RFP 006-24 Inmate Healthcare Services .pdf

Request for Proposal Proposal No. 006-24

Inmate Medical Services

Issued By:

Onslow County Purchasing Department

234 NW Corridor Blvd.

Jacksonville, North Carolina 28540

Phone: (910) 455-1750

Issued For:

Onslow County Sheriff’s Office and Detention Facility

717 Court Street

Date of Issue: April 8, 2024 Proposals Due: May 8, 2024 2:00PM

KEY INFORMATION SUMMARY SHEET

Request for Proposals Inmate Healthcare Services

RFP # 006-24

RFP Issue Date: April 8, 2024

Mailing address to submit proposals: Onslow County Purchasing Department Attn: Christina Russell, Purchasing Division Head 234 NW Corridor Blvd.

Jacksonville, NC 28540

Electronic file (pdf) Email Address: Christina_Russell@onslowcountync.gov

Deadline for Written Questions: 12:00 noon April 18, 2024

Responses to Written Questions: Addendum April 19, 2024, by 4:00PM

Sealed Proposal Due Date: May 8, 2024, 2:00PM

April 8, 2024

RE: Request for Proposals, Proposal No. 006-24

Inmate Healthcare Services

To Whom It May Concern:

The County of Onslow is seeking sealed proposals from qualified healthcare management providers authorized to practice in the State of North Carolina to provide healthcare services to inmates housed within the Onslow County Detention Center. The County has been awarded with a Federal Grant for a MAT program for opioid or alcohol users which will be a part of this proposal.

Attached you will find a Request for Proposal (RFP) which identifies the services required.

In order to be considered, all Proposals must be sealed and submitted, in writing, no later than 2:00 PM (EST) May 8, 2024. No proposal will be accepted after this time. Firms mailing proposals should allow delivery time to ensure timely receipt of their proposals. The responsibility for getting the proposal to the Onslow County Purchasing Department on or before the specified time and date is solely and strictly the responsibility of the proposing firm. The County will in no way be responsible for delays caused by any occurrence. Sealed proposals may be hand carried or mailed to:

Attention: Christina Russell, Purchasing Division Head

234 NW Corridor Blvd.

In addition, proposals must also be submitted in electronic format. The email address for electronic submittals is provided.

Any questions pertaining to this Request for Proposal must be submitted in writing no later than 12:00 PM on April 18, 2024. Questions may be emailed to: Christina_Russell@onslowcountync.gov

Any changes or modifications to this Request for Proposal will be transmitted in writing through an addendum. It will be the responsibility of the Proposer to ensure that all addenda are received.

The County encourages participation by small, minority, and woman-owned businesses. Onslow County reserves the right at its sole discretion to waive any informalities, to reject any and/or all proposals, and to accept any proposal which in its opinion may be in the best interest of the County.

No proposal will be received or accepted after 2:00 PM, EST, May 8, 2024. Late proposals will be deemed invalid and returned unopened to the Provider.

Thank you, Christina Russell, CLGPO Purchasing Division Head

1.0 Background

The Onslow County Detention Center (OCDC) was built in 2010 and has 11 cell blocks with a maximum capacity of 528 inmates. The current capacity is 369 inmates; however, the daily average inmate population is approximately 365. Of the 365 inmates, 77 are females with the remaining inmates being male.

The counts above include pretrial detainees as well as inmates from other counties that are being housed in the OCDC. Currently, if an inmate from another county needs non-emergent medical treatment, the inmate is transferred back to that jurisdiction; however, if that County is under contract with the same healthcare management provider, the Provider will treat the inmate in the OCDC but the Provider will invoice the other county for the services rendered. Should an inmate from another county need emergency medical treatment, the other County pays for treatment of their inmate. The Onslow County Detention Center (OCDC) does not house any federal inmates.

In addition to the regular adult inmate population, there are approximately 10 weekenders, inmates sentenced to weekends only, who are also covered by County medical services while incarcerated.

2.0 Staff

The OCDC is comprised of contracted services, including food services, medical services, vending and inmate commissary. The Jail Major and the Captain oversee the responsibility for contracted medical services.

The OCDC is staffed with approximately 113 employees including 1 Major, 1 Captains, 6 First Sergeants, 6 Lieutenants, 13 Sergeants, 8 Corporals, and 78 Detention Officers.

In addition, there are contracted staff for food service and other county employees who also work in the facility on a daily basis. Line correctional staff work 12-hour shifts.

3.0 Preparation of Proposal

Each healthcare management provider must thoroughly examine the Request for Proposal and contract documents to ensure that all requirements can be met. Providers are responsible for verifying any and/all information and familiarize themselves with the required services, prior to submitting a proposal.

Proposals shall be submitted on the forms included within the RFP. Proposals shall be signed by the person or persons legally authorized to bind the Medical Provider to a contract. Failure to submit a proposal with all proposal requirements may be considered sufficient cause for rejection of the Proposal. All costs associated with the preparation of the Providers proposal will be borne by the Provider.

4.0 Submission Requirements

In order to evaluate responses efficiently and equitably, responses must be tabbed as identified below. Failure to submit this information may render your proposal non-responsive.

Tab 1: Introduction: Company Information

Firm’s name and business address, including telephone, email address, website address.

The type of firm (individual, partnership, corporation, etc.) and list the names of all partners, principals, etc.

Year established. Include former company name(s) and year(s) established, if applicable.

The name, title, address, and telephone number of the firm’s authorized negotiator. The person identified must be empowered to make binding commitments for the firm.

Tab 2: Experience and Operations Summary

Experience: Describe experience with providing the Services outlined in RFP.

Current Contracts: Provide a list of current contracts, and the term of the contracts, for similar services.

Previous Contracts: List of all contracts held within the last five years that were not renewed or were cancelled by the agency prior to the initial term of contract and the reason for cancelation.

Tab 3: Proposed Staff:

Indicate capacity to successfully manage the proposed services. Propose staffing plan for 24-hour coverage, seven days a week. This information shall include a detailed overview of the on-site professional staff that will be provided, their credentials, days per week, number of hours per day for each on-site staff member, and schedule of hours for each on-site staff member, etc. See attached Proposed Staffing Form. Also included in this section should include administrative/support staff that will be assigned to the awarded Provider.

HIPAA: Describe what HIPAA security policies are in place. In addition, describe any information security breaches that may have occurred within the last 10 years.

Emergency Contact Information of Provider. A list of emergency contacts, titles, office phone and cell phone numbers will be required by the awarded Provider.

Tab 4: Forms

References of current contract holders Non-Collusion Affidavit Exceptions to the Proposal and Sample Service Contract Claims Certification Regarding Debarment and Suspension

Tab 5: Cost Proposal

Proposal Options - Fees

Tab 6: Transition Plan

Provider shall submit a plan addressing the transition from the current healthcare operation to the Provider’s proposed operation at the OCDC.

5.0 Submittal Deadline

Submittals are to be submitted in writing and electronically. In order to be considered all proposals must be in writing, sealed, and submitted no later than 2:00 PM (EST) on May 8, 2024. Time is of the essence; No proposal will be accepted after the official time and date. Only sealed proposals will be accepted; however, this is not a public bid opening. Providers mailing responses should allow delivery time to ensure timely receipt of their proposals. The responsibility for getting the proposal to Onslow County Purchasing Department on or before the specified time and date is solely and strictly the responsibility of the responding Medical Provider. The County will in no way be responsible for delays caused by any occurrence.

The outside of the sealed envelope shall be clearly marked “RFP #006-24 Inmate Healthcare Services .” Responses may be hand carried or mailed to:

Attn: Christina Russell 234 NW Corridor Blvd.

Jacksonville, North Carolina 28540 Hours of Operation: Monday – Friday 8:00 a.m. - 5:00 p.m. (EST)

In addition to the sealed proposal, an electronic copy of the proposal is required.

Electronic copies should be submitted in a pdf file and emailed to Christina Russell at Christina_Russell@onslowcountync.gov prior to the deadline for sealed proposals. It is recommended that a separate email be sent to confirm that the electronic version was received.

6.0 Questions

Should a Provider find any discrepancies in, or omissions from the documents, or should the Provider be in doubt as to their meaning, the Provider should notify the County. All discrepancies, clarifications or questions pertaining to this Request for Proposal (RFP) shall be submitted in writing no later than April 18, 2024 by 12:00 PM. Questions may be emailed to:

Christina_Russell@onslowcountync.gov

Only written questions submitted prior to the deadline will be considered formal. Any information given verbally or by telephone will be considered informal. Any questions received prior to the deadline, that the County feels are pertinent to all Proposers will be mailed as an addendum to the RFP. Questions that are not relevant will not be responded too; therefore, it is recommended that only questions needed to submit a proposal by the company be submitted.

7.0 Addenda

Any interpretation, correction or change to this RFP will be made by Addendum and issued through the County Purchasing Department. Addenda will be mailed or delivered to all who are known by the County to have received a complete set of RFP documents. It is the responsibility of the Proposer to ensure that all Addenda has been received prior to submitting a response.

8.0 Performance Bond

The successful bidder shall furnish and deliver to the County a Performance Bond covering the faithful performance and completion of the services included in this RFP and payment for all materials and labor furnished or supplied in connection with the required services.

Said bonds shall be issued and furnished to the County prior to, and as a condition precedent to, commencement of the work. The Provider will have 10 days after contract award to furnish bond. The Performance Bond shall be furnished on behalf of the successful bidder and shall name

County obligee, and coverage shall be written subject to the limit of not less than $500,000.

Although the County has never had to secure another Provider through the Surety, such bond(s) shall be solely for the protection of County.

The surety bond must be in the form set forth in NCGS 44A-33, without any variations there from. The Performance Bond shall be issued by a surety of financial standing having a rating from A.M. Best Company equal to or better than A and must be included on the approved list of sureties issued by the United States Department of Treasury. The bond shall remain in effect at least one (1) year after the date when final payment becomes due.

The successful Provider shall provide surety bond wherein Surety waives notice of any and all modifications, omissions, additions, changes and advance payments or deferred payments in or about the Contract and agrees that the obligations undertaken by the Bond shall not be impaired in any manner by reason of any such modifications, omissions, additions, changes, and advance payments or deferred payments.

The surety bond must set forth no requirement that suit be initiated prior to the time stipulated in applicable North Carolina Statutes of Limitation.

9.0 Evaluation & Award of Contract

Award will be made to the healthcare management provider whose proposal is most advantageous to the County taking into consideration the following criteria:

The ability, capacity, experience, and skill of the Provider to perform the services required under the contract;

The thoroughness and completeness of proposal; responsiveness to RFP requirements;

The quality of service and level of performance of a Provider under previous contracts, if any;

The previous and existing compliance by the Provider with laws and ordinances relating to the service;

References

Proposals will be received by an evaluation committee consisting of the Purchasing Division Head, Health Department Director, and Sheriff’s Office/Jail staff. A recommendation will be made to the Sheriff. The successful Medical Provider will be notified in writing within 45 days, or sooner, after the receipt of proposals. Verbal notification of award is not considered a liable mode of notification and therefore will not be recognized as an official notification.

Upon issuance of a contract award by the County, the successful Provider will perform the services as specified at the stated fees, within the time specified, and in accordance with all provisions of the proposal documents.

In addition, the award of a contract under this solicitation will be paid with federal funding under the MAT program services. Funding is contingent upon compliance with all terms and conditions of funding award. Provider shall comply with all applicable federal laws, regulations, executive orders, FEMA requirements and the terms and conditions of the funding award. In addition, Provider providing submittal shall be responsible for complying with state law and local ordinances.

10.0 Rejection of Proposals

The County of Onslow reserves the right at its sole discretion to reject any and all proposals received without penalty and not to issue a contract as a result of this RFP. The County also reserves the right at its sole discretion to waive minor administrative irregularities contained in any proposal. Failure to comply with any of the terms and conditions of this RFP will result in rejection of a proposal. The County reserves the right to negotiate any and all terms with the successful healthcare provider.

11.0 Contract Period

The term of the contract will be for a three-year period. It is anticipated that the contract will be begin on or about July 1, 2024. This date is approximate and may start earlier or later depending on contract negotiations.

12.0 Option to Renew

This contract may be extended for additional one-year periods. This option, if exercised, is to be executed as a letter of agreement or Amendment to Extend the Contract, issued no sooner than ninety (90) days prior to expiration of this contract. This option to renew requires the mutual agreement of both parties.

13.0 Withdrawal of Proposal

A Provider may withdraw its proposal prior to the time that proposals are due by sending a written request to the Purchasing Division Head. No proposal may be withdrawn after the scheduled closing time for receipt of proposals for a period of 90 days.

14.0 Exceptions to the Proposal

Exceptions to any requirement contained herein must be clearly stated on the “Exceptions to the Proposal and Sample Contract” form. The Exception to the Proposal form is provided herein.

15.0 Sample Agreement

Attached is a Sample Service Contract that describes the County’s contractual terms and conditions. The successful Medical Provider will be required to enter into a service contract with the County. Any exceptions to the terms and conditions of the service contract must be documented and listed on the “Exceptions to the Proposal and Sample Service Contract” form. In addition, any additional required language, terms, or conditions must be submitted with the proposal. Since this contract will include some federal funding, federal contract language has been incorporated into the Sample Service Contract for review.

16.0 Non-Collusion Affidavit

Each submittal must be accompanied by a notarized affidavit on non-collusion, executed by the Provider or in the case of a corporation, by a duly authorized representative of said corporation.

The Non-Collusion Affidavit is provided herein.

17.0 Proprietary Information

Trade secrets or proprietary information submitted by a Provider in connection with a procurement transaction shall not be subject to the public disclosure under the North Carolina Public Records Act pursuant to NC General Statutes §66-152(3). However, the Provider must invoke the protection of this section prior to or upon submission of the data or other materials and must identify the data on other materials to be protected and state the reasons why protection is necessary. DO NOT mark every page as confidential. Each individual page that is a trade secret or proprietary information must be labeled “Confidential” in the top right corner.

18.0 Change of Ownership

If the Provider changes owners or goes out of business during the term of the contract, sixty (60) days advance written notice of such change shall be provided to the County. If the Provider changes ownership and fails to comply with this provision, the County may terminate the contract immediately.

In the event the Provider provides sixty (60) days advance notice to the County of change of ownership, the County, at its sole discretion, may terminate the contract at the end of the sixty

(60) day notice period, or may continue the contract with the new owner(s) under the same terms and conditions. The new owner(s) shall not have the right to unilaterally terminate the contract.

19.0 Subcontractors

The successful Provider will be the primary Provider and will perform the services using their own workforce. The Provider shall not subcontract the services without the prior approval of the County. If the healthcare provider intends to subcontract any of the services required in this RFP, the subcontracted services and subcontractor information must be listed on the Exceptions to the Proposal form.

20.0 Insurance Requirement for Service – See sample Service Agreement for limits

The Provider shall provide the County an original Certificate of Insurance indicating that the Provider has in force the required coverage prior to the start of any Services under this Contract and agrees to maintain such insurance until the completion of this Contract. All insurance policies shall be with insurers with an acceptable rating, registered and licensed to do business in the State of North Carolina.

Each policy shall provide a thirty (30) day notification clause in the event of cancellation, non-renewal, or adverse change. In the event the insurance coverage expires prior to the completion of the project, a renewal certificate shall be on file with the County at least fifteen (15) days prior to the expiration date. Failure to maintain the proper insurance will be grounds for termination of contract.

21.0 Safety and Health Device

All equipment, whether provided by the County or the Provider, shall meet the requirements of the federal government and the State of North Carolina. Equipment shall also conform to applicable standards of all national regulations.

22.0 Quality of Services

It is preferred that the Provider have a minimum of five (5) years’ experience in this field. The successful Provider expressly warrants that all services specified in this Request for Proposal will be performed with skill, care, and diligence and in accordance with all requirements under the Request for Proposal. The successful Provider agrees to correct any deficiencies in its provision of services upon notification by the County and without additional expense to the County.

23.0 References

A minimum of three (3) references for which this type of service was provided, preferably within the State of North Carolina is required. Reference information shall be submitted on the form enclosed. Additional references may be submitted and attached to the sheet.

24.0 Objectives of the RFP

A. To implement and deliver a comprehensive inmate healthcare system consistent with all applicable standards and constitutional requirements.

B. To maximize treatment and care of inmates within the OCDC while avoiding unnecessary instances involving transportation, inappropriate utilization of staff, and security risks by such movement. Services shall be cost effective and delivered to the population in such a way as to promote quality healthcare while fulfilling the Contractor’s mission, goals, and objectives.

C. To operate the healthcare services in a cost-effective manner with full reporting and accountability to the OCDC.

D. To operate the healthcare program at full staffing and use only licensed, certified, and professionally trained personnel. The Medical Provider shall be a licensed Medical Doctor authorized to practice in the State of North Carolina and be in good standing in all respects with appropriate licensing agencies and medical boards. The Proposer must list all claims and complaints that have been filed with the Medical Board or any insurance company against the Medical Provider or Provider’s company. See attached form.

E. To define the healthcare delivery system through the establishment of, and adherence to, written policies, procedures, guidelines, and protocols thoroughly defined by the Provider to include workflow and processes aimed at the timely and cost-effective delivery of appropriate inmate healthcare services.

F. To maintain an open and cooperative relationship with the OCDC staff and more specifically with the Major who oversees the inmate healthcare services.

G. To maintain, on behalf of the inmates, a complete inmate health records system, which shall be accurate records of care, and to collect and analyze health statistics on a regular basis. It is to be understood that any and all patient records, currently existing and future, are the property of the OCDC.

H. To commit Providers on-site staff, visiting staff of the Provider, or any contracted staff by the

Provider, to adherence of existing OCDC policies and procedures.

I. To operate the healthcare program in a humane manner with respect to the inmates right to basic healthcare services.

25.0 Personnel Requirements

The County of Onslow requires that Providers meet the following personnel requirements and qualifications. Failure to meet each of the requirements may result in disqualification or possible termination of contract.

A. The Provider must be organized and existing for the primary purpose of providing healthcare services.

B. The Provider must have experience in administering healthcare programs at a jail/prison facility comparable in size or larger or must be experienced in administering a clinic and/or practice with a patient base comparable (in size) to the inmate population of the OCDC.

C. The Provider must demonstrate its ability to recruit, interview, hire, and provide training for both professionals and non-professional staff.

a. Provider shall have sufficient medical/clerical staff available to support the contract requirements.

b. Provider shall have backup or temporary replacement staff for those personnel that fail to report for their scheduled shift. Replacement staff must meet qualifications and security requirements of this section.

c. The Provider’s personnel shall comply with all security regulations and procedures.

d. The Provider will notify OCDC immediately upon discharging, removing or accepting the resignation of on-site personnel.

e. The Provider will notify OCDC promptly upon discharging, removing, or accepting the resignation of off-site personnel that have been working with OCDC staff.

D. Health professionals, who are employed by the Provider on a full-time basis, or under contractual arrangement, shall comply with appropriate state and federal licensure, certification, or registration requirements. Verification of current credentials will be maintained on file at the OCDC.

Individuals shall not begin work until completed credentials verification report is on file with the Onslow County Purchasing Director. For initial employment and annual verification, copies of and primary verification of the following documents are required:

a. Physician

North Carolina Medical Board license for the current year Copies of Board Certification if applicable Primary verification of DEA Certificate Validation of current standing with the NC Medical Board Proof of Liability Insurance Copy of North Carolina Driver’s License

b. Physician’s Assistant

North Carolina Medical Board Statement of Approval Validation of current standing with the NC Medical Board Copies of Certification, if applicable Proof of Liability Insurance

c. Nurse Practitioner/Registered Nurse/Licensed Practical Nurse

Copy of diploma from an accredited school of nursing Verification of current licensure with the NC Board of Nursing

E. Proof of malpractice insurance must be on file for all physicians, nurse practitioners, physician assistants, and any other employees, as applicable.

F. All employees shall undergo a criminal background check, drug screening, and TB test prior to employment.

G. Upon request, provide to the OCDC updated proof of licenses and/or certificates for all professional staff.

H. Employees deemed objectionable to the County, the Sheriff, or the OCDC staff, shall have security clearances rescinded and, if not agreed otherwise, replaced by the Provider.

I. Provider shall propose a weekly schedule for all positions that will cover the requirements needed for the inmate population. See attached “Proposed Weekly Schedule Form”.

J. The Provider will be required to reimburse or credit Onslow County for the actual salary and overhead expenses saved by the Provider for any staff positions that are not provided as required as part of the contract.

K. Provider agrees that in the event the County, in its discretion, is dissatisfied with any of the individual subcontracted physicians or personnel provided under this contract, the County may give written notice to Provider of such fact and the reasons thereof, and if the problem cannot be resolved, Provider agrees to remove the individual about whom dissatisfaction has been expressed by the County and the Provider will make arrangements to cover that position until other appropriate personnel can be found.

L. In the event Provider’s personnel are required to devote time with regard to litigation or threatened litigation by or on behalf of County, this shall be part of their service time pursuant to this agreement.

26.0 Scope of Services

The Provider shall be responsible for providing inmate healthcare services which meet or exceed all local, state, and federal standards and requirements to include, but not be limited to the North Carolina Jail Standards, the North Carolina Board of Nursing, the North Carolina Medical Board, the National Commission on Correctional Health Care (NCCHC), American Correction Association (ACA) Standards and Expectations, and all applicable community standards of care.

Services will be provided 24 hours a day, seven (7) days per week with full staffing by licensed, certified, and professionally trained personnel.

At a minimum, the Provider will provide the following:

Mandated and routine medical care for inmates;

Provide diagnosis or referrals to health facilities for those inmates requiring more extensive treatment;

Management of inmates with chronic illnesses or known communicable diseases or conditions;

Administration, dispensing, control, security and storage of prescription and nonprescription medications;

Address and prioritize medical emergencies;

Non-emergent dental care;

Maintenance and confidentiality of medical records;

Privacy during medical examinations.

Contractor shall use the OCDC whenever possible and whenever appropriate in the performance of its duties under a contract. It is understood by the Provider that excessive and extended ER trips and hospitalizations are particularly burdensome upon the OCDC and pose a security risk for the general public and therefore should be avoided whenever possible. It is understood that it is expected that the Provider will work diligently with the OCDC to keep such incidents to a minimum.

Contractor shall identify the need, schedule, administer, and coordinate and pay for all non-emergency and emergency medical care rendered to inmates inside or outside the OCDC. Only during emergency situations, Provider shall administer emergency medical care at the OCDC to any employee or visitor of the facility who requires such care.

Policies and Procedures of the awarded Provider relating to medical care are generally to be established and implemented solely by the Provider consistent with applicable Onslow County Detention Center policies and procedures and the Jail Medical Plan. Policies and Procedures are subject to review and approval by the OCDC Chief Detention Officer.

Intake Process:

The OCDC will perform intake screenings immediately upon arrival of the inmate. Inmates must be medically cleared before they are sent to the general intake population.

Intake screenings will be recorded on a printed form by the OCDC and turned over the Provider.

The Provider shall keep all Medical Screening History Reports in a locked cabinet. A sample of the intake forms are attached. See attached “ Jail Medical Screen History Report” and “NC Mental Health Screening”.

All new admissions/screening charts are to be reviewed by the Provider within 24 hours.

Each inmate shall be given a comprehensive health assessment, including a physical examination by contracted healthcare provider personnel within fourteen (14) days after admission to the

OCDC.

The extent of the health appraisal, including the physical examination, is defined by the Provider;

however, it shall include at a minimum:

a. Review of intake screening forms;

b. Collection of additional data regarding complete medical, dental, psychiatric, and immunization histories;

c. Recording vital signs (height, weight, pulse, blood pressure, and temperature);

d. Physical examination with comments about the mental and dental status.

e. Additional lab work if directed by the Provider for a particular medical or health problem identified or suspected;

f. The health assessment of females will also include inquiry about menstrual cycle and unusual bleeding, the current use of contraceptive medications, the presence of an IUD, breast masses, and nipple discharge, and possible pregnancy;

Review of physical examination and test results by a physician for problem identification must take place;

In addition to 24 hours a day emergency service coverage, the Provider must have a routine sick call procedure that allows inmates to communicate their health complaints each day. Provider shall be required to examine and treat any inmate in segregation/isolation or otherwise unable to attend sick call in the cell of said inmate. Should the need arise outside the scheduled sick call rounds, Provider will accommodate if the inmate is in need of medical services. Sick call is currently done by OCDC Secures Tablet System.

There is a $20 copay for non-emergency sick calls and a $10.00 copay for prescriptions.

History of Inmate Population

Total Bookings Avg Length of Stay Population Male/Female/Total 2023 5314 41 days Approx. 305/53/358 2022 5081 36 days Approx. 289/38/327 2021 5416 28 days Approx. 283/28/311 2020 5097 12 days Approx. 269/31/300 2019 6571 10 days Approx. 350/85/435

The average daily number of detox patients is 8

The average daily number of behavioral management inmates is 15 (segregated for punitive violations)

The average daily number of suicide watches is 4.

Housing of Inmates from Other Counties

Due to overpopulated jails within the State, the County currently houses, on an average, 25 inmates from other counties. Currently, if an inmate from another county needs non-emergent medical treatment, the inmate is transferred back to that jurisdiction; however, if that County is under contract with the same healthcare management provider, the Provider will treat the inmate in the OCDC but the Provider will invoice the other county for the services rendered. Should an inmate from another county need emergency medical treatment, the other County pays for treatment of their inmate. The Onslow County Detention Center (OCDC) does not house any federal inmates.

Housing of Inmates from the State – SMCP Program

The statewide Misdemeanant Confinement Program (SMCP) manages the housing, transportation, and medical expenses of state inmates convicted of a misdemeanor crime, including DWI, and sentenced to more than 90 days to be served in county jails. Currently, the OCDC houses approximately 35 inmates under the State Misdemeanant Confinement Program (SMCP). Inmates under this program that are housed within the OCDC will be provided medical care by the Provider under this contract.

Invoices for outside medical treatment will be billed directly to the State SMCP program by the outside medical provider.

Inmates Being Treated Outside the OCDC

Healthcare services are intended only for those inmates in the actual physical custody of the OCDC. This shall not include inmates under guard in hospitals or sent to the NC Department of Corrections for safekeeping. Inmates being held and treated outside the OCDC will not be included in the daily population count. Once the inmate is returned to the OCDC, the inmate will be included in the daily population count.

Clinical Supplies

The Provider will be responsible for supplying all medical and office supplies needed to perform the services.

Pregnant Females

Treatment for pregnant inmates will be provided by the Onslow County Health Department. The Health Department will do all necessary screenings, ultrasounds, and other necessary prenatal treatments.

The Provider will provide prenatal vitamins daily.

Should the pregnant inmate have addiction issues, the inmate should be referred to safekeeping.

Inmates sent to safekeeping should not be counted in the Provider’s daily count since the inmates are not on-site and the Provider is not responsible for providing treatment.

When an inmate goes into labor, the Provider shall notify the OCDC staff. The OCDC will transport the pregnant inmate to Onslow Memorial Hospital for delivery.

The Provider shall not be responsible for medical costs associated with the medical care of any infants born to inmates. The Provider shall provide healthcare services to pregnant inmates, but healthcare services provided to an infant following birth will not be the responsibility of the OCDC or the Provider.

Court Ordered Tests

The Provider will not be responsible for any medical testing or obtaining samples which are required by the Courts or forensic in nature.

DUI Blood Draws

The Provider will be responsible for conducting DUI blood draws for County when County EMS is unavailable to provide service. If subpoenaed, the Provider will be required to appear in Court on case(s) for conducting the DUI blood draw(s).

Dental Services

The Provider will only perform non-emergent dental care such as oral screenings. All extractions and other emergency dental services needed shall be referred to an outside dentist or oral surgeon.

Dental Emergencies include chipped, broken, loose, or knocked out teeth, lost filling, or crown, loose or broken braces, wires, brackets or bands and abscesses. Cleanings will not be covered under this contract. Outside dental services will be deducted from the negotiated cost pool amount.

Mental Health Services

Mental health services and evaluations are currently provided by the OCDC under a separate contract. The Provider will need to work cooperatively with the county’s independent contractor for these services but will not be responsible for providing mental health services; The Provider will be required to administer psychotropic medications when prescribed by the psychiatrist.

Chemical Dependency/Medical Detoxification

Depending on the severity of addiction, Provider will be responsible for drug and/or alcohol addicted inmates. Inmates with severe addiction may be sent to safekeeping for detoxification.

Provider will monitor/observe inmates with chemical dependencies in accordance with the Jail

Medical Plan. Provider will not be responsible for any costs associated with inmates in safekeeping. The County will pay for these services directly.

Medication Assistant Treatment (MAT)

The County has a Medication Assistant Treatment (MAT) program. Currently the MAT program is being funded through a Federal Grant for opioid and alcohol users. Provider will support the MAT program by prescribing and administering prescribed medication(s) to opioid and alcohol users, follow all ADA requirements and State and Federal regulations. Provider will be responsible for the referral process of inmates into the program abiding by protocols set forth by OCDC. Provider will conduct screening of inmates in program to ensure necessary drug testing, health/behavioral needs assessments are completed to determine the appropriate dosing of medication for each inmate under the program. Prescriptions will be paid by Federal Grant and once Federal Grant has ended Provider will be responsible for the cost of prescriptions. Provider will work with OCDC to ensure each inmate enrolled in the program receive necessary case management services.

Pharmacy Operations

The pharmacy is located within the healthcare clinic area of the OCDC and pharmacy operations are consistent with state requirements. The pharmacy shall carry generic brands of commonly needed over-the-counter medications and prescriptions. All other medications needed will be ordered (patient-specific) by the Provider. When possible, Provider shall utilize generic brands of medications/prescriptions.

The Provider shall be responsible for the cost of all drugs/medications ordered and prescribed that is necessary for the treatment of inmate’s care. The cost associated for the purchase of medications will be deducted from the negotiated cost pool amount.

The Provider shall provide oversight of the pharmacy operation to include, but not limited to, ordering, receiving, inventory, dispensing/administering, and detailed record keeping. Provider shall have the ability to provide same day or next day services on prescriptions, if medically necessary for an inmate’s care.

All pharmaceuticals, syringes, needles, and surgical instruments will be stored under security conditions acceptable to the OCDC and NC Board of Pharmacy regulations.

All medications, whether over the counter or prescribed, shall be dispensed as ordered, and administered by a licensed nurse in accordance with NC Board of Pharmacy regulations. Under no circumstances will any narcotics be given to inmates.

Psychotropic medications such as anti-psychotic, antidepressants, and drugs requiring parental administration shall be prescribed by a physician or authorized health provider and only following a physical examination of the inmate by a qualified health professional. Involuntary administration of psychotropic medications shall be in compliance with applicable State laws.

Inmates placed on medication shall be evaluated for signs of toxicity. Blood pressure and heart rate shall be regularly checked, and drug levels monitored where appropriate with documentation of this information to be placed routinely in the inmate’s medical record.

The Provider shall ensure that the recording of the administering of medications is done in a manner and on a form approved by the appropriate healthcare authority to include documentation that the inmates are receiving and ingesting their prescribed medications. Documentation shall also be required when an inmate’s ordered medication was not administered, and the reason given.

Telemedic Services:

Telemed/Teledoc is not currently being used for routine inmate medical concerns; however, the County does utilize a type of Teledoc system for psychiatric evaluations. Psychiatric services are not the responsibility of the Provider.

Outside Medical Services

Provider shall identify the need, schedule, and coordinate transportation for any inpatient or outpatient specialty services, procedures, emergency care, or hospitalization of any inmate of the OCDC. This also includes responsibility for making emergency arrangements for ambulance service to the inpatient facility and payment to the local ambulance organization for the services provided. The Provider will make payment to the ambulatory service and the cost (without markup) be billed back to the County through the cost pool.

Under the current contract, when an inmate is transported to the hospital for required medical treatment, the Hospital invoices the Provider. The Provider deducts the invoice (without markup) from the established cost pool. All expenses above the negotiated cost pool amount or shared cost pool amount are reimbursed to the Provider at 100% by the County.

The Provider will be responsible for regular communications with outside healthcare facilities to coordinate the referral of inmates requiring specialized care that is not available on-site. Provider will review and follow up on all emergency room episodes and hospital admittances within 24 hours.

The Medical Provider/Physician must consult and approve all outside medical treatment.

When outside medical services are required and the inmate is to be transported to the hospital, the Provider will be required to access the inmates medical records and send a copy of all medical records to the hospital at the time of transport. In addition, the Provider must make contact with ER doctor prior to arrival and inform the doctor of the inmate’s specific complaint and the reason for outside medical services. All outside medical treatment will be documented in the inmate’s medical record, along with services rendered.

Orthopedic Brace and Supplies:

The Provider will be responsible for all costs related to an inmate needing orthopedic braces or supplies.

Dialysis

Dialysis services will not be provided by the Provider. Depending on the inmate’s medical condition, the inmate may be sent to the Department of Corrections for safekeeping. There may be times when the County will transport the inmate locally for treatment. This expense will not be included in the cost pool amount. The County will pay the dialysis center directly.

X-Rays

When necessary, X-rays will be provided on-site by the Provider using a portable or mobile X-ray machine that will be provided by the Provider. These services will be paid for through the cost pool.

Stitches

In an effort to reduce outside medical cost, the Provider will be required to provide stitches for minor injuries. These services will be covered under the base compensation fee of the contract.

Lab Services

The Provider shall identify the need, schedule, coordinate, administer, and pay for all necessary diagnostics examinations.

Provider will perform necessary labs such as, but not limited, A1C, CBC, lipid, liver, pregnancy, HIV. The costs associated with drawing the bloodwork and testing will be part of the base compensation fee of the contract.

The Provider shall provide the necessary follow-up for health problems identified by any screening tests or laboratory tests. This would include safekeeping, hospitalization, appropriate monitoring and prescription of appropriate medications, and consultations with specialty physicians, if necessary.

Medical Transports:

Medical transports are costly in the fact that they involve a large amount of detention officers’ time. Decreasing the number of trips has the potential to save money. Efficient management and avoiding unnecessary referrals are ways to control the number of transports. Providers are encouraged to be suggest cost saving methods that could enable more inhouse services and less outside medical services.

When routine off-site medical treatment is needed, the Provider shall coordinate transportation needs with the OCDC staff. Advanced written notice of appointment scheduling is required for coordinating with OCDC staff. An off-site medical appointment roster shall be required.

Routine, non-emergent transfers will be provided by the OCDC officers in deputy/jail vehicles.

In emergency circumstances, the Provider will contact OCDC staff to coordinate and arrange for emergency ambulatory transportation of the inmate to the closest hospital facility that can treat the emergency, per the Medical Plan. The Provider will also notify OCDC staff prior to the emergency transport and document/record the emergency transfer on a written log. The Provider will be financially responsible for cost of ambulance transportation to the ambulatory service or County EMS. Invoices, without any markup, will be deducted through the cost pool amount.

Medical Waste

The Provider will be responsible for providing a method to properly dispose contaminated and/or regulated medical waste including needles, syringes, and other materials used in the treatment of inmates. The cost of such service will be included in the Provider’s proposal.

Elective Medical Care

The Provider will not be responsible for providing elective medical care to inmates. For purposes of the Agreement, “elective medical care” means medical care which, if not provided, would not, in the opinion of Provider’s Medical Director, cause the inmate’s health to deteriorate or cause definite harm to the inmate’s well-being.

Grievance System

A viable inmate grievance system must be provided by the Provider consistent with applicable standards. In addition, the Provider must collect such information as the Chief Detention Officer deems appropriate and supply such information on a schedule required by the OCDC staff.

27.0 Administrative and Reporting Requirements:

The Provider shall provide:

1. A designated licensed practicing physician (Medical Director) to assure the appropriateness and adequacy of inmate healthcare and to provide direct medical treatment to inmates.

2. A health services administrator to:

a) Plan, organize, and coordinate professional and technical medical staff;

b) Maintain a comprehensive medical record keeping system;

c) Maintain financial accountability to the Contract Administrator; and

d) Respond to complaints from the Contract Administrator and the Sheriff directed at medical services provided.

3. Well-defined operational policies and procedures to include, at a minimum, those required by; National Commission on Correctional Health Care, North Carolina Department of Health and Human Services Division of Facility Services (standards for jails) and in concert with the Onslow County Sheriff’s Office policies and procedures for service delivery. OCDC shall develop the policies and procedures necessary to specify the role of medical services and to provide a liaison between the medical and security staff. During the term of the contract, the Provider shall comply with, and assist in updating, the Jail Medical Plan on an annual basis as required by the North Carolina General Statutes and North Carolina Jail standards.

4. Provide documentation of healthcare staff roles in the facilities’ disaster plans. The Provider shall, in times of emergency or threat thereof, whether accidental, natural or caused by man, provide medical assistance to all Sheriff’s personnel and any other occupants of the building at the time of the disaster.

5. A comprehensive weekly, monthly, and annual statistical report forwarded to the Contract

Administrator and the Sheriff in accordance with the American Medical Association Standards and requests of the Contract Administrator and OCDC. Monthly narrative reports shall be submitted on the fifth (5) calendar day of each month to the Contract Administrator, with data reflecting the previous month’s workload, to include:

a. Deaths

b. Suicide data (i.e. attempts and precautions taken);

c. Safekeeping admissions;

d. Ambulance transports In and Out;

e. Transfers to off-site hospital emergency departments;

f. Off-site hospital admissions;

g. Off-site ambulatory procedures

h. Report of status of inmates in local hospitals and medical observation area/infirmary

i. Inmates seen by the physician

j. Medical observation area/Infirmary admissions, patient days, average length of stay;

k. Medical specialty consultation referrals

l. Inmates seen at sick call;

m. Inmates requests for various services (screened);

n. Inmates sent to a mental health professional

o. Inmates sent to a dentist;

p. Diagnostic studies;

q. Communicable disease reporting;

r. Staffing;

s. Report of third-party reimbursement, pursuit and recovery, if applicable

t. Summary of completed medical incident report;

u. Summary of completed medical grievance report

v. Hours worked by contracted Medical staff

6. Advise OCDC staff of any potential situation which could place inmates and staff in jeopardy.

7. Provider shall meet periodically (at least quarterly) with the OCDC Chief Detention Officer and his staff to discuss the concerns of the healthcare services and any potential issues.

Provider shall express concerns about any existing health-related procedures within the facility and propose changes for improvement to services and to propose more cost-effective ways to perform the services.

8. Training by Provider for OCDC Staff. Provider will work with the OCDC staff to provide educational materials and instructions on medical issues including, but not limited to, responses to an emergency or disaster conditions, signs and symptoms of mental illness, alcohol and drug withdrawal, chronic illness such as diabetes or epilepsy,…