Dialysis QA - Answers 43026.docx

General:

1. Does "coordinate care in the community" imply dialysis services at hospitals and/ or community outpatient facilities? Can you confirm if this only applies to hemodialysis and not a broader scope of medical care?

In emergent situations, there are times when patients need to be dialyzed at an outside hospital or referred to an outside clinic for dialysis services/treatment. The dialysis vendor would not coordinate care in the community for anything other than treatment directly related to their dialysis care.

a. Can you confirm that any hemodialysis treatments performed "in the community" will be paid for by CTDOC?

Yes, dialysis treatment that is incurred outside of the facility, while a patient is in our custody, is paid for the same was any other inmate medical service is paid for when an inmate must be sent out for care.

2. Can you confirm that the respondent will be responsible for arranging dialysis care for patients 'not' housed at MacDougal?

Respondent would only be responsible for arranging dialysis care for patients housed at MWCI. Any patients housed in other locations would be relocated to MWCI to receive this necessary treatment. For patients needing dialysis from another facility, nursing would communicate with the respondent ahead of transfer to confirm the respondent can and will accept the patient for treatment. Once that is confirmed by their treatment team, the patient will be relocated and begin dialysis shortly thereafter.

3. The RFP requests 2 budgets from the respondents. Should the budget "with physician clinical oversight of dialysis treatment" include medical directorship services and rounding nephrologist services?

Yes

3. Should the second budget exclude ALL services provided by a licensed nephrologist?

Yes

4. Who is the incumbent provider and what is their staff size by role (RN, CCHT, LPN) Current provider is DCI, Inc. Current staff size unknown. The clinic at MWCI runs with 1 RN and 1 CCHT, at minimum, during clinic hours.

5. How many dialysis stations are there in current dialysis area?

8 stations

6. What is the current patient census? Historical census from past 12 months?

Historical census from 4/2024-3/2026 is an average of 12 patients.

Current census is 12.

7. What days of the week are treatments currently performed?

Mondays, Wednesdays & Fridays

8. What is the patient shift structure per day of week?

Each day is structured the same – patients are placed on dialysis between 5a-6a, then around 10am they are turned over for the next round of patients. We essentially run 2 dialysis clinics each day.

9. What is the process for clearance of staff and does CTDOC bear the responsibility for costs associated with clearance?

Yes, DOC will run the staff names through Security Division and determine if everyone is cleared for entry. This is done yearly. The respondent is responsible for ensuring all required staff engage in providing the necessary documents for clearance timely, when requested.

10. Are staff permitted to bring food/ drink into the facility?

Staff are permitted to bring food/drink into the facility per DOC policy. These policies are provided to them as part of their orientation to the Department. All those with access to the building must comply with all Department policies and directives, even those who are working through an agency or vendor.

11. Will there always be an officer on site/ in the unit during dialysis treatments or when patients are present?

Yes.

12. Is the facility accredited/licensed? If so, what is the accreditation body – Joint Commission, CMS, etc.

NCCHC

13. Are there internet access and a phone line provided for the dialysis unit?

Yes

14. There are numerous sites that our staff may need to access to perform their jobs. Are there any restrictions on websites that can be accessed?

All websites necessary for performing duties can be authorized through IT services via the IT Help Desk Service Portal.

15. Are the dialysis services required by CTDOC limited to hemodialysis or are peritoneal services also required?

Current vendor has only provided hemodialysis treatments at this location.

16. What EHR platform does CTDOC use?

AthenaHealth v23

17. What lab service firm is currently used by the incumbent dialysis provider and is there a bidirectional integration with the CTDOC EHR?

Lab work is processed by the facility phlebotomist and processed through Quest Diagnostics.

18. It states that labs are required for patients with GFR <60. These patients are normally not ESRD/dialysis patients. Is there a requirement to follow CKD/pre ESRD patients? No.

19. The RFP mentions a CTDOC chief dialysis nurse – can you define that position and what that role encompasses? How does that role integrate with the dialysis unit and dialysis team?

DOC does not staff a Chief Dialysis Nurse. This function would be the responsibility of the Respondent to staff their on-site clinic accordingly.

20. The RFP states that CTDOC will provide clinical oversight for all dialysis treatments. Can you expand upon CTDOC's role in oversight of the treatments?

The dialysis treatment team will be responsible for communicating with the DOC treatment team on patient outcomes and compliance with treatment. The DOC treatment team will ensure they are reviewing this data as part of the larger treatment plan for the patient.

21. Hemofiltration and Hemodiafiltration are relatively new treatments and most equipment manufacturers do not yet have approved machines for sale in the United States. Those that do offer the machines and corresponding supplies at a high premium. In Addition, there are few providers/programs that offer these services in the United States resulting in a very narrow pool of hemofiltration and hemodiafiltration trained RNs and CCHTs. As a result, hemofiltration and hemodiafiltration services will come at a premium cost above Hemodialysis, does CTDOC understand this?

Yes.

22. Is CTDOC currently providing hemofiltration and hemodiafiltration services? Unlikely, typically reserved for ICU and hospital setting.

23. If CTDOC is currently providing hemofiltration and hemodiafiltration services, what equipment model(s) are being used to provide these types of treatments? N/A

24. Are hemofiltration and hemodiafiltration services required for a respondent to be considered for this RFP or is hemodialysis sufficient? Not required.

25. If hemodiafiltration and hemofiltration services are required, should these services be independent line items in the budget/pricing in order to consider the high cost of these services?

Yes.

26. The RFP states that the respondent will coordinate care in the community for inmates unable to travel or not housed at MacDougall for treatment. Does 'coordination" imply additional tasks in addition to ensuring that community providers have all relevant patient medical records and forms?

No.

27. How many CTDOC dialysis patients are currently receiving dialysis treatments from community providers? None.

28. In Service Expectations the RFP states that respondent shall be responsible for providing Catheters. Is this intended to mean supplies to support catheter care or is the respondent truly responsive for the provision of patient catheters?

They are responsible for provision of patient catheters to include all supplies required to support catheter care.

Staffing Questions:

1. Does CTDOC require the respondent to provide a social worker?

No.

2. Does CTDOC require the respondent to provide a dietician?

Yes.

3. What items are permissible to be brought in by staff? I.e. bags/size of bag, phones, keys, computer, etc.

Permitted items are outlined in DOC Administrative Directives and policies.

4. Are there any restrictions for color clothing for dialysis vendor staff?

Yes, as outlined in DOC Administrative Directives.

5. Does CTDOC require the dialysis staff to attend CTDOC training? If yes, how long is the training and how frequently is the training held?

Yes, all dialysis staff are required to attend onboarding training and orientation. This takes place at the time of hire.

6. The RFP states that all dialysis nurses and nephrologists must have ACLS. Typically, only BLS is required for dialysis teams. Will ACLS truly be required?

Yes.

Equipment and Biomedical Questions:

1. What are the dimensions of the room intended for dialysis? Approximately 13x40

2. Are backflow preventers (RPZ) and/ or water blending valves maintained by the CTDOC or a 3rd party vendor?

All dialysis equipment and related plumbing shall be serviced and maintained by a 3rd party vendor, which is the responsibility of the respondent.

3. Do dialysis drains have proper slope and air gap at MWCI ?

Yes

4. Is there sufficient water pressure to each water hook up in the current dialysis treatment room and the central reverse osmosis machine (RO), if applicable, of at least 40 PSI?

Yes

5. Are there dedicated GFCI outlets in the dialysis room/ den?

No

6. If there are dedicated GFCI outlets in the dialysis room/ den, how many are there?

N/A

7. Is the water supply to the dialysis treatment room tempered or cold water-only to each portable/reverse osmosis device (RO)?

Tempered

8. Does MWCI have a Central Reverse Osmosis (RO) machine, if so what is the current make and model? When was it installed? Who owns the RO?

Current RO machine owned by current vendor and installed March 2026:

Ameriwater Reverse Osmosis unit 2 Membrane Central RO, 4,320 GPD, 208V, 3PH with pre-treatment and loop distribution equipment

9. Are there any portable ROs or DI tanks at MWCI? If so, what are the make/models and quantity? When were they installed? Who owns these?

A portable RO was utilized during the replacement of the new RO in March 2026. There was 1 machine and this is owned by the current vendor.

10. Does MWCI have back-up emergency potable water vendors?

Yes.

11. Does MWCI have properly placed eye wash stations?

Yes.

12. Is there space for technical repairs of equipment separate from the treatment area?

Yes.

13. Can biomedical staff bring in a work laptop for documenting service?

Yes.

14. What is the process for our equipment technicians to enter MWCI with tools and necessary items to repair and maintain machines, ROs etc.?

All technicians needing entry into the facility must be cleared by security division and their time in the facility must be coordinated with custody ahead of time, as an officer will need to be present for the duration. All tools need to be inventoried prior to entry and upon departure to ensure nothing is left behind and all items are accounted for.

15. Can tools be left on site and counted? (for biomedical technician use) No.

16. Are there 2 sinks in the designated dialysis area?

Yes

Supply Questions:

1. What is the process for delivery of dialysis supplies from third party suppliers? Are there certain allowable days and times for general delivery of supplies? If so, please list days and times for each facility.

Supplies should be scheduled to arrive prior to 2pm during the week.

2. Is there a general loading dock at MWCI?

Yes.

3. Are any medications to be provided by the respondent? If yes, what medications will the respondent be expected to provide? No.

4. The RFP states that supplying catheters is the responsibility of the respondent. Does this requirement require providing supplies for catheter care or is the respondent somehow responsible to supply UCONN Health with the catheters for placement? Respondents are required to provide all necessary supplies for catheter care. Anything placed by UCONN will come from UCONN’s supplies. Once the patient returns to our care, the respondent will take over catheter care and maintenance.

Regarding Emergent and Unscheduled Dialysis:

1. Emergent dialysis has a higher likelihood of adverse events and requires close monitoring including cardiac and respiratory monitoring. Does the facility have this equipment?

No. Patients are sent to outside hospital in the even emergency dialysis care is required.

1. What are the criteria for emergent dialysis? SpO2 < 88, Arrythmia or changes in an ECG. Severe hyperkalemia (very high potassium levels in the blood leading to EKG changes), refractory pulmonary edema (Fluids in the lungs leading to very low oxygen levels), severe metabolic acidosis (very low PH levels in the blood.

1. What differentiates emergent dialysis in a hospital setting vs the corrections setting? Nothing different than the community. Security officers must accompany patients, restraints may be required, and the dialysis schedule must accommodate facility lockdowns, count times, and transport security. Hospital-based emergent dialysis operates with immediate clinical priority without these constraints.

1. Is there concern that Inmates may manipulate emergent dialysis in order one on one opportunity with staff?

Yes.

1. Will a Corrections Officer be present in the room with the nurse while the patient is on treatment?

Yes.

1. Historically, what is the frequency of emergent dialysis per year? Varies: Emergent cases typically are sent to the ED Regarding EHR integration

1. What EHR is being used? We currently use Fusion EHR which is the AthenaHealth (formerly GE Centricity) Practice Management with additional modules to support healthcare in a correctional setting

2. What are the EHR requirements for bidirectional result transmission? Our EHR vendor uses an interface engine that will support HL7 messaging between the EHR and ancillary systems

3. Will Corrections allow a VPN for the respondents EHR system? Yes.

4. Does the Corrections Electronic Health Record utilize HL7v2 or FHIR, or is there some custom specifications? Reference Question 2 above, our vendor supports an interface engine that utilizes HL7 messaging. I am not aware that FHIR is available.

5. If bidirectional result transmission is not possible, can DCI staff upload the results as PDF files into the Corrections EHR.

No. Anything that needs to be scanned into our chart will need to be provided to Medical Records for processing.

Coordination of care:

1. Is this coordination care for dialysis patients or all inmates?

Dialysis patients.

2. Is this a request to coordinate care with clinics unaffiliated with respondent clinics? Yes, as needed.

3. Is the requirement for coordination include dialysis patients where the respondent has not provided any care?

No.

4. Will the DOC be making a separate contract with community dialysis clinics? Yes.

Regarding Removal of catheter blockages:

1. Removal of clots in the dialysis unit is limited to instilling a medication to dissolve the clots. Is the medication provided by the Corrections facility or the respondent?

Respondent.

Regarding supplies:

1. Current provider does not supply catheters, is this a new requirement as respondent is not a vascular access provider? Does this refer to catheter care and supplies?

Current provider does supply and maintain dialysis catheters. The new respondents will be asked to do the same.