RFP_SD25-00019.pdf

STATE OF CALIFORNIA

DEPARTMENT OF CORRECTIONS AND REHABILITATION

REQUEST FOR PROPOSAL (RFP)

HEALTH CARE PROVIDER NETWORK AND PRIOR

AUTHORIZATION SERVICES

PROPOSAL NUMBER: SD25-00019

You are invited to review and respond to this Request for Proposal (RFP) titled Health Care Provider Network. Potential proposers are encouraged to download the solicitation package as well as any future addendums from Cal eProcure at:

https://caleprocure.ca.gov/. When submitting your proposal, you must comply with the instructions found herein. The deadline for submitting proposals is August 18, 2026, 4:00 PM Pacific Daylight Time (PDT).

The California Department of Corrections and Rehabilitation/California Correctional Health Care Services (CDCR/CCHCS), hereafter referred to as the State, is soliciting proposals from qualified entities to provide a Health Care Provider Network of community-based specialty medical services providers for CDCR/CCHCS. The successful Proposer will be awarded a contract term of up to five (5) years that is anticipated to begin on December 01, 2026, and end on November 30, 2031. CDCR/CCHCS has the option of extending this Agreement for up to five (5) optional one (1) -year terms through November 30, 2036. Contract extensions are subject to satisfactory performance, funding availability, and at CDCR/CCHCS discretion.

This RFP package consists of the following documents. Proposers must comply with all requirements in the following documents:

• Request for Proposal

• Standard Agreement (STD 213) – (Sample)

• Exhibit A – Scope of Work

• Exhibit A-1 – Service Specifications

• Exhibit B – Budget Detail and Payment Provisions

• Exhibit B-1 – Rate Sheet

• Exhibit C* – General Terms and Conditions (GTC 02/2025)

• Exhibit D – Special Terms and Conditions & Additional Provisions

• Exhibit E – Definitions https://caleprocure.ca.gov/

• Exhibit F – HIPAA Business Associate Agreement

• Exhibit G – Information Security Agreement

• Exhibit H – List of Participating CDCR/CCHCS Institutions

• Exhibit I – California State Institutions Map

• Exhibit J – Reentry Program (REPS) Facility Locations

• Exhibit K – Reentry Program (REPS) Facilities Map

• Cover Letter

• Attachment 1 – Required Attachments Checklist

• Attachment 2 – Proposal/Proposer Certification Sheet

• Attachment 3 – Bidder Declaration Form

• Attachment 4 – DVBE Incentive Application Request, if applicable

• Attachment 5 – Darfur Contracting Act Certification

• Attachment 6 – California Civil Rights Laws Certification

• Attachment 7 – Contractor Certification Clauses

• Attachment 8 – Iran Contracting Act

• Attachment 9 – Payee Data Record

• Attachment 10 – Supplement Vendor Payee Data Record

• Attachment 11 – Certificate of Good Standing

• Attachment 12 – GenAI Disclosure & Factsheet

• Attachment 13 – Customer Reference Questionnaire (CCHCS-MC-415)

• Attachment 14 – Conflict of Interest Compliance Certification (CCHCS-

MC-412)

• Attachment 15 – Confidentiality Agreement Form (CCHCS-MC-420)

• Attachment 16 – Rate Sheet

• Attachment 17 – Performance Guarantees

* Exhibit C* – General Terms and Conditions (GTC 02/2025) is incorporated in this proposal package by reference only and is available on the internet at the following link:

https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal- Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language https://www.dgs.ca.gov/OLS/Resources/Page-Content/Office-of-Legal-Services-Resources-List-Folder/Standard-Contract-Language

Proposers may request a hard copy of this document by contacting the CCHCS Project Manager listed below.

It is the opinion of the State that this RFP is complete and without need of explanation. If the Proposer has any questions regarding this RFP or believes any documents to be missing from this RFP, immediately contact the Project Manager listed below.

Project Manager: Christina Nguyen

Email: m_CHCPNRFP@CDCR.ca.gov

Please note that no verbal information given will be binding upon the State unless such information is issued in writing as an official addendum.

mailto:m_CHCPNRFP@CDCR.ca.gov

Table of Contents

1. RFP Overview

2. Background

3. RFP General Requirements

3.1 Key Action Dates

3.2 Cal eProcure Portal

3.2.1 Adobe Acrobat Version

3.2.2 Cal eProcure Portal Registration

3.2.3 Proposer’s Conference and CDCR/CCHCS Institution Tour

3.2.4 Proposer Questions

3.2.5 How to Submit Questions

3.2.6 Proposer’s Intention to Submit a Proposal

3.2.7 Disposition of Proposals

3.2.8 News Releases

4. Project Information

4.1 Healthcare Provider Network

4.2 Third Party Administrator

4.3 Prior Authorization

5. Scope of Work

5.1 Prior Authorization

6. Requirements

6.1 Mandatory Qualifications

6.2 Additional Requirements

6.2.1 Provider Network

6.2.2 Service Delivery

6.2.3 Credentialing and Privileging

6.2.4 Medical Imaging

6.2.5 Clinical Laboratory

6.2.6 Pathology Services

6.2.7 Telehealth Services

6.2.8 Health Care Services

6.2.9 Reports

6.3 Additional Proposal Evaluation

6.3.1 Company Background

6.3.2 Network Strategy

6.3.3 Prior Authorization

6.4 Deliverables and Expectations

6.4.1 Implementation Deliverables

6.4.2 Project Management Deliverables

6.4.3 Other Expectations

7. Selection Process

7.1 Evaluation Committee

7.2 Evaluation Process

8. Table 1 – Technical Scoring

9. Table 2 – Cost Scoring

10. Table 3 – Example Scoring Methodology

11. Preference Programs

11.1 Small Business/Microbusiness Preference

11.2 Non-Small Business Preference

11.3 Commercially Useful Function

11.4 Disabled Veteran Business Enterprise (DVBE) Program

12. Submittal Requirements

12.1 Modification or Withdrawal of Proposals

12.2 Public Opening

12.3 Reservation of Rights

12.4 Proposal Format

12.4.1 Cost Proposal Contents

12.4.2 Technical Proposal Contents

13. Proposers Library

14. Cost Proposal

1. RFP Overview This RFP is not subject to provisions of the Public Contract Code (PCC) pertaining to bidding and awarding of contracts but rather uses substitute procedures authorized by the United States District Court for the Northern District of California, in Plata v. Schwarzenegger, Case Number C01-1351 TEH (Plata Court).

No protest of the award of the contract resulting from this RFP is available.

Proposers are solely responsible for understanding the scope of work and all requirements, terms, conditions, evaluation criteria, etc. before submitting a proposal. If the language is unclear or ambiguous, or if clarification of the RFP is necessary, it is the Proposer’s responsibility to request clarification or assistance from the Project Manager before submitting a proposal.

If the RFP is modified prior to the final proposal submission date, the State shall post an addendum at Cal eProcure. By virtue of submitting a proposal, the Proposer accepts the terms and conditions expressed as stated in this RFP and as required by law. Costs incurred for developing proposals in anticipation of award of an Agreement are the responsibility of the Proposer and shall not be charged to the State.

CDCR/CCHCS reserves the right to modify or cancel, in whole or in part, this RFP at any time prior to contract award. Any RFP modification(s) and/or cancellation will be made via an addendum. CDCR/CCHCS reserves the right to negotiate services and related costs deemed necessary to meet the needs of the project.

CDCR/CCHCS at its sole discretion reserves the right to reject any or all proposals received in response to this RFP.

https://cchcs.ca.gov/wp-content/uploads/sites/60/2017/08/2007-06-04_Order_Waiving_State_Contracting_Laws.pdf https://caleprocure.ca.gov/pages/index.aspx

2. Background The CDCR/CCHCS is currently responsible for healthcare services to approximately 90,000 incarcerated persons in thirty (30) institutions and thirteen

(13) Reentry Programs (REPS) facilities throughout the state. The scope of the healthcare mission includes primary, urgent, acute, emergency, and long-term care, as well as preventative care, and chronic care management. Cases requiring specialty medical consultation, treatment, or complex specialty management are seen remotely by telemedicine, onsite, or referred to community based medical service providers. Some community hospitals have secured wings within the facility dedicated to CDCR/CCHCS incarcerated persons. The wings range in size from ten (10) to forty-two (42) beds.

In 2014, CDCR/CCHCS contracted with a Health Care Provider Network (HCPN) to develop and implement a network of community-based healthcare providers to provide services to incarcerated persons within CDCR/CCHCS and REPS that are not available in the CDCR/CCHCS institutions or REPS facilities. The network consists of hospitals, onsite and offsite specialty care, and a full scope of ancillary services.

In 2009, CDCR/CCHCS contracted with a Third-Party Administrator (TPA) to process claims and to implement an efficient business model for adjudicating claims. The TPA currently provides a web-based portal for both vendors and CDCR/CCHCS to view status of claims and generate reports. The Contractor shall be required to use CDCR/CCHCS’ designated TPA as its sole claims processing administrator. Contractor will require providers to send healthcare claims electronically through the TPA.

CDCR/CCHCS uses a manual authorization request for medical services, which does not validate authorization at time of claims payment. Therefore, a new prior authorization component is necessary to assure the claims paid match the services authorized and provided. CDCR/CCHCS is requesting the option for an electronic prior authorization component to be built into this contract after the first year period.

CDCR/CCHCS will have the right not to exercise this option, based on organizational directives, needs and fiscal climate.

In order to ensure the State is receiving these services, CDCR/CCHCS seeks to continue contracting for the HCPN using best practices and standards in the industry applicable to the correctional environment. The objective is to contract with a qualified firm to continue the HCPN for the following period: Five (5) initial years with Five (5) optional - One (1) year extensions.

If requested by the State, Contractor agrees to negotiate in good faith with the State, including State departments other than CDCR/CCHCS, to provide goods, services and pricing substantially similar to that set forth in this Agreement, to those departments delivering healthcare services to CDCR/CCHCS incarcerated persons. Those goods and services may be provided via written amendment to this Agreement or by separate agreement with the other State department.

The Parties agree and acknowledge that if any provision of this Agreement is determined by a final judgment of a court of competent jurisdiction to be illegal or unenforceable, such determination shall not affect the balance of this Agreement, which shall remain in full force and effect, and such invalid provision shall be deemed severable.

3. RFP General Requirements

3.1 Key Action Dates

Listed below are the anticipated key activities, actions, dates, and times for completion of this RFP. If the State finds it necessary to change any of these key activities, actions or dates, it will be accomplished via an addendum to the

RFP.

Key Activity Anticipated Date and Time RFP Available to Prospective Proposers 06/30/2026

Proposer’s Conference (1) 07/08/2026 11:00 AM PDT CDCR/CCHCS Institution Tour 07/23/2026 TBD Deadline for Submission of Letter of Intent to Submit Proposal 07/28/2026

Proposer’s Conference (2) 08/10/2026 11:00 AM PDT

Deadline for Submission of Proposals 08/18/2026 4:00 PM PDT

Proposal Review 08/19/2026 – 09/02/2026

Proposer Interviews 09/03/2026 – 09/17/2026

Proposal Evaluation 09/18/2026 – 09/22/2026

Contract Award 10/01/2026

Proposed Start Date of Agreement 12/01/2026 – 11/30/2031

3.2 Cal eProcure Portal

Cal eProcure

3.2.1 Adobe Acrobat Version

While this RFP is available electronically in Adobe Acrobat format, the official version is located on the Cal eProcure online portal.

3.2.2 Cal eProcure Portal Registration

If Proposer has not completed a one-time registration into the Cal eProcure online portal, it is requested that Proposer register on the Cal eProcure online portal.

3.2.3 Proposer’s Conference and CDCR/CCHCS Institution

Tour

CDCR/CCHCS will conduct two (2) Proposer’s Conferences and a CDCR/CCHCS Institution Tour to address verbal questions regarding this RFP.

Attendance is strongly recommended; issues that involve complexity of need, organizational culture, and technical constraints will be addressed to assist all proposers in better understanding the requirements of this RFP.

To attend the Proposer’s Conferences, email the following to the Project Manager by COB 07/06/2026:

• Name of company

• Attendee name(s)

• Attendee email address(es)

• Dates you plan to attend

Proposer’s Conference (1) Information Location: Telephonic and/or video conference call – Microsoft Teams information below Date: 07/08/2026 Time: 11:00 AM PDT

Microsoft Teams Meeting Link:

https://teams.microsoft.com/meet/27437942943433?p=PiL3Fkz6T21oPki5LM

Dial in by Phone: +1 916-701-9994, 595926464#

Proposer’s Conference (2) Information Location: Telephonic and/or video conference call – Microsoft Teams information below Date: 08/10/2026 Time: 11:00 AM PDT

Microsoft Teams Meeting Link:

https://teams.microsoft.com/meet/246253776696564?p=5ghwkoDNlJkfFiUtW J

Dial in by Phone: +1 916-701-9994, 229117863#

Verbal questions outside of the designated Proposer’s Conferences will not be accepted.

https://teams.microsoft.com/meet/27437942943433?p=PiL3Fkz6T21oPki5LM https://teams.microsoft.com/meet/246253776696564?p=5ghwkoDNlJkfFiUtWJ https://teams.microsoft.com/meet/246253776696564?p=5ghwkoDNlJkfFiUtWJ

To attend the CDCR/CCHCS Institution Tour, email the following to the Project Manager by COB 07/07/2026:

• Name of company

• Attendee name(s)

• Attendee email address(es)

CDCR/CCHCS Institution Tour Location: Folsom State Prison

300 Prison Road Represa, CA 95671-3001

Date: 07/23/2026 Time: TBD

To attend the CDCR/CCHCS Institution Tour, email a completed CDCR 2311

– Background Security Clearance Application to the Project Manager by COB 07/07/2026. Attendance is highly recommended as information related to institution requirements and/or protocols will be addressed to assist all Proposers in better understanding the requirements of this RFP. Attendees will be limited to two (2) representatives from each company.

All attendees shall familiarize themselves with the following requirements (to be provided prior to the tour) and adhere to them, without exception, while in attendance. Failure to comply will result in removal from the institution and may disqualify the company from submitting a proposal in response to the RFP.

• Appropriate Attire and Allowable Personal Property

• Tobacco Ban

• Security Overview & Laws, Rules, and Regulations Regarding Conduct and Association with Patients

3.2.4 Proposer Questions

Immediately notify the Project Manager if clarification is needed regarding the services sought or questions that arise about the RFP and/or its accompanying materials, instructions, or requirements. Question(s) shall be submitted in writing as instructed below. At its discretion, the State reserves the right to contact the Proposer to seek clarification of any question received. Proposers shall report to the Project Manager a known or suspected problem with the RFP and/or its accompanying materials or seek clarification and/or correction of the RFP and/or its accompanying materials. The successful Proposer shall not be entitled to additional compensation for any additional work caused by such problem, including any ambiguity, conflict, discrepancy, omission, or error. The State reserves the right to post the summary and responses to any questions received, and any discrepancies, omissions, or errors through the Cal eProcure portal: Cal eProcure.

Proposer desiring clarification about a specific RFP requirement and/or questions related to a sensitive issue or proprietary aspects of a proposal may submit individual questions that are marked “Confidential”. The Proposer must include, with its question, an explanation as to the reason(s) it believes a question marked “Confidential” is sensitive or is surrounding a proprietary issue. If a question appears to be unique to a single proposer or is marked “Confidential,” the State will email a response only to the Proposer if the State concurs with Proposer’s claim that the question is sensitive or proprietary in nature. If the State does not concur, the question will be answered in the manner described herein and Proposer will be notified.

What to Include in a Question:

• Proposer representative name

• Name of company

• Mailing address

• Email address

• Area code and telephone number

• A description of the subject or issue in question or discrepancy found

• Section, page number, or other information useful in identifying the specific problem or issue in question

• Remedy sought, if any

• Format questions as follows:

Section Page

Number Issue/Discrepancy Remedy sought (if applicable)

Indicate the RFP section by number. Include the number(s) or letter(s) of any subsection(s) or paragraph(s). Indicate the exhibit letter and identify any subsection(s) by number(s) or letter(s).

Example:

3.2.5 How to Submit Questions

Questions about the reporting of RFP errors or irregularities shall be directed, via email, to the Project Manager at m_CHCPNRFP@CDCR.ca.gov prior to the proposal submission deadline. The State, at its sole discretion, shall provide responses to those questions it deems necessary. Responses to questions will be posted at Cal eProcure.

mailto:m_CHCPNRFP@CDCR.ca.gov

3.2.6 Proposer’s Intention to Submit a Proposal

CDCR/CCHCS will utilize a Letter of Intent to Submit Proposal to determine the potential volume of proposers in advance of the proposal deadline to assist CDCR/CCHCS in assessing and monitoring the proposal process and to ensure there are sufficient proposers in the market given the identified project requirements in the current solicitation. The Letter of Intent to Submit Proposal is non-binding. Potential proposers who submit a Letter of Intent to Submit Proposal are not required to submit a proposal. However, Proposers are strongly encouraged to file their intention to submit a proposal in writing via email, to the Project Manager. CDCR/CCHCS reserves the right to reject any potential Proposers from participating in this proposal if the Letter of Intent to Submit Proposal is not submitted by the date specified in Subsection 3.1 – Key Action Dates. CDCR/CCHCS reserves the right to cancel any solicitation if, in CDCR/CCHCS’ sole discretion, insufficient Proposers have filed a Letter of Intent to Submit Proposal by the Key Action Date. Thus, all Proposers who intend to submit a proposal are strongly encouraged to file a Letter of Intent to Submit Proposal timely.

3.2.7 Disposition of Proposals

All materials submitted in response to this RFP upon submission are the property of the State, subject to the California Public Records Act (PRA), Division 10 of the California Government Code, commencing with Section 7920, and will be returned only at the option of the State and at the Proposer’s expense. The proposal shall be retained for official files, however, materials the State considers in its sole opinion to be confidential information will be returned upon the request of the Proposer. No protest of the award of the contract resulting from this RFP is available.

3.2.8 News Releases

News releases or any publications by a Proposer relating to an Agreement resulting from this RFP shall not be made without prior written approval of the Manager II, Direct Care Contracts Section (DCCS) or their designee.

4. Project Information

4.1 Healthcare Provider Network

CDCR/CCHCS is responsible for health care expenses for incarcerated persons in CDCR/CCHCS institutions and REPS facilities throughout the state.

Development of medical delivery models are being planned to reduce off-site medical services through on-site specialty medical consultations and use of telemedicine services. The models will also include reviews of medically complex CDCR/CCHCS and REPS incarcerated persons to determine best access to care options, which might include relocating them to different institution where access to the medical service is more readily available.

The Contractor will not be responsible for the provision of primary care services within the CDCR/CCHCS institutions or the provision of prescribed pharmaceuticals, which are filled by the CDCR/CCHCS pharmacies.

All CDCR/CCHCS institutions provide nursing services which are available twenty-four (24) hours a day, seven (7) days a week. When needed and available, contracted specialists come on-site to see the CDCR/CCHCS incarcerated persons. CDCR/CCHCS has a statewide contract for the purchase of pharmaceuticals, which is not part of this contract.

REPS facilities are located throughout the state and have no medical services on-site. These incarcerated persons require all healthcare services, including primary care, dental and vision in the community.

Unless otherwise stated in the Scope of Work, Contractor shall not be expected to provide the following on-site Services through the Provider Network as they are provided by CDCR/CCHCS:

1) Ancillary Services:

• Radiology (Imaging). Excludes read and interpret, advanced diagnostics or interventional procedures, Ultrasound, MRI, and CT.

• Pharmacy

• Dialysis

• Laboratory (Selected institutions have full lab services)

2) Telemedicine Services (CDCR/CCHCS Provider Telemedicine Services)

3) Mental Health Services

4) Dental

Unless otherwise stated in the Scope of Work, Contractor is expected to provide the following Services through the Provider Network as they are not provided by CDCR/CCHCS:

1) Mental Health (emergency services)

2) Ancillary Services:

• Radiology (Imaging) read and interpret, advanced diagnostics or interventional procedures

• Mobile Radiology (MRI, CT, Ultrasound) / Mammography

• Laboratory (specimen testing) / Pathology

• Offsite Dialysis (emergent need when services cannot be provided on-site)

3) Telemedicine Services

4) Hospital Services

5) Long Term Acute Care Services

6) Specialists/Physician Services

7) Ambulatory Surgery Centers and Specialty Services Centers

8) Medical Transportation Services

9) Dental Specialty Services

10) Congregate Living Health Facilities

11) Skilled Nursing Facility Services

12) Medicated Assisted Treatment Services

13) Reentry Programs (Primary Care)

14) Mental Health (Emergency services)

4.2 Third Party Administrator

CDCR/CCHCS currently contracts with a TPA. Claims are adjudicated and paid by the TPA for each CDCR/CCHCS and REPS incarcerated person.

CDCR/CCHCS expects the successful proposer to use the CDCR/CCHCS identified TPA for all healthcare claims processing in compliance with electronic transmission standards and security requirements and all other rules and regulations that implement the Health Insurance Portability and Accountability Act (HIPAA) and California patient privacy and security laws and California and Federal billing requirements; and to provide an integration of systems (provider network, claims, and prior authorization) as needed.

4.3 Prior Authorization

Currently, CDCR/CCHCS does not have an electronic prior authorization system that integrates with claims processing. This has challenged our ability to centrally manage and delegate institutional authority to approve treatment authorization requests; this also prevents real-time reporting of daily incurred costs for timely intervention and management. Additionally, inconsistent authorization of levels of care, associated hospitalist and imaging services, and other non-standardized hospital review data entry issues produce a higher level of retrospective audit work than is necessary. To produce a sustainable cost effective, accessible specialty and hospital review and approval process, an electronic prior authorization system may be requested after the first year of the contracted period. Contractor shall be required to develop and implement a prior authorization system to meet the needs of CDCR/CCHCS that fully integrates with the current TPA if requested by CDCR/CCHCS.

5. Scope of Work Please refer to Exhibit A, Scope of Work for a detailed breakdown of the services/tasks/deliverables applicable to this RFP.

5.1 Prior Authorization

CDCR/CCHCS seeks a Contractor who will work side-by-side with the CDCR/CCHCS Medical Management Team and Health Care Contracts and Claims Management Branch to develop and administer a Prior Authorization system; this plan shall encompass determining whether a particular procedure, service or supply is medically necessary.

Contractor shall:

1. Provide prior authorization services.

2. Use a system that will integrate claims so that the claims paid match the services authorized.

3. Use a system that can integrate with the CDCR/CCHCS electronic medical records system.

4. Ensure prior authorization system complies with CDCR/CCHCS Information Technology requirements.

5. Customize prior authorization parameters throughout the life of the contract if necessary.

6. Provide suggestions for initial parameters which will change throughout the life of the contract as the needs of the CDCR/CCHCS change.

7. Ensure that prior authorization will include a set of services that are automatically approved, based on criteria previously set by the

CDCR/CCHCS.

8. Ensure that providers and vendors are educated on the proper process for requesting or fulfilling requested services.

9. Report on comparative effectiveness, provider utilization profiling, quality of care benchmarks, and other metrics as requested.

Prior Authorization and Claims Submission Based on Current Systems:

1. Institution initiates service request.

2. Institution and utilization management review and authorize service request.

3. Institution initiates web-based electronic pre-authorization process and schedules with contracted provider.

4. Provider retrieves preauthorization and provides authorized services.

5. Provider submits claims to TPA, who retrieves pre-authorization, adjudicates and creates an electronic claim file for CDCR/CCHCS accounting office.

6. Requirements CDCR/CCHCS will evaluate proposals based on the following requirements.

Mandatory Qualifications are noted as “Pass/Fail” and failure to meet these requirements shall, in CDCR/CCHCS’ sole discretion, result in a finding of proposal non-responsiveness.

Additional Requirements - will be evaluated using the numerical point values noted for the corresponding requirements. Failure to meet these requirements may, in CDCR/CCHCS’ sole discretion, result in a finding of proposal non-responsiveness.

All other sections will be evaluated using the numerical point values noted for the corresponding sections and/or criteria.

6.1 Mandatory Qualifications

1. Contractor must demonstrate at least three (3) continuous years of experience delivering a full range of services including medical provider services to at least one public U.S. entity with a minimum of 50,000 enrolled members within the last five (5) years. Provide name, address, title, company, and phone number for each qualifying employer/company. The references must be entities not connected with this proposal in any way. Subsidiaries or divisions of the prime or subcontractors are not acceptable.

Provide the necessary documentation to support the above requirements.

Pass/ Fail

2. Contractor must demonstrate that it has been a prime contractor responsible for the performance of a subcontractor for a project with comparable scope and magnitude to this project. Also, the Contractor must demonstrate that any proposed subcontractors have functioned as subcontractors or prime contractors in contracts with comparable scope and magnitude to this project.

A. Complete Attachment 3 – Proposer Declaration Form and provide the necessary documentation to support the above requirements.

5. Contractor is required to use the CDCR/CCHCS identified TPA for all healthcare claims processing.

A. Contractor will share all Provider contract information including but not limited to; contract number, term dates, contract rates, tax id, NPI, address etc. with TPA in order to process and pay claims.

B. Contractor will provide this data daily to the TPA, in a format determined by

CDCR/CCHCS.

Does Contractor agree?

Yes.

No.

3. The Contractor will ensure as defined by applicable statutes and regulations that the contracted Providers possess throughout the term of their Agreement(s), the required current license(s), registration(s), permit(s), and certification(s) to practice in the state(s) in which they practice.

Does Contractor agree?

4. Contractor must provide and describe previous work of three (3) projects of comparable scope and magnitude for which you provided similar types of services. Provide complete reference information including project name, location, client, total contract amount (and firm’s amount if different), principal-in-charge, day-to-day technical project director/manager, key staff, date completed, client reference (name, current position, email, and phone number), and a brief narrative of project description for each project identified and described above.

Experience may not be considered if complete reference data is not provided or if named client contact is unavailable or unwilling to share required information.

The references must be entities not connected with this proposal in any way.

Subsidiaries or divisions of the prime or subcontractors are not acceptable.

Complete Attachment 13 – Customer Reference Questionnaire (CCHCS-MC-

415) to support the above requirements.

6. All functions performed under this contract must be performed within the United States.

Does Contractor agree?

Yes.

No.

7. Contractor is responsible to furnish all necessary personnel, materials, facilities, and other Services (unless otherwise specified) to accomplish delivery of the Services described in this exhibit. However, the Services in this exhibit may not be all inclusive and CDCR/CCHCS reserves the right to request additional Services, modify existing Services, and/or remove existing Services. The request(s) can be provided by written notice or amendment to the agreement.

8. Contractor must be licensed to offer all Services listed for a Provider Network, including ancillary services, in all counties of California and counties in Oregon, Nevada, and Arizona that border CDCR/CCHCS institutions.

9. CDCR/CCHCS reserves the right to be involved in contract negotiations with Healthcare Providers. CDCR/CCHCS and the Contractor shall coordinate communication and participation when requested. The Contractor must disclose to CDCR/CCHCS the rates negotiated for services provided under this contract which will demonstrate that the guarantees set forth in this agreement have been met. Such rate information will be kept confidential by CDCR/CCHCS to the extent permitted by law.

10. Contractor will contract with off-site Providers meeting the Contractor’s credentialing standards and CDCR/CCHCS service requirements. Services provided through Telemedicine and/or on-site at the institution must meet CDCR/CCHCS Credentialing Standards. Services provided on-site at the institutions must meet CDCR/CCHCS Gate Clearance and Live Scan Requirements. All Providers must be and remain credentialed in accordance with applicable law and National Committee for Quality Assurance (NCQA) standards.

Yes. Describe your solution and the process in detail that you would establish to address this requirement.

No.

11. Contractor and Providers referred by the Contractor shall be able to perform the tasks associated with providing all Healthcare Services and assume full responsibility for the provision of these Services. Any and all Services performed outside the scope of this Agreement will be at the sole risk and expense of the Contractor.

No.

12. Contractor must contract with hospitals, physicians, and other Providers requested by CDCR/CCHCS if the Provider meets Contractor’s network standard and pricing guidelines. Contractor must contract with existing preferred Providers that are currently providing and/or have previously provided services to

CDCR/CCHCS.

No.

13. Emergency Care Services shall be available on a twenty-four (24) hours per day basis for each institution.

14. Providers shall provide medical Services at the request of the CDCR/CCHCS institutions’ CEO/CME, CDCR/CCHCS Headquarters (HQ) Utilization Management (UM), or their designee and must obtain prior written authorization as required, excluding emergency.

Yes. Describe your solution and the process in detail that you would establish to address this requirement.

No.

15. Providers shall ensure that all referrals for medical Services and proposed surgical procedures shall be consistent with the urgency of the medical need as determined by CDCR/CCHCS institutions, or CDCR/CCHCS HQ UM. Services shall be delivered at the time scheduled. In the event there is to be a delay, it must be reported to the institution’s CEO/CME or their designee.

16. As required by law, CDCR/CCHCS retains full authority to determine the manner in which CDCR/CCHCS incarcerated persons are transported to the CDCR/CCHCS institutions or transferred to other Healthcare facilities, after course of treatment or therapy has been implemented or completed. Unless there is a documented and verified need for emergency Services that cannot be performed at the current Healthcare facility, Providers shall not transfer the CDCR/CCHCS incarcerated persons without prior written authorization from the CDCR/CCHCS institution’s CEO/CME, or their designee.

17. Providers shall adhere to prescribing and/or recommending medication therapy available on the CDCR/CCHCS Formulary. The CDCR/CCHCS Formulary can be found at: CDCR/CCHCS-Formulary.

Contractor and/or Provider shall consult with the referring CDCR/CCHCS primary care team, or the institutional Chief Physician and Surgeon (P&S), or the institutional CME or REPS P&S or their designees prior to discussing with the CDCR/CCHCS incarcerated persons, REPS incarcerated persons, the prescribing of the non-Formulary medications, and shall follow the CDCR/CCHCS non-Formulary approval process. If no justification for the use of a non-Formulary drug is provided, it will be assumed that a Formulary alternative is acceptable. Providers practicing on-site shall follow the CDCR/CCHCS Formulary. Providers shall not recommend experimental treatment.

No.

18. Contractor and Providers shall ensure that all ordered healthcare Services and proposed surgical procedures shall be scheduled consistent with the severity of the medical need. Once scheduled, Services shall be delivered at the time scheduled, unless unavoidable circumstances occur.

19. CDCR/CCHCS reserves the right to refuse use of certain Providers and Contractor shall assist CDCR/CCHCS with finding alternate Providers.

CDCR/CCHCS shall not pay for any Services performed by the Providers which are deemed unacceptable in accordance with required Services contemplated in the Agreement. CDCR/CCHCS reserves the right to request immediate removal of Providers through written notification by the Manager II, DCCS, or their designee.

https://cchcs.ca.gov/wp-content/uploads/sites/60/MS/CCHCS-CDCR-Formulary.pdf

20. Contractor must contract with the following services:

A. Hospital Services B. Physician/Specialty Services C. Ambulance Services D. Laboratory Services E. Radiological/Medical Imaging Services F. Reentry Program Services

21. Healthcare Claims

A. Contractor shall require Providers to utilize industry standard claim forms (i.e., UB04, CMS1500, ADA, etc.) for claims payment.

B. Providers shall bill in accordance with current Centers for Medicare and Medicaid Services (CMS) guidelines, requirements, and correct coding initiatives. CDCR/CCHCS reserves the right to override any Medicare edit based upon need.

22. Fees

A. All mandatory services as indicated in #20 above, and below (22.B), must be provided within six (6) months of the contract effective date:

1) All health care services to CDCR/CCHCS incarcerated persons and REPS incarcerated persons in the community through the provider network and/or on-site at the CDCR/CCHCS institutions.

B. Contractor must reduce their future fees if the current network is not at least

80% implemented within six (6) months of the approved contract. The fees that the Contractor is willing to put at risk must be indicated in the cost proposal, on the “Fee Per Claim” form, Attachment 16.

23. Performance Guarantees Contractor must provide performance guarantees pertaining to price guarantees as set forth in Attachment 17 in the Cost Proposal.

24. Pricing Guarantees Contractor must provide pricing guarantees as set forth in Attachment 17 in the Cost Proposal.

6.2 Additional Requirements

Points will be awarded on a scale system with the maximum points identified in each category. For each “No” response, provide an explanation and/or alternative solution to meet the requirement.

Maximum of five (5) points possible for each rating criteria within a requirement listed below:

Score Rating Criteria Description 5 – Exceeds Requirement

Clearly and thoroughly defines the requirement with complete, detailed, and accurate information.

4 – Meets Requirement (Minor Gaps)

Response is acceptable and meets the requirement, but contains small gaps in detail or clarity.

3 – Partially Meets Requirement

Addresses most of the requirement, but several elements are missing, vague, or under-developed.

2 – Minimally Meets Requirement

Shows limited understanding; major components of the requirement are missing or insufficiently described.

1 – Barely Addresses Requirement

Provides minimal relevant information; significant gaps prevent meaningful alignment with the requirement.

0 – Does Not Meet Requirement

Response does not address the requirement or provides irrelevant/incorrect information.

6.2.1 Provider Network

1. The design of the Provider Network will be a cooperative and ongoing project by both CDCR/CCHCS and the Contractor to provide a comprehensive, cost-effective health care delivery system for CDCR/CCHCS incarcerated persons and REPS incarcerated persons.

2. Contractor must have network Providers available within twenty-five (25) miles or one (1) hour for urban and fifty (50) miles or two (2) hours for rural or remote CDCR/CCHCS institutions. Contractor must have primary care (medical, dental, vision) network providers within ten (10) miles or thirty (30) minutes for REPS facilities.

No.

Points

3. In the event hospitals and/or Healthcare Provider(s) do not exist within twenty-five

(25) miles or one (1) hour from CDCR/CCHCS urban institutions, fifty (50) miles or two (2) hours for rural or remote institutions, or primary care (medical, dental, vision) network providers within ten (10) miles or thirty (30) minutes for REPS facilities or it is not fiscally sound for CDCR/CCHCS to use the Healthcare Providers based on service rates and custody cost for the additional travel times, Contractor must provide alternative solutions for obtaining in-network hospitals and Healthcare Providers for these institutions/facilities. Contractor’s alternative solutions are subject to review and approval by CDCR/CCHCS prior to implementation.

No.

4. Contractor must address accessibility, availability, and continuity of care within twenty-one (21) calendar days following the request for high priority or urgent service issues, and within ninety (90) calendar days for routine service issues.

Contractor must also monitor whether the provision and utilization of Services meet professionally recognized standards of practice.

No.

5. Contractor will establish reimbursement rates with discounts for Healthcare Services provided to CDCR/CCHCS incarcerated persons and REPS incarcerated persons and by off-site and on-site and telemedicine Healthcare Providers that meet the objectives of Penal Code Section 5023.5. Contractor will enter into contracts with sufficient numbers, types and geographic locations of participating providers to assure that all covered Services will be available and accessible to CDCR/CCHCS incarcerated persons and REPS incarcerated persons, and in accordance with CDCR/CCHCS’ requirements. Contractor will establish and expand the number of cost-effective Provider contracts within the statewide Provider Network for off-site and on-site Healthcare to CDCR/CCHCS incarcerated persons and REPS incarcerated persons. The network must include Provider Services in Oregon, Nevada, and Arizona for nearby CDCR/CCHCS institutions.

No.

6. The Provider Directory shall encompass the entire Provider Network. Newly contracted participating Providers meeting the credentialing requirements will be added to either 9.A or 9.B below within two (2) business days following their addition to the Contractor’s network and notification will be provided to CDCR/CCHCS designated representatives within two (2) business days upon contract completion. Participating Providers who are terminated will be removed within two (2) business days and notification will be provided to CDCR/CCHCS designated representatives within two (2) business days upon termination.

No.

7. Immediately notifying CDCR/CCHCS within two (2) business days regarding pending actions and/or actions taken of a quality improvement or peer review nature against a Provider by notifying the Manager II, DCCS, or their designee.

8. Contractor will be responsible for establishing a Provider Relations Group or

Representative(s) to develop Provider relations processes, effectively oversee complaint resolution, and respond appropriately within three (3) business days to participating Providers’ questions/concerns as well as to advise the Manager II, DCCS, or their designee, concerning significant Provider Network issues, as well as time frames for corrective actions.

No.

9. To ensure the Provider Network functions effectively, the Contractor will be required to develop and implement an operating plan in cooperation with CDCR/CCHCS. Elements of the plan include, but are not limited to:

Developing and distributing to CDCR/CCHCS designated representatives a Provider Directory of currently active participating Providers in the form of either of the following:

A. Customizable, web-based electronic portal directory accessible to all designated staff at the institutions, facilities, satellite locations, and headquarters, which shall include:

1) A listing of all contracted Providers for CDCR/CCHCS institutions.

2) Icons designating Providers who perform Services through telemedicine, off-site, and on-site at the institutions. CDCR/CCHCS reserves the right to request additional icons as needed.

3) Multiple functions for searching by mile radius, name, ID#, Hospital Affiliation, Provider Groups, Telemedicine, On-site, Provider Specialty, and Sub-specialty, Geographic location, etc. CDCR/CCHCS reserves the right to request additional search functions.

OR

B. Data file exchange, in either Comma-Separated Values (CSV) format or

Application Processing Interface (API), to be uploaded to CDCR/CCHCS weekly at a minimum. Elements shall include, but are not limited to:

Points (Max.

points for either

Option)

10. Contractor will submit an action plan within five (5) business days to rectify any gaps in the network whenever such gaps are identified by CDCR/CCHCS or the Contractor. CDCR/CCHCS shall have the sole discretion to determine the sufficiency of the plan and provide approval for implementation.

No.

11. Contractor will be responsible for monitoring and reporting to CDCR/CCHCS at least quarterly, but more often if requested by CDCR/CCHCS, on the status of the Provider Network. Reporting shall include a comparison of Providers in the network based on the numbers requested during implementation, and any current request for additions to the network by specialty, sub-specialty, location, deletions, coverage issues, cost issues, out of network usage, as well as activities taken by the Contractor to maintain, improve, and increase the Provider Network.

No.

1) Name, NPI, Tax ID, Address, Office Hours, Phone Number, Specialty, Sub- Specialty(s), Hospital Affiliations, Provider Groups, Service Locations, Distances from Institutions, etc.

2) CDCR/CCHCS reserves the right to use this information to create an internal Provider Directory to be housed on CDCR/CCHCS internal websites. Any updates made to the directory by CDCR/CCHCS shall be shared with the Contractor to ensure consistency of accurate information.

12. CDCR/CCHCS will make every effort to keep the Contractor informed in a timely manner regarding movement of CDCR/CCHCS incarcerated persons and REPS incarcerated persons to current CDCR/CCHCS institutions, or REPS facilities that may alter the requirements of the Provider Network. Contractor will be required to modify/expand the Provider Network to meet these changes within thirty (30) calendar days of notification by CDCR/CCHCS for Specialty Care Services and sixty (60) calendar days for hospitals upon request and written notification by CDCR/CCHCS. In the event the Contractor needs additional time to expand the network, the Contractor shall be responsible for notifying CDCR/CCHCS designated network program manager within fifteen (15) calendar days of the request in writing on the projected timeline extension needed for the specific request. CDCR/CCHCS will work with the Contractor on the request, but CDCR/CCHCS shall have final determination to approve the extension.

Does Contractor agree?

Yes. Describe your solution and the process in detail that you would establish to address this requirement.

No.

13. CDCR/CCHCS shall notify the Contractor in writing when there is an addition of a new CDCR/CCHCS institution or REPS facility that will need to have full medical access to the network and will work collaboratively with the Contractor to develop an implementation plan for provision of medical Services to the new CDCR/CCHCS institution, or REPS facility. The Contractor will be required to submit within fourteen (14) business days to CDCR/CCHCS an implementation plan to modify/expand the current Provider Network to meet the medical service needs for the new CDCR/CCHCS institutions within sixty (60) calendar days.

Should the Contractor need additional time for implementation beyond the sixty

(60) calendar days, the Contractor shall submit no later than thirty (30) calendar days prior to the required implementation timeframe a written request to extend time beyond the required period, along with a plan outline of the reason(s) to extend. CDCR/CCHCS shall have final determination to approve the extension.

No.

14. Contractor will be responsible for negotiating and implementing single case agreements with Providers to address unique treatment needs for CDCR/CCHCS incarcerated persons, and REPS incarcerated persons that may not be covered in the available network upon request by CDCR/CCHCS within two (2) business days for urgent needs. Should Contractor determine they need additional time to negotiate and implement an individual single case agreement it shall be the responsibility of the Contractor to inform the CDCR/CCHCS designated network program manager in writing, on the projected timeline needed for the specific request. Contractor will be responsible for informing the CDCR/CCHCS designated network program manager with weekly updates until single case agreements are secured. CDCR/CCHCS will work with the Contractor on a case-by-case request for extension, but CDCR/CCHCS will have final determination to approve the extension.

No.

15. If at any time CDCR/CCHCS determines that the Contractor does not provide necessary access to participating Providers, as outlined above, to provide appropriate covered services to CDCR/CCHCS incarcerated persons and REPS incarcerated persons, CDCR/CCHCS will require Contractor to submit a corrective action plan within five (5) business days of notification, for review and approval by CDCR/CCHCS. Once CDCR/CCHCS has approved the plan it must be implemented by the Contractor within three (3) business days.

CDCR/CCHCS reserves the right to request Providers be removed from the Provider Network through written notification by the Manager II, DCCS, or their

No.

16. If a Provider is removed from the network or otherwise leaves the network, Contractor will ensure that continuity of care is maintained through the departing Provider as appropriate or through another appropriate Provider. If it creates an immediate gap, Contractor will notify CDCR/CCHCS designated contract representative by email or telephone call and engage Replacement Providers within two (2) business days. Provider contracts must include continuity of care provisions requiring a Provider to continue treating CDCR/CCHCS incarcerated persons and REPS incarcerated persons, until they are assigned to another Provider, or are discharged if an inpatient, or treatment is completed although the Provider’s contract has been terminated.

No.

6.2.2 Service Delivery

17. Per Title 15, which establishes the limits of the medical care that may be provided by CDCR/CCHCS to incarcerated persons, prior authorization shall be issued to provide medical services for incarcerated persons which are medically necessary and supported by outcomes data as effective medical care. As defined in Title 15 CCR, Division 3, Chapter 2, Article 1, § 3999.98, “Medically necessary” means Healthcare Services that are determined by the attending primary medical, mental health, or dental care Provider(s) to be needed to protect life, prevent significant illness or disability, or alleviate severe pain and are supported by health outcome data or clinical evidence as being effective Healthcare Service for the purpose intended or in the absence of available health outcome data is judged to be necessary and is supported by diagnostic information or specialty consultation.