Addendum_No._2.pdf

1STATE OF CALIFORNIA — DEPARTMENT OF CORRECTIONS AND REHABILITATION EDMUND G. BROWN JR., GOVERNOR

DIVISION OF ADMINISTRATIVE SERVICES

OFFICE OF BUSINESS SERVICES

9838 Old Placerville Road Suite B-2 Sacramento, CA 95827

May 13, 2016

TO: PROSPECTIVE BIDDER

RE: INVITATION FOR BID (IFB) NUMBER 6000001895, ADDENDUM NUMBER 2

IFB package has been revised and a revised portion is enclosed. You may view or download a copy of the revised IFB document(s) by accessing the California State Contracts Register (CSCR) at www.caleprocure.ca.gov. The following corrections have been made to the IFB:

A. Revised Scope of Work (Exhibit A) to include the fire conservation camps, update language and include additional information.

B. Revised Rate Sheet (Exhibit B-1) is forthcoming in Addendum Number 3.

C. Revised List of Participating Worksites to include the fire conservation camps is forthcoming in

Addendum Number 3.

D. Letter of Inquiry questions have been answered, please see below:

1. Respiratory Protection Exam – Part A Questionnaire Review – Does this review apply to both CALOSHA 5199 Section 5144 (CDCR) OSHA Respirator Medical Evaluation Questionnaire and (CCHCS) Alternate Respirator Medical Evaluation Questionnaire?

Answer: Yes. Please see Items 1 and 2 under Rate Sheet, Exhibit B-1.

2. Rate Sheet item # 54 – the test description is “TB skin test” but the CPT code is for a Quantiferon Gold blood test.

a. Are you requesting PPD testing or blood testing?

Answer: PPD testing

b. Also, the CPT code is indicated as “x2”. Are you indicating a desire for 2 step TB testing?

Answer: Yes. Only for new employees who have not tested within 24 months.

c. If CDCR is requesting 2 step TB testing for new employees (only) in completing the pricing schedule does this imply the procedure cost for new employees or anyone else getting 2 step testing should be doubled when quoted (2 tests per one charge) or the quoted rate will be doubled for a complete examination (2 charges for one employee)?

Prospective Bidder

Answer: Quoted rate for a single test will be doubled for a complete 2 step examination. The submitted invoice shall document or identify tests associated with all new employees.

3. Rate Sheet item # 53 – Risk Assessment questionnaire

a. Who will be asked to complete the risk questionnaire, e.g., all employees, non-correctional employees?

Answer: TB Symptom Questionnaire - Everyone. Risk Assessment

Questionnaire - Prior TB negative employees.

b. How will the questionnaire be distributed? Paper? Online?

Answer: To be determined by the Office of Employee Health and Wellness.

c. If paper, is the contractor responsible for production, distribution, collection, record review and documentation?

Answer: To be determined by the Office of Employee Health and Wellness.

d. If online, is the contractor responsible for providing the online system?

Answer: No.

e. If not online, may the contractor provide an online system?

Answer: N/A

4. Rate Sheet item #55 – Laboratory services

a. Is the rate requested the percentage markup rate as described on p.21 of Exhibit A?

Answer: Yes; cost plus 20%.

b. If the quoted rate is the percentage markup, how does this rate affect the total and average procedure cost?

Answer: Cost plus 20% per item. Total and average are identified services.

The cost plus 20% applies to those not identified on rate sheet.

c. Will CDCR consider including emergency services such as varicella titer on a weekend in this category? There are instances where the only way to get a titer drawn in the needed timeframe for a varicella exposure is at a hospital, where pricing can be 10-15 times more expensive than pricing through the provider network.

Answer: Yes, on as needed basis.

5. Rate Sheet items #63-68 – are we correct in assuming that the rate should be quoted on a per tablet (per unit dose) basis? For example, if one tablet costs $1.00 and two tablets are required, is the correct rate $1.00 or $2.00?

Answer: Cost is on a per tablet basis.

6. Rate sheet #70 – post-exposure assessment – Since post exposure assessment service is variable and can include many employee interviews as well as significant interaction with public health officials and CDCR/CCHCS managers, is the rate defined as a per person evaluation or a time-driven fee (per hour or other time interval)?

Answer: Time driven fee (hourly rate)

7. Rate Sheet item # 72 – mobilization fee

a. Does the mobilization rate apply to:

i. Scheduled TB and flu clinics?

ii. Follow-up TB and flu clinics?

iii. Added TB clinics?

b. Please clarify what “ensure reasonable workload” means in this context. For example, does this mean that there will be a guaranteed minimum number of procedures paid for?

Answer: CDCR will communicate with the Contractor to provide the most up to date information on the incident to ensure the Contractor provides adequate staffing.

8. Rate Sheet item # 73 – TB screening and training

a. Please clarify the “screening” component of this service. How does this screening differ from the screening included in TB testing or symptom screening (rate sheet item #52)?

Answer: #52 is the TB symptom questionnaire. #73 is the TB risk questionnaire.

b. Is this training generally provided at the time of TB test administration/evaluation?

Answer: Yes.

c. Has this service component historically been included as part of the TB testing service? If yes, is there a specific change in approach that led to the establishment of this separate fee?

Answer: Yes. Yes, all staff will complete symptom questionnaire while TB risk assessment will not be administered to all employees.

9. Bid Submittal checklist – for the purposes of submission, is CDCR requesting the pocket license for the physician professional corporation applicant only or does CDCR expect a copy of the pocket license for each subcontracted clinical provider to be included with the bid?

Answer: The Contractor shall possess and maintain throughout the term of this agreement all licenses, permits or certificates required by the State of California to perform these services.

The Contractor shall provide the licensing information for the contractor and subcontractor(s) by submitting the Licensing Compliance Summary to CDCR/CCHCS. The Licensing Compliance Summary shall be made part of the Agreement as Exhibit H, Licensing Compliance Summary.

10. We note there is no rate request for respirator fit testing, either quantitative or qualitative.

a. Is provision of qualitative fit testing no longer needed?

Answer: No – please refer to Exhibit B-1, Rate Sheet, Item No. 77.

b. If an institution requests quantitative fit testing (which can occur if the institution’s portacount is out for calibration or repair), does the contractor refer the institution back to CDCR or is this type of request subject to an emergency contract with the institution?

Answer: Refer back to the Office of Employee Wellness for approval.

11. Exhibit A, p. 18 states “The contractor must notify the local health department and the CDPH Licensing and Certification office with jurisdiction over the facility within one day of identifying any employee with suspected or confirmed active pulmonary disease.”

a. Since determination of active disease is typically made by referral to PCP or WC panel provider and results are reported to the return to work coordinator but not the contractor, at what point does the contractor’s responsibility for reporting begin?

Answer: The Contractor has no reporting responsibility. The Scope of Work, Exhibit A, has been updated to delete this language.

b. Since the contractor is only aware of positive symptom reporting and/or positive skin test, does the contractor report either of these conditions to the local health department and CDPH Licensing and Certification Office?

Answer: No

12. Exhibit A, p. 19 – Lockbox

a. Is this rate intended to be an annual rate or a rate that covers all three years of the contract?

Answer: Annual Rate as specified in Exhibit B-1, Rate Sheet, Addendum No. 2.

b. If the rate is for three years, what happens with a contract extension?

Answer: N/A – Annual Rate.

c. What are CDCR’s specifications for the lockbox, e.g., type of lock – combination or key, dimensions, physical characteristics such as materials used, ability to be hung or fastened to a surface? (Lockboxes range from $35 to $2,000.)

Answer: There isn’t any set type, gauge, make, etc. It’s up to the individual worksite as to what type of lockbox is needed. As long as they are secure, fit in the area and don’t obstruct any other job functions. Estimated lockbox purchase should be no more than $1,000.00 as specified in Exhibit B-1, Rate Sheet, Addendum No. 2.

d. Is contractor also responsible for installation of lockbox or just provision and maintenance?

Answer: Installation of the lockbox will be performed by the CDCR worksite. The Contractor will provide provision and maintain the lockboxes once installed.

e. Will contactor have unlimited access to the box for maintenance?

Answer: No. The Contractor will have access to the lockbox for maintenance/provisioning purposes during regular business hours (8 a.m.

to 5 p.m.) unless alternative arrangements are agreed to in writing with the individual worksite.

f. Is the cost of the medication to be placed in the box to be included in the fee or is the medicine paid for under a separate line item?

Answer: The medication is to be paid for under a separate line item cost.

Please see Rate Sheet, Exhibit B-1, Items #63-#68.

g. If the medication to be placed in the box is part of the fee, does the fee also need to cover replacement of expired medications or medications required for treatment?

Answer: N/A. Medication costs are not part of the fee.

h. If medication is included in this rate, what medication or medications and at what quantity should be included in the lockbox?

Answer: Medications are not part of the rate. Medications in the lockbox should be appropriate Post-Exposure Prophylaxis medical treatment for an occupational exposure to blood borne infectious diseases including HIV/AIDS, Hepatitis B. Dosage in the lockbox should be 3 separate complete dosages.

i. If CDCR changes the requested medications to reflect update treatment guidelines, how will the rate be adjusted?

Answer: Rate sheet would be adjusted to reflect new treatment guidelines.

j. Is the flat rate paid at the beginning of the contract period to cover installation, initial medication purchase and medication refresh/resupply?

Answer: No. Installation is done by CDCR. The initial medication purchase and the subsequent refresh/resupply are identified on Rate Sheet, Exhibit B-1.

k. How will the contractor be compensated for the volume of medicine needed for exposures, beyond the initial need to stock the lockbox and replace expired meds?

Answer: Initial lockbox medication and the refresh/resupply medications are on Rate Sheet, Exhibit B-1.

13. Exhibit A p. 1 indicates that a PLHCP (MD or NP/PA) must be onsite during any service provided.

a. Since immunizations and TB testing do not require the presence of a PLHCP, is this statement related to those services that require a PLHCP such as medical examinations?

b. Current guidelines allow MAs and LVNs to perform TB test placement and LVNs to perform TB test reading; does this continue to be accepted procedure?

14. Exhibit A, p. 16 TB testing

a. Is TB testing expected to take place only in January and February of each year?

Answer: No. TB testing in 2015 and 2016 ran from January to April.

b. Or, will the schedule be made between the contractor and the individual institution?

Answer: No. The schedule is developed between the Contractor and the CDCR Office of Employee Health.

c. Does the TB testing program include the fire camps?

d. If fire camps are included, please consider a separate rate for fire camp TB testing to accommodate the additional costs associated with significant travel and low volume as previously established.

Answer: This is not a question.

e. Or, do you anticipate maintaining the prior arrangement to augment the fees for fire camp TB testing?

Answer: N/A.

f. Will a makeup testing schedule be required?

15. Exhibit A, p.18 Bloodborne pathogen exposure

a. Given the 24/7 nature of the requirement, is the initial assessment telephonic?

b. Given that initial assessment may require testing and then additional medical consultation, will the contractor be responsible for additional consultation? If yes, is it expected that the contractor will charge a separate exposure follow up charge for each clinical encounter?

Answer: The Contractor would be responsible for additional consultation.

The Contractor will not charge a separate exposure follow-up charge.

c. Is the PLHCP medical assessment contained in procedure #74 or procedure # 69?

Answer: The PLHCP refers to Item #69 post exposure consultation.

d. Blood borne pathogen screening and training – Is this training provided at the time of an exposure or in a classroom setting?

Answer: At time of exposure.

e. If classroom setting, is it anticipated that the contractor will provide BBP training to all or many employees within an institution?

f. What is the expected duration of the training session?

g. If the contractor is expected to provide regular training sessions, what is the frequency of training sessions at each institution?

Answer: Contractor is not expected to provide regular training sessions.

The worksites complete their own BBP and TB training on an annual basis.

The Contractor will provide educational services at the time of service. The Contractor will not provide classroom style training, which is completed by

CDCR.

h. If bloodborne pathogen training will be provided to large groups of employees, can the training be combined with TB testing?

16. DMV Examination Report – Should the DMV form be MCSA5875 rather than DL51?

Answer: DL 51.

17. We need information on the following item under the IFB:

V. Bidder Responsibilities and The Bid Package - page 5 Note: 1. Any quantities listed on Exhibit B-1 are CDCR's estimates only and are offered as a basis for the comparison of bids. However, the Exhibit B-1 copies do not include any quantities.

Answer: No quantities are listed for the Staff Medical Monitoring Services and are not applicable to this IFB. The Basis of Award will be based on the Average Rate of services as specified in Exhibit B-1, Rate Sheet.

The deadline for submission of your bid has been extended from May 16, 2016 to May 23, 2016, and the time of the submission and opening will remain unchanged.

**Your bid package must include the revised Exhibit B-1, Rate Sheet, Addendum Number 3 which is forthcoming.**

If you submit a new bid, your first bid will be returned unopened. However, if you have already submitted a bid and you do not submit a new bid, your current bid shall remain in our files, unopened, until the new bid opening date.

We regret any inconvenience this may have caused. If you have any questions or need assistance from this office, please do not hesitate to contact me at (916) 255-6144.

Questions regarding the Cal eProcure internet site or downloading documents should be directed to the Fiscal Service Center, Vendor Management at 1-855-421-6355.

Sincerely, Maria Costa

MARIA COSTA

Contract Analyst Institution Contracts Section Contracts Management Branch

Enclosure

Bid Number 6000001895 California Department of Corrections and Rehabilitation (CDCR) Exhibit A Scope of Work Addendum Number 2

STAFF MEDICAL MONITORING SERVICES

1. INTRODUCTION/SERVICES

This is a Master Agreement in which the Contractor shall provide all labor, materials, supplies, equipment, licenses, permits and every other item of expense necessary to provide Staff Medical Monitoring Services on an as-needed basis for employees, volunteers, and other individuals referred by the California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS), in accordance with the institutions, fire conservation camps, facilities, parole offices, and programs listed in Exhibit F, List of Participating Worksites, hereafter referred to as Worksite.

The Contractor shall provide occupational medical services for the State as specified by the CDCR/CCHCS Occupational Health Coordinator (OHC)/Worksite Liaison or designee. The Contractor shall maintain direct communication with the CDCR/CCHCS OHC/Worksite Liaison or designee in regard to medical concerns relevant to public health issues. Results of all medical services shall be submitted electronically to the CDCR/CCHCS OHC/Worksite Liaison or designee, following the Guidelines for Submitting Electronic Files, Exhibit A-1, and a hardcopy of the results shall be provided to the individual employee(s) at the end of the evaluation.

Additional reporting forms are attached in Exhibit A-3(a), Sample Summary Report of Case Contact Investigation and Exhibit A-3(b), Sample Individual Evaluation form, to notify the Public Health Branch (PHB) for monthly routine reporting and weekly (and as requested) reporting for infection breakouts. Electronic files will be submitted weekly and summarized in a Microsoft Excel worksheet, as outlined in Exhibit A-1, Guidelines for Submitting Electronic Files, and in Exhibits A-2(a) through A-2(v), Sample Medical Evaluation Files (are provided as samples), via Compact Disk or a File Transfer Protocol website that is operated and uploaded by the Contractor, with unique access for each CDCR/CCHCS Worksite.

All office locations used to provide staff medical monitoring services under this Agreement must be located within a forty-five (45) mile radius from the Worksite(s), with an exception of an one-hundred (100) mile radius from Avenal State Prison, High Desert State Prison and California Correctional Center or the Contractor must have a fully equipped, mobile clinic, capable of providing all services included in this Agreement within 24-hours of telephonic notice from CDCR/CCHCS. Use of the mobile clinic in lieu of a medical office shall incur a site mobilization/travel fee of $500 for conservation camps and fire camps only. Mobile Clinics must meet all applicable Americans with Disabilities Act requirements and all applicable federal, state and local licensing requirements for each location where they are deployed. The Contractor shall provide services at the clinic and at CDCR/CCHCS Worksite(s) (on-site) as determined by the CDCR/CCHCS OHC/Worksite Liaison or designee.

The Contractor must maintain clinic hours of Monday through Friday, from 7:30 a.m. to 4:00 p.m.

and Saturday from 7:30 a.m. to 12:30 p.m. for CDCR/CCHCS staff that travel to the Contractor’s medical office. Services provided on-site will be scheduled to meet the operational needs of the worksite and may occur Monday through Friday, between 4:30 a.m. and midnight. The Physician or other Licensed Health Care Professional (PLHCP)must be available during clinic hours and at any time on-site services are being provided to include use of mobile clinics. The Contractor shall provide requested clinic services within 24-hours of telephone notification from the CDCR/CCHCS OHC/Worksite Liaison or designee. The Contract Manager shall work from an office located in the State of California.

Scope of Work Addendum Number 2

Services are to be performed in compliance with Title 8 of the California Code of Regulations

(CCR), Subchapter 7 (8CCR):

Subsection 5144, General Industrial Safety Orders for Respiratory Protection, Subsection 5198, General Industrial Safety Orders for Lead, Subsection 1532.1, Construction Safety Orders for Lead, Subsection 5208, General Industrial Safety Orders for Asbestos, Subsection 1529, Construction Safety Orders on Asbestos, Subsection 5192, General Industrial Safety Orders for Hazardous Substances, Subsection 5193, Bloodborne Pathogens, Subsection 5199, Aerosol Transmissible Diseases and, Subsection 5097 with Appendices B, C, D, & F, General Industrial Safety Orders for

Occupational Noise, Audiometric Testing Subsection 5206, General Industry Safety Orders for Chromium, Subsection 1532.2, Construction Safety Orders for Chromium, Subsection 5207, General Industry Safety Orders for Cadmium, Subsection 1532, Construction Safety Orders for Cadmium

Services are also to be performed in compliance with:

Penal Code 6006-6009, Annual Tuberculosis (TB) Testing, 49 Code of Federal Regulations 391.41-391.49, Physical Qualifications for Drivers and

Medical Examination Requirements, and California Vehicle Code 12517.2, Medical Examination Requirements

Title 22, Chapter 12, Correctional Treatment Centers Joint Commission For Accreditation of Health Care Organizations

Wherever Current Procedural Terminology (CPT) Codes are referenced in this document, they refer to the American Medical Association, “2010 - Current Procedural Terminology, Standard Edition”. An (*) asterisk next to the CPT code indicates a code from the “2015 - Current Procedural Terminology, Standard Edition”.

The Contractor must be able to perform the tasks associated with providing the above service(s) and assume full responsibility for services performed. The Contractor will perform services in accordance with state laws and regulations.

The State assumes no responsibility for any work commenced by the Contractor and will not reimburse the Contractor for any work performed prior to approval and scheduling by the CDCR/CCHCS OHC/Worksite Liaison or designee.

2. CONTRACT TERM AND EXTENSION

The initial term of this Agreement is for three (3) years. If it is determined to be in the best interest of the State, upon agreement between CDCR/CCHCS and the Contractor, the State may extend this Agreement for two (2), optional one (1) year terms.

3. LICENSES/PERMITS/CERTIFICATION REQUIREMENTS

Scope of Work Addendum Number 2

The Contractor shall possess and maintain throughout the term of this Agreement all licenses, permits or certificates required by the State of California to perform these services.

The Contractor shall provide the licensing information for the Contractor and subcontractor(s) by submitting the Licensing Compliance Summary to CDCR/CCHCS. The Licensing Compliance Summary shall be made part of the Agreement as Exhibit H, Licensing Compliance Summary.

A current Physician and Surgeon or other appropriate PLHCP License issued by the appropriate licensing board for the State of California, and must be good standing.

A current U.S Department of Health and Human Services Clinical Laboratory Improvement Amendments (CLIA) Certificate, appropriate for the level of patient testing performed.

A current California Department of Public Health Laboratory Field Services Clinical

Laboratory License or Registration, appropriate for the level of patient testing performed.

A valid Physician’s Pocket License.

If you are a Contractor located within the State of California, a business license from the city/county in which you are headquartered is necessary. However, if you are a corporation, a copy of your incorporation documents/letter from the Secretary of State’s Office can be submitted. If you are a Contractor outside the State of California, you must include a copy of your business license or incorporation papers from your respective state showing that your company is in good standing in that state.

The Contractor shall ensure that any subcontracted clinics providing services possess and maintain, throughout the term of this Agreement:

A current Physician and Surgeon or other appropriate PLHCP License issued by the appropriate licensing board for the State of California.

A current Physician and Surgeon or other appropriate PLHCP and must be in good standing with the appropriate licensing board for the State of California.

A current U.S. Department of Health and Human Services CLIA Certificate, appropriate for the level of patient testing performed.

Laboratory License or Registration, appropriate for the level of patient testing performed.

The Contractor shall ensure that any subcontracted laboratories providing services shall possess and maintain, throughout the term of this Agreement:

A current U.S. Department of Health and Human Services CLIA Certificate.

Laboratory License.

The Contractor shall ensure that all personnel responsible for providing clinical services and

Scope of Work Addendum Number 2 requested clinical evaluations shall be licensed, certified or permitted in California to conduct said clinical services and clinical evaluations. Chest Roentgenogram associated with asbestos exams shall be interpreted and classified by a Certified B-reader. Any technician who performs audiometric tests must be supervised by an audiologist, otolaryngologist or physician. Upon commencement of this Agreement, the Contractor shall provide the CDCR/CCHCS OHC/Worksite Liaison or designee with a copy of a valid license or certificate for each personnel providing services under this Agreement.

In the event any license(s), certification(s) and/or permit(s) expire at any time during the term of this Agreement, the Contractor agrees to provide the CDCR/CCHCS OHC/Worksite Liaison or designee with a copy of the renewed license(s) and/or permits within thirty (30) days following the expiration date. If, during the course of this Agreement, any of the licenses, permits, certification requirements as stated herein are found to be inactive or not in compliance, CDCR/CCHCS may immediately terminate this Agreement.

The Contractor shall possess and maintain throughout the term of this Agreement a current and valid license to do business in the State of California for the services being provided and shall obtain at the Contractor’s expense any and all necessary license(s), certificate(s) and permit(s), required by law for accomplishing any work required in connection with this Agreement.

4. CONTRACTOR DUTIES/RESPONSIBILITIES

The Contractor shall possess the necessary state and local licenses, registrations and certificates required to provide the requested contracted services.

The Contractor shall provide a type-written opinion electronically to the appropriate worksite, for each employee tested at no charge to the State, upon completion of an exam or other service.

These opinions should be form based and shall be provided for each individual receiving service.

If an individual receives multiple examinations, results of the multiple examinations may be included in a single opinion so long as all requirements of the applicable titles and subsections of the CCR are met.

The Contractor shall meet with the CDCR/CCHCS OHC/Worksite Liaison or designee as necessary to ensure efficient provision of services under this Agreement. Under the direction of the CDCR/CCHCS OHC/Worksite Liaison or designee, the Contractor and/or subcontractor shall provide Staff Medical Monitoring Services, within the scope of practice, for occupational medicine which shall include, but is not limited to the following:

a) Respiratory Protection – provide medical evaluation in accordance with the requirements of Title 8 of the CCR, Subsection 5144(e)(2)-(4)

Required tests:

A detailed work history and medical history in accordance with 8CCR5144 (e) (2) (B) with particular attention to past pulmonary stresses (occupational and non-occupational), personal habits (smoking, hygiene) and past gastrointestinal, hematological, renal, cardiovascular, reproduction and neurological problems (CPT 99202).

Follow-up medical examination for individuals who give a positive response to any question among questions 1 through 8 in Section 2, Part A of Appendix C to 8CCR5144, or whose

Scope of Work Addendum Number 2 initial medical examination demonstrates the need for a follow-up medical examination

(CPT 99204).

The Contractor shall provide a type-written opinion regarding the employee’s ability to use the respirator, signed by the PLHCP with the following information:

Type of respirator the employee is capable of wearing

Any limitations on respirator use related to a medical condition of the employee, or relating to the workplace conditions in which the respirator will be used, including whether or not the employee is medically able to use the respirator;

The need, if any, for follow-up medical evaluation(s);

A statement that the PLHCP has provided the employee with a copy of the

PLHCP’s written recommendation; and

An electronic copy to the Worksite Liaison at the end of the evaluation (included in

CPT 99202/99204).

The Contractor shall:

1. Not reveal either in the type-written opinion, orally, or by any other means of communication with the employer examination findings, including laboratory results, or diagnoses unrelated to an employee's ability to wear a respirator; and

2. Advise the employee of any medical condition, occupational or non-occupational, which requires further medical examination or treatment.

Additional tests that may be deemed necessary during the physical exam:

If the examining appropriately licensed clinician deems additional test(s) are required, he/she must obtain written authorization from the CDCR/CCHCS OHC/Worksite Liaison or designee prior to administering the additional test(s). The written authorization serves as backup documentation for the invoices. See Exhibit A-2(v), Sample Medical Evaluation File, for a sample form. Additional tests/evaluations may include, but are not limited to:

Spirometry testing (CPT 94010).

Other evaluation (treadmill, pedal) as necessary to confirm an individual is capable to don a respirator in the performance of their duties.

b) Lead in Construction and/or Lead in General Industry - provide medical surveillance in accordance with the requirements of Title 8 of the CCR, Subsection 1532.1(j)(1)-(3) or Subsection 5198(j)(1)-(3) as requested by Worksite.

Scope of Work Addendum Number 2

A detailed work history and medical history with particular attention to past lead exposure (occupational and non-occupational), personal habits (smoking, hygiene), and past gastrointestinal, hematological, renal, cardiovascular, reproduction and neurological problems (CPT 99204).

A thorough physical examination with particular attention to teeth, gums, hematological, gastrointestinal, renal, cardiovascular, blood pressure measurements, physical measurements, and neurological systems. Pulmonary status should also be evaluated as respiratory protection will be used (included in CPT 99204).

Blood chemistry panel (CPT 80050), blood lead levels (CPT 83655), Complete Blood

Count (CBC) (includes hemoglobin, white blood count (WBC), and hematological determination) (CPT 85025), zinc protoporphyrin (CPT 84202), blood urea nitrogen (CPT 84520), and serum creatinine (CPT 82565).

Routine urinalysis with microscopic examination (CPT 81001).

The Contractor shall provide a type-written opinion regarding the employee’s ability to perform lead work, signed by the PLHCP with the following information:

Whether the employee has any detected medical condition which would place the employee at increased risk of material impairment of the employee’s health from exposure to lead;

Any recommended special protective measures to be provided to the employee, or limitations to be placed upon the employee’s exposure to lead;

Any recommended limitation upon the employee’s use of respirators, including a determination of whether the employee can wear a powered air-purifying respirator if the physician determines that the employee cannot wear a negative pressure respirator;

The results of the blood lead determinations;

PLHCP’s written recommendation; and an electronic copy to the CDCR/CCHCS OHC/Worksite Liaison or designee at the end of the evaluation (included in CPT 99204).

1. Not reveal either in the type-written opinion or orally, or by any other means of communication with the employer, findings, including laboratory results, or diagnoses unrelated to an employee's occupational exposure to lead; and

2. Advise the employee of any medical condition, occupational or non-occupational, which requires further medical examination or treatment.

Scope of Work Addendum Number 2

If the examining physician deems additional test(s) are required, he/she must obtain written authorization from the CDCR/CCHCS OHC/Worksite Liaison or designee prior to administering the additional test(s). The written authorization serves as backup documentation for invoices.

See Exhibit A-2(v), Sample Medical Evaluation File, for a sample form. Additional tests/evaluations may include, but are not limited to:

Spirometry testing (CPT 94010)

Resting electrocardiogram (EKG) (CPT 93000)

Exercise/Stress EKG (CPT 93015)

c) Asbestos Construction Standard and/or General Industry Standard for Asbestos -provide medical surveillance in accordance with the requirements of Title 8 of the CCR, Subsection 1529(m)(1)(B)-(2) or Subsection 5208(l)(2)-(3) as requested by Worksite.

A detailed work history and medical history with particular attention to past pulmonary stresses (occupational and non-occupational), personal habits (smoking, hygiene) and past gastrointestinal, hematological, renal, cardiovascular, reproduction and neurological problems (CPT 99204).

A thorough physical examination with particular attention to pulmonary functions, hematological, gastrointestinal, renal, blood pressure measurement, physical measurement, cardiovascular, and neurological problems (included in CPT 99204).

Chest Roentgenogram in accordance with 8CCR1529 (m) (2) (B) 3, Table 2 and/or

8CCR5208 (l) (3) (B), Table 2 and include (posterior-anterior 14X17 inches) (oblique projections; right and left sides). X-rays are to be interpreted by a Certified B reader (CPT 71030).

The Contractor shall provide a type-written opinion signed by the PLHCP and containing the results of the medical examination and shall include:

The physician's opinion as to whether the employee has any detected medical conditions that would place the employee at an increased risk of material health impairment from exposure to asbestos;

Any recommended limitations on the employee or on the use of personal protective equipment such as clothing or respirators;

A statement that the employee has been informed by the physician of the results of the medical examination and of any medical conditions that may result from asbestos exposure; and

A statement that the employee has been informed by the physician of the increased risk of lung cancer attributable to the combined effect of smoking and asbestos exposure (included in CPT 99204).

Scope of Work Addendum Number 2

PLHCP’s written recommendation and an electronic copy to the CDCR/CCHCS

1. Not reveal in the type-written opinion given to the employer specific findings or diagnoses unrelated to occupational exposure to asbestos; and

2. Advise the employee of any medical condition, which requires further medical examination or treatment.

authorization from the CDCR/CCHCS OHC/Worksite Liaison or designee prior to administering the additional test(s). The written authorization serves as backup documentation for the invoices as specified in Exhibit A-2(v), Sample Medical Evaluation File. Additional tests/evaluation may include, but are not limited to:

Resting EKG if Forced Vital Capacity (FVC) and Forced Expiratory Volume (FEV) (1.0) is below 70% (CPT 93000)

Exercise/stress EKG if FVC and FEV (1.0) is below 70% (CPT 93015)

d) Hazardous Waste Operations and Emergency Response – provide medical surveillance in accordance with Title 8 of the CCR, Subsection 5192(f)(4).

A detailed work history with post pulmonary stresses (occupational and non-occupational), personal habits (smoking, hygiene) and past gastrointestinal, hematological, renal, cardiovascular, reproduction and neurological problems which may include occupational and general medical history (CPT 99204).

A thorough physical fitness for “Hazmat” duty examination with particular attention to pulmonary functions, hematological, gastrointestinal, renal, blood pressure measurement, physical measurement, cardiovascular, and neurological problems and, to include the ability to wear any required personal protective equipment under conditions (e.g., temperature extremes) that may be expected at the Worksite (included in CPT 99204).

The Contractor shall provide a type-written opinion signed by the Physician and containing the results of the medical examination and shall include:

Whether the employee has any detected medical conditions that would place the employee at an increased risk of material health impairment from work in hazardous waste operations or emergency response, or from respirator use;

Scope of Work Addendum Number 2

The physician’s recommended limitations upon the employee’s assigned work;

A statement that the employee has been informed by the physician of the results of the medical examination and any medical conditions which require further examination or treatment;

PLHCP’s written recommendation and an electronic copy to the CDCR/CCHCS

1. Not reveal in the type-written opinion given to the employer specific findings or diagnoses unrelated to occupational exposure to hazardous waste; and

2. Advise the employee of any medical condition, which requires further medical examination or treatment.

the additional test(s). The written authorization serves as backup documentation for the invoices. See Exhibit A-2(v), Sample Medical Evaluation File, for a sample form. Additional tests/evaluation may include, but are not limited to:

Blood Chemistry Panel (CPT 80050)

Complete Blood Count (CBC) (CPT 85025)

e) Chromium in Construction and/or Chromium in General Industry - provide medical surveillance in accordance with the requirements of Title 8 of the CCR, Subsection 1532.2(i)(1)-(5) or Subsection 5206(k)(1)-(5) as requested by Worksite.

A medical and work history, with emphasis on past, present and anticipated future exposure to chromium (VI); any history of respiratory dysfunction; any history of asthma, dermatitis, skin ulceration, or nasal septum perforation; and smoking status and history

(CPT 99204).

A physical examination of the skin and respiratory tract (Included in CPT 99204).

The Contractor shall provide a type-written opinion signed by the PLHCP with the following information:

Scope of Work Addendum Number 2

Whether the employee has any detected medical condition(s) that would place the employee at increased risk of material impairment to health from further exposure to chromium (VI);

Any recommended limitations upon the employee’s exposure to chromium (VI) or upon the use of personal protective equipment such as respirators;

A statement that the PLHCP has explained to the employee the results of the medical examination, including any medical conditions related to chromium (VI) exposure that require further evaluation or treatment, and any special provisions for use of protective clothing or equipment;

The Contractor shall provide a copy of the type-written opinion to the employee; and

PLHCP’s written recommendation; and an electronic copy to the CDCR/CCHCS

1. Not reveal to the employer specific findings or diagnoses unrelated to occupational exposure to chromium.

2. Advise the employee of any medical condition, which requires further medical examination or treatment.

the additional test(s). The written authorization serves as backup documentation for the invoices. See Exhibit A-2(v), Sample Medical Evaluation File, for a sample form.

f) Cadmium in Construction and/or Cadmium in General Industry - provide medical surveillance in accordance with the requirements of Title 8 of the CCR, Subsection 1532(l)(1)-(16) or Subsection 5207(l) as requested by Worksite.

Initial Examination (preplacement):

A detailed medical and work history, with emphasis on past, present, and anticipated future exposure to cadmium; any history or renal, cardiovascular, respiratory, hematopoietic, reproduction, and/or musculo-skeletal system dysfunction; current usage of medication with potential nephrotoxic side-effects; and smoking history and current status (CPT

Biological monitoring as required in Title 8 of the CCR, Subsection 5207(l)(2)(B)(2) Biological monitoring that includes the following tests:

Scope of Work Addendum Number 2

Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr) (CPT 82300), Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendices F and M, standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendix F (CPT 82232); and

Cadmium in blood (CdB), standardized to liters of whole blood (lwb) (CPT 82300).

Periodic Medical Surveillance:

A detailed medical and work history or update thereof, with emphasis on past, present and anticipated future exposure to cadmium; smoking history and current status;

reproductive history; current use of medications with potential nephrotoxic site-effects;

any history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction; and as part of the medical and work history, for employees who wear respirators, questions 3-11 and 25-31 in Appendix D of Title 8 of the CCR, Subsection

5207 (CPT 99204);

A complete physical examination with emphasis on blood pressure, the respiratory system, and the urinary system (CPT 99204);

A 14 inch by 17 inch, or a reasonably standard sized posterior-anterior chest X-ray (CPT 71010);

Pulmonary function tests, including FVC and FEV at 1 second (FEV1)(CPT 94010);

Biological monitoring, as required in Title 8 of the CCR, Subsection 5207(l)(2)(B)(2);

a. Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr) (CPT 82300)

b. Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendices F and M, standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendix F (CPT 82232); and

c. Cadmium in blood (CdB), standardized to liters of whole blood (lwb) (CPT 82300).

Blood analysis, in addition to the analysis required under Subsection 5207(l)(2)(B)(2), including blood urea nitrogen (CPT 84520), complete blood count (CPT 85025), and serum creatinine (CPT 82565);

Urinalysis, in addition to the analysis required under Subsection 5207(l)(2)(B)(2), including the determination of albumin, glucose (and total and low molecular weight proteins) (CPT 81000); and

For males over 40 years old, prostate palpation or other at least as effective diagnostic test(s) (included in CPT 99204).

Examination for Respirator Use:

1. A detailed medical and work history, or update thereof, with emphasis on past exposure to cadmium; smoking history and current status; and history of renal, cardiovascular, respiratory, hematopoietic, and/or musculo-skeletal system dysfunction; a description of

Scope of Work Addendum Number 2 the job for which the respirator is required; and questions 3-11 and 25-31 in Appendix D of Title 8 of the CCR, Subsection 5207 (CPT 99204);

2. A blood pressure test (included in CPT 99204);

3. Biological monitoring, as required in Title 8 of the CCR, Subsection 5207(l)(2)(B)(2);

Cadmium in urine (CdU), standardized to grams of creatinine (g/Cr) (CPT 82300)

Beta-2 microglobulin in urine (ß2 -M), standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendices F and M, standardized to grams of creatinine (g/Cr), with pH specified, as described in Appendix F (CPT 82232); and

Cadmium in blood (CdB), standardized to liters of whole blood (lwb) (CPT 82300).

The Contractor shall provide a type-written opinion signed by the PLHCP with the following information:

1. The physician’s diagnosis for the employee;

2. The physician’s opinion as to whether the employee has any detected medical condition(s) that would place the employee at increased risk of material health issues from further exposure to cadmium, including any indications of potential cadmium toxicity;

3. The results of any biological or other testing or related evaluations that directly assess the employee’s absorption of cadmium;

4. Any recommended removal from, or limitation on the activities or duties of the employee or on the employee’s use of personal protective equipment, such as respirators;

5. A statement that the physician has clearly and carefully explained to the employee the results of the medical examination, including all biological monitoring results and any medical conditions related to cadmium exposure that require further evaluation or treatment, and any limitation on the employee’s diet or use of medications;

6. The Contractor will provide a copy of the type-written opinion to the employee; and

7. A statement that the PLHCP has provided the employee with a copy of the PLHCP’s written recommendation and an electronic copy to the CDCR/CCHCS OHC/Worksite Liaison or designee at the end of the evaluation (included in CPT 99204).

Not reveal to the employer specific findings or diagnoses unrelated to occupational exposure to cadmium.

Advise the employee of any medical condition, which requires further medical examination or treatment.

Scope of Work Addendum Number 2 authorization from the CDCR/CCHCS OHC/Worksite Liaison or designee prior to administering the additional test(s). The written authorization serves as backup documentation for the invoices. See Exhibit A-2(v), Sample Medical Evaluation File, for a sample form.

g) Hearing Conservation - Audiogram Medical Evaluation in accordance with Title 8 of the CCR, Subsection 5097(c)(3) (f) and Appendices B, C, D, & F

The Contractor shall ensure audiometric tests shall be performed by a licensed or certified audiologist, otolaryngologist or other physician, or by a technician who is certified by the Council of Accreditation in Occupational Hearing Conservation or who has satisfactorily demonstrated competence in administering audiometric examinations, obtaining valid audiograms, and properly using, maintaining and checking calibration and proper function of the audiometer being used. A technician who performs audiometric tests must be supervised by an audiologist, otolaryngologist or physician.

Testing to establish a baseline or perform annual audiogram. Compare annual audiograms to employee’s baseline audiogram to determine if a standard threshold shift (STS) as defined in 8CCR5097, (d)(8) has occurred (CPT 92552).

Audiometric Test Requirements: tests shall be pure tone, air condition, hearing threshold examinations, with frequencies included as a minimum 500, 1000, 2000, 3000 or 4000, and 6000 Hz. Tests at each frequency shall be taken separately for each ear (included in CPT 92552).

Audiometric test shall be conducted with audiometers (including microprocessor audiometers) that meet specifications of, and are maintained and used in accordance with

ANSI S3.6-1969.

Pulsed-tone and self-recording audiometers, if used shall meet the requirements specified in 8CCR5097, Appendix B, Audiometric Measuring Instruments.

Audiometer examinations shall be administered in a room meeting the requirements listed in 8CCR5097, Appendix C, Audiometer Test Rooms.

The Contractor shall provide a type-written opinion signed by the Physician and containing the results of the audiometric test(s) and shall identify:

1. When a significant shift in an individual’s hearing is noted, provide a written physician’s opinion stating if the comparison of the annual audiogram against the baseline audiogram represents a STS;

2. Whether the STS is not work related or aggravated by occupational noise exposure;

3. If additional assessment of the employee is recommended;

4. Attach audiometric test results which include the following: date of the audiogram, examiner’s name, and the date of the last acoustic or exhaustive calibration of the audiometer to the written physician’s opinion;

5. The Contractor will provide a copy of the type-written opinion to the employee; and

Scope of Work Addendum Number 2

6. A statement that the PLHCP has provided the employee with a copy of the PLHCP’s written recommendation; and an electronic copy to the Worksite Liaison at the end of the evaluation (included in CPT 99204).

1. Not reveal to the employer specific findings or diagnoses unrelated to the results of the audiogram.

2. Advise the employee of any medical condition, which requires further medical examination or treatment.

h) California Commercial Drivers Examination - Provide medical examination in accordance with the requirements of Title 49 of the Code of Federal Regulations, Subsections 391.41-391.49 and California Vehicle Code, Section 12517.2 as requested by Worksite.

A health history and physical examination including visual acuity, hearing, blood pressure, pulse rate, etc., and answer each question “yes” or “no” recording numerical readings where indicated on the California Department of Motor Vehicles form DL 51 (Medical Examination Report For Commercial Driver Fitness Determination) (CPT 99204).

Urinalysis (CPT 81000).

Complete, sign, and return to employee the DL 51.

Not return the original or copy of DL 51 to the CDCR/CCHCS.

the additional test(s). The written authorization serves as backup documentation for the invoices. See Exhibit A-2(v), Sample Medical Evaluation File, for a sample form. Additional tests/evaluation may include, but are not limited to:

Audiogram (CPT 92552).

i) Aerosol Transmissible Diseases (ATD) – provide the following medical services in accordance with Title 8 of the CCR, Subsection 5199(h) and applicable public health guidelines

The Contractor’s PLHCP will conduct assessment/evaluation after a known or suspected exposure to an ATD (such as TB, chickenpox, measles, etc.) (CPT 99204) to determine if:

The employee has:

Scope of Work Addendum Number 2

Significant exposure;

Contracted the disease;

Determine what the infectious period is/was;

The need for medical treatment and/or precautionary removal from the workplace;

or If the employee(s) are not expected to develop the disease (the exposure was not significant, the employee has adequate evidence of immunity (e.g., have been previously vaccinated or had the disease and are expected to be immune).

The assessment/evaluation shall include a thorough physical examination with a signed type-written PLHCP’s opinion including the diagnosis, impression, and treatment recommendation in accordance with Title 8 of the CCR, Subsection 5199,…