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Home My WebLink AboutNAPHCARE, INC. (2) - 2017W INSURANCE NOT UN FILE A-2017-249 WORK MAY Nff PROCEED CLERK OF COUNCIL DATEN& �� AT E E FOR THE PROVISION OF INIVIATE 1VIEDICAL SERVICES BETWEEN i)• 5 A;?(`)CZ) CITY OF SANTA ANA, CALIFORNIA AND NAPHCARE, INC. mt u TIES AGREEMENT is made and entered into this 19"' day of September, 2017, 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 taws of the State of California (hereinafter "City"). RECITALS A. On April 17, 2017, the City issued Request for Proposal ("RFP) No. 17-051 by which it sought proposals from qualified vendors for providing basic and emergency inmate medical services for the City. Two vendors responded to this RFP. 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 ftom 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: Il00081 This Agreement is for a two (2) year term and shall commence on October 1, 2017 and terminate on September 30, 2019, unless terminated earlier in accordance with Section 18, below. Said Agreement maybe renewed for three (3) one (1) year renewal years. 2. SCOPE OF SERVICES Contractor shall provide basic and emergency medical services to inmates at the Santa Ana Jail ("Jail'„) as outlined in Section five (5) and set forth in Contractor's proposal attached hereto and marked as Exhibit A, and incorporated herein by reference. Contractor's proposal is also incorporated by reference as though fully set forth herein, Contractor's responsibility shall only be applicable to imxiates 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. PERSONNEL A Staffing. Contractor will provide medical, mental health, dental, technical and support personnel necessary for the rendering of health care services to imnates as contemplated herein. The health care staff will be at levels consistent with those identified in Exhibit B to 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 fully liable and responsible for the services performed by its independent contractors and subcontractors. 4. COMPENSATION The total sum to be expended for this agreement shall not exceed $4,991,486.78, This amount is comprised of the totals for the Tier 1 costs for years one and two in the table below and includes a contingency in the amount of $100,000 for services as directed by the City. The annual sum to be expended under this Agreement for staffing, pharmaceuticals, supplies and other services shall be as below and is based on a two -tiered plan based on the Jail's ADP. Pricing for years one, two and three are as follows: Santa Ana, CA — Annual Pricing Tier 1 (ADP at or above 176 Tier 2 (ADP at or below 175) Year One $2,409,599.40 1 $2,154,301.56 Year Two $2,481,887.38 $2,218,930.61 In the event the parties agree to extend the contractual term beyond the initial two year term, compensation for any renewal period shall also be determined upon mutual agreement of the parties, subject to approval by the City Council, 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. In addition to the stated annual compensation, Contractor shall receive a monthly parking stipend in the amount of $1,500.00 to assist with staff parking expenses due to limited public parking in the immediate vicinity of the Jail. 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. Pharmacy Services: Contractor shall provide routine pharmaceutical care and routine prescription care for all inmates and will provide monthly invoicing to the City for reimbursement purposes to include average wholesale pricing (AWP) less 14% fox branded medication and AWP less 30% for generic medications, B. Repair of dentures, dental plates and partial plates: $ 220.00 per repair C. Mobile X-ray Services: $ 90.00 per study D. Ophthalmology Services: $ 165.00 per patient visit E. OB-GYN Services: $ 275.00 per patient visit F. Emergency Psychiatric Crisis: $ 60.00 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, as outlined in RFP # 17-051, page 18, and Contractor shall be responsible for billing the responsible contract agencies identified below for all off -site related costs, except for any California Department of Corrections and Rehabilitation (CDCR) inmates housed/detained within the jail. Contractor hereby understands that the City contracts with the U.S. Marshal Service, the Federal Bureau of Prison (BOP) ("contracting agency and/or 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 require the offsite providers to bill the contracting agencies directly for off -site services rendered. In the event the applicable contracting agency does not provide payment to offsite provider or Contractor for off site services rendered, City shall be responsible for reimbursing Contractor. City shall provide payment to Contractor for services rendered and not reimbursed by any contracting agency as part of its normal monthly payment following notification by Contractor of non-payment by any agency. Contractor acknowledges that the City also provides housing for other non -contracting agency inmates. 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 innate, Contractor shall be reimbursed 100% of all costs of off -site medical services for these inmates 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 10th day of the month following the month service was rendered and the City shall reimburse Contractor within thirty (30) days of receipt of invoice. Should the City house/detain California Department of Corrections and Rehabilitation (CDCR) inmates, Contractor shall not be financially responsible for their off -site treatment services. Should Contractor process and pay claims for off -site services for CDCR inmates, Contractor shall be entitled to 100% of any reimbursement or credit from CDCR related to services rendered by Contractor on behalf of any CDCR inmate housed/detained within the Jail. If reimbursement is not able to be collected from CDCR, City shall provide reimbursement to Contractor as part of its normal monthly payment following notification by Contractor of non- payment by any contracting agency, 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 wilt be maintained pursuant to applicable laws including but not limited to HIPAA and California privacy laws and will be kept separate from the imnate's confinement record. A summary of the applicable medical record will be available to accompany any inmate 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. The parties hereby agree that in the event a medical record must be released by Contractor to a requestor or inmate, Contractor may release said record via a secure electronic transmission that complies with HIPAA regulations. 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, TechCareg) 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 TechCareg) (or Contractor'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 infonnation pertaining to it confidential at all times during the term of this contract and termination thereof. EXPENDITURE AND REVENUE REPORT No later than sixty (60) days following the and 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. S. 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 Oft 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 fall's health care facilities that are City's property. C. Supplies and Equipment 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. All other equipment, supplies, and/or information technology components, hardware and servers purchased by 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 full range of services and facilities provided for other imnates 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 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 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 Agreement. 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 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 perfonnance 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. 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 medical 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: (1) Contractor shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. ( i) 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. E. I£ 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, defend, and hold harmless the City, its officers, agents, employees, Contractors, counsel, and representatives (collectively the "City") from any liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, arising from the direct or indirect medical operations of the Contractor or its subcontractors, agents, employees, or other persons acting on their behalf which relates to the medical services described in section 1 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 related to the defense of 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 medical operations of the Contractor. The parties hereby agree that Contractor shall not be responsible for, nor be required to provide a defense and/or indemnification to the City for any matters which are directly attributable to the actions, negligent acts and/or inactions of the City. 1,3. 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 famished 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 kiow 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 under 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: Clerk 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 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 35216 Facsimile (205) 536-8404 NaphCare, Inc. Attn: Legal Department 2090 Columbiana Road, Suite 4000 Birmingham, AL 35216 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 purposes 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 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 heretmder, 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 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 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 the Contractor. Contractor may terminate this Agreement by providing the City with one hundred eighty (180) 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 contraetterm. 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 oflegal 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 licensed 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 thisAgreement. 10 vi. The continued incapacity of any physician or licensed person to perform dirties 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) clays 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 care 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 Imitate Health Care. Upon termination of this Agreement, total responsibility for providing health care services to all inmates, including inmates 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. 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 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: 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 II 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 1973 (29 U.S.C. 794 or 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 not 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. 20. 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 further 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. 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, 12 and local laws, ordinances, and regulations. B. All medical services will meet California Administrative Code (CAC), Title 15 - Minimurn 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 Califonua, 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 anymanner 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. 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: Clerk of the Council 13 CTTV OF gANTA ANA APPROVED AS TO FORM: SON I6Bogosian A City By;_Tamara Assistant City Attorney RECOMMENDED FOR APPROVAL: r_D_pqavjidal-eh m Acting Chief of Police 14 NAPHCARE, INC. By: Jam S. McLane Chief Executive Officer Tax ID# 58-1823464 EXHIBIT "A" CONTRACTOR'S PROPOSAL IN RESPONSE TO RFP No. 17-051 15 Exhibit A �t aCe,,i yaor intiupendwn heolihc... choice. A. INTRODUCTION NaphCare has reviewed the RFP in detail and through this request, as well as our experience in the Santa Ana Jail (SAJ), we understand the facility, the nature of its inmate population and the scope of services to be provided. We are pleased to offer our proposal to continue services for the SAJ. All our services will meet and/or exceed the SAJ's requirements, regulatory local, state and federal standards, including but not limited to National Standards of Detention, California Titles 15 & 24 - Minimum Standards for Adult facilities, 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 provide the SAJ with a clear understanding of the services we stand ready to offer. Our goal is to continue to meet and exceed all services requested in the RFP, collaborate with SAJ personnel, and work attentively to ensure the orderly and cost-efficient provision of services. Our approach proposes a proactive healthcare delivery model that emphasizes compliance, continuity of care, and partnership with the SAJ. B. MEDICAL SERVICES NaphCare understands that the Santa Ana Jail medical services call for properly licensed medical personnel to identify, evaluate, treat and monitor inmate medical conditions, including the prescreening of all incoming inmates to determine medical needs and ability to provide adequate care. NaphCare will continue to provide a comprehensive program of inmate health care to include the following services: 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); 3. Mobile on -site radiology (x-rays) services; 4. An on -site mental health care delivery program to meet the needs of inmates; and 5. An off -site preferred provider network of hospitals, physicians, and other ancillary MSPs to provide medically necessary services to inmates which cannot be provided onsite at SAJ. C. ON -SITE MEDICAL SERVICES As the Medical Services Provider (MSP), NaphCare will continue to provide an on -site program that focuses on cost containment without compromising the quality of services deemed medically necessary. 1. Treatment Protocols NaphCare's program includes techniques and treatment protocols for managing the following list of most prevalent medical conditions or diagnoses: a. Minor lacerations, bruises (suturing, administration of Tetanus Toxic, etc.) b. Respiratory and chest pain; c. Alteration of consciousness; d. Trauma injuries; e. Asthma; f. Abdominal pain/disorders; Inmate Medical Services RFP No. 17-051 City of Santa Ana 21 a l an yoar independem he.Rhwm choice. g. Cellulites (infection of the skin); h. Joint pain; i. Diabetes and complications; j. Aids and related; k. Venous insufficiency (blood vessel disorder); I. Hypertension; m. Drug psychoses; n. Tuberculosis; o. Pandemic Flu; p. M RSA; q. Epilepsy; r. Cirrhosis and liver disease NaphCare will deliver treatment protocols in a uniform, standardized manner across the SAJ. Ourwell- coordinated model of healthcare is patient -centered and evidence -based, emphasizing prevention, continuity of care, 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. Nursing Protocols We ensure that nurses who provide clinical services are trained and do so under 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 will carry them out (NCCHCJ-E-11, Nursing Assessment Protocols). We have developed nursing 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 serious medical conditions. All nursing protocols are approved by our Chief Medical Officer and are reviewed annually by the Vice President of Operations, Health Services Administrator, and responsible physician. The protocols are available to each client facility in multiple forms —hard copy and electronic. They are also available through the NaphCare Operations website. Documentation of nurses' training in protocol use exists, including: • 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 training when new protocols are introduced or revised. Healthcare staff can access the protocols while treating the patient through TechCareo. The "Nursing Protocol" tab allows healthcare staff to easily scroll through an 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 minor ailments from emergent medical needs. Inmate Medical Services RFP No. 17-051 City of Santa Ana 22 der Wepwdanf heolfh.,o choice. Personnel Efficiency -Nurse's Queue Tech Care® also features a Nurse's Queue, which provides a daily workload for nurses. The Nurse's Queue provides a quick and complete clinical review of all the pertinent information that a nurse needs for the day or shift, all in one place. It electronically alerts staff of clinical issues that require immediate action, organizes services (e.g. sick call), and lists services that require the review of an advanced clinical provider. For example, the queue lists items awaiting review by the Charge Nurse or Nurse Manager, including Receiving Screens, TB reads, and utilization management requests. This queue also contains a Message Board which allows for inter -faculty communication. The Nurse's Queue ensures accountability through the ability to view reports quickly and the system of follow-ups it offers. 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. Urine testing; b. Blood sugars; c. Electrocardiograms (EKG's) d. Cardiopulmonary resuscitation (CPR) e. Tuberculin PPD testing f. Pregnancy testing g. Gram stains h. Hemoccult testing and Hematocrit tests I. AED (automatic external defibrillator) j. On site X-ray capability (mobile) Inmate Medical Services RFP No. 17-051 City of Santa Ana 23 r�4?re your independent h..Rhcore choic¢ 3. Intake Screening An intake screening examination will be performed by a qualified health professional on all incoming inmates within two (2) hours of initial entry into the facility. 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 following: a. Inquiry into current illnesses, health problems, and conditions, including any past history of tuberculosis or other infectious or communicable illness, or symptoms - e.g. chronic cough, hemoptysis (spitting up blood), lethargy, weakness, weight loss, loss of appetite, fever, night sweats - suggestive of illness b. Mental health problems including suicidal ideation c. Dental problems d. Allergies e. Medication taken and special health requirements f. For women, date of last menstrual period, current gynecological problems and pregnancy g. History of cerebral trauma or seizures h. Use of alcohol and other drugs i. Behavior, including state of consciousness j. Body deformities and ease of movement k. Identification of disabilities I. Persistent cough or lethargy m. Condition of skin n. Latest PPD test o. Any other medical history pertinent to the determination of housing suitability and on -going medical care p. Recording of height, weight, pulse, blood pressure and temperature NAPHCARE'S PROACTIVE INTAKE SCREENING FOR 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 needs in this area. Using our Proactive Care Model, we identify inmates' medical and mental health issues as soon as they arrive at the SAJ. We have seen that this is the most ethical and cost-effective way of delivering correctional medicine. We use quality licensed staff to perform a thorough screening and assessment at intake that allows us to identify inmates' health needs up -front and then treat them throughout their stay. Experience has shown us that this proactive evaluation and management system provides better healthcare delivery and outcomes. TechCare® automates inmate healthcare processes, creating a paperless, efficient system for monitoring and tracking all medical encounters from intake to release. TechCare® allows healthcare staff to complete the intake screening electronically, which expedites the intake process. Reports for all intake services are readily available to the healthcare and SAJ personnel. Inmate Medical Services RFP No, 17-051 City of Santa Ana 24 roe, independent heallhm. c .k, NaphCare's Intake Screening is NCCHC compliant and has been written to be proactive and to prioritize care based on need. Napheare will perform the initial Intake Screening within two hours of an inmate's admittance, using an RN available 24/7 to detect urgent medical needs early. We assess the most urgent issues first and then, in a systematic way, assess the other important areas that will help determine both the inmate's need for services and the urgency of that need. The following list describes each area of assessment: • Urgent Assessments — Covers vital signs, acute health concerns, physical appearance and 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 medications and diagnosis; past psychiatric hospitalizations and suicide attempts; PREA assessment. • Female Assessments — Covers pregnancy issues, any recent 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 interviewerto refer to any indicated services based on the above information in either urgent or routine time frame. Releases are obtained to access outside records; the inmate is educated on how to access medical and mental health care if needed in the future; and housing recommendations are made. Any inmate whose responses indicate a need for further medical or mental health intervention will have their record flagged electronically to indicate this. There are built-in prompts within TechCore® to assist the interviewer in taking appropriate action based on responses — such as placing an inmate on suicide precautions; urgently contacting medical, mental health, or security personnel; and any special housing recommendations. All Receiving Screens are included in the electronic health record for providers' review. Inmate Medical Services RFP No. 17-051 City of Santa Ana 25 Intake Screening Form in TechCareO ct- j Patient: DOE, LANE III: 02510761805067E29d89df Lang: s1d6 (1234) AddlMul lato. f 000: 41611996 (Age-26) sex. Female Race: i PICTURE Housing: SM *- MODEW" NOT AVAStAf9tE Status: ACTII Reeking aatW 4/912015 3:56€25 off u aR fat 9sa `�9yss$r6 ia, a�ia sea as . o tazo NA k 5L aY to Lv t4s ° tie M m"3 -- cen WA. Pbad Saotl r1m'gFs beam Yragi's Tfye Una T re �° Prtvwnn Ta�pvxure Ndee Revi4ebin h Fba uo.._., P9am!asv Scrwenere: All quasdona in fire, W. must be addressed. For quecdoaaasith a slisgle checkbox,. by leaving die ehsekbox unadiaeted..gan are docurnundng your Magnate" detail parameters of the quesden are face, ay w a rthq the checabax, you. erg Acknowledging a fradfiv. vespona2 tothe here and Inch., documentation must be Provided in the "cre"rtang goesdons andtaxi boxes.. ARRESTING OFFICER QUESNONS=-Sefoctand document oil that apply . Ic the err dng officer aware of any of the frallowfnp't. Y. U-0'a'Erji6fRCt �4LId�1.§dla) ;lkd[r Wkxixxad GUxm.-k¢Mf .' 2 n ueR?Mrt3 ?4Gse aZ S4K"6`Y •_.-...._._.__. __ —....��-.._ .... t NWie&i«sRu _T Y a �+aCme+2bt Ma+%cafPaecm±Nh'Yn _ .�.__._.._ Fk4: � e Proactive Health Assessment upon Intake A beneficial feature of NaphCare's Intake Screening process for the SAJ is that we perform the Health Assessment upfront, during intake. By performing this assessment at intake, we can identify urgent medical and mental health issues upon an inmate's arrival. This not only reduces costs for emergency and hospital transportation, but it also reduces the inmate movement required to provide the health assessment at 14 days. We propose to continue this model for the SAJ as we have seen positive results in doing so — Our Proactive Care Model has significantly reduced ER trips by 98% for the SAL Mental Health Screening This screening is NCCHC compliant and was created to be proactive in identifying and prioritizing inmates in need of mental health services. The following is a description of each section of the screening and the information it obtains: Inmate Medical Services RFP No. 17-051 City of Santa Ana 26 yaar Wepndenf heaAh.w chaise. Current Mental Health Symptoms— Reviews depressed mood, anxiety, psychosis, and mania. In addition, inquiries are made regarding current mental health treatment in the community, any suicidal thoughts, any recent losses, feelings about current situation, if they feel they have anything positive in theirfuture, and allows the interviewer to comment on their feeling of suicide risk based on responses and appearance. • Past Mental Health History— Reviews past treatment for mental health issues including medications and hospitalizations; reviews history of self -injury behaviors and suicide attempts. • Substance Abuse— Inquires about alcohol, benzodiazepine, opiate, and other substance use issues, as well as history of substance use related treatment. • PREA/General Assessment— Reviews any history of abuse of any kind, in any setting; any convictions for sex or violent crimes; any history of special education or developmental disabilities; history of head injury or seizures. • Disposition/Treatment Plan —Allows the interviewerto refer to indicated mental health services, refer for detox services if indicated, and/or begin discharge planning with regard to need for mental health follow up. Any inmate who is determined to need additional mental health services is scheduled for further evaluation by higher level mental health professionals (up to and including psychiatric evaluation) in the clinically indicated time frame. The Mental Health Screening also 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. This screen is also included as part of the inmate's record. Tuberculosis Testing It is our policy to administer the tuberculin skin test during the Intake Screening and to schedule a follow-up appointment. Our TB screening follows guidelines issued by the American Thoracic Society and the Centers for Disease Control (CDC) for the management and treatment of Tuberculosis. The TB test is logged in the medical record and automatically flagged for follow-up. A list of inmates requiring a TB read is generated and results of the test can be read and recorded —this ensures that all inmates receive a TB read in a timely manner. Our healthcare personnel ensure that inmates are either medically cleared before they are sent to general population or referred to the appropriate healthcare service. Nursing staff can access TB reads and results electronically, which offers significant advantages such as: 1. Drastically reduces workload; no paper charts need to be pulled. 2. Generates list of inmates grouped by TB status (positive/negative, administered, read, results, follow-up). 3. Eliminates unnecessary duplication of healthcare services for re -admitted inmates. 4. Accesses the date the last TB test was administered, history of services available. 5. Reduces costs for staff time and test supplies. Inmate Medical Services RFP No. 17-051 City of Santa Ana 27 r�;Ike your independent heoiik.ce choice. Prison Rape Elimination Act (PREA) In order to comply with PREA standards, and as an added service benefit to you, NaphCare provides PREA segment within the Intake Screening in TechCare®. The following PREA question is asked during the Intake Screening: Does the inmate have a history of sexual abuse, of sexually abusing another, or a conviction of a sex crime; or according to the interviewer, is at risk of victimization or victimizing another inmate? TechCare® automatically sets a PREA flag based on a positive response to the above question. A daily PREA report is automatically generated from TechCare® and sent to custody and NaphCare leadership at the site. In addition to this feature, the Informed Consent screen, which is also part of NaphCare's Intake Screening process, describes the PREA Announcement to ensure inmates are aware of the assistance that is available to them. These features are in place and operational at each of NaphCare's client facilities to ensure PREA compliance. r Patient DOE, JANE mx0251076iBD5467f24d$@d°tang: Ad6(1234) AsdHwnv lrtia 000: 4)8(1990 (Age�G) sex: Female .Race: PICIt1RE ieusing: "N: "H[ OM— NOT AVAB.ABCE States: AGT Bobbing tfate: 4j8j2015. 3:50:2S PM ptoetal tough Xbapitagzatlone in the ppatpear Plea$e Pcoulde location, urban and reamn how. ~ssaaasa-a suaaa$sv�*� mm �—PAO Wddb attenpte, ew., pipes, at baaupera Wtgnbmps Ltst whoa acc.cmd, what method, snit where ttaaiad b3ow _ ...x �.�«......,«.a.�,aR. :a i _lyda of abus8sexpahy+abusing aaofla(,alcoav(Ctian of awx crane; oracconiing to the blhnvhuaefstd4k*fvictlmizationorvictlnizing anothefinndte Signs of devolopmenfui dimbi@g($iow $poach. 31 Mghery Pswk. Phew uodN:c 'ch.b ofp!SAWAdm,nt. qR , Intake Screening Quality Assurance NaphCare's corporate CQI staff will monitor the Intake Screening process to ensure full compliance with NCCHC standards J-E-03, J-E-04, and J-E-05. The following proactive CIA studies help prevent costly mistakes, medical emergencies, and expensive off -site care. ✓ Timely Intake Screening: We seek to provide a timely Intake Screening in accordance with the contract requirements. Using TechCare®, we audit the Intake Screening. TechCare® searches the Inmate Medical Services RFP No. 17-051 City of Santa Ana 28 a hh Irk your independent heahhcarc choke, database of all active inmates with a bed assignment for completed Intake 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 an Intake Screening within 48 hours of site notification. ✓ Positive Mental Health Screenings: Per NCCHC standards, any inmate with a positive mental health screen must then be seen by a qualified mental health professional for a more in depth Mental Health Evaluation. Our CIA department runs a weekly report that shows all active inmates who had a positive mental health screen, but have not yet had the mental health evaluation performed. This information is sent to the site HSA so that these inmates will not be missed. The site is responsible for reviewing the list of inmates, explaining why the evaluations have not been performed yet, and providing a report of resolution back to the QA department within a few days. ✓ Daily TB Read Report: We identify any active inmate that does not have a TB read recorded in TechCare®; this alert is then automatically generated and shown on the Nurses Dashboard. This quality assurance activity helps ensure that all active inmates have a completed TB testing process or other appropriate care, such as a chest x-ray or Isoniazid treatment. 4. Initial Health Assessment An initial health assessment will be completed by a licensed MID, PA, NP or RN for each inmate immediately upon intake, ensuring completion within fourteen (14) days upon arrival at the SAJ. The initial health assessment will include, at a minimum, the following: a. Review of intake screening results and the collection of additional data to complete the medical, dental and mental health histories b. Laboratory and/or diagnostic tests to detect communicable diseases, including sexually transmitted diseases and tuberculosis (PPD or x-ray as medically indicated) and other tests as determined by the responsible physician upon consultation with and approved by the local public health authority. c. A VDRL/RPR blood test is to be drawn on the inmate, if the inmate has not had such test performed at the transferring jail with the last ten (10) months of continuous incarceration, or it is not documented on the inmate medical transfer form and/or supporting medical records received from the referring facility. d. A physical examination including comments about mental status with appropriate referral as clinically indicated. e. Oral (Dental) screening Proactive Health Assessment upon Intake A beneficial feature of NaphCare's intake screening process for the SAJ is that we perform the health assessment upfront, during intake. By performing this screening at intake, we can identify urgent medical and mental health issues upon an inmate's arrival. This not only reduces costs for emergency and hospital transportation, but it also reduces the inmate movement required to provide health assessment at the 14-day mark. Inmate Medical Services City of Santa Ana NaphCare exceeds NCCHC standards by performing the health assessment upon intake. Additionally, any inmates that have not had a Health Assessment by the lot" day will be flagged in TechCore® for immediate follow-up, ensuring compliance with the 14-day requirement. RFP No. 17-051 29 Ift . ._..tr are, your hedepondeet heahhc., choice. NaphCare's healthcare personnel ensure that a comprehensive health assessment is completed for each inmate during the intake process, and no later than within 14 days of admission to the SAJ. The health assessment record is reviewed and signed by a physician and entered in the patient's permanent medical record. The health assessment includes inquiries into the following: • Vital Signs, • Current Medications/Allergies, • Medical History, • 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, • Housing Assignment. Inmates who are referred for follow-up are seen by the appropriate healthcare professional, and referrals are documented in TechCore®. Inmates are evaluated based on the medical information obtained during the Intake Screening as to the medical necessity of conducting a health assessment. S. Non -Emergency Medical Treatment of Inmates As the SAJ's current MSP, NaphCare already has established policies and procedures for handling and responding to each inmate request for medical treatment (aka Sick Call). We understand that all policies and procedures are subject to review and approval by the Jail 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 on a daily basis and responding to requests within twenty-four (24) hours of receipt. b. NaphCare will conduct sick call line within the housing units on a daily basis. During this period, medical staff will dispense over-the-counter and prescribed medications. 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 determine the triage mechanism to be used for each inmate's chief complaint or symptoms. e. NaphCare will establish 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 provider who 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 to: L Review Inmate Medical Request forms and provide appropriate medical care. ii. Prescribe and dispense approved medications (tablet, liquid and syringe). iii. Prescribe medical diets. iv. Conduct physical examinations. Inmate Medical Services RFP No. 17-051 City of Santa Ana 30 AhEfi are, youNndepwdenf heahhw,. choice. Provide first aid and treat injuries. Apply, monitor and remove sutures. vi. Provide weekly dental clinics. vii. Provide biweekly psych clinics. vill. Provide four (4) hours of annual jail staff training related to issues of infectious diseases, including universal precautions and proper training for cleanup and disposal of bio-hazardous materials. Training will be subject to approval by the Jail Administrator or designee. ix. Maintain detailed, accurate and confidential medical records, logs and files in accordance with California Department of Corrections and Rehabilitations, Title 15 and all other relevant regulatory requirements. X. Review and approve jail medical policies and procedures. xi. Timely and accurate reports to the Jail Administrator. Al. Approval of off -site medical care by responsible contracting agency of the inmate/detainee. DECENTRALIZED SICK CALL NaphCare will continue to operate a decentralized sick call schedule for the SAJ. Our EHR system makes this possible since nurses have access to all inmate medical records via a laptop. This type of model allows nursing personnel to provide care in the modules occupied by the patients, which reduces inmate movement and increases the amount of time allowed for sick call to occur. Another advantage is that nursing personnel can address routine sick call needs, such as a headache, immediately on the floor. Our clinicians essentially take the clinic to our patients on a daily basis. Proactive Care NophCore's sick call procedures ensure proactive action to prevent a delay in care. With the implementation of NophCare's sick call protocol, patient sick call wait time decreased from an average period of 14 days to Access to care is a top priority for us, so we take extensive same -day or next -day service. steps to ensure that inmates are seen in a timely manner and that sick call days are prioritized by the severity of need. All inmates have a daily opportunity to request healthcare through our sick call system, which gives inmates unimpeded access to healthcare services. Our nursing personnel collect, triage, and respond to all inmate requests daily. For inmates who do not have access to the sick call boxes, alternative arrangements are made forfiling sick call requests. The frequency of sick call is consistent with NCCHC standards and the facility schedules, and we provide appropriate time for sick call at the correctional facility. Timeliness of the response to sick call requests is an important indicator of quality of care and NaphCare meets NCCHC standards for sick call response times. Sick call services, in compliance with NCCHC standards, are provided at sufficient levels to allow the healthcare staff to give same -day response to urgent inmate requests for healthcare services. Nursing sick call is conducted seven days a week, and physician sick call is conducted according to a set schedule agreed upon by NaphCare and the facility. If an inmate's custody status precludes attendance at sick call, then our staff consults with security staff to make access to healthcare services possible. Inmate Medical Services RFP No. 17-051 City of Santa Ana 31 <A � �tqre your independao hooAhcom chaim Our healthcare staff follows nursing protocols to facilitate the delivery of sick call 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 or the established nursing protocols, the inmate is referred to a mid -level practitioner or the on -site physician for evaluation and treatment within twenty-four (24) hours. Health services are provided in a manner that complies with state and federal privacy mandates within the scope of each facility. Triage Methods We scan all sick call requests into the TechCare® system, so the nursing staff can prioritize all requests on every shift and respond in a timely and appropriate manner. Through TechCare®, we create a sick call queue that provides a daily 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. Referrals: Requests are triaged and referred electronically to the appropriate mid -level clinical provider as necessary, which means the referral is completed immediately without the need for cumbersome paper logs. Priority sick calls supersede Routine sick call 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 can click on an inmate's name to select it, and then click on an appointment and assign it to the appropriate category. This efficient process makes it easy to respond to requests quickly and ensures that 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. Sick Call Quality Assurance NophCore's corporate CQI staff monitor the sick call process at the SAJ via TechCare®. They ensure that all inmate requests are documented and reviewed for urgency of need and any required intervention within 24 hours, and that sick call clinics are conducted on a timely basis by licensed medical staff in accordance with NCCHC Standard J-E-07, Nonemergency Healthcare Requests and Services. Inmate Medical Services RFP No. 17-051 City of Santa Ana 32 4 c? ±09:60� your independent heolihm,. choite. 6. Emergency Medical Treatment of Inmates a. NaphCare has established and will continue to implement policies and procedures for responding to requests by jail 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 are provided on -site as indicated. Medical services staff will provide on -site emergency intervention for staff, inmates and visitors when necessary. c. Naphcare will provide and have on -site two (2) or more Automatic External Defibrillators (AED) and all health care personnel will be certified as part of the annual CPR training. d. Naphcare will utilize the preferred provider network for all off -site emergency services. EMERGENCY RESPONSE NaphCare will continue to work side by side with all SAJ personnel to ensure the health, safety, and welfare of inmates, staff, and visitors are not jeopardized within the confines of the correctional institution during an emergency, and we will provide 24-hour emergency healthcare services (NCCHCJ- A-07, J-E-06). We take the following steps to ensure that NaphCare healthcare staff members are prepared to implement the health aspects of the SAJ's emergency response plan. Emergency Response Plan 1. Health aspects of the SAJ emergency plan will be approved by the responsible health authority and facility administrator, and will include: • Responsibilities of health care; • Procedures for triage; • Predetermination of the site for care; • Telephone numbers and procedures for calling health staff and the community emergency response system (e.g. hospitals, ambulances); • Procedures for evacuating patients, and • Alternate backups for each of the plan's elements. 2. At least one mass disaster drill is conducted annually in the SAJ so that over a three-year period each shift has participated. 3. A man -down drill is practiced annually per shift where health staff are regularly assigned. All training for these drills of our staff is documented on the Education Log. 4. All man -down drills will be documented using NaphCare's Medical Emergency Code Report. 5. Critiques of each emergency response, drill, and tabletop exercise are conducted, reviewed, and documented on the Emergency Response Critique Form and shared with all healthcare staff. 6. Full-time healthcare staff not assigned to a particular shift are exempt from drills. Emergency Services 1) A written plan includes arrangements for the following, which are carried out when necessary: a) Emergency transport of the patient from the SAJ including emergency medical vehicle; Inmate Medical Services RFP No. 17-051 City of Santa Ana 33 4W cx?'��e your independent hoolihcom choice. b) The Emergency Contact Numbers form will be completed and updated as necessary by the Health Services Administrator; c) Use of one (1) or more designated hospital emergency rooms or other appropriate health facilities; d) Emergency on -call physician, dentist and/or mental health staff are available twenty-four (24) hours per day, when the emergency health facility is not located in a nearby community; e) Security procedures will be reviewed to ensure the immediate transfer of patients when appropriate; f) The Health Services Administrator will be notified of all emergency situations; and g) Emergency evacuation of the patient from the SAJ. 2) On -site emergency first aid and crisis intervention using emergency medication(s), supplies and medical equipment that are regularly maintained. Monthly inspections will be performed using the Emergency First Aid Kit Monthly Inspection form. Emergency Training for Correctional and Health Staff 1) Correctional and healthcare staff will be trained to immediately initiate a response to emergency health -related situations. The training program will be conducted on an annual basis and will be established by NaphCare in cooperation with the SAJ and will include instruction on the following: a) Recognition of signs/symptoms and knowledge of action that is required in potential emergency situations; b) Administration of basic first aid; c) Certification in cardiopulmonary resuscitation (CPR) in accordance with the recommendations of the certifying health organization; d) Methods of obtaining assistance; e) Signs and symptoms of mental illness, violent behavior, and acute chemical intoxication and withdrawal; f) Procedures for patient transfers to appropriate medical facilities or health care providers; and g) Suicide intervention. 2) Training provided by NaphCare to correctional staff will be documented on the Education Log. C.A.R.E. Ambulance Dedicated to patient care and customer service for over 47 years, C.A.R.E. Ambulance Service provides emergency and non -emergency service to the citizens of Orange, Los Angeles, and Riverside Counties. C.A.R.E. Ambulance Service provides integrated, high -quality, BLS, AILS services, and is at the forefront of EMS transportation. NaphCare will continue to coordinate emergent transportation services with C.A.R.E. Ambulance to meet the needs of the Santa Ana Jail. 7. Chronic Illness/Infectious Disease Protocols a. NaphCare has established and will continue to implement policy and procedures for the care and handling of inmates diagnosed with chronic illness/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 Administrator or designee of any inmate with an infectious disease diagnosis, which may require the screening of inmates (e.g. active TB, chicken pox, rubella, mumps, etc.). Inmate Medical Services RFP No. 17-051 City of Santa Ana 34 .iq2h�44/e yaw indapmdeO he.hh.. choice. c. NaphCare will ensure policy and procedures adhere to guidelines established by the National Commission on Correctional Health Care (NCCHC), Orange County Health Authority and Title 15 and 24 regulations for adult facilities. PROACTIVE CHRONIC CARE MANAGEMENT NaphCare provides chronic care in a manner that incorporates principles of case and disease management for complex cases, and promotes maximum progress and healing. Inmates receive timely follow-up, evaluation, treatment, and education about the preventive activities available for those 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 proactive approach and effective management of inmates with chronic diseases enables healthcare professionals to treat symptoms earlier, and more effectively, preventing costly hospitalizations. We take a proactive approach to the management of chronic care disease in order to minimize the development of any urgent or emergent conditions that might require off -site transportation. Our emphasis on preventive care begins at the point of intake (intake screening), where inmates are classified into the appropriate chronic care clinic and scheduled forfollow-up treatment. Our extensive staff training, use of best practices based on nationally recognized guidelines, and innovative on -site diagnostic testing help us keep chronic care patients in a stable state throughout their incarceration. We schedule and track all chronic care clinic visits within TechCare®. This data will be available to the city 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 is seen at a chronic care clinic. • Patient refusals for a chronic care visit. Using Tech Care® helps ensure that chronic care patients are seen by a provider at appropriate intervals as clinically indicated. In the Chronic Disease Management section of TechCaree, the user can access/view inmates with certain chronic care illnesses. To see a specific chronic illness, simply select a chronic illness from the drop down list. 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. Inmate Medical Services RFP No. 17-051 City of Santa Ana 35 s9 it c?t'�7 your Weleendent hvoil choice. Chronic Disease Management within Tech Care® �a chroa�oi s a. ..a. s Am9aa j 1; 11er �oakna 1a Elr Syl, oadn are ti s _ -tat • eM. a s J bde A...Pdm :�1 ABBAS. KENNETH (#06599Y2j CA-DRMS-OS DAY, j t689 days IV18120129:05:37 AM due W be seen In 23 days AtAIN, MATTHEW (#0032272) 2408921-DZ f40 L90 ICDAY,_. 5� t.I days 2/19/201Z 3:28:36 AM due to be seen in66 days AL[CEA,]AMES (s0003653) 240CJ53-02 i90 ICDAY _7 j t843days 21A(20188:26;36 AM due to beseen in 36 days Baxter, Ella (*957667) 90 J [DAY !,498 1drys V1912013 8:28:37 AM due to be seen in 96 days BROOKS, LUIS (40670399) 60 BKA �309-02 . 3 � 1MONTH �1 1490deys V1912013 8:28:38 AN due to 6e sean in 66 days 6ryen, Sheen. (699]668j I3 1((MONTH. [� 3488 days 21,912013 a:28:36 AM due to as sees in 56 days WJMICELLI, ERNESTO (p0677063) 120A-110-01 (0 ��+ �L461 ds}a Last Vil lnfmMaHRA not aaallable Powell, Michael (k91,T]1 Lg88 dogs Last vmt infarmat on not ova abe Snider,OWen (#9W66h) �` TJ 1488days Last V T information not available VELA, AARON (4066441 606edd03-02 rLrO �� iaztdrya Lot tilslt lnrormahon noE available zoU,A (Y0047562) 1205-220-01 (LO le _ jt -j t463 days Last Isit inl not ova labia L-Notes Labs i:Vs.t U — Nate¢, r_Lebs, F_-D iNofea Lahs [:TJ j" print Notes}LWbs i..,Vsc.7.1 print i. No�rt� lebs.. :Vat. Lj pHnt 5== Labs CVw k.: [_I Mint .Rota& C�Labsa cVef , fl A., Np1� ribEmil (;; pant Nee_-] . La� , - J Anne r.--- Labs E-KI o Anne NaphCare has a proven history of reducing off -site costs through our proactive Chronic Care system within TechCare®. Using TechCoreO, we strive to enhance the level and quality of the care within the SAJ by scheduling inmates with chronic illnesses to be seen by a provider before they become acutely ill and require off -site transport or hospitalization. In addition, we greatly reduce liability by identifying this high -risk population during the intake process. Collection of Pertinent Healthcare Information Prior to incarceration, many inmates had limited contact with healthcare providers and may lack critical information about their illnesses. Our chronic care program aims to actively monitor, educate, and motivate patients to be responsible for their own 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 opportunity to identify, enroll, and refer an inmate to an advanced level provider is during the Intake 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 and, typically, their chronic issues are addressed by the provider during that initial health assessment. If a patient is on pharmacologic therapy, continuity will be maintained. If there is a patient whose chronic condition is unstable, he/she will be seen promptly. In the case where a patients' chronic disease is stable, he/she will be scheduled for a first chronic disease visit in approximately one month. NaphCare is flexible and will work on custody -related issues to reduce interruption of chronic care medications or appointments when patients with chronic disease are transferred between institutions or moved for housing, court or release issues. Before the appointment, we collect medical records and current diagnostic test results so an evidence - based treatment plan may be created. Patients enrolled in chronic care clinics will be seen by a qualified healthcare professional at appropriate intervals, or more frequently if clinically indicated. Inmate Medical Services RFP No. 17-051 City of Santa Ana 36 444#Lh area ,v fndopoM.a hwhhmrs choice. Newly diagnosed patients are seen for the first clinic within 45 days of diagnosis and then scheduled for follow-up as clinically appropriate. Chronic care clinics are built into the TechCare© system, which creates consistent documentation and standardizes the provision of care. Inmates are placed into the correct chronic care clinic by diagnostic category "TechCare° provides a to ensure proper follow-up at their scheduled dates. TechCare® is designed more efficient, effective for the classification of inmates with chronic diseases and allows the t following clinics to be easily scheduled: Heart Disease, Asthma, Cancer, High method of monitoring Blood Pressure, Diabetes, Hepatitis, Seizures, Sexually Transmitted Diseases the inmates. We can (STD), HIV, and Thyroid. Instantly accessible, TechCare° allows medical ensure that the inmate treatment to be monitored and ensures compliance with ACA and NCCHC has been placed in the requirements. Another benefit of the system is the "alert" feature, which prompts healthcare providers to schedule a follow-up for any missed inmate I appropriate chronic screenings. care clinic, an appointment has been NaphCare has education about chronic diseases available for chronically ill made with the inmates. Disease -specific information can be easily selected from a list in TechCare® and printed to give the inmate the knowledge to help take care of appropriate provider, him or herself. blood sugar checks have been initiated, Another mode of identifying chronic care patients and ensuring their etc., all from looking at continued treatment is through NaphCare's internal pharmacy team. Using TechCare®, the pharmacy team analyzes profiles with chronic care the inmate's record in medications, identifies chronic care patients who may not have been the computer, " identified yet, and updates the patient medical record. If a patient has been incarcerated for more than 30 days and has been receiving a chronic care Dyni Brookshire, RN, medication but has not been flagged as a chronic care patient, then the pharmacy sends out a second request for the patient to be re -assessed. They Director of will enroll patients in need of chronic care in the proper clinic and make sure Accreditation and they receive the appropriate labs and scheduled followups. This is a quality Compliance assurance activity that NaphCare regularly provides as part of our Proactive Care Model. Individual Treatment Plans Individual treatment plans are developed by the responsible physician for inmates with special medical conditions requiring close medical supervision, including chronic care. The plan includes directions to healthcare personnel regarding their roles in the care and supervision of the patient. Before the treatment plan is implemented, it is approved by a physician. Individual treatment plans include, at a minimum: a. 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 Inmate Medical Services RFP No. 17-051 City of Santa Ana 37 4q$a�Malre your Wopwdmf hoalihwro choim disabilities, as necessary. Management of Diabetic Inmates Diabetes is one of the most complicated chronic care diseases present in correctional settings. There are different types of diabetes, different kinds of medication management, and various, constant blood glucose testing. This has the potential to be a documentation nightmare, but NaphCare has the solution. We provide electronic devices (LifeScan OneTouch® Flexx Professional 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-safe that prevents inaccurate testing of patients. The OneTouch® Flexx Professional Blood Glucose Monitoring System • Paperless; downloads information without the need for excessive charting. • All information is synced into TechCare® in each inmate's individual electronic health record. • Photometric technology delivers accurate and precise results. • Absorbent OneTouchPro Test Strips provide easier handling and application. • Unique off -meter dosing of the test strip minimizes risk of infection for patients and staff. o Removes need to bring meter to patient. o Helps reduce risk of transmission of blood -borne pathogens between patients. • TechCare® trends/graphs the results to demonstrate to the clinician how effectively current and past medications are managing blood sugar. INFECTION CONTROL PROGRAM NaphCare has an established Infection Control Program that is based on NCCHC standard J-B-01 and ACA Standards for Communicable Disease and Infection Control Program. Our Infection Control Program provides guidelines for the management of, and reduction of unnecessary exposure to, infectious and communicable diseases for inmates, institution and healthcare staff. It also offers guidelines to enact protection for health of inmates, staff and visitors through maintenance of a clean and orderly health unit. Our program is based 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. The infection control program at the SAJ establishes a comprehensive system of programming for surveillance and treatment of infectious diseases within the correctional environment. This program also eliminates or minimizes the risk of infection and transmission of communicable diseases for inmates and employees, and provides for the reporting of diseases as required by local, state and federal law. The HSA oversees and implements infection control measures to monitor the incidence of infectious and communicable diseases, ensures proper handling and disposal of biological waste, and provides education to inmates, correctional staff, and clinical staff on control, treatment, and prevention of infection. Infection control activities are monitored by the CQI committee. At a minimum, our infection control program includes written policies, procedures, and practices to: • Define surveillance procedures for inmates identified with infectious/communicable disease; • Ensure appropriate testing and immunizations for staff; • Provide inmate immunizations as recommended by the SAJ Medical Director; Inmate Medical Services RFP No. 17-051 City of Santa Ana 38 your independent haallhcare Choice. • Provide care and treatment to inmates with communicable diseases, including the recommendation for special housing/isolation when medically indicated; • Implement Bloodborne Pathogen Program; • Monitor compliance with treatment regimens and continuity of care for inmates with communicable diseases; • Ensure confidentiality; • Define decontamination of medical equipment and proper disposal of sharp instruments and biohazard wastes; • Define strict adherence to universal precautions by all NaphCare staff to minimize the risk of exposure to blood and body fluids of inmates; and • Provide reports to designated authority of infectious diseases and nosocomial infections (infections that originate or occur in a hospital) in accordance with local, state, and federal laws and regulations. Meetings are held at least quarterly, or whenever an infection control issue requires immediate or continuing attention. A licensed healthcare provider is designated to serve as the Infection Control Coordinator. The infection control committee will consist of the following members: • Medical Director or Physician; • Dentist or representative, if applicable; • HSA; • Director of Nursing, if applicable; • Infection Control Coordinator; • Institutional Authority representative; and • Any other representatives, depending on issues for discussion as designated in conjunction with the HSA or our Corporate Office. Infectious disease reporting is achieved through the TechCare® system. An inmate diagnosed with an infectious disease is immediately enrolled in a chronic care clinic that will then provide the appropriate referrals and treatment plan. The inmate's care can be tracked through the chronic care clinic module in TechCare®. TechCare® maintains data in real time to ensure that appropriate care is provided. Infection Control Education All new hires receive a comprehensive introduction and overview of the infection control program during their orientation period via our training module, Relias Learning. In addition, we provide annual review and competency training of our infection control program for all site staff via Relias Learning as well as on -site in -services. Infectious disease education includes, but is not limited to blood -borne pathogens, air -borne pathogens, post -exposure management, proper hand washing technique, bio- hazardous waste handling, and MRSA. We also provide inmate patient education handouts that address MRSA, HIV/AIDS, and Hepatitis C for use in the facilities. Delousing Procedures As part of our policy and procedure for Infection Control, we implement delousing procedures in accordance with NCCHC standard J-13-01. Inmates entering the Jail are examined and treated, if indicated, for ectoparasites in order to prevent possible institutional infestation. • Disinfection includes the inmate, bedding, and clothing; Inmate Medical Services RFP No. 17-051 City of Santa Ana 39 *�l el?1"�'•,,,� your independent heolihwm choice. • Treatment given to infected inmates considers all conditions and is ordered by a clinician; and • Only over-the-counter medications are used for facilities which routinely delouse inmates. Pandemic Response We will prepare healthcare staff to implement the aspects of our response to a pandemic of infectious disease to ensure the health, safety, and welfare of inmates, staff, and visitors. It is our policy to work in conjunction with the City to ensure that the health, safety, and welfare of inmates, staff and visitors are not jeopardized within the confines of the correctional institution during a pandemic of infectious disease. The Pandemic Response Plan is based on guidelines established by the Center for Disease Control and Prevention (NCCHCJ-B-01a,, ACA Communicable Disease and Infection Control). 8. Medication Management a. NaphCare will continue to provide routine over-the-counter pharmaceutical and routine prescription care for all inmates. Long-term medication for chronic care, including HIV and psychotropic medications will be the responsibility of the inmate's contracting agency. Please see Exhibit C Cost Proposal Narrative (under Required Forms) for pricing explanations. NAPHCARE'S IN-HOUSE PHARMACY SERVICES Medication administration is a high -volume and high - risk process, and a responsibility that NaphCare takes very seriously. Safeguards are needed all along the delivery system. NaphCare's goal is to provide our clients with safe and efficient pharmaceutical services while also reducing their drug costs. We own and operate our pharmacy, which is dedicated solely to the correctional facilities we serve. The pharmacists are all employed by us and are highly qualified with degrees in Doctor of Pharmacy, Master of Administration, and Bachelor of Science, and possess multiple disciplines of pharmaceutical experience. NaphCare has provided pharmacy services for 28 years! Our in-house pharmacy is located in the same building as our corporate office and provides complete pharmacy services, including management, record keeping and a delivery system that stays in compliance with all regulatory policies and procedures. Safeguards for our pharmaceutical provision system ensure drugs are ordered by qualified providers. Pharmaceutical inventory controls ensure the availability of necessary and commonly prescribed drugs and protect against loss of product. NaphCare is certified and accredited by the National Association of Boards of Pharmacy° (NABP®), and is the first pharmacy in Alabama to receive this verification. The NABP° is on impartial professional organization that supports the state boards of pharmacy in protecting public health. Qb. Inmate Medical Services RFP No. 17-051 City of Santa Ana 40 kl�491re yourWependon heoilhw'r choice. A detailed description of our in-house pharmacy program is shown on the following pages. We will continue to ensure contract compliance in all our pharmaceutical services and strive to give you the finest pharmaceutical services while maximizing your cost -savings potential. We offer the following extra value benefits to facilities that utilize our in-house pharmacy services: NaphCare provides a total pharmaceutical system for prescription and non-prescription drugs and all intravenous solutions ordered by our physicians. Appropriate prescription drugs will be available to all patients at all times. Our pharmacists screen all drug orders for completeness and medical appropriateness, and then oversee order preparation, distribution, and control. NaphCare's pharmacy management policies and procedures help to ensure the following: Inmate Medical Services RFP No. 17-051 City of Santa Ana 41 ci%1 c?P your independent heolih=,e choice. Medication Review NaphCare pharmacists provide a thorough clinical review of drug orders as new prescriptions are electronically sent to the NaphCare Pharmacy. As a value-added service for the Jail, NaphCare's pharmacists review all orders for accuracy. They verify real-time prescriptions for safe dosage, allergies, specified length of time, need for drug, and duplications. By identifying duplications, we minimize the number of drugs a patient needs while still ensuring high quality care. Pharmacv Queue &Vital Signs Current vital signs, such as blood pressure and blood glucose levels, are shown on the Pharmacy Queue to alert pharmacists of any abnormal vital signs which may preclude use of the prescribed drug. Within this screen, it is easy for pharmacists to see when scheduled or appropriate vital signs have not been taken or properly recorded; they are then able to communicate with healthcare staff so that corrective action can be taken and negative outcomes can be prevented. Clinical Pharmacist Quality Assurance Management Process When inmates first enterthe Jail, a Intake Screening is completed to gather important inmate physical and mental health information up front to prevent negative outcomes later. During this screening, we identify any current or needed medications. Medication orders are entered into the TechCare® eMAR, ensuring that all medication activities are tracked. Within our eMAR, all providers have the information they need to review and approve orders and make 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 in compliance with NCCHC standards for care and the manner which you have requested. When a provider reviews and approves orders in the TechCare° eMAR, our Pharmacy Quality Assurance Management Process begins. A chart outlining this process is shown below. Inmate Medical Services RFP No. 17-051 City of Santa Ana 42 <4 .1 fTane� your indepandaot lwoahwre dwke, NaphCare's Pharmacy Quality Assurance Management Process 1, Medication Order i, Vital signs, i. Monitored Daily. i. Appropriate a. allAR Reviewed. 2. Appropriate a.cmcal Treatraent Plan. Monitoron Daily s,Dupiicam Treatmaat. Pharmacist 2.PabentCamp4anee for Complinnoe. Therapy. a/a.E�vi�Tdeme-based Roeommendations, until Medhat1.�rr 2-Nta[RoatLan DruglIItcrpc ians, y4iIlldin@$. `� ChIlical 0aevalght TjHtraFX Disj3Cnsed liaswd .(.Appropriate q. Chronic Care by Medical Provider. g Eneava medication on LItilixatiom Doses. Tracking 4.Veriaed treatment remains 3.Manage g. Drug Akygies, g.Medication Madicafiom are onrent Pharmaceutical Comphance. Continued, costa. 4. lzb Monitoring. '.Adverse Reactions. Inmate Medical Services City of Santa Ana RiedieaHon is atiapensed. Electronic Prescription Ordering Prescriptions are electronically communicated directly from our physicians to NaphCare's pharmacy and are immediately recorded on the eMAR. Once new orders have been submitted, they are entered into the Pharmacist's Queue, allowing our pharmacists to follow-up with clinical or therapeutic advice for on -site personnel and re- evaluation is documented in your inmate's health record. All healthcare staff and pharmacists have access to one central location for medication information Everyone sees the some data without the need to recreate illegible paper files or search for records. This saves time and eliminates the potential for human error. Automatic Reordering System As nurses administer drugs using our eMAR, we match refills with distribution. The result is that you only pay for what is used and avoid unnecessary drug costs. On -site staff and our pharmacy department access the same drug list, greatly reducing human error. Automatic Reordering also provides improved tracking of medications. RFP No, 17-051 43 47 IT�491re ya., independent heoliheom choice. Within our eMAR, tracking renewals of maintenance medications is easy. For the Jail, 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 medications or keep -on -person (KOP) medications lapse. Our pharmacists review all orders, verifying prescriptions for accuracy, safe dosage, allergies, specified length of time, need for drug, and duplications. Our providers review inmate records for medications near expiration and ensure that inmates assigned to regular chronic care check-ups have medications renewed on time. Within our eMAR, our pharmacists search for prescriptions which are nearing expiration and request appropriate refills. All of NaphCare's pharmaceutical operations comply with NCCHCJ-0-02 Medication Services, which mandates that medication services are clinically appropriate and provided in a timely, safe, and sufficient manner. Cost Containment Initiatives NaphCare's in-house pharmacy ensures maximum pharmaceutical savings for you. Since pharmacy services are not contracted out to a third party, you do not experience middle man expenses. We always look for opportunities for better or preferential pricing. One of the ways we save you money is in branded medications: the more generics we purchase, the higher your discounts are on branded medications. Another way our in-house pharmacists save you money is by reviewing all refills in Tech Care®, ensuring inmate medication compliance within the medication administration record (MAR), and checking to ensure the inmate is active priorto filling. The result is reduced waste and buildup of unused medications. Within TechCare®, we 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 in the administration of HIV medications at several of our sites. With our Quality Processes and Systems, we are able to dispense medications in seven-day supplies as opposed to the standard 30-day supply used by other pharmacies. With the high turnover thatjails see, and with average length of stay less than one month, our seven-day dispensing process has significantly reduced costs for our existing clients. b. Medications will be administered to inmate daily as prescribed, twenty-four (24) hours per day and seven (7) days each week by an individual authorized to administer medications by nature of training and licensure as required by law. Electronic Medication Administration Record (eMAR) NaphCare's eMAR is specifically designed for use in correctional facilities. It is included within Tech Care® and is not a separate system. This integration promotes consistency within records of care and does not cost the City additional money. It is also customizable to meet the unique needs of the SAJ. Inmate Medical Services RFP No. 17-051 City of Santa Ana 44 ym, independent hoahhcme choice. We are committed to proactively reducing medication errors. Our eMAR 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 be retrieved using a unique inmate number, and documentation complies with federal and state legal requirements. TechCare® also has a user-friendly interface for accurate documentation that is immediately accessible and can be retrieved easily for reporting and tracking purposes. Also, vital signs, such as blood pressure and blood glucose levels, are shown in our eMAR and Pharmacy Queue to alert healthcare staff of abnormal vital signs that may require further attention. The eMAR assists in developing an efficient, structured med pass process. With our eMAR, medication administration is structured and nurses organize medication carts in relation to inmate location, which greatly reduces time needed for medication administration and correctional staff oversight during this process. The TechCare° eMAR screen allows nurses operating in your facilities to access all patient information during medication pass. Sick Call Scheduling Progress Note Documentation Blood Pressure Progress Note History Blood Glucose Review & Update of Vital Signs Medication Administrationr including refusals,"disbursemeV 'of KOP medications and re- ordeiing medications cah'all be accomplished from oar eMAR. TechCare® also generates a Missed Med Report that can be viewed and printed within the eMAR function. An additional, significant benefit for you is our ability to generate a Missed Medication Report (see figure (1) below). This report can be viewed and printed using our eMAR and identifies each patient and the medication missed. Our eMAR Drug Administration History Report (see figure (2) below) provides 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 provide follow-up with SAJ patients who have refused medications to educate them on the importance of taking prescribed medications. Inmate Medical Services RFP No. 17-051 City of Santa Ana 45 <4 �49i& yam indopendoet hao8hcom choice. (1) eMAR - Missed Medication Report H> na tncatfon ei4 E9edkanena. + 1W,, Nama Nwi�ng Tpd° m Adminlstercd Drug tdame Tknei ilma2 Thw3 TM4 Our Missed Medication Report shows inmate name, housing, dosage, medication to he administered, #medications administered, and the time coed#cation was administered. (2) eMAR - Drug Administration History — Reasons for Missed Medications — Detail Within TecliCare®, the eMAR features the name of medication, dosage, frequency, date, and time ordered by the MD for each medication to be administered. In accordance with NCCHCJ-D-02, NaphCare's medication services are provided as clinically appropriate and in a safe, timely, and sufficient manner. For your reference, a screenshot of our eMAR is shown in below. Inmate Medical Services RFP No. 17-051 City of Santa Ana 46 your independent heaflhtare thaice. NaphCare's eMAR screen housed in TechCare® Other benefits of our eMAR system include the following: • Ability to control costs by efficiently reducing the overstocking of medications • Formulary drugs are prescriber's default choice • Automatically updates inmate eMARs, ensuring no inmate misses medications, even if there is a change in housing/placement • Greater correctional officer awareness and control, less inmate frustration, and safer environment • Reduction of administrative paperwork and improved efficiency • All providers, regardless of discipline have instant access to all patient Information • Optimized regulatory compliance • Improved patient outcomes and staff satisfaction Inmate Medical Services RFP No. 17-051 City of Santa Ana 47 a_h040.1h ,� your independent hoolihmre choice. c. In general, medications will be administered in 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. Formulary 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. A formulary of drugs is available, subject to City approval, inclusive of psychiatric drugs and drugs for the treatment of HIV. We work closely with SAJ custody staff at intake to review the medical requirements of your inmates. Records of non -formulary requests and responses are 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 City to manage the formulary to control costs and ensure effective clinical care. Clinical experts share information regarding the 'best practices' in formulary management techniques based on experience with clients, healthcare organizations, and the State Department of Correction. By programming 1echCore® with the approved formulary, we ensure that inmate medication orders are in strict compliance with approved formulary. To save you money, we always maintain a rigid formulary but consider lower price alternatives when purchasing medications and when medically appropriate. I. Formulary Our formulary is provided in the Appendix of our proposal, and our pharmaceutical pricing structure is included in Exhibit C under Required Forms. 9. Mental Health Services a. NaphCare will continue to provide inmates with the necessary mental health services. This includes the assessment and evaluation of mentally ill and suicidal inmates. NAPHCARE'S MENTAL HEALTH SERVICES As the mental health population in correctional facilities continues to increase, the burden of care, along with all associated costs, falls directly on facility staff, and treatment for the mentally ill impacts the community at large. Risk management is a priority, and NaphCare recognizes that a strong mental healthcare system is imperative. An inmate with mental health issues can pose a risk to themselves and other inmates, the staff, and can disrupt the facility with their behavior. We provide mental health services that are based on the identification and stabilization of inmates with mental health issues. Our clinical and administrative mental health Inmate Medical Services RFP No. 17-051 City of Santa Ana 48 La hCAM,,,� ycvt iadapendeat heaNhcare thaica. team works closely with local mental health agencies to effectively manage inmates and plan for their care after release. NaphCare's mental health services are built on a 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 ✓ Collaboration with community mental health providers at discharge. NaphCare's Chief Medical Officer, Dr. Steven Bonner, will continue to be available for clinical support and oversight of the SAJ's mental health program. He has over 16 years of clinical experience as a Board -Certified Psychiatrist. He serves as a member of NaphCare's Morbidity & Mortality Committee, and he chairs the Pharmacy & Therapeutics Committee. He also performs peer reviews, and provides provider oversight and clinical support to all NaphCare mental health programs. NaphCare will provide mental health training services to mental health professionals and correctional staff on such topics as symptom recognition, referral, and de-escalation techniques. Our goal is to reduce recidivism by collaborating with community mental health resources for effective discharge planning. Mental Health Preliminary Screening and Evaluation NaphCare's first opportunity to identify a patient with mental illness is during the Intake Screening. Our Receiving Screen asks about medical and mental health issues to proactively identify patients with these problems as soon as they arrive. Following the Receiving Screen, a Mental Health Screen is performed per NCCHCJ-E-OS, Mental Health Screening and Evaluation, and NaphCare policy and procedure. All inmates will receive a mental health screening, to include a suicide risk assessment, by a trained nurse upon arrival. The following is a description of each section of NaphCare's Mental Health Screening and the information it obtains: • Current Mental Health Symptoms — Reviews depressed mood, anxiety, psychosis, and mania. In addition, inquiries are made regarding current mental health treatment in the community, any suicidal thoughts, any recent losses, feelings about current situation, if they feel they have anything positive in their future, and allows the interviewer to comment on their feeling of suicide risk based on responses and appearance. Past Mental Health History— Reviews past treatment for mental health issues including medications and hospitalizations; reviews history of self -injury behaviors and suicide attempts. Inmate Medical Services RFP No. 17-051 City of Santa Ana 49 4.....h.1.0 your indepwdent hbahhw, chore. • Substance Abuse — Inquires about alcohol, benzodiazepine, opiate, and other substance use issues, as well as history of substance use related treatment. PREA/General Assessment — Reviews any history of abuse of any kind, in any setting; any convictions for sex or violent crimes; any history of special education or developmental disabilities; history of head injury or seizures. Disposition/Treatment Plan — Allows the interviewer to refer to indicated mental health services, refer for detox services if indicated, and/or begin discharge planning with regard to need for mental health follow up. NaphCare is committed to identifying and meeting the acute and chronic mental health needs of patients admitted to the SAJ. Each patient who is identified by the screens as needing mental healthcare treatment will have action taken to ensure this care is provided. Any inmate who is determined to need additional mental health services will be scheduled for further evaluation by higher level mental health professionals (up to and including psychiatric evaluation) in the clinically indicated time frame. In TechCare®, we electronically flag an inmate's health record if his/her responses during intake indicate the need for additional mental healthcare. All screenings and evaluations will identify inmates with suicidal and homicidal tendencies, as well as acute and chronic behavioral health issues. Alerts in the system prompt the clinical staff to take action, such as placing an inmate on suicide precautions, contacting custody about an issue, or assigning special housing. The Mental Health Screen also 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. All mental health encounters are documented electronically in the inmate's health record in TechCare®. The mental health provider can access the inmate's entire electronic health record when conducting an evaluation, or at any time the inmate is referred to the mental health program during his/her incarceration. Additionally, if or when an inmate is transferred to another facility, his or her health record, containing mental health information, will be instantly available in TechCare®. This ensures continuity of care for inmates with a mental illness. Proactive Quality Assurance Checks ✓ Using TechCare® we audit the initial mental health screenings. TechCare® searches the database of all active inmates with a bed assignment for completed 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 mental health screening within 48 hours of site notification. ✓ Per NCCHC standards, any inmate with a positive mental health screening requires a mental health evaluation. Weekly, we run a TechCare° report showing all active inmates who had a positive mental health screening, and have not had a mental health evaluation yet. This quality assurance activity assists the mental health staff in tracking Inmate Medical Services RFP No. 17-051 City of Santa Ana 50 your i,depo,id.M hoolthmre choice. and following up with the inmates in need of mental health evaluation and potential treatment during their incarceration. TechCare@ and Mental Health One of NaphCare's main tools for a successful mental health program is TechCare°. Our clients utilize TechCare's Mental/Behavioral Health Modules to maintain behavioral health records without the need for additional systems or paper records. It provides seamless communication between medical and mental health providers and iron -clad documentation of mental health services. The benefit of a centralized, coordinated EHR is that all providers, to include medical, mental health and dental, have simultaneous access to an inmate's record. Many correctional systems that use a paper medical record system battle access issues when an inmate is scheduled to see multiple providers/disciplines on a given day. This often forces providers to compete for records or make clinical decisions without a record present during an encounter. Other systems are forced to operate with dual records, creating clerical inefficiencies due to copying and filing redundancies. With a centralized EHR like TechCare®, providers also have real time access to the most current clinical information from all disciplines, thus ensuring that a patient's care is not provided in a polarized environment. This coordination and use of TechCare® between all vendors will prove to be valuable in the coordination and quality of patient care, ultimately reducing the need for expensive off -site care. With the use of TechCare®, mental health providers have the following capabilities: • We electronically flag an inmate's health record if his/her responses during the Intake Screening indicate a need for additional mental healthcare. • All screenings and evaluations identify inmates with suicidal and homicidal tendencies, as well as acute and chronic behavioral health issues. Alerts in TechCare® prompt clinical staff to take action, such as placing an inmate on suicide precautions, contacting custody, or assigning special housing. • TechCare® has an effective alerting system that can be based on several triggers within behavioral health. As an example specifically for treatment planning, the system can alert if psychotropic medications are missed or refused, diagnostic values are out of range, documents have returned from an off -site visit and if a sick call has been missed. • Electronic medication administration records (eMAR) for prescriptions and review of patient medication history and current medication use. • Access to a patient's total chart, with both medical and mental health history, for comprehensive reviews of current and past care. • Mental Health screening and evaluation results are stored within the EHR for instant, easy access to this information. • Scheduling and coordination for referrals is performed through TechCare® and off - site data is stored within TechCare° for easy access to any off -site or referral information. • All mental health activities are recorded in TechCare® and available for review at any time. Inmate Medical Services RFP No. 17-051 City of Santa Ana 51 _�491� your u,depondwt hwithmre choico- In addition, TechCare® is certified by the Office of the National Coordinator for Health Information Technology as a Complete Behavioral and Medical EHR System. "NaphCare understands that behavioral healthcare enabling individuals to maintain their own health nc we understand that this area demands specific func focused on behavioral healthcare. In my current rol TechCare® evolve into a complete EHR to serve our i ,ism and ase. Further, EHRs solely r, I have seen if and mental Telepsychiatry NaphCare will continue to provide telepsychiatry services to the SAJ. We currently provide telepsych twice a week in four-hour sessions. This not only enhances regular mental health care at the SAJ, but it also allows providers to remotely examine an inmate with a mental health emergency during an after-hours situation, while simultaneously having total access to the inmate's health record. NaphCare's Suicide Prevention Plan NaphCare is an experienced provider of correctional mental health services, and suicide prevention figures predominantly in this experience. We take our responsibility seriously, and have devoted time and resources to creating a proactive suicide prevention plan that addresses the current state of corrections and correctional healthcare. We believe our proactive approach and use of technology figure largely into our plan and its success at our client facilities. Our low suicide rates are some of the best in the industry. Inmate Medical Services RFP No. 17-051 City of Santa Ana 52 Aaha-�-Vj yoa, Wepenulecl hnallhc mchelce. NaphCare's Suicide Prevention Plan is consistent with NCCHC and ACA standards. We work closely with corrections staff to maintain clear and consistent communication in dealing with suicidal inmates. We have specific policies and procedures in place with the goal being to reduce the potential for suicide, 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: o Signs and symptoms to recognize o Risk Factors o Management of suicidal inmates o Review of policies and procedures in dealing with suicidal inmates o Ongoing training and annual review of training to keep up to date ® Screening and Identification of High Risk Inmates o 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. o Alerts in Tech Care® assist the evaluator in decision 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. o They will be placed on Suicide Watch in appropriate housing located within the facility and will be monitored as clinically indicated based on their level of acuity. o Once discharged from watch they remain in the mental health caseload and have regular follow up until released from custody. ® Review of Policies and Procedures o 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. o All policies and procedures will be reviewed regularly to keep them up to date. o Staff will be trained for any changes that occur. Effective Communication o Clear and consistent communication among all parties — corrections, medical, mental health, and inmates - is vital to the success of the prevention plan. o Our QA program monitors and provides feedback to ensure success of the plan. Inmate Medical Services RFP No. 17-051 City of Santa Ana 53 c��49re your independent hwhhmm choim, f Critical Incident Review o 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. ® Critical Incident Debriefing — Any staff who have been negatively affected by the self -harm or suicidal act will be provided assistance by trained mental health professionals in a timely manner Alerts for Suicide Risks Our initial Receiving Screen and Mental Health Screen include automatic prompts to assist healthcare staff in the decision making process when an inmate is identified or reports a potential for suicidal behavior. At intake, each inmate is asked a standard set of comprehensive questions about the possibility of suicidal thoughts. The interviewer is guided through the questions and prompted to select the appropriate referral and triage for the suicidal inmate. The mental health screening questionnaire has been carefully researched by mental health experts and is based on the latest research regarding suicide risk factors. A positive response to specific questions automatically alerts the healthcare staff of the need for an immediate referral to mental health services, communication and coordination with security staff, and a requirement for special housing. This process provides easy, quick, and legible documentation of suicidal risks and behaviors. Clear communication between medical, mental health, and correctional staff keeps the program effective. We maintain open verbal and written communication with the inmates, medical and mental health staff, and the correctional staff. Any difficulties in communication are addressed immediately. Suicide Watch Tracking Our innovative EHR system includes a feature called the Admissions Management Module. One portion of this module is devoted to Suicide Watch tracking and documentation. Once a patient is placed on suicide watch, their name is electronically entered ("admitted") into this tracking module. The module keeps track of all patients who are on Suicide Watch and also manages their documentation. This assists mental health clinicians and providers by telling them exactly who is on watch, what their status is, and provides thorough electronic forms for proper documentation of Suicide Watch monitoring. When a patient is ready to be released from Suicide Watch the proper documentation is readily available, and once released, the patient's name is removed ("discharged") from this list. Through the use of this module the entire mental health staff is kept aware of all patients on Suicide Watch. In addition, it provides the site management (HSA, etc.) with the ability to also monitor these high acuity patients and ensure their care is being delivered in a manner consistent with NaphCare expectations. NaphCare does not use other inmates to substitute for staff in supervising suicidal patients. Inmate Medical Services RFP No, 17-051 City of Santa Ana 54 < A 49 hCal`�',,, your indep..dent hea8hmre chaise. Suicide Watch Policy and Procedures NaphCare's policy and procedure for Suicide Prevention addresses Suicide Watch and complies with NCCHC Standard J-G-05, Suicide Prevention, and ACA Standard 4-ALDF-4C-32, Suicide Prevention and Intervention. Any inmate that screens positive for suicidal ideation during the initial mental health screen (upon intake) will be placed on Suicide Watch and kept under close or constant observation until evaluated by mental health staff, which will occur as soon as possible. A potentially suicidal inmate will be housed in a safe cell or other secure housing. The following procedures for Suicide Watch are from NaphCare's complete policy and procedure for Suicide Prevention. 1. Per correctional policies and procedures, the shift commander will ensure that appropriate correctional staff is properly informed of the status of each inmate placed on a Suicide Watch. The shift commander will be responsible for briefing the incoming shift commander on the status of all inmates on a Suicide Watch. 2. Inmates placed on a Suicide Watch may be strip -searched prior to being placed in a safe cell according to the correctional facility's Policies and Procedures. 3. Inmates on a Suicide Watch may be provided with a suicide resistant gown and blanket, if applicable. Removal of clothing may only be utilized as a last resort and only for periods in which the inmate is in eminent danger of engaging in self- destructive behavior. 4. The use of physical restraints may only be utilized as a last resort for periods in which the inmate is physically engaging in self-destructive behavior. The decision to utilize physical restraints for suicidal inmates are only to be made by Mental Health Staff in conjunction with the appropriate corrections staff, according to the facility's Policies and Procedures. 5. All inmates placed on Suicide Watch will receive a face-to-face evaluation by Mental Health Staff within 24 hours of initiation of the Suicide Watch. Referral s for follow- up with a Qualified Mental Health Professional is to be made as clinically indicated. 6. The inmate who is on Suicide Watch will be assessed at least once every 24 hours by Mental Health Staff. These assessments will be recorded in TechCareo. 7. Only a mental health professional has the ability to remove an inmate from suicide watch. 8. The inmate will be reassessed within 24 hours of being discharged from Suicide Watch by Mental Health Staff. Periodic follow-up assessments will continue as deemed clinically appropriate. 9. Where appropriate, interdisciplinary team meetings, to include correctional, mental health, and medical staff will be conducted to discuss suicidal inmates that require closer supervision and planning. 10. Treatment plans for the suicidal inmate are developed with follow-up as clinically indicated. 11. NaphCare will not use other inmates in anyway (e.g. companions, cell -mates, suicide prevention aides) to substitute for staff supervision of a suicidal inmate. Inmate Medical Services RFP No. 17-051 City of Santa Ana 55 <A �49jhl? your independent ho.11hcore choice. Mental Health Referral Plan NaphCare will provide a rapid response to any need for an evaluation or mental health intervention. The mental health team will be on -call and available 24 hours a day to provide a rapid response to an emergent need for an evaluation or mental health intervention. Inmates may request mental health services via sick call; additionally, correctional, medical, or mental health staff can recommend mental health services for inmates at any time. NaphCare has established detailed policies and procedures for both the on -site and off -site treatment of such inmates and for referrals to the mental health provider for continued treatment when medically necessary. The psychiatric provider and mental health professional will coordinate with the facility leadership on recommendations regarding placement of housing, monitoring, and other operational issues. Mental health referrals will be received, documented, and processed through the scheduling system in TechCore®, which provides instant, up-to-date information that is accessible to all providers. Crisis Management Plan Mental health staff provide 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. 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. Mental Health crisis management will also be a component of ongoing training provided by the NaphCare mental health team for SAJ security staff. Continuous Quality Improvement (CQI) NaphCare will conduct regular studies, identify opportunities for improvement, and develop effective corrective action plans for our mental health services as part of our larger CQI efforts at the SAJ. Ongoing improvement activities will focus on patient care areas to include: • Timely mental health screening • Effectiveness of the referral process • Timely psychiatric evaluation • Suicide policy compliance • Medical services provided for those on medical confinement status • Discharge planning • Emergency mental health response • Involuntary medication administration b. A licensed mental health specialist will be available on -site four (4) hours per week. c. All healthcare staff are properly trained on the symptoms and treatment of the inmates who are at risk or suicidal and/or homicidal acts. Inmate Medical Services RFP No. 17-051 City of Santa Ana 56 4 497 aba. re }our wd¢pendant haahko,. tha,c., We provide suicide prevention training to all on -site correctional and medical staff employees who regularly interact with inmates. Staff undergoes an 8-hour initial training that includes the following topics: • Signs and symptoms of predisposing factors of potentially suicidal inmates • Risk factors in the evaluation of suicide potential • Management of suicidal 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. NaphCare stands ready to implement a correctional -based Crisis Intervention Team Training Program for the SAJ to enhance the awareness of mental illness and intervention skills for all staff. d. NaphCare has detailed policies and procedures in place for the on -site treatment and handling of these inmates. Policy and procedures will be coordinated with the Jail Administrator or designee. 10. Medical Records Management a, NaphCare acknowledges that the SAJ is the sole owner of all inmate medical records. Ownership and Access to EHR Data In the event that leadership decides to switch healthcare vendors, NaphCare provides clients with the option to continue the use of TechCareO or to transfer electronic records from TechCareg to another EHR system. The City of Santa Ana will maintain ownership of ALL EHR DATA throughout and following the contract's end date. Upon contract end, we can provide electronic health records to the facility in one of the following three formats: 1. Electronic Bridge: NaphCare can provide the City of Santa Ana or the incoming provider with access to an electronic bridge for secure data transfer from NaphCare's EHR to another software system selected by the facility. 2. Purchase Option: NaphCare, at its discretion, can provide the City with an EHR Service Agreement that provides usage rights and support for the TechCore® application even without NaphCare providing comprehensive services. 3. Paper Export: NaphCare can provide a paper -based export of medical records as requested, b. NaphCare will continue to be responsible for the maintenance and retention of a complete, standardized medical record for all inmates in accordance with prevailing medical regulation for confidentially, retention, and access. Inmate Medical Services RFP No, 17-051 City of Santa Ana 57 your independent hedthcom: d,oiwe c. NaphCare will continue to implement our established policies and procedure 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. TechCare® controls access to and within the system at multiple levels (User, Role, Patient and Chart Section/Area) through a consistent method of identification and authentication of all users in accordance with the NIST developed, Role Based Access Control (RBAC), standard. Examples include the following: • If doctors are the only users who are allowed to prescribe medications, then no user Role except for Doctors have access to the Drug Order section of TechCare®. • 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 PHI, so their Role can be set to only access the Reports section of TechCare®. • The role Administrative Assistants can be granted view only access to TechCare® for Quality Assurance purposes. NaphCare will continue to maintain inmate records using our electronic health record system, TechCare°, which we implemented upon our initial transition to NaphCare in 2014. NaphCare scanned and attached all existing active files in medical records office into TechCare® to improve the overall continuity of care provided to patients. This process has also reduced the risk involved in managing medical paper charting systems. We will ensure continued compatibility with the SAJ's existing jail management system (ATIMS). The following pages provide a detailed description of the TechCare® EHR system. Inmate Medical Services RFP No. 17-051 City of Santa Ana 58 your indepandeM heclthcare chaff«. TECHCARE©, NAPHCARE'S ELECTRONIC HEALTH RECORD SYSTEM NaphCare's Proactive Care Model is delivered by Quality People, Quality Processes, and Quality Systems working in unity. An integral part of this model is NaphCare's comprehensive electronic health record (EHR) system, TechCare°. Beyond providing electronic health records, TechCare® is a corrections -specific operational system that automates, standardizes, and enforces proactive inmate care. It also connects NaphCare, our on -site staff, and our clients in a way that no other system can, providing on -demand, transparent information and communication regarding healthcare services. TechCare® is currently functional at ALL of NaphCare's client facilities, including the Santa Ana Jail. A Comprehensive System Most correctional healthcare providers propose to use an EHR system. With NaphCare, you receive proven, more advanced technology in a comprehensive operating system tailored specifically to the needs of correctional health care. Electronic records are one of many TechCare® features, but there is much more. TechCare° 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. The TechCare® system includes the following components: • Electronic Health Records • Customizable Reports • Off -site Medical Scheduling • CIWA-Ar Detoxification Tool ONC Certified HIT • Chronic Care Management 2014 EDITION • Grievance Tracking COMPLETE EHR • Quality Assurance • Screening Tools (Intake, TB, Mental Health) • Dental (Screening, Evaluation) • Mental Health (Screening, Evaluation, Suicide Alerts) • 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 • Interface Connections with Ancillary Services (X-Ray, Laboratory) & JMS • Medication Administration Record/Electronic Medication Administration Record • Sick Call • Flags • Queues/Dashboards (Doctor, Nurse, Pharmacy) • Alerts • Detailed, Compliance Supporting, Logging TechCare® was designed by correctional healthcare professionals, not software developers, and it makes providing excellent care faster, not slower. TechCare° training is also provided by correctional healthcare providers, and this helps to make the daily experience of using TechCare® easier. Inmate Medical Services RFP No. 17-051 City of Santa Ana S9 4f�,&Ihe your independent heellhwm choice. Dedicated IT Team TechCare® is the only proprietary EHR 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 ourfull-time developers and clinically trained support team. As a result, the SAJ receives dedicated service and support from ourtechnology experts, whose goal is to understand your site and provide fast support and complete understanding of correctional healthcare; we commit to never outsourcing this critical piece of your healthcare operation. TechCare@ Advantages for the Santa Ana Jail ® Versatile— TechCare® is highly versatile and maintains nationwide standard levels of interoperability, ensuring continuity of care across other electronic systems. It is custom-built to meet all correctional healthcare accreditation standards. • ONC Meaningful Use Certified System — NaphCare is proud to state that zota EINTION TechCare® achieved certification by the Drummond Group, an ONC-ACB, in rU mono accordance with the applicable 2014 certification criteria adopted by the > } > certified - Secretary of Health and Human Services. TechCare® is certified as a complete EHR product that does not rely on any third -party software. HIPAA Compliance— NaphCare upholds HIPAA compliance and is supported by tools such as TechCareo. TechCare® maintains centralized, secure storage of inmate information with processes and procedures automated to protect data. Large -Scale Capacity— TechCare® is used to successfully manage thousands of inmates. It is more than capable of handling all intakes and medical records that exist at the SAJ and is able to grow as needed. ® Electronic Tracking of On and Off Site Appointments — TechCore® 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. By tracking off -site care, we can analyze trends to save on future costs. Automatic Scheduling — Once an inmate is registered in Clark County realized a 27% reduction in off - site costs with the use of NophCore's Proactive Care Model in conjunction with the TechCare® system. Clark County Detention Center, NV TechCare®, 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. Inmate Medical Services RFP No. 17-051 City of Santa Ana 60 4404 �49_Ae your indopwdwt hcolH:caro &aim Contract Monitor Access to TechCare°— If yours ite has a Contract Monitor or outside auditing team, this team or the Contract Monitor will have access to off -site referral data during the term of the agreement in order to monitor contract compliance. This data is readily available in awe b- based format that can be viewed instantly. The Contract Monitor is notified of all inmates who are receiving off -site care. Suffolk County, Massachusetts achieved a 100% score during a recent Massachusetts DOC Survey in addition to passing an NCCHC audit in the some year. The use of TechCare' was a major factor in both assessments. 2014 ACA Ready —As an ONC-certified EHR, TechCare® is fully compatible with State Health Information Exchanges and State Medicaid systems across the country. We will implement connectivity to these systems for the SAJ in order to support greater continuity of care for your inmates. NaphCare successfully utilizes state Medicaid systems across the nation to pre -determine inmate eligibility and bill the proper party for off -site encounters, automatically. ® Ease of Use — TechCare® was designed by correctional health clinicians, not software developers. It was developed on the basis of improving care while reducing risk. TechCare® makes providing care in correctional institutions faster, more efficient, and more accurate. Proven System —TechCare® 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 — Maricopa County, Arizona, and Orange County, California. Fully implemented in these self -op correctional systems, TechCare® is more than a technology initiative— it's a proven system. Risk Management and Quality Assurance TechCare® provides the highest level of quality assurance and risk management for your correctional facility. It not only maintains 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 NICCHC, and ACA requirements, which will allow the SAJ to achieve these certifications as a correctional institution. Our client facilities across the country have used TechCare® countless times to meet these accreditations. ® Strict Documentation —TechCare® has a solid platform for quality charting that ensures detailed logging and documentation without loopholes, thereby supporting chart audit and litigation activities seamlessly and instantly. Staffing Management— TechCare's built-in tools help our professionals manage staffing requirements and make more efficient decisions to reduce clerical time, increase clinical care, and improve the quality of care. Inmate Medical Services RFP No. 17-051 City of Santa Ana 61 4 �161ry your independent healiheare choice. Alerts & Dashboards —TechCare® 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. Meaningful Reporting & Tracking — TechCare® provides centralized storage for data that can be easily aggregated and reported using built-in search tools. In addition, this data can be used to track aspects 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. Centralized Care TechCare® maintains nationwide standard levels of interoperability and provides centralized storage for all inmate healthcare activities. NaphCare interfaces, or connects, TechCare® to a number of 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 set up include the following: ® Jail Management Svstem: TechCare® builds upon the existing system of inmate demographic files that are currently maintained by the jail management system (JMS). We implement a bi-directional, real time interface with the JMS to gather this information in addition to getting instantly updated on inmate locations and movement. Lab Svstem: We have successfully interfaced with the BioReference for the SAJ, allowing an inmate's laboratory results to be viewed instantly. Having a direct link between the lab vendor and our EHR allows us to instantly alert the physician of critical lab values through physician dashboards. ® Additional Internal Svstems: o Diagnostics: Integrated access to add -on systems (i.e. radiology) o Kiosk: Sick call request submission and resolution documentation o Food Service: Diets, allergies, etc. communicated automatically ® public Svstems: o Health Information Exchange: Gather inmates' "free -world" medical history o Hospitals and Off -Site Providers: Maintain documentation for off -site encounters o State Medicaid: Verification and eligibility for off -site encounters Inmate Medical Services RFP No. 17-051 City of Santa Ana 62 ,�h are ;roe, independent heahh.. choice. Reliability and Support TechCare® is only as good as the team that backs it. NaphCare realizes this and has built a robust IT operations group that completely manages the IT resources needed for the TechCare® operational system. We place NO requirements on the City's IT resources or personnel while implementing the necessary infrastructure to run TechCare®. ® Computers, Servers, etc. - NaphCare provides all 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 department and will work as a fully dedicated unit to implement the servers, computers, and networking systems that are needed for TechCare® to run efficiently. a 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 there to 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 matter the time of day. No other correctional EHR can do this, nor do they have the dedicated IT support needed to keep the infrastructure and application at peak performance. We regularly test these scenarios and have seen TechCare® perform flawlessly countless times. Always On, Redundant System -TechCare® is designed for correctional facilities and will continue to operate when other EHRs cannot. As the following diagram outlines, NaphCare installs redundant servers and redundant network/Internet connections at your facility that support an automated failover system. In the event that local resources become unavailable, the application will re -direct to servers at NaphCare's corporate datacenter. Inmate Medical Services RFP No. 17-051 City of Santa Ana 63 <Aq�� aglre� year independent heahhcaw chair¢. Tech Care@ Hybrid -Cloud Infrastructure Our redundant systems & data backup process, using the cloud, ensures that critical healthcare information is always available to the City of Santa Ana. Redundant On-SiteServcrs As an additional back up measure, we supply redundant servers to your jaerYiry.. to to s D kt a larg LE11HAIrdormation €an be accessed at aIt via Desktopi4apodn'Tab€et, evensconnected from it network. Data stored atfacility and Kelm Time Replication With 2417 Monitoring & Support from our IT experts a aahcamDatacenter Our Cloud Oatacenter is located at NaphCare Corporate, where we ensure that you can access Information at all times by way of redundant Internet connections. When Hurricane Ike struck the coast of Texas in 2008, a NaphCare client facility had to completely mobilize and move off site. The Tech Care° application and infrastructure, managed by NaphCare, remained fully operational. All medical activities and documentation continued without network connectivity. Inmate Medical Services RFP No. 17-051 City of Santa Ana 64 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 operational system, TechCare®, does just that by centralizing inmate care into a highly evolved, proven system that is backed by NaphCare operations, development, and support staff. Client and Practitioner Testimonials "Sick call is twice as fast with TechCare°, which allows more inmates to be seen in less time." r9�401re yo", indepmdanf hmhhca. c 6m, We invite you to visit the TechCare© website at www.techeareehr.com. —Tony Dressler, LPN, Montgomery County Jail "TechCare® has improved organization of patient care; patients are seen and followed more promptly. Records are readily available, which is especially helpful when they move back and forth between our two facilities." —Janice Hall, Nurse Practitioner, Essex County Correctional Facility "NaphCare's medical record system, TechCare®, has enhanced the operation of the Clark County Detention Center by streamlining the management of medical records. NaphCare's focus on continuity of care has allowed us to develop and maintain strong partnerships in the community —especially in the area of mental health. As our operational needs expand and change, we are confident that our partnership with NaphCare will continue to assist us with any challenges in the future." —Sheriff Doug Gillespie, Clark County Detention Center "We were introduced to TechCare°, an electronic medical records system that is simple and time saving. It allows all members of the healthcare team to be on the same page. I can see how the nurses, dentist, mental health professionals and other providers have interacted with and treated the patient. This program also allows corporate members to monitor and guide our daily activities. Although NaphCare has not been here long, I have been quite impressed with what they have brought to the Richmond City Justice Center. I look forward to growth and development with this company." —Khairul Emran, MD, Richmond City Justice Center, VA "Implementation of an Electronic Health Record (EHR) is a complex and challenging undertaking. The Orange County Health Care Agency (HCA) - Correctional Health Services division (CHS) implemented an EHR within the five adult jails and five juvenile detention facilities earlier this year. The facilities collectively house nearly 7500 adults and juveniles on a typical day. With 14 vendors responding to the original RFP, Orange County selected NaphCare as our chosen vendor for this project. Their EHR, TechCare , was developed specifically for correctional settings. NaphCare truly understands correctional workflow, challenges, and needs. Given the size and complexity of our system, it was critical we find a system allowing us to accurately record all care provided to our patients, and interface with multiple systems Inmate Medical Services RFP No. 17-051 City of Santa Ana 65 <*�Ire your independent hooBhmm choim providing patient demographics, including current housing and custody status, diagnostic results, medication administration records, and care provided in other county programs also serving this population. The implementation process went as smoothly as one could hope! Personally, I have been involved in several EHR 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 accommodating 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." —Kim Pearson, Deputy Agency Director, CHS "Ourjourney is just beginning, but so far our impression of the [TechCare®] system's ease of use and comprehensive reporting capabilities is positive and we are excited to achieve full implementation by year's end. Our interactions with NaphCare personnel have been a favorable and collaborative process, and their understanding of the correctional healthcare field has helped us to make system change decisions that will allow us to streamline our delivery system as we move forward with this project." —Kathy Wild, Deputy Agency Director "TechCare® has made a huge impact on how we see patients. Even our most skeptical providers prior to implementation would never go back to paper again! I think the most valuable part of selecting NaphCare as a vendor is their family approach to business. As a client, they treat you just as if you were part of the NaphCare family. Most other EHR vendors are just that-EHR vendors only. NaphCare understands healthcare, which shows in the product they sell." —Jeffrey Alvarez, Medical Director Inmate Medical Services RFP No. 17-051 City of Santa Ana 66 r?�461re yae: iodepwdert heaHhcwe choice. e. NaphCare will adhere to HIPAA standards and requirements. HIPAA Compliance NaphCare's EHR system, TechCare®, meets all of the U.S. Department of Health Services requirements for HIPAA compliance. 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. We have established HIPAA protocols to be utilized by our staff members in order to ensure that protected health information is kept confidential and only disclosed in compliance with applicable HIPAA regulations and/or California State law requirements. 11. Nutritional Services NaphCare will continue to coordinate with the established food service contractor to ensure the provision of medically necessary clinical diets. The following are examples of diets that may be ordered from food service: I. Cardiac diet ii. Diabetic/caloric controlled diet iii. Gastric soft diet iv. Pregnancy diet V. High protein/high caloric diet vi. Clear liquid diet vii. Restricted protein. sodium and/or potassium diet b. NaphCare 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. NUTRITIONAL SERVICES NaphCare provides a system for managing the nutritional needs of inmates and improving continuity of care. We collaborate with the established food service provider to ensure the provision of medically necessary diets. Our physician will prescribe the following medical diets when necessary: • Pregnancy • Clear Liquid • Full Liquid • Pureed • NPO • 2,400 Cal Diabetic ADA with HS Snacks • 2,000 Cal Diabetic ADA with HS Snacks Lactose Intolerance • Allergy Alert • Low Salt • Regular Diet with HS Snacks • 2,800 Cal Diabetic ADA - No Snack • Cardiac Inmate Medical Services City of Santa Ana TechCare®isincorporated with multiple levels of security to ensure the confidentiality of medical records and comply with current HIPAA standards. RFP No. 17-051 67 4 q $ q6 ± cl, r�e� your WepwdoM hadhmm chore. • 2,800 Cal Diabet icADAwith HIS Snacks • HS Snacks Renal • Low -Fat Regular Bland Our healthcare providers and staff will work with the client to develop optimal diets to meet the specific nutritional needs of inmates. We have protocols for the prescription of optimal diets. NaphCare will only provide supplements, i.e. Ensure, when our healthcare providers deem it medically necessary. NaphCare provides a system for managing the nutritional needs of inmates and improving continuity of care. Information on inmate diets is recorded within TechCare® and available for reports and review at any time. 0sers can easily enter an inmate's medical diet needs into TechCare°, including diet start and end dates. 12. Dental Care a. Dental clinics provide a range of dental care including but not limited to x- rays, extraction, teeth cleaning and gum care. Dental clinics will not be required to provide oral surgery, orthodontic services or devices. b. NaphCare will provide an on -site dental care program that staffs license dental practitioners a minimum of four (4) hours per week. c. The dental clinic will be staffed and operated on a set schedule. d. NaphCare will provide all supplies (e.g. dental tools, lead covers, etc.) Inmate Medical Services RFP No. 17-051 City of Santa Ana 68 4 0_1Va. -r your indepnd.nt heals cwra chair.. e. Minimum staffing forth e dental clinic will consist of a licensed Dentist and one (1) dental assistant. f. NaphCare will provide oral screenings by a dentist or certified dental assistant no later than fourteen (14) days from the inmate's date of admission. DENTAL CARE NaphCare's dental program complies with NCCHC and ACA standards by which inmates receive dental treatment, not limited to extractions, when the health of the inmate would otherwise be adversely affected. Treatments include any other services deemed necessary by the 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 for all oral treatment procedures. Documentation is standardized in the health record to better document dental health conditions and treatment in order to enhance communication among healthcare staff. The dental program begins with the Intake Screening, administered by a healthcare professional specifically trained by the 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 Jail. We provide emergency and medically required dental care for inmates with an emphasis on relieving pain and attending to urgent or emergent dental needs. Dental services, except for urgent or emergent care, are provided during regular clinic hours. Emergency dental services are available on a 24 hour a day basis. 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 • Emergency and routine dental care Temporary fillings • Incision and drainage Control of bleeding • Necessary emergency surgery • Clinically indicated extractions • Referral to dental specialist if needed • Medically necessary dental -related prescriptions Our services 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 seen at the initial sick call, and we currently fulfill all non -emergent dental Inmate Medical Services RFP No. 17-051 City of Santa Ana 69 4� r9`i`,�',� your Independent heolthcore choice, 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 inmate's medical record. We do not perform cosmetic dental services. The following screenshot shows the Dental Screening form used in TechCaree. patient: TEST, DONALD Po6: 6113126g9 (Age=3) Heaving: 24OA-657-02 Status; ACTNE 5: Patient Complains of., O: Reviewed Medial f Dental Hx Allergies: Significant hied. Hx: X.Ray(s): Dental Screening Form Patient x: S207497 Sex: Male SSNR: 335-61-2555 Booking pate: 8/22/2007 11:46:04 AM Inmate Medical Services RFP No. 17-051 City of Santa Ana 70 .a_...h are yaw independent heohhcare choice. 13. Eye Care a. NaphCare will provide eye examinations and medically necessary treatment. b. Corrective lenses, when determined necessary, will be provided at the expense of the contracting agency. NaphCare will obtain approval from the responsible contracting agency prior to supplying corrective lenses. 14. Psych Clinic a. NaphCare understands that the Santa Ana Jail medical services plan requires NaphCare to provide psychiatric services in the form of one (1) psych clinic every 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 kit for each housing module, intake screening area, booking, laundry and transfer hold. b. Contents of the first aid kits will comply with NCCHC guidelines. c. NaphCare will provide a list 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 follow the Jail's established policies and procedures for processing and responding to inmate complaints and grievances regarding medical treatment. b. NaphCare will abide by Jail policies and procedure regarding responses to complaints and grievances, within established policy requirements. NaphCare has a fully electronic system for tracking complaints from receipt to resolution. Our proprietary TechCare® Grievance Tracker provides automated daily mail notifications to multiple key operations and risk management staff, including our General Counsel. This innovative daily alert feature ensures that urgent issues receive immediate attention, from the right people. NaphCare encourages inmate issues be resolved on an informal basis without the need for filing formal complaint. NaphCare's complaints and grievances policy includes an informal process: 1. Inmates shall always be encouraged to discuss healthcare concerns with the appropriate member of the health care staff. 2. The Health Services Administrator, when possible, will encourage and make available informed mechanisms for the communication of, and potential resolution of, inmate health care concerns. 3. The Health Services Administrator is encouraged to meet informally with representatives of the department (e.g., chaplain) who may have input on the adequacy of health care delivery. NaphCare's grievance process begins by ensuring that inmates have an open forum to voice their complaints and that no inmate will be denied access to the grievance process. Our personnel are trained to seek resolution to inmate concerns before they escalate into grievances. Once an inmate files a grievance, a systematic process is triggered that is fully compliant with all relevant NCCHC and ACA Inmate Medical Services RFP No. 17-051 City of Santa Ana 71 4494/7�Ire your independent healthcare choice. guidelines. This process is overseen by our Chief Medical Officer and our General Counsel. Any grievances that we are unable to successfully address will be escalated to an appeal process. Below is an outline of our grievance process: • Upon entrance into the facility, each inmate receives information about the grievance procedure and how to file a grievance form. • All NaphCare personnel are required to attend training regarding the grievance procedure. • Inmates with special needs (such as impaired vision, hearing problems, language barriers, etc.) who request special assistance in completing a grievance form receive assistance. • No inmate will be denied access to the grievance process. • Grievance notification alerts are emailed automatically to key staff daily. • Grievances are reviewed and responded to by healthcare staff daily. • Our grievance process complies with all relevant NCCHC and ACA guidelines. + Our grievance process includes electronic tracking of all medical grievances and concerns, along with our healthcare staffs response. NaphCare personnel receive ongoing corporate support and education pertaining to grievance management. NaphCare will generate a monthly report of complaints received and provide it to the City. The report includes: inmate name, identification number, date the complaint was received, complaint description, date of response, and a brief description of the resolution. NaphCare's Grievance Tracker system is a fully data -minable electronic database. As a result, grievances can be filtered by inmate or type of grievance, therefore allowing tracking of similar type issues. NaphCare regularly creates and reviews reports of grievances and their disposition to help identify and resolve problem trends. 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 has produced a 72% reduction in medically related grievances at the SAJ. Inmate Medical Services RFP No. 17-051 City of Santa Ana 72 <A r? fcl 19 year indapendartt healti+cora choice. Grievances are scanned directly into T echCare'a "s Grievance Tracking F ,,r _. Module scanned Inmate Grievance Categorized In Deily, an. RN reviews and investigates glovances. Category Category1I Category III Categorylti I CategoryV CategoryVi Category VII Healthcue Delay:Creers 54entsl Duplicate Staff Conduct topCare Dental Cara Medical Care Pee Issue Healthcare Grievance Proactive Care Model Grievance Tracking Module Communication: Immodiately by Appropriate Personnel Action Taken Written Response Provided to Inmate and Entered Into TeehCare7`' 4 TeohC... rm generates daily grievance response information for correctional staff TechCarelm emails daily grievance report to Corporate i Operations staff and legal department review the report for process improvement opportunities Action Taken, ifApperpriate Written Response Provided to Inmate and Entered Into TechCare' " Inmate Medical Services RFP No. 17-051 City of Santa Ana 73 c? .ft afl vL yawW pwdant heohhw. choice. 17. Exclusions a. NaphCare will be under no obligations to provide or pay fort he following types of services: i. Cosmetic surgery ii. Sex change surgery iii. Elective vasectomy, tubal ligation, hysterectomy and other elective care which for the purposes of this contract will mean care which if 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 be experimental in accordance with accepted medical standards V. Neonatal or newborn care (prenatal and obstetric services will be provided when required) vi. Contraceptive devices and medications D. OFF -SITE REFERRALS TO PREFERRED PROVIDERS 1. NaphCare will determine the medical necessity of all off -site medical services and obtain approval from the responsibility contract agency. III YIIIMAfV IItt']tNu/:1L'FAT"Dlutt14tli We are proud to say that NaphCare's Utilization Management Program has the distinction of being URAC accredited. URAC is an independent health management accreditation organization which requires extensive conditions to be met before accreditation can be received. As an independent, nonprofit organization, URAC is a well-known leader in promoting healthcare quality through its accreditation, education, and measurement programs. URAC offers a wide range of quality benchmarking programs and services that model the rapid changes in the healthcare system and provide a symbol of excellence for organizations to validate their commitment to quality and accountability. Sam URAC's mission is to promote continuous improvement in the quality and efficiency of healthcare management through processes of accreditation, education, and measurement. The URAC accreditation process demonstrates a commitment to quality services and serves as a framework to improve business processes through benchmarking organizations against nationally recognized standards. "By applying for and receiving URAC accreditation, NaphCare has demonstrated a commitment to quality healthcare. NaphCare should be commended for meeting strict quality standards", said URAC President and CEO Kylanne Green. "It is critically important for healthcare organizations to make a commitment to quality and accountability. URAC accreditation is a demonstration of that commitment." Inmate Medical Services RFP No. 17-051 City of Santa Ana 74 4W400r'� year Wependwi healthcare choice. 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 day's demands. We review all cases prospectively; ER visits retrospectively; and hospitalizations concurrently, ensuring the correct allocation of off -site services for our clients. NaphCare's experienced Utilization Management nurses are trained to monitor off -site services allowing them to determine the best possible outcome for patients, healthcare providers, and correctional facilities. NaphCare realizes that high quality 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 formula: match intensity of service with severity of illness. We consider the following factors during the review process: • Medical necessity using Milliman criteria • Appropriateness and efficiency of medical services, procedures, and facilities on all requests • Off -site service delivery— inpatient and outpatient setting • Length of stay using Milliman criteria • Maximization of on -site infirmary capabilities • Care consistent with community standards, contractual, or legal mandates • Coordination of on -site and off -site care —eliminates duplication of services Off -site Requests Information needed to determine approval or deferral of services is available within TechCare°, allowing NaphCare's nurses to make reliable and informed decisions in a timely manner. The following screenshot shows an off -site request in TechCare®. feat: DOE, JANE DOB: 4/811990 (Agex26) Status: AMVE Re Type e Inmate Medical Services City of Santa Ana k: 02510761a65067f29dagdSLangz)idG (i234) AdOffloWnfa. Sine: Famale :Race: pICT41RE SSW "HFDDEN"' NtlT AVAILABLE ookfng Date: 4[812018 3:50:25 PM mg� Pftt:VJD:M1n:A H FANtl .. spwdy Cart Ow.da _ ?tld Bowios4 Gde LCNiQM"J8 ' t peiilyVBNtlCtJazanlDefNne RtlaBM aIdTOM1dhbilC 1 CPT9 _.. MdoPTcpde - i ,i RFP No. 17-051 75 <Awxer�e }roar Wopwdem hooiihcom ehoice. Inmate Tracking We use TechCare® to track all off -site requests throughout the Utilization Management process. On average, NaphCare's corporate Utilization Management nurses review off -site requests in less than one day, and when appropriate, approve requests. Requests referred to the physician are reviewed within one business day. The average time frame for approved service scheduling with community based providers is one day. Emergency cases are immediately referred off -site and are reviewed retrospectively. For continuity of care, the Health Services Administrator or designee submits a notification immediately. Upon return from an emergency room visit, including psychiatric visits, the appropriate Advanced Clinical Provider or designated staff will see the inmate, review the discharge information and treatment recommendations, and issue follow-up orders as clinically indicated. Documentation of ER visits is tracked and monitored via TechCare° 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; care is not delayed within our Utilization 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. Utilization Management Key Interactive Components We control costs by performing the following types of review: 1. PROSPECTIVE REVIEW - Occurs prior to delivery of care and establishes medical necessity, ensuring appropriate and cost-effective care within the correct timeframe. The following services are reviewed for all requests: • Hospitalizations —scheduled inpatient and observation • Outpatient surgical or non -surgical Outcomes May Include ✓ Request for additional information for proper determination procedures ✓ Nurse or physician review • Specialty office visits and procedures ✓ Nurse or physician approval • Diagnostics, durable medical equipment and ✓ Alternate plan of care prosthetics • Course of outpatient treatment —physical therapy, dialysis, chemo, radiation NaphCare's site Medical Director, designated site staff, Chief Medical Officer or designee, and a dedicated utilization 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 TechCare®. Prospective review can produce multiple outcomes, all of which are tracked by TechCare®. In our approach to correctional UR, we do not "deny" a provider's recommendation for off -site care, but rather, discuss the case physician -to -physician and develop alternate plans of care as appropriate. Our UR process takes less than 24 hours on routine cases when all necessary clinical information is provided. Requests for care within 14 days are reviewed and processed the same business day. Inmate Medical Services RFP No. 17-051 City of Santa Ana 76 <4 a ha97I.E.-) ypur indepwdmf hechhsare cSoke. High Acuity Notifications: NaphCare's Utilization and Case Management team closely monitors inmates diagnosed with chronic and complex illness. TechCare° aids staff in this process by tracking the number of off -site visits by way 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, or extended hospitalizations and treatments, a high acuity notification is sent to the appropriate leadership and jail personnel. NaphCare 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. Through 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 conversations with clinical staff regarding course By following our policies, we are able to shorten the length of stay, preserve quality of care, and enhance discharge planning for return to the facility. .. , ,,. U - �11�... �� .. of treatment. Inmates have the tools necessary to improve treatment prognosis and minimize recidivism through self -care. 2. CONCURRENT REVIEW— Begins immediately after admission and continues throughout 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 remain 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. Utilization Management Reports NaphCare has unlimited reporting capabilities based on the data captured in TechCare®. We analyze costs, trends, and provide reports in any format you request. In addition to providing the above services, we study statistics that aid you in improving your utilization of off -site care. Our sophisticated reporting capabilities, combined with our strong correctional operations experience, creates highly satisfied clients. NaphCare offers: Daily Hospitalization Report —including admissions by diagnosis (DRG) & length of stay Detailed monthly utilization report —including detailed time frames for each process of the review Inmate Medical Services RFP No. 17-051 City of Santa Ana 77 a? f�C_?Ae yow, independem heolihcom choice. • Inpatient & outpatient statistical report —by service and location • Specialty services —consults, procedures, and diagnostic services • ER trips —by service and location • Utilization Review —by disease classification • Reports of all catastrophic claims incurred —any amount greater than $25,000 Case Management NaphCare provides Case Management and Utilization Review efforts for hospitalized inmates. We recognize the value of on -site nurses in the facilitation of care in the hospital setting; our nurses are dedicated to and have extensive expertise in the above areas. Responsibilities for on -site nurses in the hospital setting inlcude 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 • Establishment of 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 experience needed to best meet inmates' needs. At the onset of care for each hospitalization, our utilization nurses prepare a customized plan. NaphCare's nurses are well informed of all available infirmary services and health service units within the prison system, as well as community resources in your region, allowing our personnel to optimize internal resources while simultaneously minimizing off -site trips. For provision of continuity of care, discharge summary information and instructions are provided to inmate healthcare staff. Following off -site treatment, inmates returning to the correctional facility return with documentation of treatment received in the form of a discharge summary, consult follow-up, or other progress note. All patients returning from an inpatient hospital stay are evaluated by a registered nurse prior to placement in the general population. In addition to this evaluation, inmates meet with an on - site provider who ensures appropriate orders and follow-up. Quality Initiatives NaphCare's Utilization Management Department conducts a monthly 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 for quality improvement. Utilization Management education is an ongoing process throughout the life of the contract. CENTRALIZED MEDICAL SCHEDULING We coordinate off -site appointments for the SAJ through the Medical Scheduling Department at our corporate office. By using Tech Care®, we facilitate the exchange of important healthcare and financial information between the correctional facility and NaphCare. This system has several key features that are beneficial to Santa Ana: • Customized reporting • Ability to track inmate healthcare (off -site specialty appointment by type) Inmate Medical Services RFP No. 17-051 City of Santa Ana 78 <A e? %T m yaer mdepedeni heahhcare ch6m • Electronic calendar system • Ability to view all off -site appointments and on -site clinics • Inpatient stay status • View and print medical records for off -site appointments • Information packet for security to schedule transportation of inmates 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, cost- efficient, and safe results. Approved requests are sent to the Medical Scheduling Department where they schedule the appointment, noting such details as inmate insurance and special instructions. Appointments classified as urgent or routine and appointment requests are addressed and scheduled within the required time frames. The Medical Scheduling Department generates and maintains an off -site calendar of appointments that is visible to any authorized on -site personnel and security officers. Medical Schedulers at the central office communicate necessary information (date, time, location) so the correctional officers responsible for the transport are prepared for the inmate's appointment. The medical schedulers also communicate any pre -appointment needs to the correctional facility, such as food and drink requirements, medication instructions, labs needed, or any other special instructions that relate to the inmate's care. An example of our Off -site Calendar that is used to summarize off -site scheduled appointments is shown on the following page. We understand the issue of security and transportation costs and we work closely with custody to consolidate patient transfers. An Off -site Referral Form is completed for inmates who require specialty care services. This form accompanies the inmate during transport from the correctional facility to the provider for treatment. Each 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. Responsible Follow -Up Individuals returning to the SAJ following 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 placement in the general population. These inmates also see an on -site provider as soon as possible to ensure appropriate orders and follow-up. In addition to the vast functionality that exists within the calendar and scheduling system, NaphCare can track and trend all cancelled appointments. Missed or cancelled appointments are often unavoidable, but they create a drain on facility resources. Our goal is to work with each 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 Medical Services RFP No. 17-051 City of Santa Ana 79 < 4 _97 ... �cane, your independent heotthwm choice. • Inmate name, Date of Birth, Inmate Number • Original date of service • Who cancelled the appointment • Why the appointment was cancelled — inmate released from custody, refused treatment, security issues, provider cancelled, or other reasons 2. NaphCare will ensure that each off -site referral to a preferred provider results in a legible consultation/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. On behalf of the SAJ, we obtain copies of all diagnosis, treatments, treatment plans, final medical records, discharge summaries, 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 EHR systems (where they exist and appropriate access has been granted) to obtain records immediately upon completion of service which greatly adds to the continuity of care of the inmates. When the records are received, they are filed in the inmate's electronic health record in TechCare®. 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 site 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 compliance with program review requirements. NaphCare's Medical Record Department is also available to assist our clients in securing medical records for care that is delivered in the community priorto incarceration. Determining the appropriate course of treatment inside the facility is difficult if current outside medical records are not available. NaphCare assumes the responsibility of securing these records for 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 eliminating the need to repeat costly tests that may have been provided prior to incarceration. TechCar& stores all outside medical record information and ensures all medical records and documentation are protected. TechCare° ensures security and HIPAA compliance by utilizing industry standards of security. 3. The report will contain, at a minimum: a. Reason for consult b. Appropriate exam/lab findings c. Diagnosis d. Discharge Plan e. Follow-up Appointment (if necessary) Inmate Medical Services RFP No. 17-051 City of Santa Ana 80 < 4 e7 7�9#` your Wepwdent heolthum :heice. 4. NaphCare will continue to be responsible for billing the responsible contract agency for off -site treatment. CLAIMS ADJUDICATION Our Claims Department has the latest technology available in the market today. This enables our staff to handle your claims in the most efficient manner. The accurate and rapid processing of claims is a fundamental part of keeping costs down, and it also maintains our positive relationships with community providers, hospitals, and specialists. We 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. ✓ NaphCare's Claims Department adjudicates "clean claims' within an average of 48 hours. ✓ Average cost savings on re -priced claims are 60% off usual and customary charges. ✓ Prompt turnaround time with non - electronically received claims keyed within 24 hours. Our Director of the Claims Department, Cathy Sherbet, has over 20 years of experience in claims management, including 7 years with McKesson, where she managed a department that processed over 400,000 claims per year. Cathy currently manages NaphCare's claim's department of over 30 employees. Claims 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 adjudicated using the software system McKesson, Managed Care Optimization (MCO), specifically designed for the managed care industry. We pay claims promptly and accurately by applying all applicable payment rules. The provider's contract, fee schedules, negotiated rates, and terms and conditions are all loaded in the MCO system at the time of agreement, ensuring providers are paid according to agreement. The system does not allow for payment of a global rate and additional codes charged for the same service, known as bundling of codes. Through this system, the submitted claims are correctly analyzed for accuracy. This software also provides healthcare claim DRG calculation, APC assignment, Medicare/Medicaid reimbursement calculation, data editing, and validation to set specifications. MCO, linked with TechCare®, 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 EHR system to MCO. The integration of MCO and TechCare® also allows the flow of information obtained from healthcare claims back to TechCare®. The on -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 the SAL From claims processing to bill payment, our streamlined administrative services will provide you with valuable benefits. Each claim received by the claims department is reviewed for accuracy and adherence to community standards. Inmate Medical Services RFP No. 17-051 City of Santa Ana 81 <4 ci lay your Wepwdwf hea9hwm choim NaphCare assigns an authorization number to each off -site occurrence that includes a scenario detailing the approved services integrated with service classes and procedural codes. Only approved services are reimbursed. We review claims to determine that charges are not in excess of the appropriate Usual and Customary Charges. We also review claims for prior payment to prevent duplicate billing. In addition, we review for accuracy to include valid dates of service, CPT and ICD-9 codes, and bundling and unbundling of codes. Any claims that are not valid will be returned to the provider as a denial and a corrected claim will be resubmitted for payment. The following criteria will be used in these reviews: • Eligible Patients • Usual and Customary Charges • Prior Payment • Accuracy Services that support our clients' efforts to stay current and compliant in a dynamic environment include: • Optimize 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 fee schedules 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 HIPAA standards • 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 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 -site. A complete description of our network for the SAJ is provided within this section. 1. We have provided written letters of intent from providers willing to participate in the Preferred Network. We have included letters of intent from the following providers in the Appendix: • Prime Healthcare (includes Garden Grove Hospital Medical Center, Huntington Beach Hospital, and West Anaheim Medical Center) • KPC Healthcare, Inc. • Image Orthopedic Lab, Inc. • New Image Dentistry & Implants • Diagnostic Laboratories and Radiology • BioReference Inmate Medical Services RFP No. 17-051 City of Santa Ana 82 44 4 /7aane-,_> gnu, Independent hoallhco,e choice. • San Pedro Eye Care • Alcam Medical O&P • Range Medical Homecare Supplies 2. NaphCare will ensure that all preferred providers recruited are fully credentialed. Please see Section G, #2 for a detailed description of NaphCare's credentialing process. 3. Contracts for the preferred provider network will be between the health care provider and NaphCare. 4. To support the delivery of comprehensive health services, the preferred provider network will include the following medical specialty services/providers: a. A hospital facility to provide treatment forthose inmates requiring medical/surgical emergency services (e.g. inpatient and outpatient health care services). NAPHCAKE'S HOSPITAL NETWORKS FOR THE SAJ NaphCare is an experienced provider and administrator of off -site care and preferred provider networks. Our experienced network management department focuses on development that is based on partnerships with the community's finest hospitals, balancing proximity to the Jails and a wide range of available medical services. Since serving as the healthcare service providerfor the City of Santa Ana, we have worked diligently to establish relationships with the providers below to provide emergency and off -site care to SAJ inmates. 1. KPC Healthcare, Inc. (KPC Health) KPC Health has successfully established a group KPC of integrated healthcare delivery systems Healthcare, Inc. consisting of acute care hospitals, Independent Physicians Associations (IPAs), medical groups, urgent care facilities, and various fully integrated multi -specialty medical facilities throughout the western United States. Two of KPC Health's acute care facilities, Anaheim Global Medical Center (AGMC) and Orange County Global Medical Center (OCGMC) have provided quality, professional, and compassionate healthcare services to the Orange County community for decades. AGMC, formerly Western Medical Center Anaheim, is a 189-bed medical center located less than 7 miles from the Santa Ana Jail. In addition to its cardiac institute, inpatient, outpatient, surgical, maternity, and behavioral services, AGMC has a 24-hour full service emergency department designated as a cardiac receiving center; and the hospital has partnered with CEP America to continue to improve emergency department wait times. The Behavioral Health program at Anaheim Global Medical Center provides behavioral health services for emotional and behavioral health illnesses such as depression, anxiety, bipolar disorder, and chemical dependency related disorders. Delivery Land is AGMC's newest and most exciting addition to their comprehensive maternal child health services. The inmates at the SAJ will continue to access the OB/GYN services offered through Delivery Land at AGMC. NaphCare is familiar with AGMC's secure unit, as well as the use of the physician clinics. Inmate Medical Services RFP No. 17-051 City of Santa Ana 83 yow independent healihcom chpim. With more than 1,500 highly -trained physicians, nurses, and hospital staff, and a full range of specialty services that serve both inpatients and outpatients, OCGMC ensures each patient has a dedicated team that provides them the highest quality of care. OCGMC is one of only two Level Two Trauma Centers serving Orange County's 3.5 million residents. NaphCare is working with Estela Martinez, KPC Corporate Contract Director, and Elizabeth Gutierrez, Contract Management Analyst, to make certain the hospital's excellent health care and innovative treatments continue to be made available to the Santa Ana Jail inmates. It is NaphCare's intent to continue utilizing Anaheim Global Medical Center and Orange County Global Medical Center as primary access points for emergent, inpatient, outpatient, and psychiatric services for the Santa Ana inmates. A Letter of Intent is included in the Appendix. 2. Prime Healthcare Services, Inc. As another option, we continue to offer an offsite network Prime Healthcare with Prime Healthcare Services, Inc., one of the nation's leading hospital systems that operates Garden Grove Hospital Medical Center (GGHMC), West Anaheim Medical Center (WAMC), and Huntington Beach Hospital (HBH). Named the "fastest growing hospital system" in the country by Modern Healthcare, Prime Healthcare facilities offer Santa Ana a broad range of inpatient, outpatient, emergency, laboratory, and radiology services. Offered at each hospital are interpreters for many languages; specifically, Spanish and Vietnamese translators are available to ensure that the patient and their family are fully informed about their treatment options. It is the position of NaphCare and Prime Healthcare Services that Garden Grove Hospital is able to serve as a primary access point for the Santa Ana inmates. Located approximately 4 miles from the Santa Ana Jail, GGHMC is a 167 bed community hospital that provides a full spectrum of acute care services. The hospital offers inpatient and outpatient services that include maternity care, a wound center, diagnostic imaging, an emergency department, respiratory therapy, and pediatric services. The hospital has designated one of the floors as a secure unit for SAJ offenders, and we have secured a commitment that all necessary physician specialties will be made available under the direction of Dr. Hassan Alkhoull. West Anaheim Medical Center is approximately 10 miles from the Santa Ana Jail. Founded in 1964, WAMC is a 219-bed acute -care hospital with a long history of serving the community's healthcare needs. Every day, the facility endeavors to provide comprehensive, quality healthcare in a convenient, compassionate and cost effective manner. With 131 beds and only 9 miles from the Santa Ana Jail, Huntington Beach Hospital offers comprehensive emergency, inpatient, and outpatient services. Recognized as a "Top Performer" by The Joint Commission, HBH's mature adult psychiatric services provide comprehensive treatment programs for adults in need of specialized behavioral healthcare. Physician supervised inpatient, partial hospitalization, and outpatient programs are available to meet the individual needs of each patient. It is NaphCare's intent for HBH to serve as the primary hospital for Santa Ana inmates in need of psychiatric care, and as a safety net for inpatient or outpatient care. Inmate Medical Services RFP No. 17-051 City of Santa Ana 84 4 4 i � 4 �& 10� your irzdepnduo heafihcam chaica. NaphCare has a strong working relationship with Prime Healthcare Services leadership, including Dan Mere I, Corporate Director of Health Plan Operations; Alan Smith, Regional COO/CFO; and Dr. Hassan Alkhouli, Medical Director at West Anaheim Medical Center and Chief Medical Officer of Physician Operations for Prime Healthcare Services. A signed letter of intent is included in the Appendix. b. A psychiatric hospital facility to provide treatment for those inmates requiring inpatient psychiatric services. NaphCare will use Huntington Beach Hospital, part of the Prime Healthcare Services, Inc. network, as our primary hospital for inmates in need of psychiatric care. The behavioral health programs at Huntington Beach Hospital are designed to relieve emotional and personal distress for adults exhibiting acute behavioral symptoms. The inpatient hospitalization program includes physician supervised assessments, meetings, and case management services in a safe, supportive, and therapeutic environment; the services focus on the issues which lead to hospitalization. To assist with transitioning back into the community, the physician -led partial hospitalization program is provided five days a week and is tailored to meet the specific needs of the patient. Once a patient's symptoms are stabilized, the outpatient services program allows patients to attend therapeutic therapy sessions on an outpatient basis. NaphCare is an experienced provider of correctional mental health services, and we understand the solution for addressing and reducing the population of mentally ill inmates within the SAJ requires coordination, communication and cooperation with the mental health community. A signed letter of intent from Prime Healthcare Services, Inc. is included 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: I. Urology ii. Gastroenterology iii. Orthopedics iv. Ophthalmology/Optometry v. Internal Medicine vi. Dermatology vii. Ears/Nose/Throat viii. Allergy ix. Obstetrics/Gynecology x. Psychiatry We have secured a commitment that all needed physician specialties will be made available, under the direction of Dr. Hassan Alkhouli, 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 from Dr. Alkhouli in the Appendix. Inmate Medical Services RFP No. 17-051 City of Santa Ana 85 <ALS Lh cane..-_> your independent hoolihwm choice. We only hire highly qualified healthcare professionals who understand the City of Santa Ana's processes and who have strong California community partnerships. The full spectrum of specialties listed in the following chart among NaphCare's network of hospital partners are represented by hundreds of physicians who maintain staff privileges at the hospitals within our SAJ off -site network, helping to ensure that patients receive the specialty healthcare they need. e• a Acute Care ®• Neurology Allergy &inflammation Neurosurgery Anesthesia Obstetrics and Gynecology Cardiology Occupational Medicine % Cardiac Surgery / Cardiac Rehabilitation Ophthalmology Cardiovascular Disease' Optometry . Cardiothoracic Surgery Oral/Maxillofacial Surgery Colon & Rectal Surgery Orthopedics Critical Care Orthopaedic Surgery Dentistry Otolaryngology . Dermatology Pain Management Diabetes Management and Treatment Pathology Emergency Medicine Physical Therapy Endocrinology Plastic & Reconstructive Surgery Family Medicine Podiatry Gastroenterology Psychiatry General Surgery Pulmonary Medicine Gerontology Radiation Oncology Hematology / Oncology Radiology Immunology Thoracic Oncology / Thoracic Surgery Infectious Disease Urology Internal Medicine Vascular Surgery Nephrology Wound Care Neonatology To ensure the inmates of the SAJ have access to a comprehensive network, we have established relationships with providers for the following ancillary services: Ambulance DrEquipmen7t Dental Laboratory Services Durable Me Diagnostic Imaging & Laboratory Orthotics Inmate Medical Services RFP No. 17-051 City of Santa Ana 86 }cur indppndeni 4w14 m c€ k., d. A laboratory provider to provide all necessary routine tests. NaphCare will continue to use BioReference for laboratory needs, We have provided a signed letter of intent in the Appendix. e. A radiological provider to provide all necessary routine x-rays which cannot be accommodated by on -site mobile x-ray services. Diagnostic Labs and Radiology Diagnostic Laboratories and Radiology is the nation's leading provider of digital radiography, ultrasound, electrocardiogram and other Mobile Clinical Services, and has been serving patients in healthcare facilities and institutions for more than 50 years. For the past two years, NaphCare has successfully partnered with Diagnostic Laboratories and Radiology for the purpose of this contract. Diagnostic Labs and Radiology is dedicated to continuing a partnership with NaphCare in our shared interest to meet the radiological needs of the Santa Ana Jail inmates. A signed letter of intent is included in the Appendix. f. A pharmacy provider to provide all prescriptions and non-prescription medications. NaphCare proposes to continue using our in-house pharmacy to provide all prescription 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 detail in Section C, #8 — Medication Management. Our formulary is provided in the Appendix of our proposal, and our pharmaceutical pricing structure is included in Exhibit C under Required Forms. g. A durable medical equipment provider to provide all orthotic devices for inmates which are determined medically necessary. Image Orthopedic Lab Image Orthopedic Lab has provided quality footwear since its beginning In 2005. Creating custom -engineered orthotic devices for specific needs, Image Orthopedic Lab is able to provide functional and diabetic foot orthotics to the Santa Ana Jail inmates. Dennis Kause, President, is excited to be actively involved in the community and looks forward to partnering with NaphCare to meet the orthotic needs of the inmates at the SAJ. A signed letter of intent is included in the Appendix. Alcarn Medical O&P The Alcam Orthotics Program was developed to provide enhanced levels of care that promotes the highest levels of independence and function for patients of all ages and abilities. Alcam Medical is at the orthotic forefront offering 24 hour on -call services for post -operative and surgical orders, delivery 7 days a week, and on -site fabrication. NaphCare has reached out to Cameron Stewart, Clinic Director, to discuss partnering to address the orthotic and prosthetic needs of SAJ inmates. A signed letter of intent is included in the Appendix. Inmate Medical Services RFP No.17-051 City of Santa Ana 87 r? h�filre your Independent hecefhc.. choice. Range Medical Homecare Supplies Range Medical Homecare Supplies serves the residents in Orange County. Range Medical offers a wide range of services which include bath safety, mobility products, lift chairs, scooters, wound care, cushions, ADL's and more. NaphCare is working with Chris Helliesen, Owner and President, to discuss future opportunities for providing medical supplies to the offenders at the SAJ. A signed letter of intent is included in the Appendix. F. MEDICAL SERVICE PROVIDER MINIMUM STAFFING Staffing Narrative for the Santa Ana Jail NaphCare has offered the RFP's minimum staffing models to comply with the RFP and meet the unique needs of the Santa Ana Jail. It is our goal to always provide the necessary support to efficiently administer all medical, mental, and emergency healthcare services for SAJ detainees. We achieve this by blending a multi -disciplinary team with TechCore®, combining clinical talent with technology to yield a standard of care unequaled in the correctional healthcare industry. While current staffing at the SAJ has and continues to provide competent support for the operation of our medical care program, we offer the City the RFP minimum, two -tiered plans based on the Jail's ADP. Each of these plans supports our Proactive Care Model, focusing on identifying critical medical issues up front in order to prevent more serious outcomes later. At the SAJ, our proactive strategy has significantly reduced ER trips by 98%, shortened sick call wait time from 14 days to one, and decreased medical grievances by 72%. In addition, NaphCare's staffing plan for both Tier 1 and Tier 2 includes a Health Services Administrator to lead, direct, manage, and evaluate operations at the SAJ. The HSA ensures all operations are in compliance with the contract and jail requirements, NCCHC, ACA, and professional nursing standards. The HSA also serves as the primary liaison between the SAJ and the corporate office. The HSA oversees operations for healthcare at the Jail and maintains consistent communication with the corporate office clinical and administrative personnel. Our HSA, in collaboration with corporate office staff, will be devoted to keeping Santa Ana administration informed of contracted healthcare services for inmates. NaphCare will perform the initial Intake Screening within two hours of an inmate's admittance, using an RN available 24/7 to detect urgent medical needs early. We identify any medical and mental health issues needing prompt attention. Then, we conduct a comprehensive Health Assessment up front, during the intake encounter, whereby a thorough history and physical examination is performed, vital signs are recorded, and the inmate's medical history is obtained, all of which is documented in TechCare®. Our system also streamlines the Jail's mental health program by focusing on early recognition and intervention. By devoting more attention to critical mental health needs, we stabilize your mental health and medical population quickly, allowing us to reduce suicide risks and improve the overall stability of your incarcerated population. Care is improved, grievances and movement within the Jail is reduced, and the probability of legal complications is minimized. NaphCare's proactive strategy works to identify, assess, and treat a detainee with mental illness as quickly as possible, and when necessary, in collaboration with the PET Team, Anaheim Global, and/or an appropriate provider. Inmate Medical Services RFP No. 17-051 City of Santa Ana 88 448LA cfine--__� sour WePOM"u theohlu- echoler_ NaphCare's medication administration will be provided by LPNs who are trained to review a patient's vital signs and think in a critical manner. Our staffing model also facilitates the continued use of telemedicine as an efficient means to treat inmates needing consults, follow-up care and certain mental health services. We intend to enhance our existing telemedicine program by having our STATCare team provide telemedicine service when needed. Playing a pivotal role in an inmate's transition back into the community, our team will continue to perform discharge planning, working closely with partner agencies to ensure that offenders are engaged and supported in services that include employment/training, housing, mentoring, counseling and other services. For staffing vacancy replacement, rather than using agency nurses, NaphCare has established and maintains an extensive pool of highly qualified clinical relief staff. Each medical professional has been pre-credentialed to confirm California licensing/certification compliance and Is trained in advance to know TechCore®. This relief pool ensures the SAJ will always have consistent and familiar staff ready to work at a moment's notice. NaphCare's staffing matrix for Santa Ana Jail remains fully compliant with the RFP as well as ACA and NCCHC guidelines. We have developed our staffing plan based on our hands-on experience managing SAJ inmates since 2014, in addition to information obtained during the bidding process and always listening to your needs. Our tiered plans are shown below. We look forward to continuing our positive relationship with SAJ. Inmate Medical Services RFP No, 17-051 City of Santa Ana 89 <A �97LA 4 a, �re yourW pwdw he hhwre choice. 1. TIER 1 (ADP at or above 176): Medical staff will be present 24 hours daily, every day of the year. Our staffing reflects the following: a. Physician - One (1) on call 24 hours daily. b. NP — One (1); eight (8) hours per day, five (5) days per week. c. RN —Two (2); twenty-four (24) hour coverage, seven (7) days per week. (1 dayshift/1 nightshift) d. Psych RN — One (1); 12 hours per day, seven (7) days per week. e. LVN — Four (4); twenty-four (24) hour coverage, seven (7) days per week. (2 dayshift/2 nightshift) f. DDS — Four (4) hours per week. g. Dental Assistant— Four (4) hours per week, if necessary. h. Psychiatrist— Four (4) hours per week, if necessary. I. Medical Records Clerk— One (1); forty (40) hours per week, five (5) days per week. j. One (1) physician will be on call twenty-four (24) hours daily for phone consultation and or response to the Jail. L A physician will be available by cell phone and will be required to telephone the jail within thirty (30) minutes of a call. ii. A physician will be required to arrive at the jail within two (2) hours of a request to respond. Total FTEs 18.000 Inmate Medical Services RFP No. 17-051 City of Santa Ana 90 4 ka_Val�re your independent hooMmre choice. 2. TIER 2 (ADP at or below 175): Medical staff will be present 24 hours daily, every day of the year. We meet the following minimum staff requirements: a. Physician - One (1) on call 24 hours daily. b. NP — One (1); eight (8) hours per day, seven (5) days per week. c. RN —Two (2); twenty-four (24) hour coverage, seven (7) days per week. (1 dayshift/1 nightshift) d. Psych RN — One (1); 12 hours per day, seven (7) days per week. e. LVN —Three (3); twenty-four (24) hour coverage, seven (7) days per week. (2 dayshift/1 nightshift) f. DDS— Eight (8) hours per month, g. Dental Assistant — Eight (8) hours per month, if necessary. h. Psychiatrist— Four (8) hours per month, if necessary. I. Medical Records Clerk— One (1); forty (40) hours per week, five (5) days per week. j. One (1) physician will be on call twenty-four (24) hours daily for phone consultation and or response to the Jail. i. A physician will be available by cell phone and will be required to telephone the jail within thirty (30) minutes of a call. ii. A physician will be required to arrive at the jail within two (2) hours of a request to respond. Total FTEs 15.750 Inmate Medical Services RFP No. 17-051 City of Santa Ana 91 4 �41;e your independent hwhhcar choice. 3. Responsible Physician/Health Authority a. NaphCare will appoint one (1) physician as the Responsible Physician for the Santa Ana Jail. The Responsible Physician for the jail will perform all duties and functions of the Responsible Physician as described and referred to in California Department of Corrections and Rehabilitations, Title 15 Standards and National Commission on Correctional Health Care (NCCHC). b. NaphCare will appoint one (1) physician or medical administrator as the Health Authority forthe Santa Ana Jail. The Health Authority for the jail will perform all duties and functions of the Health Authority as described and referred to in California Department of Corrections and Rehabilitations, Title 15 Standards. c. We understand that the physician appointed as the Responsible Physician for the jail may also be appointed as the Health Authority for the jail. G. QUALIFICATIONS OF STAFF 1. Medical staff shall possess no less than three (3) years of correctional medical experience as a state licensed medical practitioner. NaphCare will strive to recruit medical staff that possess no less than three years of correctional medical experience as a state licensed medical practitioner. Additionally, we will consider all applicants of reasonable experience and skills who would be well suited for open positions at the Santa Ana Jail. 2. All medical staff will maintain current licensing from the State of California to practice medicine. CREDENTIALING All NaphCare staff providing medical, dental, or mental health treatment meet state licensure and/or certification requirements. To ensure that our medical professionals have the appropriate licensure and/or credentialing to provide the services required, we conduct a thorough interview and credentialing process, which includes the following steps: • Pre-screening applicants through phone interviews and the submission of credentials/licensure. • Interviewing of candidates at the Santa Ana Jail by our health services administrator (HSA) or another company representative. • Verifying references and licenses with the appropriate state and/or national agencies. • Extensive site visits to the Santa Ana Jail prior to making a formal employment decision. • Requiring prospective employees to undergo and pass a criminal background check. • Requiring prospective employees to undergo and pass a pre -employment drug screen. We ensure that all professional staff, including contract physicians working in the Santa Ana Jail has evidence of current licensure, 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. Copies of all current nursing and physician licenses are also kept on file in Inmate Medical Services RFP No. 17-051 City of Santa Ana 92 4 c? /J cllre,,> y.e, Wependere fi nithwm choim the health administrator's office. We make credentialing, profiling, privileges, competency reviews, licensure, disciplinary and other regulatory data available to the City upon request. We check for primary source verification with the American Medical Association, National Practitioner Data Bank and the state licensing web site, and credential all physicians and mid -level practitioners. We verify licenses, education 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 corresponding verification website. NaphCare not only maintains a system for verifying that our stoff's licenses remain current and Credentialtng Support Saves Time unexpired, we also subscribe to the National Practitioner's Data Bank Continuous Query Our unique process far exceeds the service. Continuous Query keeps us informed 24 hours a day, 365 days a year about any adverse competition in organization and saves licensure, privileging, Medicare/Medicaid exclusions, on -site staff countless hours in civil and criminal convictions, and medical accreditation preparation. malpractice payments on our enrolled practitioners. As a result, we are notified electronically within 24 hours of a report received by the Data Bank and have continuous access to check the credentials of our enrolled practitioners. Our credentialing files are always available for review, as these files are maintained by our corporate Human Resources Department and can be viewed electronically at any time. Each NaphCare employee has an electronic personnel file that includes an accreditation specific file so that with the click of a button everything you need for an accreditation audit can be accessed. H. 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 RFP. 2. NaphCare will provide each of these services, either internally or via subcontractor. We have detailed our plan for the provision of each of these services. 3. Repair of dentures, dental plates and partial plates. This service will be available on an as -needed basis and billed one flat rate per repair. New Image Dentistry & Implants Dr. Inna Bosh provides high quality general and cosmetic dental care to patients throughout Santa Ana and Orange County. New Image Dentistry & Implants offers a wide range of preventive, restorative and cosmetic procedures. NaphCare has reached out to Dr. Bosh to discuss a partnership to address the general and restorative dental needs of the inmates at the SAL A signed letter of intent is included in the Appendix. Inmate Medical Services RFP No. 17-051 City of Santa Ana 93 4 �49_re yoer independent heollhcore choice. 4. Mobile X-ray services. This service will be available on an as -needed basis and billed one flat rate per study. Diagnostic Labs and Radiology is capable of responding to the jail to provide service and is capable of providing x-ray study, technical component, radiologist interpretation, transcription and delivery on the same day when necessary. Diagnostic Labs and Radiology NaphCare will continue to use Diagnostic Laboratories and Radiology to provide mobile X-ray services. For the past two years, NaphCare has successfully partnered with Diagnostic Laboratories and Radiology for the purpose of this contract. Diagnostic Labs and Radiology is dedicated to continuing a partnership with NaphCare in our shared interest to meet the radiological needs of the Santa Ana Jail inmates. S. Ophthalmology services. This service will be available on an as -needed basis and billed one flat rate per patient visit. San Pedro Eye Care With the experience of Board Certified Ophthalmologists and Optometrists, and the equipment necessary to provide treatment, San Pedro Eye Care offers a number of cutting -edge vision care services and products for vision correction procedures and surgeries. San Pedro Eye Care will continue to partner with NaphCare to provide eyewear and eye care services to the offenders at the Santa Ana Jail. A signed letter of intent is included in the Appendix. 6. OB-GYN services. This service will be available on an as -needed basis and billed one flat rate per patient visit. NaphCare will continue to utilize the Anaheim Global Medical Center (AGMC) for OB/GYN services. The inmates at the SAJ will continue to access the OB/GYN services offered through Delivery Land at AGMC. Emergency Psychiatric Crisis Intervention and Evaluation. This service will be on an as -needed basis for inmate in psychiatric distress, i.e. severe depression (suicidal ideation) and psychotic disorders (schizophrenia). Upon completion of evaluation, a finding and suggested disposition 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 per visit. The PET Team comes onsite for those patients that do not stay onsite more than 12 hours. They are evaluated and it is determined if the patient can be released out of custody or needs to be 5150 hold at a hospital for further evaluation. Contracted patients are evaluated onsite by NaphCare's Psychiatrist and are sent to Anaheim Global for further evaluation if the patient needs emergency psychiatric crisis intervention and evaluation offsite. 8. Billing services for off -site emergency medical care. NaphCare will provide billing services, which include a complete accounting of all services performed in addition to a detailed report of the cost of such services. Billing services will include a monthly administrative fee. Billing for off -site care is included in NaphCare's baseline medical services price. Inmate Medical Services RFP No. 17-051 City of Santa Ana 94 your iodepwderct hwith., choice. 1. JAIL STAFF SERVICES 1. NaphCare will provide baseline tuberculosis testing to all Santa Ana Jail personnel every six months and immediately after any exposure incident. Baseline skin test will be via the Mantoux technique: intradermal injection of 0. 1 ml of purified protein derivative (PPD) containing five (5) tuberculin units. 2. NaphCare will provide a three (3) injection hepatitis immunization series to all Santa Ana Jail personnel (unless already done). Immunization series will be Recombivax HB' manufactured by Merck, Sharpe & Dohme 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 will administer a booster to those employees that have diminished immunity. 3. NaphCare will maintain accurate and detailed records of all employees' immunization and baseline history. 4. NaphCare will provide four (4) hours of annual training to Santa Ana Jail personnel. Training consists of two (2) hours of blood -borne pathogens training and two (2) hours of tuberculosis awareness training in accordance with State mandate. J. MEDICAL SERVICE PROVIDER REQUIRED QUALIFICATIONS 1. NaphCare is eligible to submit a proposal in response to this RFP. We were organized for the purpose of providing contractual health care services. 2. NaphCare possesses 28 years of experience providing correctional health care services with proven effectiveness. 3. NaphCare possesses prior experience providing health care services to correctional facilities of similar size, and we have provided health care services to the Santa Ana Jail for almost three years. 4. NaphCare is able to satisfactorily meet all requirements of this RFP. Please see Section 1, Statement of Qualifications, for detailed information about NaphCare and the qualifications we have to continue to provide inmate medical services for the City of Santa Ana. K. SOLE CONTRACTOR NaphCare understands that should a contract be executed as a result of this RFP, 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. L. EQUIPMENT AND SUPPLIES Contractor shall purchase, own, and maintain all medical equipment and consumable supplies. Contractor shall ensure that adequate supplies of pharmaceuticals and consumable medical supplies are maintained at all times. Inmate Medical Services RFP No. 17-051 City of Santa Ana 95 EXHIBIT "B" Santa Atnt� CA Tier 1,RVP Staffing- p 0 m` €�G.,,re�'�.. m"�+lk,.t%A?v''iY:1tYA3k,�e��9d Mkt",�.'3'Mou"Y*Xltl'ues,:fiV�etlxir�r,�hgr c.,,��ela��a%f*�°+„$uu'��5�'.Klos+�"��TE'4�xi 0. .�v,.g,iL.4'1-Y i 091tlOu iTl4re tw6"J rF.+v,d ,1. +y,F e +, ni!i S � , E J�iflr' y . t,.i Health Services Administrator 8.000 8,000 8.000 B.000 8.000 40 1,000 Administrative Assistant/ Medical Records Clerk 8.000 8,000 8.000 8.000 8,000 40 1,000 Medical Director/Physician On Call 24 hours Daily PA/NP 8.000 8.000 8.000 8,000 8.000 40 L000 RN Charge - Intake/Siok call 12,00 12,00 12.00 12,00 12.00 12.00 12.00 84 2.100 LVN - Med Pass 24.00 24.00 24.00 24.00 24.00 24.00 24.00 168 4.200 Psychiatrist 4.00 4 0,100 Psych RN/ Social Worker 12.00 12.00 12,00 12.00 12.00 12.00 12.00 84 2100 Dentist 00 4 0.100 Dental Assistant 4.00 4 0.100 mfiN' •A 'JI VE. fia 1f 1 .'h n yt�$'44q . Y. I! { J - w,.tl .,t 5. �' fA D ,3 pa i, � SA , ) y ' tr ry"x7¢t �,�- RNCharge- Intake/Sick call 12.00 12.00 1100 12,00 t2,00 12.00 1200 84 2.100 LVN -Med Pass 24.00 24.00 24.00 24,00 24.00 24.00 24.00 168 4.200 Total GTE3 18.000 Santa ADS, CA ARP and Down .{ 94�! *,,. hjy1gva i ;y�.. 1 .t } G 6 .1' $Ji WORM P[695I 4PF5's'..� WEfI' �v ,ya.hL[S�kI. r PP-� VPCS+e 1 s.A, irt,p. y Ni'§+°l �hpri ".' „. f 'i'"' � i„4%`M� i4if ad�D {'. "$ w4` + x '�$h�fkx;+ iN l� ,:. �fi�i�li�`a, , t �'' , Health Services Administrator 8,000 8.000 1 8.000 8.000 1 8,000 40 1 I.000 Administrative Assistant/ Medical Records Clerk 8.000 8,000 8.000 8,000 1 8.000 40 1 1.000 Medical Direetor/Physician On Call 24 hours Daily PA/NP 8.000 8.000 8.000 8.000 8,000 40 1.000 RN Charge- Intake/Sick call 12,00 12.00 12.00 12.00 12.00 12.00 12.00 84 2.100 LVN-Mod Pass 24.00 24.00 24.00 24,00 24,00 24.00 24.00 168 4.200 Psychiatrist 2.00 2 0.050 Psych RN / Social Worker 12.00 12.00 12.00 12.00 12.00 12.00 12.00 84 2.100 Dentist 2.00 2 0.050 Dental AssistanL 2.00 2 0.050 �1 4Gahlit. . ,ifi1':"+^u^�u `*3iP� �+i�wv 'fir+ Ytls RN Charge - Intake/Sick call 12.00 12,00 12.00 12,00 12.00 12.00 12.00 84 2.100 LVN -Med Pass 12.00 12.00 12.00 12.00 12.00 12.00 12.00 84 2100 Total TTEs 15.750 ACOROa DATE (MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 09/21/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of si ich endorsement(s). PRODUCER V1G, LLC., dba/The Vestavia Group 2090 Columbiana Road, Suite 4400 A-2017-249 CONTA NAME: PA °NN F.. 205-552-0244 Not; 205-244$072 E-MAIL sarah.brandt@na hcare.com INSURFR(S) AFFORDING COVERAGE NAICS Birmingham, AL 35216 INSURER A: ProAssurance Casualty Company "A+" XII 38954 ''. INSURED INSURER B: The Travelers Insurance Company "A++" XV 19046 NaphCare, Inc. 2090 Columbiana Road, Suite 4000 INSURERC: INSURER D:__ INSURER E : Birmingham AL 35216 INSURERF: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ITR TYPE OF INSURANCE ADDL IN„NSo UBR WVD "" POLICY NUMBER POLICY EFF MIDDIYYYYl POLICY EXP MWDD LIMITS X COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE s 1,000,000 CLAIMS -MADE X OCCUR i to PREMISESiF�occunencel $ 50,0 00 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 PRO- POLICY LOC PRODUCTS-COMPIOPAGG S 1,000 000 OTHER: $ AUTOMOBILE LIABILITY Not Applicable COMBINE SINGLE DRY _(Ea accident) $ XXX)O= ANY AUTO BODILY INJURY (Per person) S XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S XXXXXXX P erOPERTYtlAMAGE $ �� HIRED NON -OWNED AUTOS ONLY AUTOS ONLY s UMBRELLA LIAR OCCUR HCLAIMS-MADE Not Applicable EACHOCCURRENCE $ XX�CCXXX EXCESS LIAB AGGREGATE S XYX>()= DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS'LiABILITY N TC2NUB-9D896241-17 09/30/2017 09/30/201 X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 YIN ANYPROPRIEfORIPARTNERIEXECUTIVE TROUB-9D896253-17 M OFFICEREMBEREXCLUDED? �Y (Mandatory in NH) NIA E.L. DISEASE • EA EMPLOYEE s 1,000,000 fyes.describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liability Y N ES1840 09/30/201709/30/2018 Each Med. Incident $ ,000,000 Claims Made Ann Aggregate $5,00 ,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) It is understood and agreed the City, its officers, employees, agents, volunteers and representatives are named as Additional Insured as respects liability. NaphCare, Inc., will provide a written thirty (30) day notice to the City of Santa of any changes or material modifications made to the policies. .. y p CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Santa Ana Jail THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 62 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702 AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD A� o® CERTIFICATE OF LIABILITY INSURANCE (MMIDD oAl2/28/2018 n THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Susan Crain VIG, LLC., dbafrhe Vestavia Group PNONE 205-552-0244 ac Ne: 205-244-8072 E4AA1L ADDRESS: 2090 Columbiana Road, Suite 2300 INSURERS AFFORDING COVERAGE NAIC0 INSURERA: Ironshore Specialty Insurance "A" XIV 14375 Birmingham AL 35216 INSURED INSURER B: The Travelers Insurance Company "A+" XV 19046 INSURER C: NaphCare, Inc. INSURER D: 2090 Columbiana Road, Suite 4000 INSURER E: INSURER F: Birmingham AL 35216 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUBR xm POLICY NUMBER POLICY EFF MM/DD POLICY EXP MWDD LIMITS X COMMERCIAL GENERAL ABILITY CLAIMS -MADE XI OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE (RENTED PREMISES (Eaoccurrence)$ 55,000 A N N #003886500 12/31/2018 12/31/2019 MEO IXP(Any one person) $ 5,000 PERSONALS ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: GENERA -AGGREGATE $ 5,000,000 POLICY JET LOD PRODUCTS -COMPIOPAGG $ 1,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Me accident $ XXXXXX BODILY INJURY (Per person) $ ANY AUTO Not Applicable OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per aaitleni) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per eccitlent $ UMBRELLALUIB OCCUR Not Applicable EACH OCCURRENCE $ XXXXXX AGGREGATE $ XXXXXX EXCESS LIAR CLAIMS -MADE DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERMIEMBEREXCLUDEDT l (Mandatory In NH) N/A N TC20-UB-9D896241-18 TRO-UB-9D896243-18 09/30/2018 09/30/2019 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yyes, describe antler DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 A Professional Liability Claims Made #003886500 12/31/2018 12/31/2019 Each Med. Incident 1,000,000 Professional Liability N N Ann. Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Sohedule, maybe athched it more space is required) It is understood and agreed NaphCare, Inc, will name the City of Santa Ana as additional insured; also understood and agreed any material changes or modifications to the policy will require a thirty (30) day written notice to the County. NaphCare, Inc., will comply with the specifications of the Indemnity Agreement of the contract with the City of Santa Ana. I.3 r� 9 Chief of Police City of Santa Ana Santa Ana Police Department 60 Civic Center Plaza Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 44�'� IRONSHORE. A Liberty Mutual Company IRONSHORE SPECIALTY INSURANCE COMPANY Mailing Address: 75 Federal Street 5th Floor Boston, MA 02110 Toll Free: (877) IRON411 Endorsement Policy Number: 003886500 Insured Name: NaphCare, Inc. Effective Date of Endorsement: December 31, 2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CITY OF SANTA ANA ENDORSEMENT LIMITS OF LIABILITY THIS ENDORSEMENT MODIFIES THE GENERAL LIABILITY COVERAGE PART AND THE PROFESSIONAL LIABILITY COVERAGE PART OF THE POLICY AS FOLLOWS: The coverage provided by the policy applies to each insured against whom claim is made or suit is brought subject to the applicable limit of liability. ADDITIONAL INSUREDS THIS ENDORSEMENT MODIFIES THE GENERAL LIABILITY COVERAGE PART AND THE PROFESSIONAL LIABILITY COVERAGE PART OF THE POLICY AS FOLLOWS: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its officers, employees, agents, volunteers and representatives are included as additional insureds under the above -described Coverage Part(s) of the policy, but only with respect to liability arising solely out of the operations of the policyholder. The coverage provided by this policy shall be primary and non-contributory, provided that the alleged acts or omissions giving rise to the liability are otherwise covered by the policy. SPECIAL NOTICE OF CANCELLATION The policy is hereby amended as follows: We will provide thirty (30) days prior notification to the City of Santa Ana in the event that we cancel or materially change or alter this policy. City of Santa Ana 20 Civic Center Plaza Santa Ana, California 92701 Page 1 of 2 All other terms and conditions of this Policy remain unchanged. Authorized Representative January 30, 2019 Date Page 2 of 2 ACORO® CERTIFICATE OF LIABILITY INSURANCE 16#./ DATE(MNVDD/YYYY) 1 10/24/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the certificate holder In lieu of such endorsements . PRODUCER CONTACT - NAME: Susan Crain VIG, LLC., dba7The Vestavia Group PxawE , 205-552-0241 205-244-6072 2090 Columbiana Road. Suite 2300 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC0 INSURERA: lronShoreSpecieftyinsuranoe A XV 14375 Binnin ham AL 35216 INSURED INSURER B: Great American Insurance A+XIV 16691 INSURER C : The Travelers Insurance Company A++XV 19046 NaphCare, Inc. INSURER D 2090 Columbiana Road, Suite 40DO INSURER E : INSURER F: Birmingham AL 35216 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCEJim ADOLSUBIR J= POUCYNUMBER POLICY EFF SV POLICY EXP M LIMITS COMMERCIALGENERALLIAaIUTY EACH OCCURRENCE $ 1,000,000 A X CLAIMS -MADE OCCUR Y N 003886500 12/312018 1251/2019 DAMAGE TOR PR MIS S Ee P. $ 50,000 MED EXP (Any one parson) 3 5,000 PERSONAL& ADVINJURY $ 1,000,000 GENE AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000 POLICY ❑ jE�T LOC PRODUCTS - COMPIOP AGG S 1,000,000 $ OTHER AUTOMOBILE LIABILITY COMOIN90 SINGLE LIMIT Ea accident S 1,000,000 B X ANY AUTO Y N CAP1116382 09/30/201g 091302020 BODILY INJURY (Per parson) S XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S XXXXXXX HIRED NON-0WNEO AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Perecddenl $ XXXX)= S UMBRELLA OAS OCCUR Not Applicable XXXXXXXX XXXXXXXX EACH OCCURRENCE S %OOLIOCf AGGREGATE S XXXKKXX EXCESS LIAR CLAMS -MADE DED RETENTION S S C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETORIPARTNERIE%ECUTIVE OFFICERIMEMBEREXCLUDED9 a (Mandatory In NH) NIA N UB-1P248768-19-51-K UB-1P250924-19-51-R 09/302019 09l3012020 PER O H- x srnr r ER E.L. EACH ACCIDENT S 1.000.000 E.L. DISEASE - EA EMPLOYEE s 1,000.000 R yes. describe under DESCRIPTION OF OPERATIONS bob E.L DISEASE - POLICY LIMIT S I,000,000 A Professional Liability Y N 0388610/1 12/312/118 12/31/2019 Each Med. Incident 1,000,000 Claims Made Ann. Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101. Additional Remarks Schedule,may lea attached if more apace Is requlrad) It is understood and agreed the City of Santa Ana, officers, employees, agents, volunteers and representatives are named as additional insured as respects their Contract with NaphCare, Inc.; the insurance carded by NaphCare, Inc., shall be primary and non-contributory to insurance carried by the City of Santa Ana; if policies are changed or materially modified a thirty (30) day Written notice will be provided to the City of Santa Ana as respects their Contract with NaphCare, Inc. REVIEWED & APPROVED By RISk MANAGEMENT DIVISION CERTIFICATE HOLDER nnr n .. GANGELLATION City of Santa Ana S NY ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Division 9 FRANCINE R. N DATE THEREOF, NOTICE WILL BE DELIVERED IN V W TH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th Floor AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 urL C'A.a,-k) 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD LARGE GROUP COMBINED LIABILITY POLICY BLANKET ADDITIONAL INSURED ENDORSEMENT POLICYHOLDER: NaphCare, Inc. ENDORSEMENT EFFECTIVE DATE: December 31, 2018 POLICY NUMBER: 003886500 The policy is hereby amended as follows: Each ofganization contracting with the policyholder for the provision of professional services is included as an additional insured under the policy, but only with respect to vicarious liability arising solely and entirely out of the rendering of or failure to render professional services directly by an insured professional and provided that the alleged acts or omissions giving rise to the liability are otherwise covered by the policy. Each additional insured described in this endorsement shall not have its own insurance coverage, but shall share in the coverage of the insured whose acts or omissions gave rise to the liability of the additional insured. REVIEWED & APPROVED By Risk MANAGEMENT DIVISION 4CT 28 2019 FA lNNE R. VILLAREAL Large Group Combined Liability Policy Page 1 of i Blanket Additional Insured Endorsement A-2p11.. ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWODYYYn lkw� 1 2/07/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endomement(s). PRODUCER VIG, LLC., dba/The Vestama Group CONTACT NAME. $USaD Crain PHONE 2055$2-0244 F" No ; 205-244-8072 Ea1A1L ADDRE 2090 Columbiana Road, Suite 2300 INSURERS) AFFORDING COVERAGE NAIL# NWRER A: IronShore Insurance Company 'A" XV 25445 Birmingham AL 35216 INSURED INSURERS: Great American Insurance Company 'A+XIV 16691 NsuR c: The Travelers Insurance Company 'A" XV 19M NaphCare, Inc. D: 2090 Columbiana Road, Suite 4000 =;Z NSIIRER E: NSURFAF: Birmingham AL 35216 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERPJN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LSR TYPE OF INSURANCE ADOLSUSR Jill&POLICY NUMBER POLICY EFF MWDD POLICY ESP UNITS A X. COMMERCUU.GENERALLIABILITY X CLMM64AADE F-1 OCCUR Y N #03886501 121312019 12(312020 EACH OCCURRENCE Is 1,000.000 PREMISES anaarNke1 50,000 MED EXP (Any ore �) s 5,000 PERSONAL SADV INJURY f 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY ❑JEPRO.Cr LOC GENERAL AGGREGATE S 6,500,000 PRODUCTS -COMPIOPAGG S 1,0001000 $ OTHER I AUTOMOBLE LIAUNU Y COMBINED SINGLE UMIT tlM I S 1'000'000 B ANY AUTO N CAP1116382 09/30/2019 09/302020 BODILY INJURY(Pw lwl ) f XXX)COOO( OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY I BODILY INJURY(Pw acddwd) f X)OOoOO(X PROPERTY DAMAGE a 'Cant S XX)XX)OO( S A X uMBRELU LIAR OCCUR N 003928601 12/312019 12/312020 EACH occuRRENcE S 5,000,DDO AGGREGATE f 5,000,000 EXCESS LNB X CLAIMSAVDE ]1A DED RErENTIONf S C WORKERSCONPENSATmN AND EMPLOYERS' UABLRY r/xN ANYPROPwETORIPARTIERIEXECUTNE OFFICERNEMBERUCLUDED? ❑Y VB-iP248768-19-51-K UB-1P250924-19-51-R 091302018 09/302020 X PER STATUTE O - EL EACH ACCIDENT S 1,000,000 EL DISEASE • EA EMPLOYE S 1,000.000 (Yaadawry In NH) N yes Onmw abler DESCRIPTION OF OPERATIONS txN E.L. DISEASE -POLICY LIMIT f 1,000.000 A Professional Liability N #03886501 12/31/2019 12/312020 Each Mad Incident $1,000,000. Claims Made Ann. Aggregate $6,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Ackfitt al Remaft Seha N. may In atM d N. span is ra 1N 1) It is understood and agreed the City Ana, officers, employees, agents, volunteers and representatives are named as additional insured as respects their contract with NaphCare, Inc.,; the insurance provided by NaphCare, Inc., shall be primary and noncontributory to the insurance carried by the City of Santa Ana; A policies are changed or materially modified a thirty (30) day notice shall be provided to the City of Santa Ana as respects their contract with NaphCare, Inc. REVI D & APPR VEC CERTIFICATE HOLDER CANCELLATION '1MON City of Santa SHOULD ANY OF THE ABOVE DESCRIBED POU0AWHATICAMR-RT � Risk Management Division 9 THE EXPIRATION DATE THEREOF, NOTIC ACCORDANCE WITH THE POLICY PROVISIONS. IN 20 Civic Center Plaza, 4th Floor AUTHORREDREPRESENTATNE Santa Ana, CA 92702 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD IRONSHOU A 1jhc"1 :Mu;ual Compznv IRONSHORE SPECIALTY INSURANCE COMPANY Mailing Address: 75 Federal Street 5th Floor Boston, MA 02110 Toll Free: (877) IRON411 Endorsement Policy Number: 00399650D Endorsement Effective Dale: 12I312019 Insured Name: NaphCare, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CITY OF SANTA ANA ENDORSEMENT LIMITS OF LIA81ury THIS ENDORSEMENT MODIFIES THE GENERAL LIABILITY COVERAGE PART AND THE PROFESSIONAL LIABILITY COVERAGE PART OF THE POLICY AS FOLLOWS: The coverage provided by the parity applies to each insured against whom claim is made orsuit is brought subject to the applicable limit of liability. ADDMONALINSOREDS THIS ENDORSEMENT MODIFIES THE GENERAL LIABILITY COVERAGE PART AND THE PROFESSIONAL LIABILITY COVERAGE PART OF THE POLICY AS FOLLOWS: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its officers, employees, agents, volunteers and representatives are included as additional insureds under the abave-clescribed Coverage Part(s) of the policy, but only with respect to liability arising solely out of the operations of the policyholder. The coverage provided by this poly shall be primary and non-contributory, provided that the alleged acts or omissions giving rise to the liability are otherwise covered by the policy. SPECIAL NOTICE OF CANCELLATION The policy is hereby amended as follows: We will provide thirty (30) days prior notification to the City of Santa Ana in the event that we cancel or materially change or alter this policy. of Santa Ana 20 CivicREVIEWED&APPROVED 20 Civic Center Plaza I� Santa Ana, California 92701 ABy' S MANAGEMENT DIVISION 122020 M. LAMBERT Francine R. Digitally signed by FrancineR. Villareal Villareal Date:2022.01.20 13:34:07-08'00' ACCWV CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 01 /18/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER VIG, LLC., dba/The Vestavia Group CONTACT NAME: Susan Crain PNONE . 205-552-0244 ac No): 205-244-8072 E-MAIL ADDRESS: SUSan.Crafn@V2StaVlagrOUp.COm 2090 Columbiana Road, Suite 2300 INSURERS AFFORDING COVERAGE NAIC # INSURERA: Ironshore Insurance Company "A" XV 25445 Birmingham AL 35216 INSURED INSURER B : Great American Insuance Company"A+"XIV" 16691 INSURER C : The Travelers Indemnity Company "A++" XV 19046 NaphCare, Inc. INSURER D 2090 Columbiana Road, Suite 4000 INSURER E Birmingham, AL 35216 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICYNUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY Y N HC7BAB5A62002 12/31/2021 12/31/2022 EACH OCCURRENCE $ 2,000,000 X I CLAIMS -MADE El OCCUR DAMAGE To RENTED- PREM SES (E. occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 Retro date: 12/31/2018 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 8,000,000 POLICY PRO- JECT 7 LOC PRODUCTS - COMP/OP AGG $ 1,000,000 $ OTHER: _R B AUTOMOBILE LIABILITY Y N CAP-1116396 09/30/2021 09/30/2022 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) _ $ XXXXXXXX ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ XXXXXXXX PROPERTY DAMAGE Per accident $ XXXXXXXX HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB z OCCUR Y N HC7BAB5A67002 12/31/2021 12/31/2022 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAR CLAIMS MADE DIED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? y (Mandatory in NH) NIA N UB-1P248768-21-51-K UB-1 P250924-21-51-K 09/30/2021 09/30/2022 X I STATUTE I ERH E.L. EACH ACCIDENT — $ 1,000,000 E.L. DISEASE - EA EMPLOYEE -- $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liability Claims Made Y N HC7BAB5A62002 12/31/2021 12I31/2022 2,000,000 Retro: 7/01 /2003 8,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) It is understood and agreed The City of Santa Ana, its officers, employees, agents, volunteers and representatives are named as Additional Insured, as respects their contract with NaphCare, Inc.; the insurance provided by Naphcare, Inc., shall be primary and non-contributory to the insurance carried by the City of Santa Ana; The City shall receive a (30) thirty day notice of any material modification of policies, as respects their contract with NaphCare, Inc. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana, CA 92702-1988 AUTHORIZED REPRESENTATIVE o" Nye z RiskMwaganentDivision REVIEWED & APPROVED BY. 01988-2015 ACORD C ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD --- Risk Management Analyst O' I _E IRONSHORE SPECIALTY INSURANCE COMPANY 175 Berkeley Street Boston, MA 02116 Toil Free: (877) IRON411 Endorsement # 5 Policy Number: HC7BAB5A62002 Insured Name: NaphCare, Inc. Effective Date of Endorsement: December 31, 2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CITY OF SANTA ANA ENDORSEMENT LIMITS OF LIABILITY THIS ENDORSEMENT MODIFIES THE GENERAL LIABILITY COVERAGE PART AND THE PROFESSIONAL LIABILITY COVERAGE PART OF THE POLICY AS FOLLOWS: The coverage provided by the policy applies to each insured against whom claim is made or suit is brought subject to the applicable limit of liability. ADDITIONAL INSUREDS THIS ENDORSEMENT MODIFIES THE GENERAL LIABILITY COVERAGE PART AND THE PROFESSIONAL LIABILITY COVERAGE PART OF THE POLICY AS FOLLOWS: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its officers, employees, agents, volunteers and representatives are included as additional insureds under the above -described Coverage Part(s) of the policy, but only with respect to liability arising solely out of the operations of the policyholder. The coverage provided by this policy shall be primary and non-contributory, provided that the alleged acts or omissions giving rise to the liability are otherwise covered by the policy. SPECIAL NOTICE OF CANCELLATION The policy is hereby amended as follows: We will provide thirty (30) days'prior notification to the City of Santa Ana in the event that we cancel or materially change or alter this policy. City of Santa Ana 20 Civic Center Plaza Santa Ana, California 92701 All other terms and conditions of this Policy remain unchanged. Authorized Representative MMF.END.171(2.19 ed.) May 22, 2020 Date Pa o NSF Risk Management])Msian z REVIEWED & APPROVED BY. - Risk Management Analyst