RFP_Amendment_7-32901-31378-24.pdf

RFP # 32901-31378-24 – Amendment # 7 Page 1 of 154

STATE OF TENNESSEE

Department of Correction

REQUEST FOR PROPOSALS # 32901-31378-24

AMENDMENT # 7

FOR CLINICAL SERVICES

DATE: November 1, 2024

RFP # 32901-31378-24 IS AMENDED AS FOLLOWS:

1. This RFP Schedule of Events updates and confirms scheduled RFP dates. Any event, time, or date containing revised or new text is highlighted.

EVENT TIME

(central time zone)

DATE

1. RFP Issued August 5, 2024

2. Disability Accommodation Request Deadline 2:00 p.m. August 9, 2024

3. Pre-response Conference 10:00 a.m. August 12, 2024

4. Notice of Intent to Respond Deadline 2:00 p.m. August 14, 2024

5. Notify State of RSVP for Facility Tours 10:00 a.m. August 16, 2024

6. Facility Tours - Debra K. Johnson Rehabilitation

Center

DeBerry Special Needs Facility

Bledsoe County Correctional Complex

10:00 a.m.- 12:00 p.m.

2:00 p.m. – 4:00 p.m.

9:00 a.m. – 11:00 a.m.

August 21, 2024

August 22, 2024

7. Written “Questions & Comments” Deadline 2:00 p.m. August 27, 2024

8. State Response to Written “Questions &

Comments” November 1, 2024

9. Response Deadline 2:00 p.m. November 22, 2024

10. State Completion of Technical Response

Evaluations December 3, 2024

11. State Opening & Scoring of Cost Proposals 2:00 p.m. December 5, 2024

12. Negotiations (Optional) December 6-10, 2024

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13. State Notice of Intent to Award Released and RFP Files Opened for Public Inspection

2:00 p.m. December 12, 2024

14. End of Open File Period 4:30 p.m. December 19, 2024

15. State sends contract to Contractor for signature December 20, 2024

16. Contractor Signature Deadline December 27, 2024

2. State responses to questions and comments in the table below amend and clarify this RFP.

Any restatement of RFP text in the Question/Comment column shall NOT be construed as a change in the actual wording of the RFP document.

RFP Section Page # Question/Comment State Response

1. Please provide the names and participation levels (dollars spent) of all small/minority/ woman/veteran owned subcontractors used under the current contract.

TDOC is not a party to those subcontracts; therefore, we cannot share those at this time.

2. Please provide (by year) the amounts of any staffing paybacks/credits the Tennessee Department of Correction (TDOC) has assessed against the incumbent vendor over the term of the current contract.

Centurion Health

FY 19 - $1,471,770.74

FY 20 - $1,082,629.39

FY 21 - $889,241.49

FY 22 - $1,045,773.55

FY23 - $1,013,791.54

FY24 - $957,708.03

Centurion BH

FY24 - $214,718.40

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3. Please provide (by year) the amounts and reasons for any non-staffing penalties/ liquidated damages the TDOC has assessed against the incumbent vendor over the term of the current contract.

Centurion Health

FY 19 - $205,320.00

FY 22 - $914,500.00

FY23 - $1,734,750.51

FY24 - $332,217.00

Centurion BH – Contract started in FY24

FY24 - $1,287,850.00

4. Are any of the TDOC facilities currently subject to any court orders or legal directives? If “yes,” please provide copies of the order/directive.

No

5. With regard to lawsuits (frivolous or otherwise) pertaining to inmate health care:

a. How many have been filed against the TDOC and/or the incumbent health care provider in the last three years?

b. How many have been settled in that timeframe?

a.) Currently, the State can locate 14 cases.

Current statuses:

In Discovery = 3

Dismissed = 5

No Award = 3

Answer Filed = 2

No Status Update = 1 b.) none

6. Please provide five-year population projections regarding the size of the inmate population.

TDOC will not provide population projections because the projections would be based on current laws and could change at any time. In addition, we have no plans to build new prisons or look to contract for additional private bedspace at this time.

our population as of 9/22/24 was 19,324 our operating capacity as of 9/22/24 was 21,593

RFP # 32901-31378-24 – Amendment # 7 Page 4 of 154 our operating capacity can change at any time based on the status of maintenance projects and capital projects.

7. Please provide two years’ worth of historical data on the number of TDOC intakes.

Male:

To date 2024 =2202 Total 2023 =3725

Total 2022 =4059

Female:

To date 2024 =549 2023=679

2022=625

8. Is the TDOC aware of any upcoming legislation or government policy that could result in a drop in its inmate population (e.g., compassionate release, population reduction measures, etc.)? If yes, please describe and provide a timeframe for the legislation/policy implementation.

No, not at this time.

9. Does the TDOC have any plans to change the mission, size, or scope of any of its facilities within the term of the contract? If so, please provide details (including timeframe) on the planned change.

No, not at this time

We understand the TDOC facilities are currently accredited by the American Correctional Association (ACA). Please provide the following information.

a. Most recent accreditation date for each facility

a. January 2022

• DJRC-Deborah Johnson Rehabilitative Center

• WTSP-West Tennessee State Penitentiary

• MCCX-Morgan County Correctional Complex

August 2022

• TCIX-Turney Center Industrial Complex

• RMSI- Riverbend Maximum Security Institution

August 2023

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b. Copy of most recent accreditation audit report for each facility

• NECX-Northeast Correctional Complex January 2024

• BCCX-Bledsoe County Correctional Complex

• MLTC-Mark Luttrell Transition Center

August 2024

• DSNF-Lois DeBerry Special Needs Facility

• NWCX-Northwest Correctional Complex

b. ACA reports are not public record, so they will not be released as part of this RFP. Although verbiage is shared with the medical contractor at times, the ACA reports are not routinely shared with vendors.

11. By facility and by position, please indicate how the Minimum Staffing Requirements provided in RFP Attachment Five differ from:

a. What is required by the current contract

b. What is actually in place and physically being provided at the TDOC facilities

Please see Addendum 3 to this amendment.

12. For each TDOC facility, please provide a listing of any current health service vacancies, by position.

BCCX 17.2

DJRC 6.5

DSNF 6.5

MCCX 9.4

MLTC .9

NECX 7.7

NWCX 29.3

RMSI 6.9

TCIX 0

WTSP 33.0

Please see Item X below

Ce 13. What is the overall vacancy rate among nursing staff at the TDOC facilities?

LPN Rate is 10.17 RN Rate is 15.18

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14. What percentage of the incumbent vendor’s health care staff at the TDOC facilities is currently employed through a staffing agency?

Of the TDOC facilities- only one uses agency significantly: DSNF which utilizes agency for roughly 68% of its nursing staff.

15.For each TDOC facility, please indicate the length of time each of the following staff members has been in their position at the institution.

a. Site Health Services Administrator (HSA)

b. Site Director of Nursing (DON)

c. Site Medical Director

d. Site Behavioral Health Administrator

a) BCCX- >5 years DSNF->3 years DJRC- >3 years MCCX- >3 years MLTC- >3 years NECX -less than a year NWCX-vacant now RMSI-> 2 years TCIX-> 20 years TCIX-A- > 10 years WTSP-less than a year WTRC-less than a year

b) BCCX- less than a year DSNF->3 years DJRC- < 1 year

MCCX- > 2 year MLTC- n/a (HSA/DON same position/person)

NECX - > 1 year NWCX->2 years RMSI- <1 year TCIX-> 20 years TCIX-A- (HSA/DON same position/person) WTSP- >1 year WTRC- < 1 year

c) BCCX- < 1 year DSNF->4 years DJRC- >3 years

MCCX- Vacant MLTC- none NECX - > 2 years

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NWCX->1 year RMSI- >2 years TCIX-> 1 year TCIX-A- (TCIX same position/person) WTSP- Vacant WTRC- < 1 year

d) BCCX- less than a year DSNF->5 years DJRC- > year MCCX- >1 year

MLTC- >1 year NECX - <1 year NWCX-Vacant RMSI- <1 year TCIX->1 year TCIX-A- (covered by TCIX) WTSP- <1 year WTRC- >1 year

16.Please confirm that if the awarded vendor retains existing health care staff who are already credentialed, those incumbent staff will not need to go through the credentialing all over again with the new vendor.

If their credentials are already current and are within the state law limitations and requirements, then their credentials will be accepted.

17. Are any members of the current health service workforce unionized? If yes, please provide the following.

a. A copy of each union contract

b. Complete contact information for a designated contact person at each union

c. The number of union grievances that resulted in

Not to TDOC’s knowledge.

RFP # 32901-31378-24 – Amendment # 7 Page 8 of 154 arbitration cases over the last 12 months

18. Please provide the salaries/wages your incumbent health service Vendor is paying to its staff.

a. How recent is this data?

b. What is the source of this data (e.g., State/County records, data from the incumbent Vendor, etc.)?

TDOC does not have this data. We pay the vendor a per diem rate and staff salaries are included in that rate.

19. Please confirm that labor hours in the following categories will count toward any “hours provided” requirements of the contract.

a. Time spent by health care staff in orientation, in-service training, and continuing education classes

b. hours

c. Agency hours

d. Approved paid-time-off

a) No

b) No

c) No

d) No

20. Please list all medical equipment (e.g., blood pressure cuffs, scales, x-ray machines, etc.)

currently in use at the health care units and identify which items on the list will remain in place for the new Vendor to use.

See RFP Attachment 6.9

21. Please list all office equipment (e.g., PCs, printers, fax machines, copiers, etc.) currently in use at the health care units and identify which items on the list will remain in place for the new Vendor to use.

See RFP Attachment 6.9

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22. Does the TDOC maintain any full-time information technology (IT) staff at any of its facilities? If not, please describe any State IT resources that would be able to assist with hardware/software tasks that need to be performed hands-on, in person at a facility.

TDOC IT staff are available to image and install computers on the state network and assist with fiber or CAT6 needs. All other service is vendor provided.

23. Please provide the name and version of the offender management system software currently in use at the TDOC facilities. Does the TDOC have any plans to change to a different system within the next few years?

TOMIS, yes

24. With regard to health care staff accessing the State/TDOC network, please provide the following information.

a. Currently, are the computers used by health care staff on (a) the State/TDOC network or (b) a private network supplied by the health care vendor?

b. Will this scenario continue under the new contract?

c. Will the TDOC permit the incoming health care vendor to utilize existing network infrastructure at the facilities, e.g., wiring, switches, etc.?

d. Who is financially responsible for network upgrades, additions,

a) Currently on the state network, but there is a STS network charge of approximately $65 per month per machine. If on the vendor network, the state only provides fiber between buildings and CAT6 in buildings.

b) Yes

c) Yes

d) TDOC

RFP # 32901-31378-24 – Amendment # 7 Page 10 of 154 or expansions necessary to support the TDOC inmate health care program?

25. With regard to health care staff accessing the Internet:

a. Do vendor staff access the Internet through (i) a State/TDOC network or (ii) the vendor’s network?

b. Please describe how this currently happens, i.e., what type of hardware, wiring, and connectivity is in place.

c. Who (TDOC or vendor) is financially responsible for this hardware, wiring, and connectivity?

d. Who (TDOC or vendor) will be financially responsible for any necessary upgrades or expansions for this hardware, wiring, and connectivity?

a.) Both b.) Hard-wired internet c.) TDOC d.) TDOC

26. Is there currently WiFi capability within the TDOC facilities?

a. If “yes,” who is providing this capability, (a) the incumbent vendor or (b) the TDOC?

b. What hardware is utilized to provide the WiFi capability?

c. How many wireless access points exist within each facility?

No wireless is currently utilized. The state is resistant to wireless use for security reasons. CAT6 installation will be provided where required.

27. With regard to timeclocks or other timekeeping devices, please provide the following information.

a) A timeclock is located at each facility in each facilities site medical clinic.

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a. The number of timeclocks in place at each TDOC facility

b. Where in the buildings they are located (for example, in the lobbies, at the security sally ports, in the medical units, etc.)

c. Will the TDOC allow the incoming Contractor connect its timeclocks to the State/TDOC network?

b) For example, BCCX is one facility with three “sites”.

Each site medical clinic has a timeclock.

c) The timeclocks are on the vendor’s network

28. With regard to electronic health records (EHRs), please provide the following information.

a. Please confirm that the TDOC does not currently utilize an EHR.

b. What is the State’s timeframe for procuring an EHR for the TDOC’s use?

c. Since the transition from paper records to an EHR may require temporary staffing increases, please indicate whether (a) Respondents should include these temporary staffing costs in their bid prices or (b) the TDOC will negotiate these costs through a contract amendment at the time of its EHR procurement and implementation.

A.) not currently but will be in the future.

B.) it has already been procured.

C.) No, the respondents should NOT include any Temporary staffing costs in their bid prices. No additional staff will be needed.

29. Does the TDOC currently utilize telehealth? If so, please provide the following information.

a. Description of any equipment that will remain in place for the new vendor to use

Yes Telehealth is utilized.

a) Each facility as telehealth equipment at each site with peripherals. All equipment listed in Attachment 6.9 is intended to be onsite for the new vendor to use.

b) Yes the equipment will be in place for use

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b. Description of the telehealth connectivity (network) that will remain in place for the new vendor to use

c. The type of telehealth clinic (e.g., telepsychiatry, telecardiology, etc.)

d. How often each telehealth clinic is currently conducted (e.g., weekly, monthly, as-needed, etc.)

e. The length of each telehealth clinic currently conducted (e.g., day, half-day, etc.)

f. The average number of patients in each telehealth clinic

g. The name and contact information for the tele-provider who conducts each telehealth clinic

c) Telehealth clinics are conducted for Audiology, Cardiology, Dermatology, Endocrinology, Hematology, Infectious Disease, Nephrology, Neurology, Nutrition, Oncology, Orthopedics, Physical Therapy, Pulmonary, Urology, Wound.

d) Depending on patient need telehealth is conducted at some sites daily, as needed

e) The telehealth clinic time depends on number of telehealth orders and the patient need, generally half day and occasionally full day depending on the site.

f ) Approximately 23/month for the last 12 months.

g) Telehealth clinics vary and can be composed of different specialties at different sites. For example, the average telehealth clinic at any given site may be composed of all infectious disease or of cardiology, nephrology, and infectious disease. TDOC does not have specific information as these would be subcontracted by the vendor.

30. What laboratory subcontractor does your current health care vendor use for lab services, e.g., LabCorp, Garcia, Bio-Reference, etc.?

TDOC is not a party to those subcontracts, therefore We do not have that information to provide.

31. Are any x-ray services currently provided onsite? If “yes,” is this done (a) with permanent TDOC-owned xray equipment or (b) through a mobile radiology vendor (PLEASE

IDENTIFY VENDOR)?

Yes, however

32. Are any optometry services currently provided onsite? If “yes,” is this done (a) with permanent TDOC owned optometry equipment or (b) through a mobile optometry

Yes, however

RFP # 32901-31378-24 – Amendment # 7 Page 13 of 154 vendor (PLEASE IDENTIFY

VENDOR)?

33. Section A.5.c of the pro forma contract states, “The Contractor shall provide mobile CT and MRI specialty care services as defined by TDOC Chief Medical Officer or designee at Central and Western regions.” Please provide the following information on this topic.

a. Are mobile CT and MRI services currently being provided?

b. If “yes,” please identify the subcontractor/provider that is performing these mobile diagnostic services.

a.) yes b)

34. Section A.5.d of the pro forma contract states, “The Contractor shall provide three (3) mobile medical trailers equipped for providing oncology infusion services.” Please provide the following information on this topic.

a. Are these mobile oncology trailers currently in place?

b. If “yes,” who is providing the staff for these units, (a) the incumbent medical vendor or (b) a subcontracted oncology specialty provider?

c. Please identify the subcontracted oncology specialty provider (if any) that is staffing/managing the mobile units.

THIS REQUIREMENT IS BEING REMOVED FROM THE RFP

THROUGH THIS AMENDMENT. Please see item #5 below.

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d. What is the average weekly volume of treatments delivered through the mobile oncology trailers?

35. Section A.5.e of the pro forma contract states, “The Contractor shall provide two (2) modular buildings for medical expansion needs.” Please provide the following information on this topic.

a. Are these modular buildings currently in place?

b. If “yes,” what services are housed/being provided in the buildings?

c. Please provide the current staffing plan for each modular building.

d. Please provide a list of the equipment located in each modular building and indicate whether the items will remain in place for the incoming Contractor.

THIS REQUIREMENT IS BEING REMOVED FROM THE RFP

THROUGH THIS AMENDMENT. Please see Item # 6 below.

36. For each TDOC facility, which hospital(s) is used most frequently?

The closest hospital based on acuity of the patient.

37. In Attachment Three – Key Performance Indicator Manual, the critical indictors for Specialty Care/ Consultations require “all initial visits to a specialist [to] occur within 60 days from the date of the

A)85%.

B)The $200 penalty is assessed on a case-by-case basis with consideration to exigent circumstances.

RFP # 32901-31378-24 – Amendment # 7 Page 15 of 154 provider’s request.” Please provide the following information on this topic.

a. What percentage of specialty visits are currently being completed in the mandated 60-day timeframe?

b. Please confirm that the $200 penalty will not be assessed in instances where a delay is not within the control of the health care Contractor.

38. Does the TDOC participate in any programs or legislation (e.g., the Affordable Care Act, Medicaid expansion, Workers Compensation, State law, etc.)

that mandate special discounts for inpatient care for TDOC patients? If “yes,” please provide the following information.

a. Name and brief description of the program

b. What services are discounted under the program?

c. Who is responsible for enrolling TDOC patients in the program?

d. Please provide the current processes and timeframes for (a) enrollment in the program and

(b) payment at the program’s discounted rates.

No.

39. With regard to any specialty care clinics currently conducted onsite at the TDOC facilities,

a) Telehealth-Audiology, Cardiology, Dermatology, Endocrinology, Hematology, Infectious Disease, Nephrology, Neurology, Nutrition, Oncology, Orthopedics, Physical Therapy, Pulmonary, Urology, RFP # 32901-31378-24 – Amendment # 7 Page 16 of 154 please provide the following information.

a. The type of specialty clinic (e.g., orthopedics, neurology, etc.)

b. How often each specialty clinic is currently conducted (e.g., weekly, monthly, as-needed, etc.)

c. The length of each specialty clinic currently conducted (e.g., day, half-day, etc.)

d. The average number of patients in each specialty clinic

e. The name and contact information for the provider who operates each specialty clinic

Wound. The average number of monthly Telehealth sessions is 131.

b) As-needed

c) As-needed

d) Vendor manages this.

e) TDOC is not a party to these sub-contracts, and

Therefore, does not have the information to Provide.

40. Please identify the number, type, and timeframes of any backlogs (chronic care clinics, offsite referrals, dental encounters, etc.) that currently exist at the TDOC facilities.

NWCX – backlog of 4 inmates for Optometry, and 2 Inmates for TB/IGRA.

RMSI – backlog of 12 inmates for Dental, and 1 Inmate for TB/IGRA DJRC – backlog of 1 inmate for TB/IGRA.

NECX – backlog of 3 inmates for Dental.

41. Please provide the following information about any medical, behavioral health, or other special needs units (infirmary, addiction recovery, sex offender, geriatric, skilled nursing, hospice, etc.) at the TDOC facilities.

a. Type of each unit

b. Location of each unit

c. Capacity of each unit

d. Average occupancy of each unit

e. Staffing for each unit

f. Type of services/Acuity able to be handled in each unit

Addiction treatment TC programs: On average the substance use treatment TC program stays at a 98% occupancy because it is open-ended, and admissions and discharge are fluid day to day.

BCCX- Unit 15, 16, and 2 (50 beds in each unit) MCCX – Units 8 and 9 (50 beds each unit) Plans to expand up to 50 more beds. Unit hasn’t been identified yet.

NWCX – Unit N06 and 13 (128 beds and 50 beds) TCIX – Unit W1A and W2A (50 beds each depending on the need and 24 beds at TCIX Main Site) WTRC –Unit 7A (128 Beds) 7B- 128 Beds substance use education program (SURE) WTSP – Unit 3 A (128 Beds) plans to increase 50 beds once unit and beds are identified.

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Unit 3B Pre (Sure Program) and Post (Aftercare) substance use treatment (128 Beds) Unit 5 alpha and Bravo Withdrawal Managment (46 Beds) Unit 5 Charlie Pod-Veteran's TC (24 beds) Please see pgs 72, 73, and 74 in RFP for staffing requirements.

DSNF Sex Offender Treatment Program: Unit 5A1 and 5A2 Occupancy Rate 100% fill rate, 32 beds.

SLU units for LOC 3 and 4 behavioral health patients- BCCX – Unit 21D Capacity 48 DSNF – Units 7A1, 7B1,7D1, 7C1, 7F1 Capacity 160 MCCX – Unit 26B Capacity 24 NWCX – Unit N05 Capacity128 WTRC – 8A 128 beds – generally occupancy is in range of 35 to

40. However, there is ongoing plans to move the SLU from WTRC to DJRC in the near future. Once moved to DJRC, it will be in Unit 3 with the capacity of 36 Please refer to the Matrix for staffing pattern for behavioral health.

Geriatric- TCIX Wayne County- Dorm WD1, WD3, WD4 with a capacity of 175. On average 56 inmates are assigned to those geriatric beds.

42. For each of the past 36 months, please provide the following mental health data.

a. Number of individuals on the mental health caseload

b. Number of individuals on suicide watch each month

c. Number of suicide attempts

d. Number of successful suicides

e. Number of self-injurious behavior incidents

a. FY 2022: 6012

FY 2023: 5945

FY 2024: 6425

Current: 6826

b. FY 2024: 1886- Avg: 157.2 per month

c. We don’t have this answer broken out from SIB numbers in e.

d. 10 suicides in 2022

9 suicides in 2023 6 suicides in 2024 (thus far.)

e. Average number of SIB by year

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2022 – 57 2023 – 61 2024 – 36 Average number of SIB inmates 2022 – 53 2023 – 55 2024 - 31

43. With regard to the Medication Assisted Treatment/Withdrawal Management Unit program at WTSP, please provide the following information.

a. Is the Medication Assisted Treatment/Withdrawal Management Unit program at WTSP already in place and operating?

b. Does the TDOC currently screen all intakes for both opioid use disorder and substance use disorders?

c. If “yes,” what screening tools are currently in use?

d. Please provide the TDOC’s current protocols for determining who receives MAT/MOUD treatment.

e. For each of the past two years, please provide the average number of TDOC patients receiving MAT/MOUD treatment.

f. Please indicate which of the three FDA-approved MAT/MOUD drugs the TDOC currently

a. Yes

b. Yes

c. Texas Christian University Drugs Screen 5 and Opioid

Supplement And COWS

d. Policy 113.93.1 established procedures for MAT.

e. The number of patients on MOUD/MAT is relatively new to TDOC and we are in the process of expanding. In September 2023 we had nine patients on MAT and by November 2023 we had 35. Currently we have 234 patients on MAT. We are expanding weekly.

f. Subutex is used mostly and is on stock. Sublocade is specific orders and 57 people are on injectables. We are in the process of implementing suboxone film and this is not on stock yet and is specific orders, currently. 234 people are on MAT

g. See f.

h. Yes, as needed for specific patients

i. No

RFP # 32901-31378-24 – Amendment # 7 Page 19 of 154 uses/prescribes in its program(s) and provide a breakdown of how many patients are being prescribed each medication.

g. Specifically, what buprenorphine product is currently being used, e.g., tablets, films, mono-product, or combo product?

h. Is the TDOC currently using any long-acting injectable MAT medications for its incarcerated patients?

i. Are any of the TDOC facilities certified as an Opioid Treatment Program?

44. With regard to medication administration.

a. Who administers the medications (RNs, LPNs, or other position)?

b. Do CMAs pass medications at the TDC facilities?

c. Is the current process: (a) med carts go to the housing units or

(b) patients come to the medical unit?

d. How often does med pass occur each day?

e. On average, (a) how many FTEs and (b) how long does it take to perform a med pass?

a. LPNs and RNs

b. No

c. a. yes and b. yes It will depend on facility.

d. Typically, twice a day.

e. That is dependent on site and if medication is administered on unit or if a special Medline is utilized.

45. Please provide copies of the following documents.

a. The drug formulary currently in use

b. The most recent pharmacy report

a. Attachment 11

b. Specify which pharmacy report is being requested we have several.

c. This is confidential information and cannot be provided.

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c. The lab test formulary currently in use

46. On average, how many TDOC patients per month receive these types of prescription drugs?

a. Psychotropic medications

b. Hepatitis C medications

c. HIV/AIDS medications

a. Psychotropic medications: 4,240

b. HCV medications:

c. HIV: 148

47. Does the TDOC currently participate in any 340B pharmacy discount programs? If “yes,” please provide the following information about the program.

a. What specialties (categories of medication) does the 340B agreement cover, e.g., HIV meds, Hepatitis C, cancer, etc.

b. Please identify the Federally Qualified Health Center (FQHC) or other 340B-certified health care entity whose physicians are prescribing the drugs for the current program.

c. Which pharmacy is providing the 340B medications?

a) a. TDOC is a STD Grantee

There is no designated formulary for the 340B Program.

STD (318 grantee) clinics that participate in the 340B Program may purchase 340B drugs (including prescribed contraceptives), for grantee patients that meet the patient definition criteria [61 Fed. Reg. 55156 (Oct. 24, 1996)]. The covered entity may purchase and dispense any 340B drugs associated with a service for which the covered entity is responsible, including contraceptives, to that patient, to the extent it aligns with patient definition and is consistent with the scope of the grant.

b. TDOC Contracted Centurion prescribers

c. TDOC owned Central Pharmacy

48. With regard to transgender individuals, please provide the following information.

a. Please provide the TDOC policy(s) on transgender individuals and gender reassignment surgery.

b. In the past five years, how many (if any) transgender individuals in TDOC custody have undergone gender reassignment surgery?

a. 113.37Clinical Services Intervention for Gender Dysphoria Policy

b. Zero

c. One. However, recent changes to state law precludes TDOC from spending any state funding on transgender medical care to include hormones and surgical.

d. Not applicable currently. The cost would likely be shared with state and vendor.

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c. How many (if any) transgender individuals in TDOC custody are currently awaiting gender reassignment surgery?

d. Who is financially responsible for the cost of gender reassignment surgery?

49. Please provide the following information relating to Interstate Compact individuals.

a. Please describe any Interstate Compacts in which the TDOC participates and identify the involved states/jurisdictions.

b. On average, how many TDOC incarcerated individuals are housed in other states’ facilities?

c. Who is financially responsible for the cost of health care provided to TDOC incarcerated individuals are housed in other states’ facilities?

d. On average, how many individuals from other states’ jurisdictions does the TDOC house?

e. Who is financially responsible for the cost of health care provided to individuals from other states’ jurisdictions that are housed in a TDOC facility?

a.) yes, we do. Kansas, New Mexico, South Carolina, Oklahoma, Florida.

b.) exact percent not available, numbers are low c.) likely TDOC but could depend on if there are other circumstances involved.

d.) currently 12 total inmates.

e.) TDOC is required to provide normal healthcare maintenance, if there are medical costs for healthcare outside of the normal healthcare maintenance, we have to contact the sending state for their approval and payment for those costs.

50. For each of the past 36 months, please provide statistical data for each of the following categories. If the TDOC includes data from the privately managed institutions in this response, please separate a.) average based on review of 3 months of data= 2023 monthly average 111, 2024 monthly average 94.4.

b.) 2023 monthly average 5.5 days, 2024 monthly average 6 days c.) TDOC does not track this information.

d.) specialty consultation referrals= 2023 monthly average is 1,105 and 2024 monthly average is 1183.3.

RFP # 32901-31378-24 – Amendment # 7 Page 22 of 154 the information into “TDOC facility” and “private facility” categories.

a. Number of (offsite) inpatient hospital admissions

b. Number of (offsite) inpatient hospital days

c. Number of outpatient surgeries

d. Number of outpatient referrals

e. Number of trips to the emergency department (ED)

f. Number of ED referrals resulting in hospitalization

g. Number of ground ambulance transports

h. Number of air ambulance transports

i. Number of dialysis treatments e.) monthly average 2023 113, monthly average 2024 93.7.

f.)TDOC does not track this information.

g.) TDOC does not track this information.

h.) TDOC does not track this information.

i.) Dialysis Treatments:

- CY 2022- total 5,217; monthly Avg-434

- CY 2023- total 5,688; monthly Avg-474

- CY 2024 through August- total 4,224

Total number of dialysis patients:

FY23- 39 patients FY24- 43 patients

Average number of weekly treatments past 12 months:

-Sept 2023-August 2024- 121 avg weekly treatments

51. In the past five years, how many (if any) TDOC inmates have received organ transplants? How many have received tissue transplants?

None.

52. Please provide the following information relating to the TDOC’s use of Skilled Nursing Facilities (SNFs) or Long-Term- Acute Care Facilities (LTACs).

a. For each of the past 3 years, please indicate how many (if any) TDOC patients have been admitted to a SNF or an LTAC.

b. Please provide the average length of stay (ALOS) for the TDOC’s SNF/LTAC patients.

No SNF or LTAC’s have been used.

RFP # 32901-31378-24 – Amendment # 7 Page 23 of 154

c. Please provide a list of the SNF and LTAC facilities used by the

TDOC.

53. For each of the past 3 years, please provide total spend amounts for the following categories.

a. Offsite services

b. Laboratory services

c. Offsite diagnostic (x-ray) services

a) These costs are included in the per diem amount and TDOC has no way to track these costs.

b) These costs are included in the per diem amount and TDOC has no way to track these costs.

c) These costs are included in the per diem amount and TDOC has no way to track these costs.

54. Section A.8.a.3 of the pro forma contract states, “The hospitals used by the Contractor shall provide vehicle parking, local telephone calls and meals for security staff who are accompanying hospitalized inmates. The Contractor shall pay any costs associated with providing these items.” For each of the past three years, please provide the dollar amount associated with such security-related parking, phone calls, and meals.

FY21 $111,286.75

FY22 $103,123.85

FY23 $ 71,155.95

55. Section A.8.e of the pro forma contract states, “Starting on day three (3) of an inpatient stay at a hospital that does not contain a secured unit, the Contractor shall pay six hundred dollars ($600.00) per day per inmate to cover the cost incurred by the State to provide security.”

For each of the past three years, please provide the dollar amount

Data is only available for FY24

FY24 - $505,200.00

RFP # 32901-31378-24 – Amendment # 7 Page 24 of 154 associated with such security-related coverage.

56. Section A.8.f of the pro forma contract states, “The Contractor shall pay all costs associated with maintenance and capital improvements of the existing secured unit at Nashville General Hospital to ensure all inmates requiring community-based hospital services are properly secured while receiving offsite medical care.” Please provide the following information on this topic.

a. Please provide the dollar amount the TDOC’s incumbent health care vendor has paid related to the secured unit maintenance and capital improvement at Nashville General Hospital.

b. Please provide the capital improvement plan for the next five years for the existing secured unit at Nashville General Hospital.

The State has no intent of another secured unit being created for this contract.

57. Section A.16 of the pro forma contract states, “The Contractor shall provide all medical and dental noncapital equipment including maintenance of existing equipment and including Telemedicine Equipment.” Please on this topic.

a) The contractor will be responsible for the purchase of capital medical equipment

b) Capital equipment is any equipment costing $5,000 or more.

RFP # 32901-31378-24 – Amendment # 7 Page 25 of 154

a. Who is responsible for the purchase of capital medical equipment?

b. What are the criteria for determining whether equipment is a capital outlay or a non-capital outlay?

58. We understand that the awarded Respondent will be financially responsible for 50% of the costs of HIV/Acquired Immunodeficiency Syndrome (AIDS) and Hepatitis C antiretroviral medications. For each of the past three years, please provide the total (State + Contractor) annual expenditure on such medications.

HCV

FY 2022: $16,636,132.39

FY 2023: $11,319,333.99

FY 2024: $13,551,162.49

HIV

FY 2022: $5,303,651.64

FY 2023: $6,056,391.77

FY 2024: $4,289,740.74

59. We understand that the State will reimburse the Contractor for 50% of the cost of all psychiatric medications. For each of the past three years, please provide the total (State + Contractor) annual expenditure on psychiatric medications.

FY 2022 $1,030,825.32

FY 2023 $1,033,633.96

FY 2024 $1,079,595.54

60. With regard to medication costs for the Medication Assisted Treatment/Withdrawal Management Unit program at WTSP, we understand that the awarded Respondent will be financially responsible for 50% of the costs of MAT/MOUD medications. For each of the past three years, please provide the total (State + Contractor) annual

Annual expenditure; cost share not applicable

FY 2022: $453.83

FY 2023: $1,685.14

FY 2024: $34,987.74

RFP # 32901-31378-24 – Amendment # 7 Page 26 of 154 expenditure on MAT/MOUD medications.

61. Will the vendor be financially responsible for any of the following services under the new contract? For any category that will be at the vendor’s cost, please provide three years of cost data on the expenses incurred in that category.

a. Care for newborn babies after the actual delivery

b. Abortions that are not clinically necessary

c. Cosmetic surgery that is not clinically necessary

d. Gender reassignment (sex change) surgery and any follow-up treatment or related cosmetic procedures

e. Contraception, including vasectomy, tubal ligation, or reversal of such

f. Experimental care

g. Elective care, i.e., care which if not provided would not (in the opinion of the Medical Director) cause the patient’s health to deteriorate or cause the patient definite and/or irreparable physical harm

h. Autopsies

i. Organ, tissue, or other transplant surgery and related costs, including, but not limited to labs, testing, pharmaceuticals, pre- or post-op follow-up care, or

a) No, this care is provided outside of the contract and the State.

b) No, abortion laws do not allow this to take place.

c, d, e, g, i and j) these services would be provided if medically/clinically indicated. If they are, the vendor has the primary responsibility to cover the costs for these services.

f.) Experimental care – This would be a case-by-case basis.

h.)The vendor is not financially responsible for these costs. .

RFP # 32901-31378-24 – Amendment # 7 Page 27 of 154 ongoing care relating to the transplant

j. Factor and other medications for the treatment of bleeding disorders

62. Section A.8.d of the pro forma contract states, “The Contractor shall assume responsibility for the coordination, provision and cost of inpatient hospitalization of inmates housed at the four (4) privately managed facilities after the cost exceeds four thousand dollars ($4,000)…” Please provide the following information about this cap.

a. In each of the past three years, how many times have inmates from the privately managed facilities experienced hospitalizations with costs that exceeded $4,000?

b. How many bed-days are included in each of these annual statistics?

c. For each of these instances, please provide the actual total dollar amount of the cost of the hospitalization.

This information is maintained by Core Civic and/or Centurion. TDOC Fiscal does not have access to this data.

63. Section A.11 of the pro forma contract states, “Services included in the Utilization Management and Review Process shall include, facility-based services, outpatient referral services, inpatient hospitalization for jail and state inmates, a- On average we can house 60 safekeepers.

b- DJRC, MCCX, RMSI, DSNF, and WTRC (Until policy is updated) are currently w here we house the safekeepers.

c- If we have safekeepers in TDOC facilities, then there would have been a court order for them to be housed

RFP # 32901-31378-24 – Amendment # 7 Page 28 of 154 including safe keepers.” Please on this topic.

a. On average, how many jail inmates/safekeepers are housed by the TDOC at any given time?

b. Which TDOC facilities house jail inmates/safekeepers?

c. Please define the Contractor’s financial responsibility with regard to providing health services for jail inmates/safekeepers housed in a TDOC facility.

d. Who is financially responsible for inpatient costs incurred by patients (TDOC and/or jail) who are on suspension status with TennCare?

in TDOC prison. Therefore, they are part of TDOC population, and the vendor is responsible for health services just like every other inmate. There is no difference, they are court ordered to be with TDOC.

d- As above the safekeepers are TDOC inmates per court order and financial responsibility is like every other inmate as the financial responsibility for health services is on the vendor.

The TDOC healthcare vendor does not provide any health care for inmates that are housed in the county jails.

64. Section A.11.7 of the pro forma contract states, “The Contractor shall assist the State with developing protocols for tracking state inmates on suspension status with TennCare in both the prisons and county jails.” Please provide the following information on this topic.

a. Please define the Contractor’s role in providing services to inmates housed in County jails.

Are these TDOC inmates or County detention agency inmates?

b. At any given time, for how many County-jail-housed inmates

Currently DOC supplies the vendor the list from TennCare of those on suspension status.

a) TDOC inmates

b) TDOC is not able to give a number as it

Changes every day.

c) Email exchanges

RFP # 32901-31378-24 – Amendment # 7 Page 29 of 154 will the Contractor be responsible?

c. Please describe the current process for County jails keeping the TDOC health care Contractor informed/aware/up-to-date on the health status of applicable inmates.

65. Section C.3.c of the pro forma contract states, “The Contractor’s responsibility shall be capped at two million dollars ($2,000,000) per year for HCV.” Please provide the following information about this cap.

a. Please list exactly which specific categories of HCV services are included under the cap, e.g., diagnostic services, treatment, hospitalization, medications, etc.

b. For each of the past three years, by how much (if at all) have total HCV expenses exceeded the contracted cap amount?

a. applies to medication treatment costs

b. HCV vendor cost share is $2M; it is not reflective of total HCV medication cost. 2021 costs were outliers due to $26M grant received for HCV treatment Reference:

FY 2022 Total Cost $16,636,132.39 FY 2023 Total Cost $11,319,333.99 FY 2024 Total Cost $13,551,162.49

66. Section C.3.d of the pro forma contract states, “When a single hospitalization for a single inmate from the date and time of admission through the date and time of discharge exceeds fifty

a) TDOC does not track this information by date and time, we do have totals by Fiscal Year. .

b) FY22 - $4,965,566.56

FY23 - $5,255,560.96

RFP # 32901-31378-24 – Amendment # 7 Page 30 of 154 thousand dollars ($50,000), the State shall reimburse the Contractor for seventy-five percent (75%) of the cost of the hospitalization in excess of fifty thousand dollars ($50,000).”

Please provide the following information about this cap.

a. In each of the past three years, how many times have hospitalizations occurred with costs that exceeded the $50,000 cap?

b. For each of these instances, please provide the actual total dollar amount of the cost of the hospitalization.

FY24 - $4,599,866.25

67. For each 12-month period of the contract, the RFP requires a performance bond covering 25% percent of the Contract amount.

Please clarify if this is (a) 25% percent of the ANNUAL Contract amount; (b) 25% percent of the total 3-year base Contract amount; or (c) 25% percent of the total 5-year base + option years Contract amount.

The bond amount is 25% of the annual amount each year.

68. There are conflicting population levels in the RFP, e.g., “21,496” on Tab 6.3.A of the cost forms, “28,642” on Tab 6.3.B of the cost forms, etc. So that all vendors submit pricing based on the same population size— thereby allowing the TDOC to compare apples-to-apples bids— please provide the ADP on which

The 21, 496 is the current TDOC population inclusive of inmate at the 4 Private facilities. The 28,642 number was listed in error.

The average number of inmates in the ten state facilities over the last twelve months was 12,391.

Please refer to RFP Attachment 6.3.A and 6.3.B for the population figures vendors should use to determine their bid prices.

RFP # 32901-31378-24 – Amendment # 7 Page 31 of 154 vendors should base their bid prices.

69. Please provide instructions on how Respondents can take exceptions to the RFP specifications, as we do not see a form for this purpose included in the solicitation documents.

Please refer to section 3.3 of the RFP. There is no template for requesting exceptions as they are not permitted as part of the RFP response. Per RFP Section 5.3.5. the state can entertain, at its sole discretion, limited terms and conditions negotiations provided that such revision of terms and conditions or performance requirements shall not materially affect the basis of response evaluations or negatively impact the competitive nature of the RFP and contractor selection process.

70. Please provide instructions on how Respondents are to redact/protect the proprietary and confidential information (such as financial statements) in their responses, as we do not see this information in the solicitation documents.

All information provided as part of a vendor response is subject to the State’s Open Records laws and can be made available upon request during the Open Records period. Please refer to section 4.8 of the RFP. Respondents may not submit redacted response to the RFP.

71. Section A.3.f of the pro forma contract requires the Contractor to, “utilize Physician, Mid-Level Provider, and nursing staff Adjunct Appointments at all academic institution partners in the correctional healthcare rotations.”

a. Please clarify if this means (a) clinical instructors from the academic institution partners will need to be onsite at the TDOC facilities with the students OR (b) the Contractor’s clinical staff need to become adjunct instructors at academic institution partners.

b. Please reconcile how the “Adjunct Appointment” requirements of pro forma A.3.f

a) Onsite

b) During student clinical rotations onsite-providers and nursing staff are expected to support student learning by educating them on patient care performed onsite.

RFP # 32901-31378-24 – Amendment # 7 Page 32 of 154 relate to pro forma Section A.24 SUPERVISION OF INTERNS, which does not require any adjunct appointment at an academic institution, but simply states, “appropriately licensed clinician[s] will provide supervision to inter or practicum students. Each licensed clinician can be requested by the State to supervise at least two (2) interns.

The Contractor’s providers shall be available for teaching purposes and providing training...”

72. Section B.2 of the pro forma contract states, “The State reserves the right to execute up to two (2) renewal options…at the State's sole option.” Please confirm that such renewal options also require agreement/permission from the awarded Respondent/Contractor.

In the event that the State executes a renewal, it is at the state’s sole discretion and would not require signature from the Contractor. In the event that contractual changes (clauses or maximum liability) are included with a renewal it would require signature from the Contractor.

73. Section A.25.i.2 of the pro forma contract requires the Contractor to “provide treatment services for the inmate population including a…Family program for people with co-occurring disorders.” Please define what the TDOC means by a “family program” and provide a detailed description of the TDOC’s requirements for this initiative. Is this program currently in place?

Yes, this program is currently in place at BCCX for TCOM with the Cooccurring disorders. This is covered under policy 513.07.3 under C.(1)(2)(3)

RFP # 32901-31378-24 – Amendment # 7 Page 33 of 154

74. Please provide the TDOC’s minimum educational and licensure requirements for the following positions.

a. Addiction Treatment and Recovery Services Coordinator

b. Case Management Coordinator a.LADAC

b. No license required. Must possess a Bachelor’s degree.

75. Please provide the average number of males and females receiving sex offender treatment services, by facility.

Males only, 30-32 on average per month.

76. Does the TDOC operate a Youthful Offender Program for youths incarcerated as adults? If “yes,” please provide the following information for the program.

a. Youthful Offender average daily population (ADP)

b. Youthful Offender average length of stay (ALOS)

c. Average number of these individuals enrolled in the Youthful Offender Program

d. Description of the scope, type, and frequency of behavioral health programming offered through the Youthful Offender Program

TDOC established a Young Adult Offender Program at TCIX Main.

See Policy 513.14

a. 128 beds

b. 12 to 24 months

c. Typically, 128

d. The Young Adult Program criteria established that the program is only available to LOC I or II. Behavioral health only provides support to the LOC II mental health patients as with any LOC patient. Young Adults may participate in GRTH on compound if the need is identified.

77. With regard to RFP Attachment Four–Minimum Staffing Requirements, many positions in the staffing plan are highlighted in yellow. What is the significance of this highlighting?

No significance. A new document has been submitted without highlighting.

78. In the Minimum Staffing Requirements, there are 6.0 FTE

Please see the attached revised Amendment 4.

RFP # 32901-31378-24 – Amendment # 7 Page 34 of 154

Administrative Staff and 6.0 FTE UM staff under the “Healthcare Services” tab PLUS ANOTHER 6.0 FTE Administrative Staff and 6.0 FTE UM staff under the “Behavioral Healthcare Services” tab. Is this accurate, that the TDOC is requiring (at minimum) a total of 12.0 FTE Administrative Staff and 12.0 FTE UM staff? If not, please publish a corrected minimum staffing plan.

79. In the Minimum Staffing Requirements, please provide the following information about the

6.0 FTEs in the row entitled

“Utilization Management.”

a. What are the TDOC’s minimum educational and licensure requirements for these positions, e.g., are they RNs, LPNs, administrative support, etc.?

b. Please confirm that these positions may work remotely and do not have to be physically located within the State of Tennessee.

a) RN

b) Yes, remotely

80. Throughout the RFP, specifications require the Contractor to comply with, and to provide training on, TDOC policies which were not provided as part of the solicitation documents. Can the TDOC please provide the missing policies listed below?

a. Policy 110.04

Several of the policies listed here were among the many TDOC policies included in Attachment 6.8 of the RFP as issued.

a. Policy 110.04 was included in Attachment 6.8

b. Policy 110.05 was included in…