200000002287 Q and A (Prisoner Health Care & Pharmacy Services).docx

UM rep Rti

STATE OF MICHIGAN

ENTERPRISE PROCUREMENT

525 W. Allegan St., 1st Floor.

Lansing, MI 48909

Bidder Questions & Answers Prisoner Health Care & Pharmacy Services Request for Proposal 200000002287 PLEASE NOTE: 2nd round questions new deadline is September 28, 2020 by 8:00 a.m.

Answer (to be completed by the State)

Does the psychiatrist have to be onsite?

Or can this be done via tele-psychiatry?

See Section 1.0 C. 1.g. in the RFP.

Why is the contract out for bid?

Is it required to be put out for bid?

The State has elected to rebid the services instead of exercising the option years.

Is there an incumbent and current contract for this service?

If so, can you please provide the vendor name and current contract rate?

The current Contractor is Corizon Health Inc. See the current contract for the current rate at:

https://www.michigan.gov/documents/micontractconnect/6600081_526101_7.pdf

If combined, is it possible to break out the two different segments for tota prisoner health care costs and total annual pharmacy costs?

For contract year 4 (June 1, 2018 to May 31, 2019):

$92,003,349.12 = Prisoner Healthcare Services $27,670,223.89 = Pharmaceutical Services*

*This does not include Hep C medication purchases.

Does the MDOC model override the Contractor's model?

The Contractor will be responsible for reporting an outline of an identified performance improvement activities using MDOC’s template. Currently the template allows the Contractor to propose tracking and other solutions for improving performance. The goal is a team approach.

Is the requirement to list all of these personnel meant to be completed when contract is awarded?

Bidders are to indicate as much as can be identified regarding Key Personnel. Only when a position is not able to be identified should Bidder indicate such.

Yes, the most recent document would hold precedence.

Pricing is not being scored. Proposals passing technical evaluation will have pricing evaluated and considered for award. The State is not obligated to accept the lowest price proposal.

14-15

For vendors bidding on the complete RFP (medical and pharmacy), please confirm that the same contract be listed as both medical "Experience" and pharmacy "Experience" (assuming the contract included both of those components).

Yes, the same contract may be listed for medical experience and pharmacy experience if both components were included in the contract.

(a) Inmates who are sentenced to the MDOC but who are not yet housed in an MDOC facility

(b) MDOC prisoners who are housed at county jails (for any purpose)

a. The Contractor is not responsible for inmates who are not yet housed in an MDOC facility.

b. The Contractor may be responsible for MDOC prisoners housed at county jails, such as prisoners housed in county jails on a court writ.

(a) How many surgical procedures for the initiation, advancement, or maintenance of sex reassignment has the MDOC approved in the past three years (2017 through 2020 YTD)?

(b) Who was financially responsible for the cost of these procedures: the MDOC, the Contractor, or the prisoner?

(a) None.

(b) If one were to be approved by the State, the Contractor would be responsible.

(a) What is the MDOC's policy on these procedures?

(b) How many organ and/or tissue transplants has the MDOC approved in the past three years (2017 through 2020 YTD)?

(c) Who was financially responsible for the cost of these procedures: the MDOC, the Contractor, or the prisoner?

a. For donors, the outside recipient’s insurance typically pays those costs. For prisoners as recipients, MDOC does not have a specific transplant policy. However, our general stance is that we follow evidence-based and best-practices guidelines and follow the community standards in our delivery of health care. So, if procedures/treatments are determined to be medically appropriate and necessary, then we typically support the same delivery of care the person would receive in the community.

b. There have been no organ and/or tissue transplants approved in the past three years.

c. The Contractor would be responsible for the cost of these procedures.

(a) With which universities are these students affiliated?

(b) Who holds the agreements with the universities for these students: the MDOC or the Contractor?

(c) Please provide copies of the current agreements.

(d) What scope of services do these students provide?

(e) Who is responsible for the cost of having these students provide services?

(f) Who supervises these students?

(g) Who is legally liable for these students' actions in case of litigation?

(h) Who provides professional liability insurance for these students?

a. The students are affiliated with various universities.

b. The Contractor holds the agreement.

c. The MDOC does not have copies of the agreements.

d. This would be up to the Contractor based on the agreement.

e. Typically, there is not a cost. It is handled as a clinical rotation/internship.

f. The Contractor is responsible for supervision of the students.

g. The Contractor is legally liable for the students’ actions based on their agreement and the student’s program.

h. This would depend on the agreement and the student’s program.

(a) What type(s) of dental staffing has the MDOC required the Contractor to provide?

(b) How many hours for each type of dental staff, e.g., dentist, dental assistant, etc.?

(c) How does the MDOC reimburse the Contractor for these hours?

a. The current Contractor has not provided any dental staff at this point.

b. Not applicable,

c. Not applicable.

(a) Do psychiatrist hours count towards fulfillment of this RFP specification?

(b) If not, please confirm that the MDOC is requiring provider hours in excess of the current staffing listed in Schedule A-17, since the non-psychiatric provider staffing in Schedule A-17 is insufficient for 24-hour coverage at MBP (only 0.8 FTE physician plus 2.9 FTE mid-level) and WCC (only 1.0 FTE Physician).

a. No, psychiatrist hours do not count towards fulfillment of coverage in the infirmaries, unless the psychiatrist is going to provide a full scope of services, not just limited to psychiatric care.

b. Schedule A-17 is only providing the current staffing model. The bidder must provide a staffing plan to cover the requirements of the RFP.

(a) When is it projected to open/begin housing prisoners?

(b) Does the MDOC want bidders to (i) include the cost of providers for this unit in their bids; or (ii wait until the Unit is open and negotiate an amendment to the contract for the additional provider FTEs?

(c) If bidders are to include the cost of providers for the Medically Frail/Older Adult Unit in their pricing, please provide a staffing plan for the Unit.

a. This unit has been delayed due to COVID. MDOC does not have a projected open date at this time.

b. The MDOC would like the bidders to include those staff in their bids, but designate them so that the MDOC knows they are for that Unit.

c. It is a 240-bed unit that will house our medically frail individuals. The population may also have behavioral health needs. Staffing should be based on the number of beds and the needs of the population, which was described in the pre-bid meeting.

(a) What is the average daily census of inpatients?

(b) Are these inpatient expenses covered by Medicaid?

a. The average daily census at DWHC is 137 inpatient prisoners. This includes patients housed on DWHC’s COVID positive wing. DWHC has 30 beds designated for COVID positive prisoners with high medical needs.

b. No.

(a) Are these staff (i) stationed at the DDC on a regular schedule or (ii) located elsewhere, but travel to the DDC to deliver care on an as-needed basis?

(b) If the staff are regularly scheduled at the DDC, please provide the staffing grid and weekly schedule for the facility, by shift.

(c) Who is financially responsible for the cost of the medical supplies and pharmaceuticals used by the Contractor's staff in delivering care to DDC prisoners?

(d) Please provide the most recent 24 months of data on the cost associated with providing this care.

a. Due to the closing of DRC, on-call coverage will need to be conducted via telehealth at DDC.

b. Not applicable.

c. The MDOC pays for medical supplies and the Contractor pays for the pharmaceuticals.

d. MDOC does not have cost broken out by facility for onsite services. For off-site services, the City of Detroit is responsible for the costs associated to DDC detainees.

(a) Number of beds in the Unit

(b) Average monthly number of female prisoners receiving inpatient treatment

a. The unit has the capacity of 30; however, 5 beds are dedicated to AC and 20 are dedicated to RTS.

b. On average WHV has 21 prisoners receiving inpatient services.

(a) Please describe the telehealth connectivity that will be available for the incoming Contractor.

(b) This section states that the telehealth equipment has been used "most often" for mental health services. Please list any other clinics that are currently being conducted via telehealth.

(c) For each of the clinics listed in the preceding response (including tele-mental health and telepsychiatry), please indicate the frequency at which the clinic is held.

(d) Please also indicate the average number of participants for each clinic.

a. MDOC has Polycom video conferencing units that have different telemed peripherals connected to them, such as dermatology cameras, otoscopes, and stethoscopes.

b. The following clinics are currently being conducted via telehealth: infectious disease, nephrology, oncology, gender dysphoria, dietary, urology, dermatology, and optical.

c. Telepsych - Monday – Friday between 7:00 a.m. – 4:00 p.m. depending on facility’s operational needs. Telehealth is based upon the facility needs (see attached Telehealth Ave Monthly Usage).

d. See attached Telehealth Avg Monthly Usage for telehealth. See also Additional Information on average number of participants. See attached Telemed MH visits totals (Jan 2020 to August 2020) for telepsych.

(a) This section states that the MDOC owns all of the inventory listed in Schedule A-4. However, some of the items are labeled as "Corizon" equiment. Please confirm that ALL items listed in Schedule A-4 will stay and be available for the use of the incoming Contractor.

(b) Does the MDOC have any brand requirements if additional telehealth equipment becomes necessary, e.g., will the MDOC require any new hardware to be Polycom equipment, or is any equivalent, compatible brand acceptable?

(a) Anything with “Corizon” in the name is a computer that the Contractor put in the facilities for video conferencing to lessen the load on the MDOC video equipment at the facilities. Any equipment without “Corizon” in the name is a State-owned piece of equipment utilized for video conferencing and will be available for the incoming Contractor. The RFP has been revised to reflect this information.

(b) No, we do not have a brand requirement. The equipment would need to be evaluated by the MDOC IT section.

McLaren Greater Lansing University of Michigan Hospital Sparrow Ionia Hospital War Memorial Hospital Marquette General Hospital Sparrow Carson Hospital Phys St. Joseph Mercy Hospital Helen Newberry Joy Hospital Mercy Health Muskegon Community Health Center of Branch County

(a) Which MDOC facilities currently have onsite x-ray capabilities?

(b) Is this performed using (i) State-owned permanent equipment or (ii) mobile x-ray vendor services?

(c) What is the Contractor's financial responsibility (if any) with regard to onsite x-ray capabilities at the MDOC facilities?

a. The following MDOC facilities have onsite x-ray capabilities:

Baraga Correctional Marquette Branch Prison Alger Correctional Chippewa Correctional Oaks Correctional Earnest C. Brooks Correctional Carson City Correctional Ionia Correctional Michigan Reformatory Bellamy Creek Correctional St. Louis Correctional Saginaw Correctional Thumb Correctional Woodland Center Correctional Women’s Huron Valley Correctional Gus Harrison Correctional Duane Waters Health Center Macomb Correctional Detroit Reentry Center

b. Onsite x-ray services are provided using State-owned equipment, with the exception of Lakeland Correctional Facility. The Contractor must provide an offsite x-ray clinic at Lakeland Correctional Facility.

c. The Contractor will be financially responsible for off-site x-ray clinic at Lakeland Correctional Facility, x-ray interpretation statewide and any procedures conducted by the Contractor’s radiologist/subcontractor.

(a) Average daily inpatient census

(b) Average number of bed-days See attached Utilization Management (UM) reports.

(a) For what cost components is the Contractor responsible, e.g., Security? Utilities? Leasing or maintenance fees to the hospital? Etc.?

(b) Please provide the most recent 24 months of data on the costs associated with eac h secure unit.

See response to question 11.

(a) Audiology

(b) Podiatry

(c) Nephrology

(d) Ophthalmology

(e) Orthopedics

(f) Oral surgery

(g) Physical therapy

(h) Pulmonary services See response to question 8.

If "yes," please provide the following information on this topic:

(a) Name of MDOC facility

(b) Type of specialty clinic implemented

(c) Frequency with which the specialty clinic is conducted

(d) Duration of each specialty clinic (whole day, half-day, etc.)

(e) Average number of patients seen during the specialty clinic Yes.

All sites have their own optometry with the exception of:

· JCF, JCS and SMT go to DWHC

· KCF goes to URF

· STF goes to SLF

· MTU goes to IBC Clinic(s) are conducted based on the facility’s operational needs.

All sites have x-ray onsite except for:

· NCF – goes to a local hospital

· KCF – goes to URF

· STF – goes to SLF

· MCF – goes to LRF

· MTU – goes to ICF

· JCS, JCF and SMT go to DWHC

· LCF - Currently the Contractor brings a portable unit onsite. The clinic is held every Wednesday for the entire day. The average number of patients varies depending on the need.

WHV also has mammography onsite and the Contractor provides the mammogram technician.

· 2019 – 708 mammograms reported

· 2020 – to date 110 mammograms performed

There is also an ultrasound technician provided by the Contractor that goes to a few different sites to do ultrasounds. See response to question 105.

URF has a Physical Therapy technician that comes onsite weekly as arranged through the Contractor. MDOC was investigating doing this at LCF also before COVID.

The pharmacy license is maintained by the pharmacy vendor. The DEA licenses are maintained by the providers and the Contractor is responsible for ensuring that these licenses are maintained.

(a) Does the MDOC currently have a 340B program in place?

(b) If "yes," please identify the covered entity(s) whose providers prescribe the 340B discounted medications.

(c) Please also identify the medical conditions currently covered by the MDOC/Corizon 340B program, e.g., hepatitis C, HIV/AIDS, cancer, etc.

a. No, the MDOC does not currently have a 340B program in place.

b. Not applicable.

c. Not applicable.

(a) Please define "government pricing" more narrowly, e.g., Medicare, Medicaid, 340B, etc.

(b) Please describe the pricing model for this Narcan. Is it (i) a pass-through item which the Contractor must procure and supply to the MDOC at cost/no mark-up; or (ii) to be provided at the Contractor's expense and included in bidders' prices.

(c) Please provide the historic cost of this Narcan for each of the past three years.

a. The manufacturer offers government pricing to government entities. MDOC currently receives this pricing through our current pharmacy vendor.

b. Nasal Narcan is to be provided to MDOC at cost/no mark-up outside of the risk share.

c. Nasal Narcan spend for the last three years:

2018 - $40,195.25 2019 - $17,475.00 2020 - $13,742.00

(a) This section references an "existing civil servant (one pharmacist)," but Schedule A-17 shows that two pharmacist FTEs are authorized. Does the MDOC plan on filling its vacant pharmacist position at the DWHC facility?

(b) This section also states that the Contractor must "supplement additional...staffing as needed." Please confirm that this statement is referring to the 8.0 blue-highlighted FTEs in Schedule A-17 (1 Pharmacist Manager, 1 Clinical Pharmacist, 2 Pharmacists, and 4 Pharmacy Technicians).

(c) Please indicate if this level of staffing--one civil servant and eight Contractor staff--is sufficient, as we note that the incumbent Contractor has seen fit to overfill its authorized pharmacy positions by 1.1 FTEs.

(d) Is the extra 1.0 FTE Clinical Pharmacist provided by the Contractor covering the gap created by the MDOC's 1.0 FTE vacant Pharmacist?

(e) If "yes," is it the MDOC's expectation that the new Contractor will continue to provide 1.0 FTE Clinical Pharmacist over and above the staffing levels approved in the contract?

a. No, the MDOC is not planning to fill the vacant pharmacist position.

b. This is the current staffing model.

c. The bidder is responsible for submitting a proposed staffing plan.

d. No.

e. Not applicable.

(a) Please provide a description and flowchart for this mechanism.

(b) Who is responsible for reviewing and authorizing the use of non-formulary medications?

a. See attachment titled “How to Enter a Non-formulary Request.”

b. There are four levels of authorization: Clinical Pharmacist, Contractor’s Regional Medical Director, MDOC’s Assistant Chief Medical Officers, and MDOC’s Chief Medical Officer.

(a) Please provide the salaries/wages your incumbent health service Contractor is paying to its staff at the MDOC facilities.

(b) Please indicate how old the data is.

(c) Please indicate the source of this data, e.g., did it come from State records, from the incumbent Contractor, etc.

The MDOC does not have this information. These costs would be built into the current PPPM pricing model.

The Contractor would be responsible for non-emergent ambulance transport when the MDOC ambulance is not available.

(a) Calculated on the number of inpatient claims

(b) Calculated on the dollar value of inpatient claims MDOC does not have this information. MDOC does not get notified of amounts paid by Medicaid. MDOC is only notified of hospitalizations that aren’t covered by Medicaid.

Who makes this decision?

An authorization process is utilized for durable medical equipment. A contractual Regional Medical Director reviews and approves the request. The approval includes which vendor to utilize based on meeting the prisoner’s needs and cost-effectiveness. These processes are guided by Medical Services Advisory Committee and MDOC’s Procurement Processes.

(a) Do health care staff access the Internet, COMS/PHR, and other health care systems via (i) a State of Michigan network or (ii) the Contractor's network?

(b) Will the MDOC allow the Contractor to use the existing network infrastructure (wiring, switches, etc.) at each correctional facility.

(c) Who will be financially responsible for the cost of any necessary additions or expansion of the existing network infrastructure at a facility: (i) the MDOC or (ii) the Contractor?

a. Systems would be accessed via the State of Michigan network.

b. Not applicable.

c. Not applicable for this contract.

(a) Risk assessment tool

(b) Audiology

(c) Optometry

See response to question 8. Subcontractors are listed in the current Contractor’s contract.

Note: The MDOC does not have the contact information for the risk assessment tool vendor and this information is not noted in the current contract.

Please describe (i) to what extent and (ii) for what purpose mobile devices are currently used within the prisons.

No, the MDOC does not permit the use of mobile devices within the MDOC correctional facilities.

If not, please describe any State of Michigan IT resources that would be able to assist with hardware/software tasks that need to be performed hands-on, in person at an MDOC correctional facility.

No, the MDOC does not maintain full-time IT staff at the facilities. The Department of Technology, Management and Budget (DTMB) does employ field staff to support IT functions at the facilities.

(a) What are the (i) Base and (ii) Cap amounts for the Risk Share in the current contract?

(b) For each of the past three years (2017-2019), by how much (if at all) did applicable Risk Share expenses exceed the designated Cap amount?

a. See response to question 8 to obtain the current contract.

b. The MDOC has never exceeded the Cap amount.

a. Neonatal/newborn care after the infant's actual delivery

b. Elective or mandated abortion

c. Cosmetic surgery

d. Sex change surgery (including related cosmetic procedures)

e. Contraceptive care including the reversal of elective vasectomy or tubal ligation

f. Extraordinary and/or experimental care

g. Elective care, which, if not provided, would not (per the Lead Physician) cause the patient's health to deteriorate or cause definite and/or irreparable harm to the patient's physical status

h. Autopsies

i. Any organ, tissue, or other transplant and related costs, including, but not limited to, labs, testing, pharmaceuticals, pre- or post-op follow-up care, or ongoing care related to such a procedure

j. Medications to treat bleeding disorders, including, but not limited to, Factor VIII and IX

a. Neonatal/newborn care after the infant's actual delivery – The Contractor is not responsible for this service.

b. Elective or mandated abortion – MDOC Health Care leadership is unfamiliar with mandated abortion. As stated in response to question 22 (a), MDOC’s prisoners have access to clinically appropriate, medically necessary care as offered in the community. Elective abortions have been performed. The Contractor would be responsible.

c. Cosmetic surgery - Surgery that is focused solely on aesthetic appearance, treating areas that are fully functional is not covered.

d. Sex change surgery (including related cosmetic procedures) - Gender validation surgery is a recognized treatment that may be medically necessary for persons with Gender Dysphoria. As such the MDOC is working on a surgical benefit package in coordination with MDHHS’s benefit coverage.

e. Contraceptive care including the reversal of elective vasectomy or tubal ligation - If the reversal were deemed to be medically necessary it would be covered, though MDOC Health Care leadership is unaware of such circumstances. Hormonal treatment is available to women for a variety of reasons. Medical necessity specifically for fertility contraception would be unlikely as interpersonal sexual activity is not allowed.

f. Extraordinary and/or experimental care - Extraordinary care has a variety of definitions. Additional information with examples would be needed to address directly. MDOC does not allow medical research to be conducted on our prisoners. However, there are examples of novel treatments that are allowed with prisoner consent, such as recovered plasma for COVID-19 in hospitalized cases.

g. Elective care, which, if not provided, would not (per the Lead Physician) cause the patient's health to deteriorate or cause definite and/or irreparable harm to the patient's physical status - There are many interpretations of medical necessity. Legal precedent is against a strict standard of only delivering care to prevent loss of life, prevent deterioration or irreparable harm. Instead, MDOC takes into account quality of life and community standard of care.

h. Autopsies - Autopsies are not the responsibility of the MDOC.

i. Any organ, tissue, or other transplant and related costs, including, but not limited to, labs, testing, pharmaceuticals, pre- or post-op follow-up care, or ongoing care related to such a procedure - See response to question 22.

j. Medications to treat bleeding disorders, including, but not limited to, Factor VIII and IX – MDOC does offer medication treatment for bleeding disorders if medically necessary.

(a) How many have been filed against the MDOC and/or the incumbent health care provider in the last three years?

(b) How many have been settled in that timeframe?

The MDOC is currently composing a response to potentially be provided with the 2nd round question responses.

If “yes,” please provide copies of the order/directive.

The MDOC is currently composing a response to potentially be provided with the 2nd round question responses.

(a) Number of (offsite) inpatient hospital admissions

(b) Number of (offsite) inpatient hospital days

(c) Number of outpatient surgeries

(d) Number of outpatient specialty referrals

(e) Number of trips to the emergency department (ED)

(f) Number of ED referrals resulting in hospitalization

(g) Number of ground ambulance transports

(h) Number of air ambulance transports

(i) Number of dialysis treatments See Schedule A-15 Databook and the Utilization Management reports provided as an attachment to the Q&A Round 1 for available information.

Note: There will not be three years of data for all of the categories.

(a) Total spend for offsite services

(b) Total spend for pharmacy services

(c) Total spend for laboratory services See Schedule A-15 Databook for available information. The Databook will only provide one year of data.

(a) There is a 1.0 FTE Infectious Disease Director listed in the staffing for DWHC. There is also an "Infectious Disease Director" required under Key Personnel on Page 66 of the RFP. Are these (i) referring to the same position; or (ii) two separate and distinct positions, making a total of 2.0 FTE Infectious Disease Directors (one at DWHC and the other on the Contractor's Key Regional Office staff)?

(b) There is 1.0 approved FTE Clinical Pharmacist listed in the staffing for DWHC. There is also a "Clinical Pharmacist" required under Key Personnel on Page 66 of the RFP. Are these (i) referring to the same position; or (ii) two separate and distinct positions, making a total of 2.0 FTE Clinical Pharmacists (one at DWHC and the other on the Contractor's Key Regional Office staff)?

(c) There are 2.0 approved FTEs Pharmacist listed in the staffing for DWHC. There is also a "Pharmacist" required under Essential Personnel on Page 67 of the RFP. Are these (i) referring to the same position; or (ii) two separate and distinct positions, making a total of 3.0 FTE Pharmacists two at DWHC and the third on the Contractor's Essential Regional Office staff)?

a. These are two different positions. The DWHC Infectious Disease Director is an RN position and is responsible for DWHC internal operations. The RN position is staffed by the MDOC. The Key Personnel position is a medical provider position intended to oversee and guide statewide infectious disease processes and treatment, and is the responsibility of the Contractor.

b. This is the same position. The expectation is for this position to oversee statewide practices and positions, not just DWHC.

c. These are separate positions. The Key Personnel is to oversee statewide processes.

Should Cell 513D have a value of 0.8 FTE Psychiatrist? This would make Row 513 total across correctly; and would make the Psychiatrist FTEs at the various facilities total to 37.65.

That is correct. Cell 513D should have 0.8 FTE, which would make the Psychiatrist FTEs total 37.65. An updated Schedule A-17 will be provided with the Q&A Round 1 response.

595 & 596

(a) 2019 and 2020 YTD population data

(b) 2017 through 2020 YTD population data broken down by month

(c) 2017 through 2020 YTD population data broken down by facility See attached Population Data by month by facility reports (January 2017 to present).

https://www.michigan.gov/documents/corrections/Sec_401_681499_7.pdf

If yes, please describe and provide a timeframe for the legislation/policy implementation.

No, while the MDOC does not directly control the prisoner population or legislation that may be introduced in the future, the MDOC is not aware of any legislation or policy that would have a significant impact on the prisoner population. Based on current factors such as intake, parole decisions, and parole returns, the MDOC projects a continued slow decline in the prisoner population over the next 5 years.

If yes, please provide the position by type at each facility.

The MDOC does not have a designated position that serves as the Collaborative Care team leader.

a. location

b. model, age, and condition

c. ownership (or lease)

d. If leased, from whom The Contractor is not responsible for providing or maintaining this equipment, and this information is not relevant to provide a response to the RFP.