Attachment 12 - Medical Services for Non-IHSC Facilities 2026_7.16.26.pdf

Article 6. Medical Services for Non-IHSC Facilities This document defines requirements for medical services provided by the Service Provider at facilities where ICE

Health Service Corps (IHSC) is not the provider of medical services. All policies and attachments referenced below will be provided at request.

Table of Contents

1.0. Health Services Overview

1.1. Health and Medical Care Policies

1.2. Medical Space Requirements

1.3. Environmental Health

1.4. Health and Safety

1.5. Certified/ Licensed Health Care Personnel

1.6. Medical Service Provider Employee Health Records

1.7. Medical Care Expenses and Reimbursement

2.0. Standards of Medical Care

2.1. Evidence-based Standards of Medical Care

2.2. Credentialing Requirements:

2.3. Basic Life Support (BLS) Certification, Medical Emergency Response, and Suicide Prevention

2.4. Serious Medical Conditions

2.5 Notification Requirements for Medical Conditions that Render Continued Detention Unacceptable

2.6. Serious Mental Disorders or Conditions/Serious Mental Illness (SMI)

2.7. SMI Training

3.0. Specialized Behavioral Health Unit and Programming

4.0. Off-site Medical Care and Reimbursement

4.1. Prescription Drug Reimbursement

5.0. Emergency Medical Services

5.1. Emergency Health Care Contact List

5.2. Facility Emergency Evacuation Procedure Guide

6.0. Hospitalization of Detainees

7.0. Detainee Death Management and Reporting

8.0. Facility Requirements for Infectious Disease Prevention, Management, and Screening

9.0. Quality Assurance (QA) Program

10.0. Immediate Jeopardy

11.0. Uniformed Corrective Actions Plans

12.0. Detainee Reporting Requirements

13.0. Health Records Requests and Physical Access

13.1. Detainee Medical Records

14.0. Electronic Health Record (EHR) Requirement

A. Health Services Overview

The Service Provider is responsible for providing all medical services for this contract.

The Service Provider shall furnish 24/7 on-site health care under this agreement as defined by the Facility Local Health Authority (usually the Health Administrator) and as approved by the ICE Health Authority on the effective date of this agreement. The Service Provider shall not charge any ICE detainee a fee or co-payment for medical services or treatment provided at the facility. In accordance with 18 USC § 4006(b)(1), the contractor shall not charge the government more than would be paid “for the provision of similar health care items and services under the Medicare program under title XVIII of the Social Security Act.” The Service Provider shall ensure that ICE detainees receive no lower level of onsite medical care and services than those spelled out in the current applicable ICE detention standards or any modified version of it published by ICE and based on community standards of care.

Facility Care Levels are based on the level of care required by ICE. The definition for all Facility Care Levels and Baseline Clinical Capabilities requirements will be provided by ICE/ERO/IHSC. Facilities with a bed capacity greater than 2,000 shall, at a minimum, meet Facility Care Level 3 requirements and provide Baseline Clinical Capabilities. As designated by ICE ERO/IHSC, the Service Provider will ensure adequate medical and behavioral health staff, to include staff to provide direct patient care as well as support staff, as well as facilities and equipment to provide the following services at a minimum:

a. Facility Care Level 4: Facilities at this level shall provide medical management for individuals with complex, chronic medical and mental health conditions that require frequent clinical interactions to maintain control or stability of the condition, including assistance with activities of daily living (e.g., feeding, toileting, bathing, and hygiene). Such facilities are intended to prevent hospitalization or further medical complications.

Baseline Behavioral Health Capabilities include infirmary beds for medical and mental health care, 24-hour onsite registered nurse coverage, enhanced mental health services, and suicide precaution rooms. The facility shall be capable of managing detainees who are considered high priority or high risk, including detainees with severe functional impairment and a significant population of detainees with serious mental illness.

b. Facility Care level 3: Facilities at this level shall provide medical management for stable patients who are suitable for outpatient care, but require regular clinical interventions and clinician evaluations at intervals ranging from monthly to every three months. These facilities shall have access to enhanced medical resources, including consultations with specialty services provided by medical specialists in the local community. May also require more than monthly clinical interactions for those with SMI.

c. Facility Care Level 2: Facilities at this level shall provide medical management for stable chronic conditions across all age groups (e.g., diabetes, hypertension, asthma).

d. Facility Care Level 1: Facilities at this level shall provide medical management for detainees under 60 years of age who are otherwise healthy.

The Service Provider shall be responsible for providing both culturally competent and trauma-informed health care services for all ICE detainees at the facility, in accordance with applicable ICE detention standards, American Correctional Association (ACA), and any other accreditation standards, which refers to formal certification by authorized organizations confirming compliance with established health care service standards that are in place at the time of award of this contract or incorporated through modification.

The Service Provider shall ensure detainees have access to medical services, preferably on-site or via telehealth, with minimal wait times for community providers appointments. Telehealth shall not be utilized for daily mental health treatment for patients on suicide watch, nor shall tele-behavioral health be used to remove or change suicide precautions. All mental health providers shall possess the highest-level of independent clinical certification and/or license in their profession within the state where the provider is practicing, except as otherwise provided herein.

Services provided shall include, but are not limited to: intake screening; infectious disease screening and treatment;

emergent, urgent, acute, chronic, and emergency care; on-site sick call; treatment of minor injuries; treatment of special needs; provision of mental health services; dental services, including dental health assessments;

participation in compliance, quality improvement and risk management activities; and provision of over-the-counter and prescription medications:

a. On-site health care personnel shall perform an initial medical screening within twelve (12) hours of arrival at the facility. Each detainee shall be afforded the opportunity to shower and shall be issued clean clothing, bedding, towels, and personal hygiene items. Intake screening shall include, at a minimum, testing for tuberculosis (TB) infection and/or disease, and the elicitation and recording of past and present medical history (mental and physical, dental, pregnancy, lactation or post-partum status, history of substance abuse, screening questions for other infectious disease, and current health status including any physical, mental, or intellectual/developmental disabilities or impairments):

1) The Service Provider shall elicit a medical history and provide recommended vaccinations for ICE detainees pursuant to Centers for Disease Control and Prevention (CDC) and the Advisory Committee for Immunization Practices (ACIP) or state health department recommendations. This requirement applies, at a minimum, to populations at highest risk (e.g., individuals with diabetes, HIV, cancer, seizure disorder, heart disease, asthma, chronic lung diseases, chronic liver diseases, and over the age of fifty (50), pregnant females, and other special populations), as well as those necessary to address pandemic events in accordance with ICE guidance and CDC recommendations.

2) Measurement of height, weight, and a complete set of vital signs (blood pressure, pulse, respiration, and temperature) shall be completed during initial screening. Blood sugar, peak flow, and pulse oximetry readings shall be obtained as clinically indicated based on diagnosis or medical concerns exhibited or verbalized by the detainee and observed by the medical provider. Detainees affirming medical concerns or who have abnormal results shall be referred for evaluation to a qualified, licensed health care practitioner as soon as possible, but no later than two (2) calendar days.

3) Pregnancy testing shall be conducted during initial screening for all female detainees/residents ages ten

(10) to fifty-six (56). The Field Operations Director (FOD) shall be notified immediately regarding females determined to be pregnant, no later than seventy-two (72) hours after such determination. The Field Medical Coordinator (FMC) and other IHSC personnel shall coordinate with the Assistant FOD and/or FOD to ensure facility staff are aware of these notification requirements pursuant to ICE Directive 11032.4: Identification and Monitoring of Pregnant, Postpartum, or Nursing Individuals.

b. A comprehensive health assessment, including a history and physical examination, shall be completed within fourteen (14) days of detainee arrival, unless clinical circumstances dictate an earlier evaluation. Detainees with chronic medical, dental, and/or mental health conditions shall receive prescribed treatment and follow-up care with the appropriate level of provider, in accordance with ICE detention standards, ACA, and/or any other accreditation standards, which refers to formal certification by authorized organizations confirming compliance with established health care service standards.

c. The Service Provider shall utilize IHSC-developed screening tools including, intake screening, comprehensive health assessment (i.e., fourteen-day (14) physical examination), Mental Health Assessment, or equivalent:

1) The Service Provider shall offer the following discretionary mental health screening tools to direct patient care providers: Columbia-Suicide Severity Rating Scale (C-SSRS), Patient Health Questionnaire (PHQ)- 9, General Anxiety Disorder (GAD)-7, Mini Montreal Cognitive Assessment (MoCA), full MoCA, and World Health Organization (WHO) Disability Assessment. Additional evidence-based screening tools may be used at the Service Provider’s discretion;

2) The Service Provider shall add a data-field to relevant screening and assessment forms indicating that a qualified mental health provider (QMHP) has reviewed available medical records and shall document which records specifically have been reviewed;

3) Within the electronic health record (EHR), the Service Provider shall implement a built-in prompt, or equivalent, to auto-refer a detainee for a Mental Health Assessment following a positive intake screening or comprehensive health assessment;

4) Service Providers operating in Arizona, California, and Washington, shall add an EHR data field requiring the QMHP to indicate whether the detainee meets designated medical criteria (see section, Serious Mental Illness) after each mental health visit. If the QMHP determines the non-citizen does not meet the designated medical criteria, the QMHP will document the rationale.

d. The Service Provider shall ensure that its healthcare system and personnel solicit and triage detainees’ requests for healthcare (sick call) daily. The Service Provider shall track these requests through a written system of accountability and document them within the health record. Care shall be delivered in accordance with current ICE detention standards, ACA and any other accreditation standards, which refers to formal certification by authorized organizations confirming compliance with established health care service standards.

e. Upon receipt of an authorization to transfer a detainee from ICE ERO to another facility, the medical provider shall prepare and provide a Medical Transfer Summary or equivalent form, that includes at minimum: current medications, current diagnoses, scheduled and/or medically indicated appointments and consultations (to include any referred community specialty care appointments), and medical equipment for continuity of care (IHSC Form 849) (available by request).

1) Transporting Officer: The transporting officer shall review the Medical Transfer Summary, or equivalent form for completeness and to ensure he or she has the supplies required to provide any indicated in-transit care. The transporting officer is responsible for delivering the Medical Transfer Summary or equivalent to the medical provider at the receiving facility and shall advise them of any medical interventions provided to the detainee in transit. For any patient with a mobility or communication impairment, IHSC Form 819 should be attached to the medical transfer summary.

f. The facility mental health program shall include appropriate group counseling, individual talk therapy, peer-support groups, and psychiatric services to meet the needs of the population. The facility will provide adequate spacing for group counseling and other behavioral health groups. The Service Provider shall furnish mental health evaluations as determined by the Facility Local Health Authority and in accordance with the current applicable ICE detention standards, ACA and/or any other accreditation standards, which refers to formal certification by authorized organizations confirming compliance with established health care service standards. The FMC and Behavioral Health Case Manager (BHCM) will review policies as a part of the annual site visit to ensure the policies align with the detention standards and IHSC's expectations for optimal patient care and services.

The Service Provider is required to provide prescribed medications. The Service Provider may acquire these medications through an IHSC network pharmacy. Prescribed medications include formulary medications per the current IHSC Formulary and approved nonformulary medications (e.g., IHSC Form 943 or equivalent) (available by request). Formulary medications include approved vaccinations. All travel medications shall be provided per ICE policies. ICE only will cover costs associated with medications provided by network pharmacies.

g. In accordance with detention standards, the Service Provider may approve a list of nonprescription medications available to detainees outside of health services (e.g., sold in commissary). IHSC does not reimburse non-prescription medication services outside of health services.

A.1. Health and Medical Care Policies The Service Provider shall comply with written policies and procedures for appropriately addressing the health needs of detainees in ICE custody. Written policies and procedures shall include, but not be limited to, the following:

a. Policies and procedures for prompt summoning of emergency medical personnel;

b. Policies and procedures for evacuation of detainees, if deemed necessary by qualified medical personnel;

c. Policies, procedures, and post procedures for duty officers to ensure that medical emergencies are recognized and promptly attended to.

A.2. Medical Space Requirements The Service Provider shall provide adequate space for health services, to include office and support space within the medical clinic. The facility shall include sufficient space for services such as infectious disease screening and treatment; emergent, acute and chronic care; on-site sick call; medical unit housing (infirmary);

dental services; mental health services; an on-site pharmacy; case management for medical and mental health services, including quality management. Space provided shall be adequate to account for the needs of the full anticipated population. Medical storage space shall be inclusive of clean and dirty linen storage, biohazard storage, dedicated environmental health equipment and supply, and medical equipment (such as nursing equipment, medication carts, emergency response equipment.

Dedicated medical space shall be inclusive of holding areas to house detainees and support clinic traffic when medical care is not performed for mixed gender populations and security classifications.

Medical personnel shall have space available for secure storage of medical records. Spatial and equipment requirements for medical record storage rooms shall comply with the IHSC Design Standards.

A.3. Environmental Health The Service Provider shall implement all requirements of the environmental health and safety sections of the applicable standard in the health services areas, to include all areas where medical, dental, mental health, and intake medical screening services are performed. The Service Provider shall implement all general housekeeping and environmental cleaning and disinfection in all areas where medical, dental, mental health, and intake medical screening services are rendered, including routine and terminal cleaning of medical housing and medical isolation units based on 24/7/365 needs.

The Service Provider shall maintain uniform procedures for the safe handling and disposal of sharp objects to prevent injury and transmission of infectious diseases, especially the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV):

a. Inventory control shall maintain a perpetual inventory of sharp instruments (needles, syringes, scissors, etc.). Inventory shall be reconciled weekly by the Health Services Administrator (HSA) or designee;

b. Handling and used sharps shall be placed immediately, without removal of needles or replacement of covers, into the National Institute for Occupational Safety and Health (NIOSH)-approved biohazard containers;

c. Disposal containers shall be labeled “Infectious Waste” or with biohazard symbol. Sharps are disposed through a licensed commercial Service Provider in compliance with federal and local infectious and hazardous waste regulations;

d. In the event of accidental exposure, a written exposure-control plan shall be followed in all needle-stick incidents.

A.4. Health and Safety

The Service Provider shall comply with the requirements of the OSHA and all codes and regulations associated with 29 CFR 1910 and 1926. The Service Provider shall comply with all applicable laws, statutes, regulations, and codes. In the event there is more than one reference to a safety, health, or environment requirement in an applicable, law, standard, code, regulation, or ICE policy, the most stringent requirement shall apply.

A.5. Certified/ Licensed Health Care Personnel The Service Provider shall ensure that all healthcare personnel employed under this agreement to provide care to ICE detainees shall be licensed and/or certified as required by the State in which the designated facility covered under this agreement resides. At no time shall unlicensed, uncertified and/or inactive status health care personnel provide care to ICE detainees. The Service Provider shall ensure that all health care providers utilized for the care of ICE detainees are credentialed, to include: primary source verification, current licensure, certifications, and/or registrations within the State and/or City where they treat the detained population, and inquiry regarding sanctions or disciplinary actions (i.e., National Practitioner Data Bank).

A.5.1. Staffing Levels

The Service Provider shall have a staffing plan to effectively staff the facility in a safe and secure manner. The number, type, and distribution of health care personnel as described in the approved staffing plan shall be maintained throughout the term of the agreement. Written requests to change the number, type, or distribution of healthcare personnel shall be submitted to the Contracting

Officer (CO) and Contracting Officer’s Representative (COR) for approval prior to implementation and incorporation into this agreement.

Staffing levels shall not fall below a monthly average of 85% for each health care position and categories, including direct-care clinical health services personnel, and all other departments, calculated in the aggregate, as outlined in the approved staffing plan; however the various types of health services personnel must be adequate to provide medical and mental health care and achieve optimal health outcomes. The Service Provider shall retain, at a minimum, health care staffing levels as approved by IHSC at the time of implementation.

A.5.2. Key Personnel

The Contracting Officer (CO) shall provide written approval before any employee is assigned as key medical personnel to perform duties under this contract. The Service Provider shall have key personnel employed and available for duty before the Service Provider can begin contract performance. Any subsequent changes to key personnel shall meet these criteria and be approved in writing by the CO. The following are considered key personnel for the contract (position descriptions below): Health Services Administrator; Clinical Director; Nurse Manager, Behavioral Health Supervisor/Lead, Behavioral Health Providers, Psychiatrist, Psychiatric Nurse Practitioner/PA, and Behavioral Health Program Manager...

Health Services Administrator. The Health Services Administrator (HSA) shall have a minimum of an accredited bachelor’s degree in a health-related field of study (master's degree preferred). The HSA shall have three years of leadership experience, and two years management of programs and services experience. The HSA shall maintain the Basic Life Support (BLS) for Healthcare Providers certification through the American Heart Association and if the HSA holds a clinical license, it is their responsibility to fulfill the obligations of their licensing or certifying body to ensure continued status. This is an onsite full-time position.

Clinical Director. The Clinical Director shall have a Doctor of Medicine or Doctor of Osteopathic Medicine from a university in the United States or from a foreign medical school that provides education and medical knowledge equivalent to accredited schools in the United States or any of its territories as established by the National Committee on Foreign Medical Education and Accreditation and permanent certification by the Educational Commission for Foreign Medical Graduates. The Clinical Director shall have a minimum of six years’ post residency experience providing direct patient care as a board-eligible/certified physician in Family Medicine, Internal Medicine, Emergency Medicine, or Preventive Health as well as a minimum of three years’ experience in the provision of clinical supervision and leadership to other medical professionals and ancillary clinic staff. The Clinical Director shall maintain the current, full, and unrestricted licensure to practice medicine for the entirety of the employment term in the state in which the duty station is located. The Clinical Director shall also maintain the Basic Life Support (BLS) for Healthcare Providers certification through the American Heart Association. This is an onsite full-time position.

Nurse Manager. The Nurse Manager shall be, at minimum, a bachelor’s degree trained registered nurse (RN) and have current and documented professional licensure to be an RN. The Nurse Manager shall have a minimum of six years of professional nursing experience and shall also maintain the Basic Life Support (BLS) for Healthcare Providers certification through the American Heart Association as well as any professional credentials/certification appropriate to the job specialty. This is an onsite full-time position.

Behavioral Health Supervisor, Behavioral Health Program Manager, & Mental Health Providers. Mental Health Providers shall only consist of Psychiatrists, Psychiatric Advanced Practice Providers, Clinical/Counseling Psychologist, Licensed Clinical Social Workers (LCSWs), or Licensed Professional Clinical Counselors/Licensed Clinical Professional Counselors/Licensed Clinical Mental Health Counselors (LPC/LPCC/LCPC/LMHC/LCMHC) or equivalent. Clinical license shall be independent and unrestricted. Licensed Marriage and Family Therapists (LMFTs) are not acceptable for CDFs without detained families. Staff shall maintain appropriate licensure to conduct mental health evaluation, mental health and substance abuse treatment (i.e. psychotherapy

– individual or group; clinical counseling, etc.), mental health diagnosis, segregation monitoring, serious mental illness (SMI), monitoring, and assessing suicidality/homicidality risk, and suicide watch contacts. Mental Health Providers are onsite positions and shall adhere to staffing requirements.

The following key personnel shall not provide direct patient care at, or on behalf of, non- IHSC facilities or their personnel:

Field Medical Coordinators (FMC) Role & Core Functions Field Medical Coordinators (FMCs) are U.S. Public Health Service officers within ICE ERO field offices who serve as healthcare compliance officers and liaisons between ICE/IHSC and the non- IHSC health care staff at non-IHSC detention facilities that house ICE detainees.

1) Provides oversight and consultation regarding health care compliance and delivery of health care in accordance with ICE medical standards. Collaborates with other IHSC entities as needed (i.e., Behavioral Health Unit, Regional Clinical Directors);

2) Assists ICE and IHSC with the coordination of services and transfer of detainees as needed or warranted for continuity of care;

3) Performs case monitoring of hospitalized detainees and those with significant chronic health care needs based on daily updates, documents, and/or reports provided electronically by the vendor, or upon request as needed;

4) Gathers information and documents from the vendor for medical reviews, follow-up reports and investigations;

5) Conducts site visits annually, situationally/ad hoc, as needed at non-IHSC staffed detention facilities which house detainees in ICE custody to ensure compliance with ICE standards regarding health care;

6) Collaborates with other appropriate health officials to ensure continuity of care for detainees with significant health conditions upon release/removal; and

7) Oversees the adjudication process of requested medical services referrals entered into the Medical Payment Authorization Request (MedPAR) system.

Referral Coordinators (RC) Role & Core Functions Referral Coordinators (RCs) are contractors assigned to non-IHSC facilities who administratively process electronic medical referrals for off-site community specialty health services, in accordance with IHSC policies, protocols, and guidance.

1) Performing recordkeeping functions aligned with IHSC policy;

2) Tracking of appropriate follow up and completion of scheduled appointments;

3) Executing and completing reports to ensure referrals are transmitted to the TPA (third party administrator) correctly;

4) Serving as the liaison between IHSC, the requesting facility provider, and off-site community providers;

5) Scheduling of off-site community specialty consults and follow-up appointments;

6) Handling correspondence requiring authorization for payment of medical services;

7) Prepare, update, and maintain medical referral information and ensure accuracy of the information in the patient medical record;

8) Provides timely notices or reminders prior to each scheduled appointment where applicable and requests completed off-site community medical records for routing to appropriate clinical staff for review;

9) Assists with billing and claims resolution, including denied claims, as needed for off-site community providers;

10) Supports the off-site community provider enrollment process by initiating recruitment efforts and maintaining a reference of vendorized off-site community providers for appointment scheduling;

11) Contacts the off-site community provider to schedule appointment for specialty care based on IHSC provider referral and coordinates transport for off-site community medical appointments as needed; and

12) Coordinate receipt of needed durable medical equipment for patients in custody.

Behavioral Health Case Manager (BHCM) Role & Core Functions Behavioral Health Case Managers (BHCMs) are U.S. Public Health Service officers within ICE ERO field offices who serve as behavioral health compliance officers and liaisons between ICE ERO and IHSC, as well as the non-IHSC health care staff at non-IHSC detention facilities that house ICE detainees.

1) Provides oversight and consultation regarding behavioral health care compliance and delivery of behavioral health care in accordance with ICE behavioral health standards.

Collaborates with other IHSC entities as needed (i.e., Field Medical Coordinators);

2) Assists ICE and IHSC with the coordination of services and transfer of detainees as needed or warranted for continuity of care;

3) Performs case monitoring of hospitalized detainees and those with significant chronic behavioral health care needs based on daily updates, documents, and/or reports provided electronically by the vendor, or upon request as needed;

4) Gathers information and documents from the vendor for behavioral health reviews, follow-up reports and investigations;

5) Conducts site visits annually, situationally/ad hoc, as needed at non-IHSC staffed detention facilities which house detainees in ICE custody to ensure compliance with ICE standards regarding behavioral health care;

6) Collaborates with other appropriate health officials to ensure continuity of care for detainees with significant behavioral health conditions upon release/removal; and

7) Oversees the adjudication process of requested medical services referrals entered into the Medical Payment Authorization (MedPAR) system.

A.6. Medical Service Provider Employee Health Records

Employee health files for medical Service Provider personnel shall be maintained on-site in a locked cabinet or secured electronic files that are readily accessible. Health files shall be maintained in accordance with DHS and ICE Privacy Policies and the Privacy Act of 1974 and contain the following documents:

a. Initial and annual TB infection testing results;

b. Vaccination records including results, titers, and Immunization

c. Declination Form(s);

d. OSHA 301 Incident forms;

e. Blood borne pathogen exposure documentation;

f. Respirator medical clearance;

g. Respirator fit test results; and

h. Other employee health documents.

The following can be referenced for all OSHA regulations: https://www.osha.gov/law-regs.html

The Service Provider may initiate employment of an individual who has initiated or declined the required vaccines schedule prior to employment, and the individual hired may begin work on the contract if they meet all subsequent vaccine schedule requirements, including any State and/or Federal vaccination mandates until fully vaccinated.

All Service Provider medical personnel shall provide documentation regarding the following to the Health Services Administrator or designee:

a. Evidence of TB clearance within the last 12 months:

https://www.osha.gov/law-regs.html

1) Personnel shall complete acceptable TB infection testing and present documentation during initial orientation prior to direct patient care and periodically as part of a TB contact investigation, exposure, or due to medical indication.

2) Chest x-ray if employee has a history of latent TB infection (LTBI), treatment history for LTBI or TB disease, if applicable.

3) Staff shall submit acceptable types of TB testing; tuberculin skin test, interferon-gamma release assay, or chest X-ray to the facility HSA upon request.

4) Personnel who are positive at hire shall be cleared to work by their primary care provider prior to starting at facility.

5) Staff who initially were documented as negative and free of any form of TB and later have a positive test shall have a chest X-ray and have their provider clear them to return to duty.

Staff shall follow their respective employer workman’s compensation policy if they become infected due to workplace exposure.

6) Additionally, on an annual basis and at own expense, the Service Provider shall provide a current tuberculin skin test or interferon-gamma release assays test result if the employee previously tested negative for LTBI, evaluation for TB symptoms if the employee previously tested positive for LTBI and follow up as appropriate in accordance with Centers for Disease Control and Prevention (CDC) guidelines.

b. Recommended Immunizations:

Individuals employed by the Service Provider in a custody or detention environment are at significant risk for acquiring or transmitting Hepatitis B, measles, mumps, rubella, varicella, seasonal influenza, and COVID-19. These diseases are vaccine preventable. Therefore, the following vaccinations are highly recommended for the Service Provider personnel. If staff decline or refuse any of these recommended vaccines, an Immunization Declination Form is required, and the COR shall be notified of the refusal. ICE reserves the right to refuse Service Provider employees that refuse vaccines:

1) Hepatitis A;

2) Hepatitis B; (Note: The U.S. Occupational Safety and Health Administration (OSHA) Blood-borne Pathogens (BBP) Standard requires employers to provide employees at risk of occupational exposure to blood and other potentially infectious material (OPIM) with the Hepatitis B vaccination series. Refer to OSHA regulations https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact05.html

3) Varicella;

4) Measles, Mumps, Rubella (MMR);

5) Diphtheria, tetanus, a-cellular pertussis (DTAP);

6) Annual seasonal influenza; and

7) COVID-19.

The Service Provider’s personnel will provide immunization documentation or titer results to the HSA or the employer’s designee for placement in the employee health file. It is recommended that the CDCs Immunization of Health- Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC) be used as a reference for employee health immunization issues.

A.7. Medical Care Expenses and Reimbursement

All costs associated with the medical care provided by the vendor shall be included in the pricing for this contract. On-site routine labs and CLIA waived testing will be a requirement of the Service Provider. The Service Provider shall obtain and maintain CLIA certificate of waiver. Off-site labs shall be approved through the Medical Payment Authorization Request (MedPAR)/referral or waiver processes established by IHSC and the off-site lab provider will be reimbursed through IHSC’s claim processing third-party administrator (TPA). All routine medical supplies will be provided by the Service Provider, at no additional cost to the government or the ICE alien and shall be included in the pricing for this agreement. The following are not included in the pricing: off-site specialty care, emergent care, hospitalizations, approved https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact05.html formulary and non-formulary network pharmacy purchases of medications and patient specific durable medical equipment (DME). Any non-formulary medications purchased through a network pharmacy require IHSC medical authority or designee approval. All high value medications purchased through a network pharmacy with cost above $5,000 per prescription require IHSC medical authority or designee approval. Retail purchases are only allowed by authorized health staff as designated through the position description submitted by the Service Provider. DME identified as clinically necessary by a medical provider and approved by an IHSC Regional Clinical Director (RCD) or designee, will be made available through the MedPAR system or purchase card process with the assistance of the IHSC Field Medical Coordinator (FMC), or designee as needed.

2.0. Standards of Medical Care

2.1. Evidence-based Standards of Medical Care

The Service Provider is responsible for providing resources for evidence-based standards of medical care which can be used as a guide for treatment of most diagnosed health care concerns. See examples of resources below:

IHSC Sample Clinical Practice Guidelines (To Be Provided Upon Request)

c. HIV;

d. Asthma;

e. Gender Dysphoria;

f. Hepatitis and Liver Disease

g. Tuberculosis;

h. Seizure

i. Hyperlipidemia

j. Hypertension;

k. Bipolar Disorder;

l. Anxiety;

m. Sleep Disorder

2.2. Credentialing Requirements:

The Service Provider will maintain written documentation confirming that everyone providing services under this agreement has and maintains requisite credentials. Any change in status regarding any credentialing requirements shall be reported in writing by the Service Provider to the COR and the IHSC FMC within seven business days. The Service Provider shall ensure the following medical personnel maintain valid, active, permanent, full, independent, and unrestricted credentials in accordance with State law:

1) Licensed Independent Provider (LIP):

An LIP is defined as an individual, as permitted by law and regulation, and by the organization, to provide care and services without direction or supervision within the scope of the individual’s license and consistent with the privileges granted by the organization.

a. Physicians: Medical Doctor (MD), Doctor of Osteopathy (DO).

b. Dentists: Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD).

c. Psychiatrists: Doctor of Medicine or Doctor of Osteopathic Medicine from a school in the

United States or:

i. Doctor of Medicine or equivalent degree from a foreign medical school that provided education and medical knowledge substantially equivalent to accredited schools in the United States as established by The National Committee on Foreign Medical Education and Accreditation (NCFMEA);

ii. Permanent certification by the Educational Commission for Foreign Medical Graduates (ECFMG);

iii. Completion of four years of medical specialty training leading to board eligibility in psychiatry;

iv. Minimum of 12-years clinical psychiatric experience as a licensed practicing psychiatrist;

v. Experience in a detention/correctional or residential healthcare setting (preferred, not required);

vi. Board Eligible/Certified in Psychiatry preferably including child and adolescent care; and

vii. Shall have unrestricted medical license in State or Territory where you are practicing in the United States (and where patient is located).

d. Psychologists: Doctor of Psychology (PsyD or PhD) in Clinical Psychology from a graduate program in Psychology accredited by the American Psychological Association:

i. At least, two (2) years of supervised experience in Clinical, Counseling, or Health Psychology; and

ii. Meet requirements for inclusion in the National Registry of Psychologist Providers if graduated after 1 January 1982.

e. Social Workers: Licensed Clinical Social Worker (LCSW) requirements:

i. Successful completion of a Master of Social Work (MSW) from a graduate program accredited by Council on Social Work Education (CSWE);

ii. The clinical social worker license/certification shall be the highest clinical LCSW designated by the licensing board where it was received;

iii. A minimum of three years post-independent licensure clinical experience providing independent clinical assessment, diagnosing using the DSM-V-TR (or most updated version of DSM), providing clinical treatment (individual/group psychotherapy);

iv. Provide documentation/transcripts demonstrating clinical work within completed graduate program requested;

v. Shall complete 20 hours of Continuing Education Units (CEUs) annually; and

vi. Shall maintain membership with licensing board associated with clinical license and submit required completion of CEUs to the licensing board annually as required;

Membership with the state or territory clinical licensing board is required.

f. Licensed Clinical Professional Counselors (LCPC)/Licensed Clinical Mental Health Counselors (LCMHC)/Licensed Professional Mental Health Counselor requirements:

i. Education: Hold a master's or doctoral degree in: Clinical Mental Health Counseling;

Clinical Rehabilitation Counseling; Clinical Mental Health Counseling and Clinical Rehabilitation Counseling; or a related field, from a program accredited by the Council on Accreditation of Counseling and Related Educational Programs (CACREP).

Examples of related mental health counseling fields include but are not limited to Addiction Counseling; Community Counseling; Gerontology Counseling; Marital, Couple, and Family Counseling. CACREP defines the date when graduates are considered to have graduated from a CACREP accredited program. Additional information may be obtained from http://www.cacrep.org/directory/. NOTE:

Traditional Rehabilitation counseling programs that are accredited by CACREP do not meet the LPMHC qualification standards as Traditional Rehabilitation counseling differs from Clinical Rehabilitation counseling;

ii. Shall hold a full, current, and unrestricted clinical license to independently practice as a Licensed Professional Mental Health Counselor (or other acronym from above), which includes diagnosis and treatment; and

iii. A minimum of three years post-independent licensure clinical experience providing independent clinical assessment, diagnosing using the DSM-V-TR (or later addition), providing clinical treatment (individual/group psychotherapy), and developing clinical treatment plans without supervision.

http://www.cacrep.org/directory/

2) Licensed Supervised Provider (LSP):

An LSP is defined as an individual, as permitted by law and regulation, and by the organization, to provide care and services under a Collaborative Practice and Prescriptive Authority Agreement

(CP/PAA).

a. Physician Assistants/Physician Associates – Certified (PA-C);

b. Nurse Practitioners: Adult Nurse Practitioner (ANP or NP-C), Advanced Practice

Registered Nurse (APRN), Certified Nurse Practitioner (CNP) , Family Nurse Practitioner (FNP-C or FNP-BC); Psychiatric Mental Health Nurse Practitioner (or equivalent).;

c. Clinical Pharmacist.

3) Licensed Dependent Provider (LDP):

All licensed or certified healthcare providers that do not fall under the category of LIP or LSP are considered LDPs.

a. Registered Nurse (RN);

b. Dental Hygienists (DH);

c. Licensed Vocational Nurses (LVN) or Licensed Practical Nurses (LPN);

d. Certified Nursing Assistants (CNA);

e. Certified Medication Aid (CMA);

f. Behavioral Health Technician: Minimum high school diploma or GED required, associate's degree in a behavioral science/specialty field is preferred, and; Minimum of two years of work experience in a mental health hospital, clinic, or residential healthcare setting.

2.3. Basic Life Support (BLS) Certification, Medical Emergency Response, and Suicide Prevention The Service Provider shall ensure that all facility personnel, to include medical personnel, administrative staff, and custody officers, complete all training and drills related to fire, man down, mass disaster, emergency evacuation, life safety, and suicide prevention. These activities shall be conducted in accordance with applicable ICE standards and, if required, relevant accreditation standards (e.g., ACA).

The Service Provider should consider the Train-the-Trainer concept for cost savings.

All medical personnel shall achieve and maintain BLS certification through American Heart Association (AHA) approved vendors.

1) All personnel shall complete, at minimum, initial (4 hrs.) and annual (4 hrs.) training on the following:

a. Response to health-related emergencies within 4-minutes;

b. Cardiopulmonary resuscitation (CPR);

c. Automated external defibrillator (AED) use;

d. Emergency first aid;

e. Signs of potential health emergencies and required response;

f. Methods of obtaining emergency medical assistance;

g. Signs and symptoms of mental illness and suicide risk;

h. Plan and procedures for providing emergency medical care including, when required, the safe and secure transfer of detainees for appropriate hospital or other medical services;

i. All other emergency response requirements as outlined in the applicable ICE standard, to include accreditation standards (e.g. ACA), if required;

j. Any training that occurs more frequently than initial and annual shall be adhered to as outlined in the applicable ICE standard, to include accreditation standards (e.g. ACA), if required;

k. Administer medications; and

l. Know the universal precautions for protection against blood-borne diseases.

– AND –

2) Complete 8hrs of Suicide Prevention and Intervention training annually, to include:

a. Training on emergency use of cutdown tools, which should be provided upon hire and 2hrs of this training annually; and

b. Training on Nonviolent Crisis Intervention through the Crisis Prevention Institute (CPI), https://www.crisisprevention.com/ (or a similar nonviolent crisis intervention modality) and trauma-informed care practice.

2.4. Serious Medical Conditions

The Service Provider shall notify ICE and the IHSC FMC of detainees with serious medical conditions immediately upon identification of conditions and no more than 24 hours of identification of the case.

Examples of cases include but are not limited to: uncontrolled hypertension; uncontrolled diabetes;

unstable respiratory disease or any detainee requiring oxygen treatment; history of congestive heart failure complaining of shortness of breath; pregnancy; multiple unstable chronic conditions; liver failure; renal failure; infectious and communicable diseases (i.e., HIV/AIDS, viral hepatitis, varicella, measles, mumps, COVID-19); and infectious disease outbreaks.

2.5 Notification Requirements for Medical Conditions that Render Continued Detention Unacceptable If the Service Provider determines that an ICE detainee has a medical condition which renders that person unacceptable for detention under this agreement (for example, condition needing life support, uncontrollable violence, or serious mental health condition), the Service Provider shall notify their FMC, Behavioral Health Case Manager (BHCM) and ICE. Upon such notification, the Service Provider shall allow ICE reasonable time to make the proper arrangements for further disposition of the detainee. The Service Provider should expect to be requested and attest to ICE that the detainee is medically cleared for transportation and advise ICE of the necessary precautions and equipment required for such transportation.

IHSC FMC, BHCM, and/or Medical Case Management Program Coordinators (MCMPC) consultation regarding these matters is available at any time.

2.6. Serious Mental Disorders or Conditions/Serious Mental Illness (SMI) The Service Provider shall identify, track, record and maintain a list of all detainees identified as having a serious mental disorder or condition and/or who are determined to be incompetent by an immigration judge until removal or release. The Service Provider shall complete the IHSC Form 883 (available by request) and submit it to IHSC FMC/Behavioral Health Case Manager (BHCM) when the detainee has been identified. Notification to the FMC and ICE ERO shall occur as soon as practicable but no later than 72 hours after identification of detained individuals with a serious mental disorder or condition. In addition, a list shall be provided to ICE ERO and IHSC FMC on a weekly basis and include name, A#, date of arrival, diagnosis (es), presence or absence of suicidality, specific symptoms exhibited by detainee that meets criteria of a Serious Mental Disorder or Condition, list of prescribed psychotropic medication with dosage, date when IHSC Form 883 was completed and submitted to IHSC FMC, and details for Safe Release Planning in accordance with current ICE policies and procedures in coordination with IHSC, and communicated through the COR.

A serious mental disorder or condition/SMI is characterized by a qualified mental health provider or physician after:

a. Determining that an individual in custody:

1) Has a mental disorder that is causing serious limitations in communication, memory, or general mental and/or intellectual functioning (e.g., communicating, conducting activities of daily living, social skills), or a severe medical condition(s) (e.g., traumatic brain injury or dementia) that is significantly- impairing mental function; or

2) Is exhibiting one or more of the following active psychiatric symptoms and/or behavior: severe disorganization, active hallucinations or delusions, mania, catatonia, severe depressive symptoms, suicidal ideation and/or behavior, and/or marked anxiety or impulsivity;

https://www.crisisprevention.com/

– OR –

b. Otherwise diagnosing a detained individual as demonstrating significant symptoms of one or more of the following:

1) Psychosis or Psychotic Disorder;

2) Bipolar Disorder;

3) Schizophrenia or schizoaffective disorder;

4) Major Depressive Disorder with Psychotic Features;

5) Dementia and/or a Neurocognitive Disorder; and/or

6) Intellectual Development Disorder (moderate, severe, or profound).

2.6.1. SMI Training

The Service Provider shall provide semi-annual SMI training, in accordance with current ICE policies and procedures in coordination with IHSC, and communicated through the COR for Detained Individuals with Serious Mental Disorders or Conditions and/or Who Are Determined To Be Incompetent By An Immigration Judge, to all Qualified Medical Health Professionals (QMHPs).

3.0. Specialized Behavioral Health Unit and Programming

If requested by ICE ERO, the Service Provider shall design and construct, or utilize an existing, separate and dedicated onsite Behavioral Health Unit (BHU) to provide behavioral health treatment to detainees with serious mental illness and mental health conditions of at least moderate severity.

The Service Provider shall accept detainees who meet the criteria for admission from within the facility, as well as from any IHSC-staffed or non-IHSC-staffed facility in any AOR nationwide, in accordance with ICE ERO Policy 11309: Detained Noncitizen Transfers Required Due to a Healthcare Condition and IHSC Directive 01-38,…