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2. The term of this Agreement is:

Contractor Name Contract Number California Department of Corrections and Rehabilitation California Correctional Health Care Services Scope of Work Exhibit A

SCOPE OF WORK

A. The Contractor agrees to provide to the California Department of Corrections and Rehabilitation (CDCR), California Correctional Health Care Services (CCHCS) all labor, including travel and per diem, materials, non-consumable supplies, transportation, equipment, and every other item of expense necessary to provide Staff Medical Monitoring Services as defined in Exhibit A-1 - Detailed Scope of Work.

B. The Contractor agrees to adhere to the minimum qualifications and requirements as set forth in Solicitation # SD25-00023.

C. The Contractor’s work hours shall be between 8:00 a.m. to 5:00 p.m., Monday through Friday for contract administrative support.

D. The Contractor shall provide requested clinic services within 48-hours of telephone/e-mail notification from the CDCR/CCHCS Contract Manager or designee. No work shall be performed on State holidays. No overtime shall be authorized in conjunction with this Contract.

On-site clinic services provided shall be scheduled to meet the operational needs of the worksite and may occur Monday through Friday, between 4:30 a.m. and 12:00am (end of day).

The Physician or other Licensed Health Care Professional (PLHCP) must be available when on-site services are being provided. The Contractor shall ensure all on-site clinics are fully equipped including licensed clinical staff as well as supplies and equipment needed to provide all required services under this agreement, including, but not limited to vaccination supplies, TB testing (skin testing) supplies, potential exposure testing supplies, needles, refrigeration, wipes, disposal systems (e.g. syringe disposal), emergency equipment, and epi-pens.

E. The term of this Contract shall be July 1, 2026 (or upon approval, whichever is later) through June 30, 2029. The Contractor is not authorized to commence work, as described in this Contract, until the Contract has been fully executed. Any services provided prior to execution of the Contract shall be considered voluntary and non-compensable.

F. CDCR/CCHCS reserves the option to amend the Contract and reduce funds when it is in the best interest of the CDCR/CCHCS, or when fiscally necessary.

G. The representatives during the term of this Contract will be:

CDCR/CCHCS Contract Manager Contractor Representative CDCR/CCHCS Contractor:

Name: Name:

Phone: Phone:

Email: Email:

Contractor Name Contract Number California Department of Corrections and Rehabilitation

Scope of Work Exhibit A

Direct all contract inquiries to:

CDCR/CCHCS Contract Analyst Contractor Representative Acquisitions Management Section Contractor:

Contract Analyst Name: Heather Lohmiller Name:

Address:

Physical:

8280 Longleaf Drive, Building D-2 Elk Grove, CA 95758 Mailing:

PO Box 588500 Elk Grove, CA 95758

Address:

Phone: (916) 691-0262 Phone:

Email: Heather.Lohmiller@cdcr.ca.gov Email:

The remainder of the page has been intentionally left blank.

mailto:Heather.Lohmiller@cdcr.ca.gov

Contractor Name Contract Number California Department of Corrections and Rehabilitation

Detailed Scope of Work Exhibit A-1

DETAILED SCOPE OF WORK

A. PURPOSE AND DESCRIPTION OF SERVICES:

The California Department of Corrections and Rehabilitation, California Correctional Health Care Services, herein referred to as “CDCR/CCHCS”, has identified a need for Staff Medical Monitoring Services for CDCR/CCHCS worksite locations identified in Exhibit A-2 – List of Participating Worksites.

The Contractor shall provide occupational medical services for the State as specified by the CDCR/CCHCS Contract Manager or designee. The Contractor shall maintain direct communication with the CDCR/CCHCS Contract Manager or designee regarding medical concerns relevant to public health issues.

Services are to be performed in compliance with Title 8 of the California Code of Regulations (CCR), Subchapter 7 (8CCR) California Code of Regulations, Title 8, General Industry Safety Orders:

• Subsection 5144, General Industrial Safety Orders for Respiratory Protection,

• Subsection 5193, Blood borne Pathogens,

• Subsection 5199, Aerosol Transmissible Diseases, Services are also to be performed in compliance with:

• Penal Code 6006-6009, Annual Tuberculosis (TB) Testing,

• Joint Commission for Accreditation of Health Care Organizations,

• Annual seasonal influenza vaccine shall be offered within the designated time suggested by regulatory agencies.

Wherever Current Procedural Terminology (CPT) Codes are referenced in this document, they refer to the American Medical Association, “2010 - Current Procedural Terminology, Standard Edition”. An (*) asterisk next to the CPT code indicates a code from the “2015 - Current Procedural Terminology, Standard Edition.”

The Contractor must be able to perform the tasks associated with providing the services described herein, Exhibit A-1 – Detailed Scope of Work and assume full responsibility for services performed at all worksite locations listed in Exhibit A-2 – List of Participating Worksites. The Contractor shall perform services in accordance with state laws and regulations.

B. LICENSE/PERMIT/CERTIFICATION REQUIREMENTS:

The Contractor shall possess and maintain throughout the term of this agreement all licenses, permits or certificates, and regulatory compliance required by the State of California to perform this service. A list of all licenses held by contract staff shall be provided to CDCR/CCHCS upon execution of this contract and as updates occur.

1. A current Physician and Surgeon or other appropriate PLHCP License issued by the Medical Board of California for the State of California and must be in good standing.

https://www.dir.ca.gov/Title8/sub7.html https://www.dir.ca.gov/Title8/sub7.html

Contractor Name Contract Number California Department of Corrections and Rehabilitation

2. A current United States (U.S.) Department of Health and Human Services Clinical Laboratory Improvement Amendments (CLIA) Certificate.

Acceptable CLIA certificates:

a. Certificate of Waiver – Laboratories performing only waived tests

b. Certificate of Provider – Laboratories performing limited provider-performed microscopy procedures.

c. Certificate of Compliance – Laboratories performing nonwaived or moderate and/or high complexity tests.

d. Certificate of Accreditation – Laboratories that are accredited by a private accreditation organization approved by Centers for Medicare & Medicaid Services (CMS). These laboratories perform nonwaived or moderate and/or high complexity tests.

3. A current California Department of Public Health Laboratory Field Services Clinical Laboratory License or Registration.

4. A valid Physician’s Pocket License.

The Contractor shall ensure that any subcontracted clinics providing services possess and maintain, throughout the term of this agreement:

1. A current Physician and Surgeon or other appropriate PLHCP License issued by the Medical Board of California for the State of California and must be in good standing.

2. A current U.S. Department of Health and Human Services CLIA Certificate. (see above list of acceptable CLIA certificates)

3. A current California Department of Public Health Laboratory Field Services Clinical Laboratory License or Registration.

The Contractor shall ensure that any subcontracted laboratories providing services shall possess and maintain, throughout the term of this agreement:

1. A current Physician and Surgeon or other appropriate PLHCP License issued by and must be in good standing with the appropriate licensing board for the State of California.

2. A current U.S. Department of Health and Human Services CLIA Certificate, appropriate for the level of patient testing performed. (See above for acceptable CLIA certificates)

3. A current California Department of Public Health Laboratory Field Services Clinical Laboratory License or Registration, appropriate for the level of patient testing performed.

4. The Contractor shall ensure that all personnel responsible for providing clinical services and requested clinical evaluations shall be licensed, certified or permitted in California to conduct said clinical services and clinical evaluations.

In the event any license(s), certification(s) and/or permit(s) expires at any time during the term of this agreement, the Contractor agrees to provide the CDCR/CCHCS Contract Manager or designee with a copy of the renewed license(s) and/or permits within thirty (30) days following the expiration date. If, during this agreement, any of the licenses, permits, and certification

Contractor Name Contract Number California Department of Corrections and Rehabilitation requirements as stated herein are found to be inactive or not in compliance, CDCR/CCHCS may immediately terminate this agreement. The Contractor shall possess and maintain throughout the term of this agreement a current and valid license to do business in the State of California for the services being provided and shall obtain at the Contractor’s expense any and all necessary license(s), certificate(s) and permit(s), required by law for accomplishing any work required in connection with this agreement.

C. CONTRACTOR RESPONSIBILITIES:

1. The Contractor shall possess and maintain through the life of the contract, the necessary state and local licenses, registrations and certificates required to provide the requested contracted services.

2. The Contractor shall provide the licensing information for the Contractor and subcontractor(s).

3. The Contractors mobile clinics must meet all applicable Americans with Disabilities Act requirements and all applicable federal, state and local licensing requirements for each location where they are deployed. The Contractor must be able to set up on-site clinics that are accessible by all staff, including those with disabilities and/or requiring mobility assistance.

4. The Contractor shall comply with all applicable federal, state, and local laws and regulations, including but not limited to CLIA certification requirements and Cal/OSHA regulations related to vaccinations and TB testing/screening (e.g. sanitation, patient privacy, proper storage and disposal, refrigeration, and required tracking and reporting).

5. The Contractor shall provide a type-written medical opinion, resulting from the services provided (language specific requirements can be found under 8CCR), electronically within two (2) business days to the appropriate worksite, for each employee evaluated/tested at no charge to the State upon completion of an exam or other service. This opinion should be documented and shall be provided for each individual receiving service. If an individual receives multiple examinations, results of the multiple examinations may be included in a single opinion so long as all requirements of the applicable titles and subsections of the CCR are met (DIR Title 8 Index Page (ca.gov).

6. The Contractor shall develop a service schedule for each identified worksite per fiscal year, beginning July 1st and ending June 30th the following year. The service schedule shall address all routine occupational medical services the CDCR/CCHCS requires. The schedule shall be confirmed with the worksite contract liaison(s) after review and approval from CDCR/CCHCS Contract Manager.

7. The Contractor shall meet with the CDCR/CCHCS Contract Manager or designee as necessary to ensure efficient provision of services under this agreement. Under the direction of the CDCR/CCHCS Contract Manager or designee, the Contractor and/or subcontractor shall provide Staff Medical Monitoring Services, within the scope of practice, for occupational medicine which shall include, but is not limited to the following:

a. Aerosol Transmissible Diseases (ATD) – provide the following medical services in accordance with Title 8 of the CCR, Subsection 5199(h) and applicable public health guidelines.

https://www.dir.ca.gov/Counters/t8index.htm

Contractor Name Contract Number California Department of Corrections and Rehabilitation

i. The Contractor’s PLHCP shall conduct assessment/evaluation after a known or suspected exposure to an ATD (such as TB, chickenpox, measles, etc.) (CPT 99204) to determine:

1. If the employee had significant exposure.

2. If the employee had contracted the disease.

3. What the infectious period is/was.

4. The need for medical treatment and/or precautionary removal from the workplace; or

5. If the employee(s) are not expected to develop the disease (the exposure was not significant, the employee has adequate evidence of immunity (e.g., have been previously vaccinated or had the disease and are expected to be immune).

ii. The assessment/evaluation shall include a thorough physical examination with a signed type-written PLHCP’s opinion including the diagnosis, impression, and treatment recommendation in accordance with Title 8 of the CCR, Subsection 5199, (h)(8)(h)(9) (included in CPT 99204). Public Health Branch (PHB) data from contact investigation examination results shall be promptly summarized and reported weekly to the PHB, CDCR/CCHCS Contract Manager, Chief Executive Officer (CEO), Warden or designee and the worksite liaison coordinator for outbreak.

iii. ATD evaluation as ordered: to determine if the employee is free from an ATD and can return to work or for other return to work issues depending on exposure history.

1. Chickenpox immunity screening IgG (CPT 82784), including vaccination (CPT 90716), if clinically indicated.

2. Measles immunity screening (CPT 82784), including vaccination (CPT 90707), if clinically indicated.

3. Liver panel – SGPT (alanine transaminase) and SGOT (aspartate transaminase) (CPT 80076).

4. Tuberculin Skin Test for TB (CPT 86580).

5. Cell mediated immunity blood test (IGRA) for TB (CPT 86480).

6. The employee’s name and employee identifier (Personnel Number/Employee Number- PERNR).

7. Date of the vaccine dose or determination of immunity.

8. Whether the employee is immune to the disease, and whether there are any specific restrictions on the employee’s exposure or ability to receive vaccine.

Contractor Name Contract Number California Department of Corrections and Rehabilitation

9. Whether one or more additional vaccination doses are required, and if so the date(s) the additional vaccination dose(s) should be provided.

10. Provide informed declination form for all employees who decline to receive offered vaccination services.

a. Additional Vaccination Services: additional vaccinations that may be required due to the issuance of new applicable public health guidelines recommending the additional dose in accordance with title 8, CCR, Subsection 5199; (h)(5)(B).

b. Additionally, the Contractor shall provide vaccination services to staff as recommended by Cal/OSHA or public health guidelines related to vaccinations and TB testing/screening (e.g. sanitation, patient privacy, proper storage and disposal, refrigeration, and required tracking and reporting). Such vaccination include:

i. Measles, Mumps, Rubella (MMR)

ii. Tetanus, Diphtheria, and Acellular Pertussis (Tdap)

iii. Varicella

iv. Hepatitis B

b. Influenza Vaccine Administration

i. The Contractor shall provide on-site annual seasonal influenza vaccine during the period designated by the CDC for administration.

ii. The Contractor shall develop a schedule in collaboration with the CDCR/CCHCS Contract Manager and worksite liaison(s) 30 days prior to the season.

iii. The Contractor shall document directly into the CDCR/CCHCS system of record any vaccinations administered within 12 hours.

c. TB Screening and Educational Services

i. The Contractor shall provide on-site annual TB testing/screening services at sites throughout California. The Contractor shall develop a schedule in collaboration with the CDCR/CCHCS Contract Manager and worksite liaison(s) 30 days prior to the season.

ii. The Contractor shall provide all TB clients with TB training (education) that meets the requirements of Title 8, CCR, Subsection 3203 (a) (7) and Title 8, CCR, Subsection 5199. The Contractor may use training/educational materials prepared by CDCR/CCHCS, the Contractor, other sources, or a combination thereof. Training shall occur while the Contractor is on site at the testing location, or upon CDCR/CCHCS approval, during the 30-day period preceding testing at the location. TB training is to be provided by qualified medical professionals and must be addressed at a minimum:

Contractor Name Contract Number California Department of Corrections and Rehabilitation

1. Occupational risk factors for TB.

2. Modes of TB transmission.

3. Symptoms of TB disease.

4. The employer and employee’s responsibilities with exposure control procedures.

5. Use and limitations of methods that will prevent exposure, including engineering controls, work practice controls, and personal protective equipment.

6. Decontamination and disposal of personal protective equipment.

7. TB screening and treatment of latent TB infection (LTBI).

8. Employee’s responsibility in seeking prompt medical evaluation in the event of a positive skin test if symptoms of active TB disease occur; and

9. Persons with a recent (within two (2) years) TB skin test (TST) conversion are more likely to develop TB disease. The Contractor shall collaborate with CDCR/CCHCS to develop this training program; the training program is subject to CDCR/CCHCS approval.

iii. TB testing, interpretation, recording of test results and reporting shall be conducted according to the guidelines of the California Department of Public Health.

iv. The Contractor shall conduct an annual symptom screen and/or TST of all TB clients, to determine whether the TB client has experienced any of the following in the past year:

1. Coughing up blood,

2. Persistent cough lasts two weeks or more,

3. Unexplained excessive fatigue,

4. Unexplained persistent fever lasting two weeks or more,

5. Excessively unexplained sweating at night,

6. Unexplained weight loss.

CDCR/CCHCS will maintain records of all responses using the CDCR 7336 (TB Form) or in another manner agreed upon by CDCR/CCHCS.

i. Using records provided by the CDCR/CCHCS and TB client interview, the Contractor shall assess each TB client to determine whether the TB client has a documented history of a past positive TST or test to determine TB infection.

Contractor Name Contract Number California Department of Corrections and Rehabilitation

ii. For TB clients with no documented baseline history of TB, the Contractor shall administer test for TB infection (that is Food and Drug Administration (FDA) approved, and Centers for Disease Control and Prevention (CDC) recommended) and symptom screen.

iii. The Contractor shall document directly into the CDCR/CCHCS system of recording any symptom screen and/or TSTs administered within 12 hours

The Contractor shall immediately notify CDCR/CCHCS and PHB of any TB client meeting both of the following criteria:

1. Newly documented TB infection or documented history of past TB infection

2. Symptomatic for infectious TB (as defined above).

d. Bloodborne Pathogen (BBP) Screening and Educational Services

The PLHCP shall conduct assessment(s)/service(s) within 24 hours of notification after a known or suspected exposure to a BBP to determine:

i. Occupational risks of blood-borne infection,

ii. Prophylactic treatment and screening for infection in consultation with a national Human Immunodeficiency Virus (HIV) hotline (e.g. 888-HIV-4911),

iii. Modes of blood-borne infection transmission,

iv. Hepatitis B vaccination service for employees at risk of blood borne infection,

v. Post exposure follow-up consultation,

vi. Immediate post-exposure evaluation, prophylaxis, and/or follow-up consultation,

vii. Establish and maintain accurate record for each employee with exposure, including name, exposure characteristic for “sharps log”, vaccination status, and date of vaccinations and copy of results,

viii. HIV testing (CPT 86703),

e. Post-exposure Assessment

The Contractor shall provide post-exposure medical services for infectious diseases following the protocols of the California Department of Public Health and the CDC and as ordered by the local Health Officer and recommended by the PHB to include at a minimum:

i. A review of work assignment to assess risks to co-workers and vulnerable patients.

ii. An assessment of the level of exposure.

Contractor Name Contract Number California Department of Corrections and Rehabilitation

iii. Communication, as necessary, with PHB and representatives of local health departments regarding source and exposed employee.

iv. Prompt post exposure prophylaxis, as appropriate.

v. Counseling to employees regarding risks to employees, co-workers, inmates, family and other community members.

vi. Vaccinations as recommended by California Department of Public Health and CDC for exposed workers.

vii. Recommendation to employer regarding the need for precautionary removal.

viii. Notification to employer of any employees newly infected as a result of the workplace exposure.

ix. In addition, with PHB and local Health Officer input the Contractor shall conduct assessment/evaluation of staff significantly exposed to a specific infectious disease (such as novel influenza) and provide the above listed services in this section (CPT 99204).

f. Individual Medical Services

Individual medical services may be ordered by CDCR/CCHCS or deemed necessary by the examining physician. If the examining physician deems the test to be necessary but not yet ordered by PHB or CDCR/CCHCS, authorization from the PHB or CDCR/CCHCS Contract Manager or designee must be obtained prior to administering the test. Wherever CPT Codes are referenced in this document, they refer to the American Medical Association, “2010 - Current Procedural Terminology, Standard Edition.” An asterisk next to the CPT code indicates a code from the “2015 - Current Procedural Terminology, Standard Edition.”

All services provided shall be documented via a type written opinion signed by the Physician and providing appropriate recommendations.

i. Blood Chemistry Panel (CPT 80050),

ii. Blood Chemistry Complete Blood Count (CBC) (CPT 85025),

iii. Chest X-ray with a Certified B reader (CPT 71030),

iv. Chest X-ray-single view (CPT 71010),

v. Varicella (Chickenpox) Immunity Screening – IgG (CPT 82784),

vi. Varicella (Chickenpox) vaccination (CPT 90716),

vii. Measles Immunity Screening (CPT 82784),

viii. Measles/Mumps/Rubella (MMR) vaccination (CPT 90707),

ix. Mumps Immunity screening (CPT 86735), Contractor Name Contract Number California Department of Corrections and Rehabilitation

x. Rubella Immunity screening (CPT 86762),

xi. Liver panel – SGPT (alanine transaminase) and SGOT (aspartate transaminase) (CPT 80076),

xii. HIV blood draw (CPT 36415),

xiii. T- dap (Tetanus/Diphtheria/Pertussis) vaccination (CPT 90715),

xiv. Influenza Vaccination-Trivalent Influenza Vaccine (TIV) (CPT 90656),

xv. Influenza Vaccination-Trivalent Influenza Vaccine (TIV – egg free) (CPT 90656),

xvi. Hepatitis B vaccination (CPT 90746),

xvii. Hepatitis B surface antigen (CPT 87340),

xviii. Hepatitis B surface antibody titer (CPT 86317),

xix. Hepatitis B core antibody test (CPT 86705),

xx. TB symptom interview without TST,

xxi. PPS skin test for TB (administration & reading) (CPT 86580),

xxii. Cell Mediated Immunity Blood Test for TB (CPT 86480),

xxiii. Chest X-ray for TB infection (CPT 71020),

xxiv. Blood Borne Pathogen assessment (immediate post-exposure evaluation to determine risk of blood borne infection and prescribe prophylaxis needed) (CPT 99214),

xxv. California Department of Public Health Compliant and PHB accepted TB risk assessment when ordered by PHB (see ctca.org).

Additional healthcare services to be provided upon CDCR/CCHCS request that may include but are not limited to:

i. Laboratory services as requested,

ii. Physician Consultation (hourly rate) (only when ordered by CDCR/CCHCS),

iii. Medical Examination Team – Site Mobilization (only when ordered by

CDCR/CCHCS),

Additional services may be necessary, per the examining PLHCP, and may not be listed. Prior written authorization from the CDCR/CCHCS Contract Manager or designee is required before administering any additional services. The written authorization serves as backup documentation for the invoices.

Contractor Name Contract Number California Department of Corrections and Rehabilitation

i. Medical Examination Team – Site Mobilization

The Contractor shall be available to perform on-site medical services at CDCR/CCHCS worksites. These services shall be provided on a predetermined schedule between the hours of 4:30 a.m. and midnight, Monday through Friday.

The need for on-site medical services will be based on the existence of unusual circumstances (i.e., a large number of employees requiring services, potential exposure event), where it is more cost effective for CDCR/CCHCS to have services performed on-site versus sending staff to the medical clinic. These services are on an as needed basis as determined by each Worksite. The service is intended to cover travel costs per individual, associated with mobilizing from the Contractor’s office(s) to a CDCR/CCHCS Worksite(s) with all supplies, equipment, etc., necessary to perform the scheduled services, and does not include examination costs which are already identified in Exhibit B-1

– Rate Sheet. The CDCR/CCHCS worksite will provide space for the Contractor to perform the on-site services and ensure a reasonable workload for the duration of the scheduled on-site services.

D. ADDITIONAL TEST/PROCEDURES:

The Contractor must notify and provide written estimate to the CDCR/CCHCS Contract Manager or designee for approval prior to providing any tests, procedures or services not specifically identified in Exhibit B-1 - Rate Sheet.

The Contractor shall provide a published price list for tests, procedures and services. The published price list submitted at the time of bid shall be incorporated as Exhibit B-1 - Rate Sheet and made part of this agreement by reference only. All costs for tests, procedures and services shall be in accordance with the rates specified in Exhibit B-1 - Rate Sheet, and payment will be in arrears. CDCR/CCHCS assumes no responsibility and will not reimburse the Contractor for tests, procedures and services performed prior to authorization by the CDCR/CCHCS Contract Manager or designee. All prices shall be firm for the entire contract period and shall be submitted with the Contractor’s invoice to the State.

E. CONSULTATION:

The Contractor shall provide consultation to CDCR/CCHCS Chief Executive Officers, Health Care Managers and other designated employees responsible for the development and oversight of the CDCR/CCHCS system wide ATD exposure control program. The consultation services shall be paid at the Physician Consultation Hourly Rate as specified in the Exhibit B-1 - Rate Sheet.

F. PHYSICIAN OWNERSHIP AND REFERRAL ACT OF 1993:

In accordance with Physician Ownership and Referral Act of 1993, the Contractor shall not refer a patient to any health care provider or health-related facility if the Contractor has a financial interest with that health care provider or health related facility.

The Contractor may make a referral to or request consultation from a sole source health care provider or health-related facility, in which financial interest if held, if the Contractor is located where there is no alternative provider or service within either twenty-five (25) miles or forty

(40) minutes of traveling time. The Contractor shall disclose, in writing to the CDCR/CCHCS, Contractor Name Contract Number California Department of Corrections and Rehabilitation the Contractor’s financial interest at the time of referral or request for consultation. In no event shall this prohibit patients from receiving emergency health care services.

G. SUBCONTRACTOR DUTIES/ RESPONSIBILITIES (if applicable):

The subcontractor shall possess all necessary state and local licenses, registrations, permits and certificates to deliver the services provided on behalf of the Contractor. The Contractor shall provide copies of all subcontractor licenses, registrations, permits and certificates to the

CDCR/CCHCS.

H. CDCR/CCHCS RESPONSIBILITIES:

CDCR/CCHCS shall:

1. Coordinate to provide adequate physical space at locations identified in Exhibit A-2 – List of Participating Worksites to ensure the Contractor’s staff has adequate space to effectively provide services.

2. Provide network access to the Contractor’s on-site staff, to properly report and document vaccination services provided.

3. Provide a wheeled stretcher for Contractor use, should the need arise.

4. Provide access to and training, to the Contractor’s on-site staff for the utilization of CDCR/CCHCS software, to include SAP S4/Hana.

5. Provide Contractor with workstations, including computers and printers (including toner and paper), for use at each participating CDCR/CCHCS worksite.

6. Maintain electronic records of all Staff Medical Monitoring Services (i.e., (TB tests/screenings, vaccinations, ATD exposure testing, etc.) within the CDCR/CCHCS software system of record.

I. RECORD KEEPING AND CONFIDENTIALITY:

The Contractor is advised of the following in regard to employee examinations:

The Contractor shall maintain the confidentiality of all CDCR/CCHCS employee medical questionnaire and evaluation records in accordance with all applicable Federal and State laws and regulations including, but not limited to, the Cal/OSHA General Industrial Safety Order, §3204, the California Confidentiality of Medical Records Act, and the California Evidence Code Sections 1156 and 1157.

If, during the term of this agreement, any record keeping laws, regulations, procedures, or policies change, the Contractor must comply with the updated requirements within 30 days after adoption of the regulation, procedure and/or policy change at no additional cost to CDCR/CCHCS. Such references are hereby incorporated by reference into this agreement.

Contractor Name Contract Number California Department of Corrections and Rehabilitation

The Contractor shall not release any records identifying a CDCR/CCHCS employee’s medical condition and/or procedures during medical examinations to anyone except the CDCR/CCHCS employee, without the CDCR/CCHCS employee’s signed consent or as required by law.

Copies of all physicians’ type-written opinion forms shall be provided to the CDCR/CCHCS employee and CDCR/CCHCS. The Contractor shall send results of evaluations for staff referred via electronic means to the CDCR/CCHCS Contract Manager or designee following Exhibit A-1, Section J, Guidelines for Submitting Electronic Files.

Data and records produced under this agreement or provided by the CDCR/CCHCS to the Contractor for work under this agreement remain the property of the CDCR/CCHCS for which the Contractor serves as custodian. At the end of this agreement, the Contractor agrees to return, or transfer to the CDCR/CCHCS or to a third-party vendor designated by the CDCR/CCHCS, all data and records produced or used in the conduct of this agreement within 60 days. Contractor shall then destroy all copies of data and records unless State and/or Federal laws require the Contractor to maintain such records.

The Contractor shall treat all Personally Identifiable Information (PII) as confidential and shall comply with the provisions of Exhibit F - Business Associates Agreement (HIPAA), related to confidential medical information. Data obtained, accessed, used and/or produced under this agreement are to be used only for the purposes of work under this agreement.

Upon the CDCR/CCHCS’s request, the Contractor shall also provide the following services for additional medical records and/or data provided to the Contractor:

1. Secure storage,

2. Encryption,

3. Conversion of paper records to electronic format,

4. Confidential medical record destruction,

5. Secure transportation of medical data.

The Contractor shall utilize the CDCR/CCHCS system of record SAP S4/Hana, in lieu of other recordkeeping systems, for collection of data and generation of records associated with services provided under this agreement.

J. GUIDELINES FOR SUBMITTING ELECTRONIC FORMS:

The Contractor shall provide occupational medical services for the State as specified by the CDCR/CCHCS Contract Manager or designee. The Contractor shall maintain direct communication with the CDCR/CCHCS Contract Manager or designee regarding medical concerns relevant to public health issues. Results of all medical services shall be submitted electronically with encryption to the CDCR/CCHCS Contract Manager or designee, and a hard copy of the results shall be provided to the individual employee(s) at the end of the evaluation. Additional reporting may also be summarized in a Microsoft Excel worksheet or a File Transfer Protocol website that is operated and uploaded by the Contractor, with unique access for each CDCR/CCHCS worksite. The Contractor shall

Contractor Name Contract Number California Department of Corrections and Rehabilitation be available and technologically capable of implementing enhanced data exchange methods, such as an application programming interface (API), when and if requested by

CDCR/CCHCS.

K. PRIMARY LAWS, RULES, AND REGULATIONS

For each Contractor staff who will be working in a CDCR/CCHCS institution and around incarcerated person(s), the Contractor shall complete and submit to the Contract Manager, or designee, Attachment 1 – Primary Laws Rules and Regulations Regarding Conduct and Association with State Prison Inmate. This document apprises Contractor staff of the laws, rules and regulations governing conduct in associating with prison inmates (Title15, Section 3285).

L. NON REDISCLOSURE

The Contractor shall complete and submit to the Contract Manager, or designee, Attachment 4 – Non Redisclosure Agreement as the Contractor may be exposed to confidential information (e.g., Medical Records, Protected Health Information [PHI], Personally Identifiable Information [PII], etc.).

M. SECURITY AWARENESS, UNDERSTANDING & ACCOUNTABILITY FORM

The Contractor shall complete and submit to the Contract Manager, or designee, Attachment 2 – Security Awareness Understanding and Accountability Form (SAUA), as the Contractor has access to CDCR/CCHCS computer systems, technology, assets, and information as part of their functional duties.

N. DISPUTES:

If the Contractor believes that there is a dispute between the Contractor and the CDCR/CCHCS arising out of or relating to this Contract, the Contractor shall first discuss and attempt to resolve the issue informally with the Contract Manager as listed in this Contract. If the issue cannot be resolved at this level, the Contract Manager shall follow the following procedures:

Contract Manager must submit a request to the Manager, Acquisitions Management Section, explaining why the Contract Manager’s resolution is unacceptable to the Contractor. The request must include any information provided by the Contractor and the Contract Manager’s response. The Manager, Acquisitions Management Section, or designee, shall review the issues raised and shall render a decision to the Contract Manager. The decision of the Manager, Acquisitions Management Section, or designee, shall be final.

O. AMENDMENTS:

Consistent with the terms and conditions of the original solicitation, and upon mutual consent, the State and Contractor may execute written amendments for changes to this Contract, if they were originally evaluated and considered.

No amendment shall be considered binding on either party until it is formally approved by both parties and the Department of General Services (DGS).

Contractor Name Contract Number California Department of Corrections and Rehabilitation (CDCR) California Correctional Health Care Services (CCHCS) List of Participating Worksites Exhibit A-2

STAFF MEDICAL MONITORING SERVICES

*CDCR/CCHCS makes no guarantee that all sites listed will request services.

CDCR & CCHCS OFFICES

CDCR/CCHCS Elk Grove Campus 8260 Longleaf Drive Elk Grove, CA 95758

Advanced Learning Institute (ALI) 10000 Goethe Rd, Building B, 1st Floor Sacramento, CA 95827

Richard A. McGee Correctional Training Center (CTC) 9850 Twin Cities Road Galt, CA 95632

Rancho Cordova Campus 1900 Birkmont Dr Rancho Cordova, CA 95742

Fresno Regional Office 1320 E Shaw Ave Suite 150 Fresno, CA 93710

Bakersfield Regional Office 3655 Unicorn Rd Bakersfield, CA 93308

Rancho Cucamonga Regional Office 10750 Fourth St Suite 150 Rancho Cucamonga, CA 91730

ADULT REGIONAL PAROLE OFFICES

Northern Region Parole Headquarters 9825 Goethe Road, Suite 200 Sacramento, CA 95827

Southern Region Parole Headquarters 21015 Pathfinder Road, Suite 200 Diamond Bar, CA 91765

Bakersfield Parole 3416 Sillect Ave Suite A & B Bakersfield, CA 93308

Redding Parole 391 Hemsted Drive Redding, CA 96002

Fresno Parole 1,2,5,6,7, & Central GPS 5060 East Clinton Way Fresno, CA 93727

Chico Parole 1370 Ridgewood Drive Chico, CA 95973

Santa Rosa Parole 3222 Airway Drive Santa Rosa, CA 95403

Salinas Parole 320 Airport Blvd Salinas, CA 93905

El Monte Parole Complex 9900 Baldwin Place El Monte, CA 91731

Riverside Parole Complex 1777 Atlanta Ave Suite G3 Riverside, CA 92507

Chula Vista Parole Complex 765 Third Ave Chula Vista, CA 91910

Anaheim Parole Complex 2911 E. Coronado Street Anaheim, CA 92806

Contractor Name Contract Number California Department of Corrections and Rehabilitation (CDCR)

INSTITUTIONS

Avenal State Prison (ASP) 1 Kings Way Avenal, CA 93204

Calipatria State Prison (CAL) 7018 Blair Road Calipatria, CA 92233

California Correctional Institution (CCI) 24900 Highway 202 Tehachapi, CA 93581

Central California Women’s Facility (CCWF) 23370 Road 22 Chowchilla, CA 93610-1501

Centinela State Prison (CEN) 2302 Brown Road Imperial, CA 92251

California Health Care Facility (CHCF) 7707 Austin Road Stockton, CA 95215

California Institution for Men (CIM) 14901 Central Avenue Chino, CA 91710

California Institution for Women (CIW) 16756 Chino-Corona Road Corona, CA 92880

California Men’s Colony (CMC) Highway #1 North San Luis Obispo, CA 93409

California Medical Facility (CMF) 1600 California Drive Vacaville, CA 95696

California State Prison-Corcoran (COR) 4001 King Avenue Corcoran, CA 93212-8309

California Rehabilitation Center (CRC) 5th Street & Western Norco, CA 92860

California Training Facility (CTF)

HWY 101N

Soledad, CA 93960

Folsom State Prison (FSP) 300 Prison Road Represa, CA 95671

High Desert State Prison (HDSP) 475-750 Rice Canyon Road Susanville, CA 96127

Ironwood State Prison (ISP) 19005 Wiley’s Well Road Blythe, CA 92225

Kern Valley State Prison (KVSP) 300 West Cecil Avenue Delano, CA 93215

California State Prison–Los Angeles (LAC) 44750 – 60th Street, West Lancaster, CA 93536-7620

Mule Creek State Prison (MCSP) 4001 Highway 104 Ione, CA 95640

North Kern State Prison (NKSP) 2737 West Cecil Avenue Delano, CA 93215

Pelican Bay State Prison (PBSP) 5905 Lake Earl Drive Crescent City, CA 95531

Pleasant Valley State Prison (PVSP) 24863 West Jayne Avenue Coalinga, CA 93210

Richard J. Donovan Correctional (RJD) 480 Alta Road San Diego, CA 92179

California State Prison – Sacramento

(SAC)

100 Prison Road Represa, CA 95671

California Substance Abuse Treatment Facility at Corcoran (SATF) 900 Quebec Avenue Corcoran, CA 93212

Sierra Conservation Center (SCC) 5100 O’Byrnes Ferry Road Jamestown, CA 95327-0497

California State Prison – Solano (SOL) 2100 Peabody Road Vacaville, CA 95696

California State Prison – San Quentin (SQ) 1 Main Street San Quentin, CA 94964

Salinas Valley State Prison (SVSP) 31625 Highway 101 Soledad, CA 93960-1020

Valley State Prison (VSP) 21633 Avenue 24 Chowchilla, CA 93610-0099

Wasco State Prison (WSP) 701 Scofield Avenue Wasco, CA 93280-8800

Contractor Name Contract Number California Department of Corrections and Rehabilitation (CDCR)

STATE HOSPITALS

Patton State Hospital 3102 East Highland Ave Patton, CA 92366

San Joaquin State Hospital 500 W. Hospital Road French Camp, CA 95231

Alvarado State Hospital 7050 Parkway Drive La Mesa, CA 91942

Tri-City State Hospital 4002 Vista Way Oceanside, CA 92056

CALIFORNIA CONSERVATION CAMPS

Acton Conservation Camp #11 8800 Soledad Canyon Road Acton, CA 93510

Alder Conservation Camp #20 P.O. Box 906 Klamath, CA 95548

Antelope Conservation Camp #25 P.O. Box 270160 Susanville, CA 96127

Bautista Conservation Camp #36 33015 Bautista Road Hemet, CA 92544

Ben Lomond Conservation Camp #45 13575 Empire Grade Road Santa Cruz, CA 95060

Cuesta Conservation Camp #24 635 N. Santa Rosa Street San Luis Obispo, CA 93405

Deadwood Conservation Camp #23 17148 McAdams Creek Road Fort Jones, CA 96032

Delta Conservation Camp #8 6246 Lambie Road Suisun City, CA 94585

Eel River Conservation Camp #31 850 Eel River Camp Road Redway, CA 95560

Fenner Canyon Conservation Camp #41 25900 Big Rock Creek Road Valyermo, CA 93563

Francisquito Conservation Camp #4 3510 San Francisquito Canyon Road Santa Clarita, CA 91390

Gabilan Conservation Camp #38 31801 McCoy Road Soledad, CA 93960-9615

Growlersburg Conservation Camp #33 5440 Longview Lane Georgetown, CA 95634

Holton Conservation Camp #16 12653 North Tujunga Canyon Road Sylmar CA, 91342

Intermountain Conservation Camp #22 651-025 Foothill Road Bieber, CA 96009

Ishi Conservation Camp #18 30500 Plum Creek Road Paynes Creek, CA 96075

Julius Klein Conservation Camp #19 22550 East Fork Road Azusa, CA 91702

Konocti Conservation Camp #27 8275 South State Highway 29 Lower Lake, CA 95457

La Cima Conservation Camp #42 15108 Sunrise Highway Julian, CA 92036

Malibu Conservation Camp #13 1250 South Encinal Canyon Road Malibu, CA 90265

Miramonte Conservation Camp #5 49039 Orchard Drive Miramonte, CA 93641

Mountain Home Conservation Camp #10 45260 Bear Creek Road Springville, CA 93265

Mount Bullion Conservation Camp #39 5730 Mount Bullion Access Road Mariposa, CA 95338

Norco Conservation Camp #0 3195 Western Avenue Norco, CA 92860

Oak Glen Conservation Camp #35 41100 Pine Bench Road Yucaipa, CA 92399-9710

Owens Valley Conservation Camp #26 2781 South Round Valley Road Bishop, CA 93514

Parlin Fork Conservation Camp #6 23000 Highway 20 Fort Bragg, CA 95437

Contractor Name Contract Number California Department of Corrections and Rehabilitation (CDCR)

Pine Grove Conservation Camp #12 13630 Aqueduct-Volcano Road Pine Grove, CA 95665

Prado Conservation Camp #28 14467 Central Avenue Chino, CA 91710

Puerta La Cruz Conservation Camp #14 32363 Highway 79 Warner Springs, CA 92086

Salt Creek Conservation Camp #7 10655 Round Valley Road Paskenta, CA 96074

Sugar Pine Conservation Camp #9 15905 Sugar Pine Camp Road Bella Vista, CA 96008

Trinity River Conservation Camp #3 3325 Pettijohn Road Lewiston, CA 96052

Vallecito Conservation Camp #1 3225 Six Mile Road Angels Camp, CA 95222

Washington Ridge Conservation Camp #44 11425 Conservation Camp Road Nevada City, CA 95959

Contractor Name Contract Number California Department of Corrections and Rehabilitation

Budget Detail and Payment Provisions Exhibit B

BUDGET DETAIL AND PAYMENT PROVISIONS

A. Invoicing and Payment:

1. For services satisfactorily rendered, and upon receipt and approval of the invoices, the

State agrees to compensate the Contractor for actual expenditures incurred in accordance with the rates listed below or specified in Exhibit B-1 - Rate Sheet, which is attached hereto and made a part of this Contract.

2. Invoices shall include the Contract Number, Purchase Order Number, sufficient scope and detail to define the actual work performed, including a description of the activities of the Contractor and Subcontractor, the hours allocated to those activities, the locations where work was performed, the expenses claimed, any required reports, and shall be submitted not more frequently than monthly in arrears to:

California Department of Corrections and Rehabilitation Sacramento Accounting Office

Attn: MSC 15 - Accounts Payable - A P.O. Box 187021

Sacramento, CA 95818-7021 The Contractor also has the option to submit invoices electronically to the appropriate email address listed below. The Contractor must use the name of the Contract and the Contract number on the subject line of the email. The email must include an attached PDF file of the invoices, in accordance with the information above, and must reference the institution acronym and the invoice number. For electronic submission, send invoices to:

APA.Invoices@cdcr.ca.gov

B. Budget Contingency Clause:

1. It is mutually agreed that if the Budget Act of the current year and/or any subsequent years covered under this Contract does not appropriate sufficient funds for the program, this Contract shall be of no further force and effect. In this event, the State shall have no liability to pay any funds whatsoever to Contractor or to furnish any other considerations under this Contract and Contractor shall not be obligated to perform any provisions of this Contract.

2. If funding for any fiscal year is reduced or deleted by the Budget Act for purposes of this program, the State shall have the option to either cancel this Contract with no liability occurring to the State, or offer a Contract amendment to Contractor to reflect the reduced amount.

C. Prompt Payment Clause:

1. Payment will be made in accordance with, and within the time specified in, Government

Code Chapter 4.5, commencing with Section 927.

D. Subcontractor:

For all Agreements, with the exception of Interagency Agreements and other governmental entities/auxiliaries that are exempt from bidding, nothing contained in the Agreement, or otherwise, shall create any contractual relation between the State and any subcontractors, and no subcontract shall relieve Contractor of contractor’s responsibilities and obligations hereunder. Contractor agrees to be as fully responsible to the State for the acts and omissions mailto:APA.Invoices@cdcr.ca.gov

Contractor Name Contract Number California Department of Corrections and Rehabilitation of its subcontractors and of persons either directly or indirectly employed by any of them as it is for the acts and omissions of persons directly employed by the Contractor. The Contractor’s obligation to pay its subcontractors is an independent obligation from the State’s obligation to make payments to the Contractor. As a result, the State shall have no obligation to pay or to enforce the payment of any moneys to any subcontractor.

E. Travel Reimbursement:

[X] The following does not apply to this Contract:

Pursuant to the terms established in this Contract, travel reimbursement may not exceed the rates, terms, and conditions that apply to comparable State employees, in accordance with travel rules and regulations, as specified in California Code of Regulations, Title 2, Division 1, Chapter 3, and/or regulations of the California Department of Personnel Administration (DPA), specifically Sections 599.619 through 599.631.

F. Outreach and Marketing Contracts:

[X] The following does not apply to this Agreement Pursuant to AB 323, this contract falls into a category of contracts that must be monitored throughout the life of the contract.

Upon receipt of an itemized invoice, in arrears, stating the goods/services provided, time period covered, detailed costs and the Contract number, the Contract Manager will notify the Contractor of the required information.

The Contractor will provide the Contract Manager:

• Total amounts paid against this contract;

• Breakdown of dollars paid against this contract to target each identified community (Latino, African American, Pacific Islander, Middle Eastern, LGBTQIA, or other);

• Breakdown of subcontractor dollars paid against this contract per identified communities, if applicable;

• Selected media platforms used to target each identified community (such as newspaper, radio, internet, print etc.

• Subcontractor selected media platforms (if applicable) used to target each identified community (such as newspaper, radio, internet, print etc.)

G. CAL-Card Payments:

[X] The following does not apply to this Contract Upon receipt of an itemized invoice, in arrears, stating the goods/services provided, time period covered, detailed costs and the Contract number, the Contract Manager will notify the Contractor of payment authorization.

The Contractor will provide the Contract Manager a copy of the itemized, transaction receipt showing payment was received, the invoice, the Contract number and the CAL-Card card verification number charged.

Contractor to send invoices to:

Contractor Name Contract Number California Department of Corrections and Rehabilitation

• Name, mailing address and phone number of the Contract Manager/Cardholder.

• Name, mailing address and phone number of Contractor payment authorization contact.

H. Employee Benefits and Wage Reporting Requirements:

[X] The following does not apply to this Contract Effective July 1, 2003 Government Code Section 19134 was amended to require Contracts for janitorial, housekeeping services, custodians, food service workers, laundry workers, window cleaners, and security guards (“covered services”) to include provisions for employee wages to be no less than 85% of the value of wages and benefits provided to State employees for performing similar duties. Contractor must pay no less than the following:

• Hourly Rate:

• Blended Benefit Rate:

Also, applicable to subcontractors providing these services in state-leased facilities where the facility is at least 50,000 square feet in area and the state leases all of the occupied floor space, of the facility.

“Employee benefits” means either 1) health, dental, vision, holiday pay, vacation and retirement (either through a purchased plan or self-insurance); 2) cash-in-lieu payments; or 3) a combination of actual benefits and cash-in-lieu payments.

1. Contractors must indicate on their Exhibit B-1 – Rate Sheet, whether they will be providing the required benefits either through a purchase plan or by self-insurance or making ‘in-lieu’ payments to employees. Contractors choosing to offer employee benefits must provide coverage prior to commencement of work.

2. Contractor can meet the “employee benefits” and 85% wage requirement by:

a. Providing “employee…