2421 Exhibit A Work Contract Requirements.pdf

COUNTY OF KENOSHA REQUEST FOR PROPOSALS (RFP) #2421

MEDICAL SERVICES FOR CORRECTIONS

EXHIBIT A - WORK/CONTRACT REQUIREMENTS

Required Services

The following are the general service requirements that the successful Contractor is expected to meet as a result of its services under a contract with the County.

A. ADMINISTRATIVE

1. The contractor shall cost-effectively operate the program, with full reporting and accountability to the Kenosha County Sheriff’s Department. (KCSD)

2. The contractor shall implement a written and continually updated services plan with clear objectives, policies, procedures, and an annual evaluation of compliance subject to KCSD approval. The contractor shall notify KCSD of who will perform and when objective compliance evaluations will take place.

3. The contractor shall maintain an open and cooperative relationship with other KCSD contractors and the staff of the KCSD.

4. The contractor, in concurrence and upon approval by the KCSD, shall develop and implement policies for inmate population services. The Contractor shall develop and maintain site-specific procedures and protocols for its service unit and staff and those processes shall be consistent with KCSD safety and security processes and procedures.

5. The contractor shall be responsible for ensuring that any problems and/or unusual incidents are reported by its staff through the Sheriff’s chain of command or a designee of the KCSD Captain of Detentions.

6. The contractor will specify procedures for the Contractor and the KCSD to identify, discipline, and terminate unsatisfactory employees.

7. The contractor shall ensure that the healthcare status of inmates admitted to outside hospitals is reviewed to ensure that the duration of the hospitalization is no longer than medically indicated.

8. The contractor shall ensure that its staff documents all healthcare contacts in the inmate’s healthcare record in the problem-oriented electronic medical record (EMR) format and software as designated by the KCSD.

9. The contractor shall maintain complete and accurate electronic records of inmate care and collect and analyze health statistics regularly.

10. The contractor shall operate in a constitutionally humane manner concerning the inmates’ rights to basic medical and mental health services.

11. The contractor shall be responsible for full, current, and detailed knowledge of, and compliance with, the pertinent requirements of Federal and Wisconsin State Law, applicable Administrative Codes, and the implementation of regulations and guidelines promulgated thereunder as they pertain to the services requested herein.

12. The contractor shall assume complete responsibility for the cost and timely accomplishment of all activities and duties required by the contract and carry them out in a competent manner.

13. The contractor shall date stamp all correspondence forms, documents, notices, and any other material pertinent to the administration of the contract.

14. The contractor shall utilize forms that conform to all federal, state, and local rules and regulations, and Sheriff’s Department's requirements.

EXHIBIT A - WORK/CONTRACT REQUIREMENTS

15. The contractor shall immediately notify the KCSD of any changes in the persons authorized to bind the contract.

16. The contractor shall maintain a dedicated administrative organization for the

Contractor to discharge its contractual responsibilities. This contractual obligation shall require the contractor to maintain staff who shall be directly accessible to KCSD staff. There shall be a designated Director of Correctional Health and a minimum of one position as a Nurse Manager. The KCSD shall be notified in writing and in advance of all reductions in staff below the levels required by the contract, and any such reductions shall require written approval of the KCSD.

17. The contractor shall maintain a liaison responsible for contract compliance and shall foster cooperation with the KCSD to ensure proper and timely performance of all contractual responsibilities.

18. The contractor shall immediately notify the KCSD upon learning of any situation that might reasonably be expected to adversely affect the KCSD’s operation or reputation in the community. Within one (1) business day, the Contractor shall provide a written description of the situation and include a recommendation for resolution whenever possible.

19. The contractor shall recognize and agree that any services performed outside the scope of the contract or without consent of the KCSD shall be deemed by the KCSD to be gratuitous and not subject to charge by the contractor.

20. The contractor shall meet with the KCSD Contract Manager and/or KCSD Captain of

Detentions or designee at a minimum of weekly during the initial three (3) months of operation, or as otherwise agreed upon with the KCSD. Thereafter, meetings will occur as needed. This may require monthly meetings with more frequent informal contacts by telephone. The contractor’s manager shall prepare and deliver to the

KCSD Contract Manager monthly summary reports on procedure development, staffing levels, problems or backlogs encountered, planned activities for the next two

(2) months, meetings held, and other information deemed necessary by the KCSD or the Contractor.

21. The contractor shall provide, quarterly, those statistical reports deemed necessary by the KCSD on contractor operations. Failure to provide these reports or the objective compliance evaluation described in section “A (2)” will result in a penalty being assessed against the contractor. The penalty imposed will be a ten percent (10%) reduction in the monthly amount due under the contract.

22. Records associated with the Contractor's work are understood to be the records of the

KCSD. The contractor will promptly provide all requested records to KCSD Security

Supervision, Sheriff’s Administration, Public Information Officer, Kenosha County

Corporation Counsel, or another county designee upon request or notification of the receipt of public/open records or other requests by the County for any reason. The contractor will also retain records in compliance with applicable federal, state, and local government requisites and retention schedules.

B. PERSONNEL

1. The contractor must operate the program at mutually agreed upon full staffing and use only qualified Wisconsin State licensed, certified, and professionally trained personnel to perform duties within their licensure. The contractor must provide adequate personnel for all shifts. This staffing is to include all personnel required to comply with the Contractor’s applicable scope of services outlined in this RFP. The contractor shall maintain a current organizational chart, a complete list of employees, daytime and after-hours 24/7 contact phone numbers, and a call tree, which shall be provided to the KCSD initially and upon any revision.

2. Where licensure or certification is required, the contractor shall only recruit and interview candidates who are currently licensed or certified in the State of Wisconsin.

The contractor shall interview each candidate with a special focus on technical expertise, job fit characteristics, and motivation. The Jail Command Staff or designee shall retain the right to be involved in the interviewing process. It is recommended that the healthcare administrator be a Certified Correctional Health Professional

(CCHP). The HSA and Nursing manager must be at least a licensed Registered

Nurse.

3. The contractor and its personnel shall be subject to and shall comply with all security regulations and procedures of the County and the detention facilities. Violations of regulations may result in the contractor’s employee being denied access to the detention facility. In this event, the contractor shall provide alternate personnel.

4. Initial and continued employment of staff and subcontractors shall be subject to the approval of the County. The County reserves the right to prohibit any of the contractor's employees and/or independent contractors from performing service concerning this contract.

5. Security for contract employees and agents shall be consistent with security provided to other employees in the respective buildings.

6. All personnel shall be required to pass a background investigation for initial and or continued employment. Additionally, all personnel performing on-site services may be required to undergo random urinalysis or blood tests. Additional testing may be required if there is “reasonable suspicion” of the current use of drugs/alcohol that is affecting the employee's ability to perform their assigned duties. All test results

(negative or positive) will be provided to the medical vendor and designated jail medical liaison. Additional testing will be paid for by the compelling party.

7. Items that are reviewed in a typical background may include, but not be limited to most of the following components; Criminal History Check, Driver’s License Check, Work History Check, Educational History Check, Reference Check, Neighbor Check, Professional License Check, Credit Check, and Drug Testing.

8. Typical items that will not pass this background check: conviction of a felony; use of illegal drugs within the last 12 months; illegal use or misuse of prescribed substances in the past 3 years; 1 or more DUI convictions; deception or fraud during the hiring process; non-availability for shift work; dishonorable discharge from military; three or more employment terminations or resignation instead of termination; and lack of proper documentation for non-US citizens.

9. All personnel shall comply with current and future state, federal, and local laws and regulations, court orders, administrative directives, institutional directives, KCSD-designated NCCHC standards, KCSD-designated ACA standards, and standards, policies, and procedures of the County, the Kenosha County Sheriff’s Department, and the contractor regardless of accreditation status.

10. Personnel files of all subcontractors and contract employees shall be maintained in a locked file. The files shall be made available to the Captain of Detentions or designee upon request. These files shall include at a minimum: copies of current licenses, proof of professional certification, DEA numbers, malpractice insurance certificates, evaluations, E-Verify information, and position responsibilities.

11. The contractor shall provide the names of corporate or regional management personnel assigned to this contract. A resume of the regional manager shall be included with this proposal. Any replacement personnel information shall be provided to the County.

12. The contractor cannot approve facility access for anyone and must allow sufficient time to activate a jail clearance, typically 14 days.

13. The contractor shall notify and obtain concurrence with Jail Administration before discharging, removing, or failing to renew contracts of professional staff or vendors.

14. The contractor is prohibited from entering into covenants “Not To Compete or Non-

Competition Clauses” with either employees or independent contractors, or any party specifically related to the performance of any obligation required under this agreement, which would prohibit said independent contractor or employee from competing, directly or indirectly, in any way with the contractor. For this paragraph, the term "competing directly or indirectly, in any way with the contractor" shall mean the entering into or attempting to enter into any similar business with that carried on by the contractor with any individual, partnership, corporation, or association that was or is the same or related business as the contractor.

15. The contractor shall implement an aggressive hiring stance to maintain full staffing levels.

a. The contractor shall engage only Wisconsin State licensed and qualified personnel to provide professional medical, mental health, dental, or pharmaceutical coverage.

b. Initial and continued employment of the Contractor’s staff shall be subject to the approval of the KCSD.

c. The contractor shall provide a comprehensive training program for the continuing education of its professional staff. Selected topics that require staff training will be identified on an ongoing basis through the Quality Assurance Program, which is covered in a later section.

d. Contractor’s personnel shall comply with current and future federal, state, and local laws and regulations and court rulings (both federal and state case law) relating to performance under the contract. This includes training as required by the Prison Rape Elimination Action (PREA).

e. The contractor understands that all personnel must pass preliminary and subsequent security background checks to the satisfaction of the KCSD before performing services under the contract.

f. While working in county facilities, the Contractor’s personnel shall adhere to the same standards in place for county employees with regards to harassment, alcohol, and drug-free workplace, violence in the workplace, as well as all workplace and security rules, regulations, and procedures.

g. The contractor shall maintain personnel files in its unit, which will be made available to the KCSD Divisional and/or Administrative staff upon request.

h. A synopsis of the contractor's benefits program should be included in the proposal.

16. The contractor shall agree to credit the County the full value (salary and fringe benefits) of any service hours not provided by classification as contained in the staffing plan. Staffing a position with a lessor qualified position also constitutes a penalty and reimbursement will be sought.

17. Provide a weekly staffing report and schedule including total hours for each position to the Captain of Detentions.

18. The contractor shall also make provisions in their staffing plan to cover periods of vacation, educational staff, or sick time by including appropriate relief factors and per diem staff. The contractor shall specify in their staffing plan relief factors. Every effort will be made to use contractor’s employees, not an agency or temporary staff.

19. The contractor may substitute a person with higher licensure for positions requiring lower licensure (e.g. RN for LPN).

C. SCHEDULES

1. All working hours shall be spent on-site at the specified corrections buildings, except as otherwise agreed to by both parties.

2. Healthcare in a correctional facility is an essential service and the contractor shall endeavor to provide these essential services without interruption.

3. All contractual staff (both employees and independent contractors) shall be required to comply with sign-in and sign-out – (search) procedures as specified by KCSD &

Jail Administration.

4. As is evident from the proposal, the Kenosha County Sheriff’s Department

Detentions Division must be staffed 24 hours every day with medical staff. This personnel must be able to respond to all medical emergencies by providing basic emergency care, as well as serving the needs of the general population inmates.

Staffing will be population dependent. Current population levels and demographics are listed in this RFP. Staffing levels and positions must be approved by the Jail

Command Staff. Administration staff will be dependent upon the contractor to establish a schedule based on their needs to complete the necessary duties and maintain relations with the County staff. Please be cognizant of the requested night hours.

Proposed staffing levels are listed as work hours in Attachment D Proposed Staffing

Schedule and are not necessarily intended to represent the number of employees needed to meet that level of service.

5. The following are stipulations to Attachment D Proposed Staffing Schedule:

a. Staff Triage/respond to urgent cases per protocol.

b. Schedule to be adjusted based on daily patient care needs.

c. Nursing positions currently work 12 hr. shifts.

d. Immediate response for urgent needs is continuous at the Pretrial and Detention

Center at all times

e. RN must be physically on-site at the Pretrial Facility and the KCDC at all times.

D. SECURITY

1. The contractor’s personnel shall be subject to all the security regulations and procedures of the KCSD.

2. The contractor’s personnel will be required to receive security and orientation training as stipulated by the KCSD.

3. The contractor’s staff, agents, and subcontractors will submit to all check-in and check-out procedures as well as all other security procedures of the KCSD.

4. All successful proposer’s agents and personnel inside the facilities will be required to wear and openly display Jail Administration-approved unobscured/unredacted identification badges.

Since the successful proposer’s agents and personnel will be working in a 24/7 environment of a public safety entity; work will need to continue regardless of disasters caused by man or nature. (Essential Employees)

E. REFERRALS

1. The contractor shall make referral arrangements with healthcare specialists/agencies, subject to the approval of the KCSD, for the treatment of those inmates with problems, which extend beyond the scope of services provided on-site, only after every effort has been made to accommodate services on-site.

2. The contractor shall pursue Medicaid coverage when applicable.

3. The contractor shall follow the USM protocol for medical referrals(USM inmates).

F. TRAINING/QUALITY ASSURANCE/ACTION PROGRAMS

1. The contractor shall provide annual in-service medical education programs for

KCSD staff and the Contractor’s personnel. These education programs shall include

CPR, first aid, Personal Protective Equipment, Bloodborne pathogens, infectious disease, intake screening, and suicide prevention consistent with requisites of the

Wisconsin Administrative Code and subject to change and customization upon request by the KCSD Administration. Training shall include the production of written lesson plans, course outlines, itineraries, and supporting handouts or documentation and shall be provided to designated KCSD staff for review, approval, and archive before instruction begins. Generally, training for these sessions is provided in four to six-hour breakout sessions per week for up to fifteen weeks in a schedule determined annually. A designated training coordinator representing the

Contractor is to attend training planning meetings as required by KCSD.

2. The contractor shall conduct TB screening for KCSD custody staff. This is typically conducted during the annual staff in-service.

3. The contractor shall provide N-95 test fitting services by qualified fit testers to all

KCSD employees. The Contractor shall maintain all fit testing records for the

KCSD. These records shall be forwarded to the KCSD Administration quarterly. The contractor will supply all fit testing materials. The County shall be responsible for the cost of N-95 masks.

4. The contractor shall institute a quality assurance program consistent with ACA and

NCCHC Medical Quality Assurance Program, which shall include but not be limited to audit and medical chart review procedures at required intervals.

Monthly meetings shall be held between detention officials, facility staff, and appropriate contractual personnel to review significant issues and changes and to provide feedback relative to the Quality Assurance/Action Plan program, so that any deficiencies or recommendations may be acted upon. Also, when requested by the

KCSD, the Contractor will provide appropriate personnel to participate in department meetings to include but not limited to the Infectious Disease Control

Committee. (Director of Correctional Health, Nurse Manager or designee, Medical

Director, Etc.)

5. Interdisciplinary meetings shall be held to discuss inmates of high liability or high risk.

G. SECURITY OF INMATE FILES

Inmate files are confidential. Full-time contractor employees shall be allowed access to this information only as needed for their duties related to the contract and under the rules established by the KCSD. The contractor shall honor all laws, policies, and procedures for protecting files and safeguarding the confidentiality of these files.

H. PUBLIC INFORMATION

Neither the Contractor nor the County shall publish any findings based on data obtained from the operation of the contract without the prior written consent of the other party, consistent with applicable public records/disclosure local, state, and federal statutes.

I. LIABILITY

1. The contractor assumes complete responsibility for any liability arising from the administration or delivery of its services provided by this contract.

2. The contractor will defend all lawsuits and pay associated legal costs and settlements regarding any claims under the contract.

3. The contractor will carry adequate insurance for all necessary professional and malpractice liability claims.

4. The contractor shall not be responsible for failure to perform the duties and responsibilities imposed by the contract due to acts of God, and similar occurrences beyond the control of the Contractor that made performance impossible or illegal. As a public service entity providing essential services to the public, the KCSD will make reasonable efforts to ensure that a safe and secure environment is provided to the contractor's employees to ensure that the contractor may reasonably provide these duties and responsibilities.

J. NOTIFICATION OF DEFICIENCIES

1. The KCSD shall use a system of progressive disciplinary letters to notify the

Contractor of its concerns with the Contractor’s performance. Nothing shall preclude the KCSD from implementing financial remedies or termination clauses if, in the

KCSD’s opinion, the deficiencies warrant such action. In the course of normal business, however, the KCSD shall use three (3) types of notification to the

Contractor upon the discovery of a deficiency. These shall be an “Alert” letter, a

“Warning” letter, and a “Notice of Intent to Take Action” letter as described below.

2. An “Alert” letter is the least severe of the three (3) letters. An “Alert” letter shall be sent when the KCSD observes performance, which if left uncorrected could, in the opinion of the KCSD, result in unsatisfactory performance on behalf of the

Contractor. An “Alert” letter shall be issued if monthly reports or performance standards as outlined elsewhere in this RFP fall below the minimal acceptable monthly figures or expectations. An “Alert” letter may also be to document a change to contractual services that fail to conform to contractual standards as well as non-compliance.

3. A “Warning” letter will follow if two (2) “Alert” letters have been issued on a specific deficiency and the situation has not been corrected or a written corrective action plan has not been implemented. A “Warning” letter shall also be issued if quarterly performance statistics fall below minimum acceptable levels or if a compliance audit reveals performance deficiencies of such magnitude that corrective action is needed.

4. A “Notice of Intent to Take Action” letter shall be issued by the KCSD when the

Contractor fails to implement corrective action after receiving two (2) “Warning” letters on the same deficiency, or such other situation arises of such grievous nature as determined by the KCSD as to warrant immediate and strong action by Contractor to correct the deficiency.

5. In all cases, the Contractor shall respond to the KCSD Administration and the KCSD

Contract Manager within ten (10) calendar days of receiving such notices described under this section from the KCSD. The contractor’s responses shall include a corrective action plan with timetables acceptable to the KCSD, and the Contractor’s plans to take action to remedy any pattern of problems or compliance issues raised in the Contractor’s letter for deficiencies. If the issues still cannot be resolved, the

KCSD may, in the exercise of its discretion, implement all applicable provisions of the contract.

K. CONTRACT MONITOR

The KCSD may provide and designate an individual to monitor the compliance of the contractor with the health care contract. The contractor shall agree to allow the contract monitor to have unfettered access to all medical records, statistical reports, quality assurance reviews, personnel files, personnel training records, databases, and attendance at quarterly CQI meetings, as the contract monitor deems necessary to fulfill his/her duty.

The county shall be responsible for the expenses of the contract monitor.

L. BACKGROUND SERVICES

As noted in section B.7, all personnel entering the security portions of the buildings shall undergo a jail clearance check. All persons performing medical services within any portions of the secure buildings shall undergo an extensive background process. The

KCSD shall provide the jail clearance check at no expense to the contract provider. To that end, onboarding and staff retention are extremely important to the process and it is expected that the Contractor shall be proactive in those areas. All contract staff will be pictured and printed during onboarding.

M. ACCREDITATION

The contractor may obtain accreditation by NCCHC for the Correctional Facility at its option. The contractor shall be responsible for the payment of all costs associated with accreditation including but not limited to fees. However, regardless of accreditation status, the site shall be constantly operated under KCSD stipulated and agreed-upon

NCCHC and ACA standards as if accreditation had been achieved. “No announce audits” of contractor-supplied operations shall be an option of KCSD to ensure 100% compliance with this provision.

N. SCOPE OF SERVICES

The contractor is to provide comprehensive health care services for the Kenosha County

Pretrial Facility, Kenosha County Jail, and the Kenosha County Detention Center. The program is to meet constitutional, professional, and community standards and, at a minimum, meet the KCSD stipulated and agreed-upon standards of the National

Commission on Correctional Health Care; the American Correctional Association, Kenosha County Policies, and Procedures regarding the provision of health services in jail facilities, the State of Wisconsin, State Licensure restrictions and all other applicable health care standards. The contractor shall provide monthly, those statistical reports deemed necessary by the KCSD on contractor operations, such as; treatments, sick call visits, grievances, pharmaceuticals, etc. A consistent computer tracking system shall be used to collect data for actuary and statistical reasons.

O. RECEIVING SCREENING

The Arresting Agency shall be responsible for pre-booking injuries incurred during the arrest process. At the intake facility, a preliminary health triage will be conducted by the contractor to determine if the arrestee may be requested to be deferred or referred to outside acute care or emergency medical facilities before admittance to the jail facility. It is an expectation that the Contractor’s personnel will, consistent with policy and procedures, perform a receiving screening on all new or transferred inmates upon their arrival at other locations covered in this contract. The screening process may change to follow all or exceed updated elements of the NCCHC standard for Receiving Screening, with the intent of identifying potential emergencies.

At a minimum, the Receiving Screening must interview the inmate/juvenile elements contained in NCCHC Standards for Health Services in Jails 2018 and subsequent editions or requirements by case law:

• Current and past illnesses, health conditions, or special health requirements

• Past serious infectious diseases

• Recent and/or current communicable illness symptoms

• History of or current suicidal ideation

• Dental problems

• Allergies

• Legal and illegal drug use (including type, amount, and time of last use)

• Withdrawal symptoms

• Current or recent pregnancy, and

• Other health problems as designated by the responsible physician.

Also to be recorded are the screening observations during the time of the interview, including:

• Appearance (such as sweating, tremors, anxious, disheveled)

• Behavior (such as disorderly, appropriate, insensible)

• State of consciousness (such as alert, responsive, lethargic)

• Ease of movement (such as gait, body deformities)

• Breathing (such as persistent cough, hyperventilation) and

• Skin (such as jaundice, rashes, infestations, tattoos, needle marks, bruises, scars, signs of abscess, or skin infection).

Should an arrestee arrive at the intake facility- regardless of location- and that person requires immediate medical attention; the arresting agency will be asked to defer arrest drop-off processes and be referred for off-site emergency care and clearance before acceptance. This medical stabilization will be the responsibility of the arresting agency.

Should the agency refuse to defer drop-off, the KCSD shall be responsible for the medical stabilization of the prisoner consistent with KCSD policy and procedure. Medical and mental health preliminary review for all others is to be completed by a qualified health care professional or other staff trained in intake screening processes. Persons who need to be examined by a physician or mental health professional are to be referred for such evaluation by the on-duty Registered Nurse before the end of the shift and care is arranged as soon as possible. Correctional Staff has been trained to conduct medical and mental health intake screening upon admission.

The findings of the preliminary screening and evaluation will be recorded on a form

(and/or electronically) approved by the County and entered into the inmate's or juvenile’s medical record. Appropriate disposition based on the findings of the receiving screening shall occur and be documented. When health-trained corrections staff perform the receiving screening and identify healthcare or mental healthcare concerns (as predefined by the contract medical Director), RN health staff shall be notified to review the interview form, see the inmate, and decide on the disposition. Nursing staff shall be expected to review the findings of all the receiving screenings before the end of each shift or earlier, upon request. Nursing staff shall be expected to make medical and/or mental health referrals to medical, mental health, and dental service providers in the jail based on their preliminary triage.

An explanation of procedures for accessing medical, mental health, and dental services shall be provided to inmates/juveniles during facility orientation.

P. INTOXICATION AND WITHDRAWAL

The contractor will ensure that specific procedures and protocols are in place and implemented for inmates under the influence of alcohol or other drugs or those undergoing withdrawal. Such protocols must be approved by the responsible physician, be current, and be consistent with nationally accepted guidelines. Detoxification is only to be done under physician supervision in accordance with local, state, and federal laws.

As part of the submission, the respondent shall provide their definition of Intoxication and Detoxification.

Inmates/juveniles experiencing severe, life-threatening intoxication (overdose) or withdrawal are to be transferred to an acute care facility or provided appropriate follow-up care. The contractor shall ensure that the special needs of inmates undergoing withdrawal are addressed, such as the appropriate level of observation status and treatment of pregnant inmates with a history of opiate use.

The contractor will provide bridge Medically Assisted Treatment (MAT) to chemically dependent inmates who are currently on MAT and compliant with treating providers' orders and medications booked into the facilities. The contractor will propose a program for the initiation of opioid addiction MAT as determined necessary by the medical provider within the policies of the KCSD.

The contractor will implement an expanded MAT program for all inmates who are chemically dependent and request MAT, The contractor agrees to work with the KCSD designee in the exploration and pursuit of grant funding for this purpose. The contractor will work with the program and enfold existing participants and continue services should the grant program conclude during the life of this contract.

Q. HEALTH APPRAISAL

The contractor will ensure that a full health appraisal is completed by an RN, physician’s assistant, nurse practitioner, or physician for each inmate or juvenile within fourteen (14) days or less after arrival in custody.

The full health appraisal must include the following:

• review of the initial receiving screening.

• complete medical, dental, and mental health history

• physical examination by a physician, physician assistant, nurse practitioner, or

RN

• Recording of vital signs, height, and weight;

• Mental health evaluation;

• Dental screening;

• Vision and hearing screening;

• Skin testing for tuberculosis, this item shall be completed within the first 72 hours in the facility.

• Laboratory and/or diagnostic tests for communicable diseases, such as a syphilis test, and other diagnostic tests as clinically indicated;

• Review of the results of the health appraisal by a physician or midlevel practitioner;

• Initiation of therapy, when appropriate.

• Work detail screening

• Initiation of a problem list, along with a diagnostic or therapeutic plan for each problem

• Elements that may be subsequently added by the Wisconsin State Legislature or

Administrative Code; ACA or the NCCHC; or as a result of litigation against the

Contractor or KCSD.

• An immunization history shall be taken as part of the history and physical exam.

Immunization vaccines shall be updated as indicated.

R. NON-ENGLISH SPEAKING INMATES AND/OR SPEECH AND HEARING

IMPAIRED INMATES

The KCSD makes use of a third-party telephone interpreter service. Should these interpretive services being used by the contractor for KCSD be used by Medical Contract

Staff they shall follow County procedures for billing and tracking purposes. The County is responsible for the fees incurred in the utilization of these services.

The KCSD also makes use of a third-party electronic ASL service. The usage of this service will follow the plan listed in the telephonic translation services. The KCSD may have alternate providers for this service. The County is responsible for the fees incurred in the utilization of these services.

S. PERIODIC HEALTH APPRAISALS

The contractor shall conduct annual physicals on all inmates and juveniles who have been incarcerated at the facility for over one year. A protocol or narrative defining the extent of the health assessment shall be discussed or included in this section.

T. NON-EMERGENCY HEALTH CARE REQUESTS AND SERVICES

The contractor shall conduct sick calls according to NCCHC standards for jail facilities.

An on-site registered nurse, mid-level practitioner, or physician shall conduct the sick call clinics. In conducting these clinics, healthcare staff shall utilize triage protocols and shall ensure all appropriate follow-up care is provided. Oral, written, or electronic requests for care are to be received daily by health staff and triaged within 24 hours. All inmates are to be seen at their site’s sick call within 48 hours (72 hours for weekends or holidays) of their submission of a request for health services – sooner if the situation warrants. Care by correspondence alone is not sufficient. While education sheets or instructions to patients to review electronically available education sheets are encouraged; each request for medical services shall result in a face-to-face sick call interaction.

There is a co-pay program in place for the KCSD facilities for which contract staff is expected to supply timely, appropriate, complete, and thorough information. The

Contractor shall comply with recommendations of the KCSD and Kenosha County as related to the administration of the inmate co-pay system.

U. SICK CALL/SEGREGATION UNIT (INTAKE & SPECIAL HOUSING UNITS)

The contractor will ensure that healthcare rounds shall be conducted a minimum of once daily in the segregation units at all facilities. RN staff or mental health staff will conduct rounds (to determine whether medical, mental health, or dental needs contraindicate the placement or require accommodation) and provide appropriate follow-up care on a day-to-day basis. Documentation of the RN’s segregation rounds (done seven days a week) will be made on individual cell logs and in the inmate’s health record and include the date and time of the contact and the signature or initials of the health professional making the rounds. Any significant health findings are documented in the inmate’s health record.

V. CLINICIAN CLINICS

The contractor will provide routine clinician clinics on weekdays. Inmates will be scheduled to see a physician or midlevel practitioner according to clinical priority.

Clinicians shall see non-urgent sick call requests in a timely fashion, based on their immediacy of need and the intervention required.

W. HOSPITAL CARE

The contractor shall make every effort to accommodate appropriate care on-site. The contractor shall coordinate, in cooperation with KCSD staff, routine outpatient/inpatient services from hospitals to meet the health care requirements of the inmates. When outside hospitalization is required, the contractor shall coordinate with the security staff in arranging transportation and notification for deputy coverage. All transport information shall be kept confidential from inmates (and/or their families) for security reasons.

The contractor is responsible for utilization review for all law enforcement inmates, who are arrested and subsequently booked into the KCSD Detention System, within 10 days of the utilization of outpatient/inpatient services, including preapprovals, case management, and discharge planning.

Local area hospitals are to be utilized when practicable.

The contractor shall be responsible for quality assurance for all costs associated with outside consults and inpatient hospitalizations. This shall include but not be limited to the pre-notification of all outside vendor use and the hospitalization of all inmates.

The contractor shall avail themselves of the KCSD’s agreement with the Health Care

Authority to enroll detained personnel in Medicaid.

X. SPECIALTY CARE AND REFERRALS

The contractor shall make every effort to accommodate appropriate care on-site. The contractor shall make referral arrangements with specialists for the treatment of those inmates with healthcare problems, which may extend beyond the healthcare services provided on-site. All outside referrals shall be coordinated with the County for security arrangements that will be kept confidential from inmates.

The contractor shall operate on-site specialty clinics at the housing facility. The contractor shall identify, in their staffing plan, specialty clinics to be conducted on-site as justified by the clinical workload and availability of specialists. Clinics that are required include providing or concerned with long-term medical care lasting usually more than 90 days, especially for individuals with chronic physical or mental impairment, including but not limited to orthopedics, and OB/GYN.

The County shall be responsible for all supplies used or ordered by the specialist, including recommended prosthetics, braces, special shoes, glasses, dentures, hearing aids, orthopedic devices, etc. The contractor shall establish policies and site-specific procedures for the provision of such items, regarding the frequency of eligibility, etc. The

County shall pay for the items when the safety or well-being of the inmate/ juvenile would be adversely affected.

All specialists must be Board Certified or eligible in their respective specialties. The utilization review process developed by the contractor for approval of outside consultations or inpatient care shall be completed within five (5) working days of the request.

The contractor shall develop provisions for prenatal care. According to accepted prenatal guidelines, prenatal care shall include:

• Medical examinations;

• Laboratory and diagnostic tests (including offering HIV testing, counseling, and treatment when indicated);

• Advice on appropriate levels of activity, safety precautions, and nutritional guidance and counseling;

• Dietary supplement;

• Observation for signs of toxemia; a list of specialized obstetrical services is maintained; there is documentation of appropriate postpartum care, and a list is kept of all pregnancies and their outcomes.

Regardless of personal or professional beliefs, female prisoners are legally entitled to abortions. The medical Contractor should have a proposal that include procedures for dealing with this issue.

Y. CHRONIC CARE PATIENTS

The contractor shall develop and implement a chronic disease program to decrease the frequency and severity of symptoms, prevent disease progression and complications, and improve the function of affected inmates and juveniles. The responsible physician shall establish and annually approve clinical protocols consistent with national clinical practice guidelines. These clinical protocols for the management of chronic diseases include, but are not limited to:

• Asthma

• Cancer

• Chronic Obstructive Pulmonary Disease (COPD)

• Crohn's disease, ulcerative colitis, other inflammatory bowel disease, irritable bowel syndrome

• Diabetes

• Heart Disease

• HIV

• Hypertension

• Seizure disorder

• Mental illnesses

• Renal and Hepatic Disease

The chronic care provided shall entail the development and implementation of an individual treatment plan(s) by the responsible physician specifying instructions on diet, medication, diagnostic testing, frequency of follow-up medical evaluation, and adjustment of treatment modalities as clinically indicated. Chronic care patients shall be provided a review by a physician, minimally every three months. Upon completion of detainment, these individuals shall be provided with a limited supply of prescription medication(s) for ongoing health issues. They shall also, as necessary, be transported to an appropriate care facility. A roster of chronic care patients shall be maintained.

Z. EMERGENCY CARE

The contractor shall provide First Responder emergency medical services on-site at the

Pretrial Jail and KCDC facility 24 hours per day seven (7) days per week. Arrangements must be made for required emergency services beyond on-site capabilities with appropriate community resources. The contractor will be responsible for training staff and maintaining emergency response kits or bags and other items deemed necessary by the Contractor and County. Appropriate AED devices shall be provided and maintained by the County. Treatment will consist of stabilization and referral to a personal physician or local hospital. The medical director and health administrator shall be on-call 24 hours per day.

AA. MEDICAL OBSERVATION UNIT

The contractor shall operate a medical observation unit. This unit has one negative pressure room. A separate inpatient record (or separate section in the patient’s ambulatory care record) is to be created upon an inmate’s admission to the unit. RN coverage shall be adequate to care for inmates admitted to the unit. In certain unique circumstances, jail staff may house people in this unit who do not have medical problems

(e.g. high profile individuals). Upon rare occasions, KCSD will house a person requiring significant medical care. While these instances are few, these individuals must be provided the standard of care that needs community and applicable corrections standards.

In these extraordinary cases, KCSD will partner with the medical vendor by allowing the vendor to contract C.N.A.s or hospice staff to provide the appropriate additional care.

BB. ORAL CARE

The contractor must provide dental services that comply with NCCHC standards (J-E-

06). They at a minimum will include:

• Oral screening by a dentist or qualified health care professional trained by a dentist within fourteen (14) days or sooner, of booking;

• Dental treatment not limited to fillings and extractions provided upon clinical indications;

• Oral treatment includes the full range of services that in the supervising dentist's judgment are necessary for maintaining the patient's health;

• Prevention of dental disease and oral hygiene education provided within one (1) month of booking;

• Referral to a dental specialist as needed;

• Provision for emergency care;

• Provision of all dental prosthetics and lab services; and

• Provision of maxillofacial surgery services, when indicated.

There is an on-site dental facility at the KCSD Pretrial Facility.

CC. ANCILLARY SERVICES

The contractor shall utilize on-site facility ancillary services to their fullest extent. The county shall be responsible for the cost of all on-site and off-site laboratory, x-ray, and other diagnostic services as required, indicated, and ordered by the contractor or outside specialist from contractor referrals. The contractor shall arrange for regular laboratory, x-ray, ultra-sound, and EKG services. The contractor shall have a contract with a certified laboratory to perform lab services.

A clinician shall review all laboratory results within 24-48 hours after receipt of test results to assess the follow-up care indicated and to screen for discrepancies between the clinical observations and laboratory results. The clinician on-call will be notified immediately of all STAT reports as well as all critically abnormal results. A list of critically abnormal lab values will be available for healthcare staff reference at all times.

All routine X-rays shall be provided by the contractor on-site at the facility by utilizing mobile X-ray services. X-rays shall be read by a Board Certified or eligible radiologist and taken by a registered technician. Abnormal X-ray results shall be called or faxed to the healthcare staff and relayed to the clinician in-house or on-call immediately for disposition. The contractor shall ensure that all results are reported to the institution and placed in the medical record within twenty-four hours.

DD. THERAPEUTIC DIET PROGRAM

The contractor will monitor and make recommendations for inmates concerning therapeutic diets. A registered or licensed dietitian contracted to the County evaluates regular and therapeutic diets for nutritional analysis annually. Current food services are provided by the County at the respective facilities. For further information regarding the therapeutic diet program during the contract, contractors may call the Food Services

Manager. Protein or nutritional supplements ordered by the contractor are the fiscal responsibility of the County.

EE. PHARMACY SERVICES

The county is currently in a contract for pharmacy services. The cost of all medications shall be borne by the county.

The contractor shall work in coordination and cooperation with the contracted pharmacy service and KCSD to ensure that the pharmacy services received comply with all applicable state and federal regulations, NCCHC and ACA standards, and contractor and

KCSD requisites regarding prescribing, dispensing, administering, procuring, and storing pharmaceuticals.

Prescriptions are to be provided in unit doses and are received within 24 hours after they are ordered. The contractor, if using a remote pharmacy, will have an agreement with a local pharmacy to provide emergency orders.

The contractor shall establish and maintain procedures that allow for delivery six days a week. There is a “keep on person” medication policy for certain prescriptions and certain inmates. Medications may be administered by personnel as required by law and consistent with their scope of practice.

The contractor shall maintain starter doses of medications, which, if not readily available, could compromise the inmate's health status. Additionally, the contractor will ensure that all inmates have access to their prescribed medications, whether in a facility, on work detail, in court, or transport.

The contractor shall provide routine reporting to KCSD regarding pharmacy interaction.

The contractor shall provide oversight of the pharmacy operation with a minimum of quarterly consultant pharmacy visits and written reviews by a registered pharmacist at all sites.

The contractor shall include a medication administration record to include all information contained on the prescription label and the name of the practitioner who prescribed the medication. Every dose of medication shall be recorded on this record, with the time administered and the name or initials of the person who administered the dosage. The medication record shall have an individual acknowledgment for each dose per the EMR system setup.

The contractor is strongly encouraged to use liquid psychotropic medications, if possible, on patients who have a history of violence and non-compliance with medication policies.

The contractor shall supply a limited supply of continuing medication for released inmates.

Pharmacy services shall include the availability to support a full Medication-Assisted

Treatment (MAT) program for opioid addiction, including but not limited to Methadone, buprenorphine, and naloxone.

The contractor shall supply a list of their standard medication formulary with the proposal and liquid alternatives for inmates with swallowing issues, or a history of hoarding (palming or “cheeking”) medications and causing a jail security situation.

The contractor is expected to maintain all medications in a locked location. Any narcotics stored on-site are required to be inventoried by Health Services staff minimally once per shift preferably at shift exchange.

FF. MENTAL HEALTH

The contractor will be responsible for the provision of mental health counseling, and psychiatric services at all of the Sheriff’s Facilities.

The contractor will provide psychiatric services for inmates in all contracted facilities experiencing a crisis, psychosis, active or potentially suicidal ideation, depression, emotional/cognitive disorder, or other acute or chronic mental health issues.

Mental health services will consist of psychiatric and…