pamphlet "Anatotxry of a Set Up" CMCMC will also provide an adequate number of reference books for use by th® medical staff. Reference books will include, but not be limited to, current medical dictionary, current Physician's Desk Reference, Drug I-Ia7dbooks and physical assessment manuals, CMCMC will provide job descriptions for all staff positions. All employees will receive a copy of their respective ,job description, and signed acknowtedgment of receipt will be placed in all personnel files. Job descripdo.ns will be reviewed Land updated annually to ensure compliance with standards and contract requirerraerats. E � PERFORMANCE REVIEW Perfennance reviews are conTpletod as follows. D 40 -Day Rwlew: This review is :solely for the purpose of evaluating an etnployce's continued employment by CMCMC. City a7'SUntn Ana Jult ,39, Proposal for Inmate Mtl&al Svr&e,a RPPN 07,162 25H -150 A Annual Review: Co:nerally given each year on the anniversary of an employee's date of hire. A Non .Scheduled Review. From time to time a supervisor may administer non-scheduled reviews of an employee's porformanoc. Those reviews may be the result of prior disciplinary action, recognition of outstanding perfortaftace, or as part of CMC,MC's continued efforts to provide timely feedback on an employee's effcaiveness, F. SECURITY ISSUES All potential employees will be required to successfully compioto a background investigation conduoted by the Jail. CMCMC understands that the company, and its staff, are subject to, and will comply with, all Jail security regulations and proceduros. It is also understood that the jail Administrator. and/or his /her designee has the right to deny and/or rescind facility access to any employee who does not ,pass the background investigation or who viotatses facility policies, rules and/or regulations. G RESPONSIBLE PHYSICIAIN/flEAUI'II AUTHORITY Dr. Gogia, CWW's Chairman of the Board is the Responsible Physician and the Health Authority for the Jail, As such, Dr. Gogiu is responsible for all clinicaijtzdglnents related to inmate treatment, City of,8aataAdo Jail 40- Rroposni Rx lnmato Medical 9oNioos nrra ar•osz 25H -151 H. SOLE CONTRACTOR CMCMC understands that the City intends to award this contract to a single contractor, We further understand that if our contract is renewed, CMCMC wilt have sole responsibility for all company business issues includitig, but not limited to, 6Iboontracto'r affairs; salaries; licensing; training; adminlWation and management issues; and bookkeeping and benefits. L STAFFING RE, QUiREMENTS CMCMC will maintain adequate levels of on -site staff to fulfill, the health care needs of the inmates housed at the Tall. Full time (FTB) staff schedules will be based on 40 -hour workweek. CMCMC will observe 'those holidays rccogaized by the City. Holidays will be staffed as weekend coverage, Each FTL will be credited with eight (8) hours of work for each holiday, Due to the close proximity of CNICMC's corporate alf w, Linda Ca rdoza, Chief Operatlag Officer, 'will oversee the: daily operations of this cont:raet with the on -site supervisor, Te,ra ,Thort. lets, Cardoza will be on -site as often as needed and will be available on -oall 24 hours a day, seven (7) days a week. RN'.s and/or T,VN's will be on -site 24 hours a day, seven (7) days per week and will provide the majority of an -site rnedical services. Tha NP will be on-site to conduct sick call and complete inmate health appra'lsals for the Jail The NP will be on -site 4 -5 botrrs per day, ftvo (5.6) days par wool(.. Medical Records Clerk will also be available Monday -- Friday to assist the medical staff as needed, In addition to on -site visits, the City dP Saota Aoa Jail .41- PLI)Pasal roc Inmate Medioat Sam= 25H -152 physician will be on -call 24.11OUrs a day, seven (7) days per week for emergency services. CMCMC is submitting the staffing plans that meet the requirements detailed in the RFP. Please see the following pages for the required staffing plans, On -call staff including physicians and administrative staff will be required to carry pagers and/or cell phones at all tirncs, and will be required to respond to calls within 30 minutes, and to arrive at the Jail within two (2) hours of a request to respond. My argaata AnaMI .42,. P[oposptl Prn' lamatn Modloal SLfVICC3 RI�pA 07 »062 25H -153 MEDICAL STAFFING PLAN "B" MINIMUM REQUIRE,M'aN''I"S Position andn� Ma "d, ny,• Tno$ AV w0 nesAa Thursda2„ .,w•,,,F'riday - 3a�urdNY Chitf On -call On -call On -call On -call On -call On -call On -call Operating 24 hr. 24 hr. 24 he, 24 hr. 24 hr. 24 hr. 24 hr. tltfleur •- -" Oa.caU On-call ON.-tall On-call On -call Oil-call Oa-call MO 24 hr. 24 hr. 24 hr. 24 hr. 24 hr. 24 hr. 24 hr. NP 11002100 1700 -2100 1700.2.100 1700.2100 0800 -1200 RN 0900.2100 090021.00 0900.2100 0900 -2t00 0900 -2100 0900.2100 0900.2100 nN 2100.0900 21000900 2100.0900 2100,0900 2100 -0900 2100.0900 2100.0900 UVN 0800 -2000 08002000 08002000 0800.2000 08002000 0800.3000 0800 -2000 2000.0900 2000 -0900 20000900 20000900 2000 - 0900 20000900 2000 -0900 Clerk 0820.1700 0830 -1700 0890 -1700 0830.1700 0830.1700 chief oporating Officer: On -cat] 24 hours a day,'7 rays per week MD Position: on -call 24 hours a day, 7 days per week - (On,site sick pall once a week or as needed) NP Position; 43 hours per day, 5 -6 days per week RN Position: 24 hours por day (2 Day shift& 1 on night shift), 7 days per week LVN Position: 24 hours per day (2 Day shift& 1 on night shift), 7 days per week Medical 12caords Cleric 8 hours per day, 5 days per week (4) -hour work week) Dentilin t clktie a week (Wednesdays), minimum 4-hour ollnic Dental Ass't; 4 hours a u]inie, as needed Psychiatrist: Two 4 -hour o inics per month, t" and 4 "I' Monday 25H -154